|
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 |
$1,868.82 |
| 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 |
$7,093.28
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$8,776.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5,678.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7,743.75
|
| Rate for Payer: Blue Shield of California Commercial |
$6,411.82
|
| Rate for Payer: Blue Shield of California EPN |
$6,060.78
|
| Rate for Payer: Cash Price |
$4,646.25
|
| 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 |
$4,976.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,868.82
|
| 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 |
$3,764.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,449.58
|
| 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
OP
|
$27,343.00
|
|
|
Service Code
|
CPT 33221
|
| Hospital Charge Code |
906820254
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$454.37 |
| Max. Negotiated Rate |
$46,256.43 |
| Rate for Payer: Adventist Health Commercial |
$5,468.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18,784.64
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$36,518.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$26,780.04
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$24,345.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$12,304.35
|
| Rate for Payer: Cash Price |
$12,304.35
|
| Rate for Payer: Cash Price |
$12,304.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$17,772.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36,518.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$26,780.04
|
| Rate for Payer: Dignity Health Senior |
$24,345.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,556.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$24,345.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$16,925.32
|
| Rate for Payer: Heritage Provider Network Senior |
$29,944.95
|
| Rate for Payer: Humana Medicare |
$24,345.49
|
| Rate for Payer: IEHP Medi-Cal |
$454.37
|
| Rate for Payer: IEHP Medicare Advantage |
$24,345.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$46,256.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,949.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28,727.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,835.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30,675.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30,675.32
|
| Rate for Payer: Multiplan Commercial |
$20,507.25
|
| Rate for Payer: Multiplan WC |
$33,283.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$26,780.04
|
| Rate for Payer: TriValley Medical Group Senior |
$26,780.04
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,002.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14,303.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36,518.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26,780.04
|
| Rate for Payer: Vantage Medical Group Senior |
$24,345.49
|
|
|
HC PACE INSERT EXIST MULT HC LEADS
|
Facility
IP
|
$27,343.00
|
|
|
Service Code
|
CPT 33221
|
| Hospital Charge Code |
906820254
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,949.08 |
| Max. Negotiated Rate |
$20,507.25 |
| Rate for Payer: Adventist Health Commercial |
$5,468.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18,784.64
|
| Rate for Payer: Cash Price |
$12,304.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$18,511.21
|
| Rate for Payer: Heritage Provider Network Senior |
$18,511.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,949.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,835.75
|
| Rate for Payer: Multiplan Commercial |
$20,507.25
|
|
|
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: Aetna of CA Non-Gatekeeper |
$12,508.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$8,193.60
|
| Rate for Payer: Cash Price |
$8,193.60
|
| 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 |
$12,326.82
|
| Rate for Payer: Heritage Provider Network Senior |
$12,326.82
|
| 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 |
$6,638.64
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,083.29
|
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$15,476.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$10,014.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13,656.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,307.17
|
| Rate for Payer: Blue Shield of California EPN |
$10,688.10
|
| Rate for Payer: Cash Price |
$8,193.60
|
| 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 |
$8,776.26
|
| 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 |
$6,638.64
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,083.29
|
| 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: Aetna of CA Non-Gatekeeper |
$12,508.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$8,193.60
|
| Rate for Payer: Cash Price |
$8,193.60
|
| 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 |
$12,326.82
|
| Rate for Payer: Heritage Provider Network Senior |
$12,326.82
|
| 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 |
$6,638.64
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,083.29
|
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$15,476.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$10,014.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13,656.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,307.17
|
| Rate for Payer: Blue Shield of California EPN |
$10,688.10
|
| Rate for Payer: Cash Price |
$8,193.60
|
| 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 |
$8,776.26
|
| 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 |
$6,638.64
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,083.29
|
| 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
IP
|
$25,002.00
|
|
|
Service Code
|
CPT 33228
|
| Hospital Charge Code |
906811419
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,525.36 |
| Max. Negotiated Rate |
$18,751.50 |
| Rate for Payer: Adventist Health Commercial |
$5,000.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17,176.37
|
| Rate for Payer: Cash Price |
$11,250.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$16,926.35
|
| Rate for Payer: Heritage Provider Network Senior |
$16,926.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,525.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,250.50
|
| Rate for Payer: Multiplan Commercial |
$18,751.50
|
|
|
HC PACE REMV REPL EX DUAL LEADS
|
Facility
OP
|
$25,002.00
|
|
|
Service Code
|
CPT 33228
|
| Hospital Charge Code |
906811419
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$452.07 |
| Max. Negotiated Rate |
$25,349.38 |
| Rate for Payer: Adventist Health Commercial |
$5,000.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17,176.37
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$20,012.67
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14,675.96
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13,341.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,706.95
|
| Rate for Payer: Blue Shield of California EPN |
$4,045.41
|
| Rate for Payer: Cash Price |
$11,250.90
|
| Rate for Payer: Cash Price |
$11,250.90
|
| Rate for Payer: Cash Price |
$11,250.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16,251.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20,012.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$14,675.96
|
| Rate for Payer: Dignity Health Senior |
$13,341.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,556.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$13,341.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$15,476.24
|
| Rate for Payer: Heritage Provider Network Senior |
$16,410.39
|
| Rate for Payer: Humana Medicare |
$13,341.78
|
| Rate for Payer: IEHP Medi-Cal |
$452.07
|
| Rate for Payer: IEHP Medicare Advantage |
$13,341.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$25,349.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,525.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,743.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,250.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16,810.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16,810.64
|
| Rate for Payer: Multiplan Commercial |
$18,751.50
|
| Rate for Payer: Multiplan WC |
$18,240.12
|
| Rate for Payer: TriValley Medical Group Commercial |
$14,675.96
|
| Rate for Payer: TriValley Medical Group Senior |
$14,675.96
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,002.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14,303.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20,012.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14,675.96
|
| Rate for Payer: Vantage Medical Group Senior |
$13,341.78
|
|
|
HC PACE REMV REPL EX DUAL LEADS
|
Facility
IP
|
$27,654.00
|
|
|
Service Code
|
CPT 33228
|
| Hospital Charge Code |
906820213
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,005.37 |
| Max. Negotiated Rate |
$20,740.50 |
| Rate for Payer: Adventist Health Commercial |
$5,530.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18,998.30
|
| Rate for Payer: Cash Price |
$12,444.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$18,721.76
|
| Rate for Payer: Heritage Provider Network Senior |
$18,721.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,005.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,913.50
|
| Rate for Payer: Multiplan Commercial |
$20,740.50
|
|
|
HC PACE REMV REPL EX DUAL LEADS
|
Facility
OP
|
$27,654.00
|
|
|
Service Code
|
CPT 33228
|
| Hospital Charge Code |
906820213
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$452.07 |
| Max. Negotiated Rate |
$25,349.38 |
| Rate for Payer: Adventist Health Commercial |
$5,530.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18,998.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$20,012.67
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14,675.96
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13,341.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,706.95
|
| Rate for Payer: Blue Shield of California EPN |
$4,045.41
|
| Rate for Payer: Cash Price |
$12,444.30
|
| Rate for Payer: Cash Price |
$12,444.30
|
| Rate for Payer: Cash Price |
$12,444.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$17,975.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20,012.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$14,675.96
|
| Rate for Payer: Dignity Health Senior |
$13,341.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,556.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$13,341.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$17,117.83
|
| Rate for Payer: Heritage Provider Network Senior |
$16,410.39
|
| Rate for Payer: Humana Medicare |
$13,341.78
|
| Rate for Payer: IEHP Medi-Cal |
$452.07
|
| Rate for Payer: IEHP Medicare Advantage |
$13,341.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$25,349.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,005.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,743.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,913.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16,810.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16,810.64
|
| Rate for Payer: Multiplan Commercial |
$20,740.50
|
| Rate for Payer: Multiplan WC |
$18,240.12
|
| Rate for Payer: TriValley Medical Group Commercial |
$14,675.96
|
| Rate for Payer: TriValley Medical Group Senior |
$14,675.96
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,002.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14,303.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20,012.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14,675.96
|
| Rate for Payer: Vantage Medical Group Senior |
$13,341.78
|
|
|
HC PACE REMV REPL EX MULT LEADS
|
Facility
IP
|
$32,150.00
|
|
|
Service Code
|
CPT 33229
|
| Hospital Charge Code |
906820214
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,819.15 |
| Max. Negotiated Rate |
$24,112.50 |
| Rate for Payer: Adventist Health Commercial |
$6,430.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$22,087.05
|
| Rate for Payer: Cash Price |
$14,467.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$21,765.55
|
| Rate for Payer: Heritage Provider Network Senior |
$21,765.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,819.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,037.50
|
| Rate for Payer: Multiplan Commercial |
$24,112.50
|
|
|
HC PACE REMV REPL EX MULT LEADS
|
Facility
IP
|
$25,844.00
|
|
|
Service Code
|
CPT 33229
|
| Hospital Charge Code |
906811420
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,677.76 |
| Max. Negotiated Rate |
$19,383.00 |
| Rate for Payer: Adventist Health Commercial |
$5,168.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17,754.83
|
| Rate for Payer: Cash Price |
$11,629.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$17,496.39
|
| Rate for Payer: Heritage Provider Network Senior |
$17,496.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,677.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,461.00
|
| Rate for Payer: Multiplan Commercial |
$19,383.00
|
|
|
HC PACE REMV REPL EX MULT LEADS
|
Facility
OP
|
$32,150.00
|
|
|
Service Code
|
CPT 33229
|
| Hospital Charge Code |
906820214
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$470.31 |
| Max. Negotiated Rate |
$46,256.43 |
| Rate for Payer: Adventist Health Commercial |
$6,430.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$22,087.05
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$36,518.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$26,780.04
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$24,345.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,706.95
|
| Rate for Payer: Blue Shield of California EPN |
$4,045.41
|
| Rate for Payer: Cash Price |
$14,467.50
|
| Rate for Payer: Cash Price |
$14,467.50
|
| Rate for Payer: Cash Price |
$14,467.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$20,897.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36,518.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$26,780.04
|
| Rate for Payer: Dignity Health Senior |
$24,345.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,556.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$24,345.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$19,900.85
|
| Rate for Payer: Heritage Provider Network Senior |
$29,944.95
|
| Rate for Payer: Humana Medicare |
$24,345.49
|
| Rate for Payer: IEHP Medi-Cal |
$470.31
|
| Rate for Payer: IEHP Medicare Advantage |
$24,345.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$46,256.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,819.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28,727.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,037.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30,675.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30,675.32
|
| Rate for Payer: Multiplan Commercial |
$24,112.50
|
| Rate for Payer: Multiplan WC |
$33,283.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$26,780.04
|
| Rate for Payer: TriValley Medical Group Senior |
$26,780.04
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,002.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14,303.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36,518.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26,780.04
|
| Rate for Payer: Vantage Medical Group Senior |
$24,345.49
|
|
|
HC PACE REMV REPL EX MULT LEADS
|
Facility
OP
|
$25,844.00
|
|
|
Service Code
|
CPT 33229
|
| Hospital Charge Code |
906811420
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$470.31 |
| Max. Negotiated Rate |
$46,256.43 |
| Rate for Payer: Adventist Health Commercial |
$5,168.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17,754.83
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$36,518.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$26,780.04
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$24,345.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,706.95
|
| Rate for Payer: Blue Shield of California EPN |
$4,045.41
|
| Rate for Payer: Cash Price |
$11,629.80
|
| Rate for Payer: Cash Price |
$11,629.80
|
| Rate for Payer: Cash Price |
$11,629.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16,798.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36,518.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$26,780.04
|
| Rate for Payer: Dignity Health Senior |
$24,345.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,556.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$24,345.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$15,997.44
|
| Rate for Payer: Heritage Provider Network Senior |
$29,944.95
|
| Rate for Payer: Humana Medicare |
$24,345.49
|
| Rate for Payer: IEHP Medi-Cal |
$470.31
|
| Rate for Payer: IEHP Medicare Advantage |
$24,345.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$46,256.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,677.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28,727.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,461.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30,675.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30,675.32
|
| Rate for Payer: Multiplan Commercial |
$19,383.00
|
| Rate for Payer: Multiplan WC |
$33,283.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$26,780.04
|
| Rate for Payer: TriValley Medical Group Senior |
$26,780.04
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,002.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14,303.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36,518.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26,780.04
|
| Rate for Payer: Vantage Medical Group Senior |
$24,345.49
|
|
|
HC PACE REMV REPL EX SINGLE LEAD
|
Facility
IP
|
$22,733.00
|
|
|
Service Code
|
CPT 33227
|
| Hospital Charge Code |
906820212
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,114.67 |
| Max. Negotiated Rate |
$17,049.75 |
| Rate for Payer: Adventist Health Commercial |
$4,546.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15,617.57
|
| Rate for Payer: Cash Price |
$10,229.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$15,390.24
|
| Rate for Payer: Heritage Provider Network Senior |
$15,390.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,114.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,683.25
|
| Rate for Payer: Multiplan Commercial |
$17,049.75
|
|
|
HC PACE REMV REPL EX SINGLE LEAD
|
Facility
OP
|
$22,733.00
|
|
|
Service Code
|
CPT 33227
|
| Hospital Charge Code |
906820212
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$433.84 |
| Max. Negotiated Rate |
$20,168.10 |
| Rate for Payer: Adventist Health Commercial |
$4,546.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15,617.57
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$15,922.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$11,676.27
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$10,614.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,706.95
|
| Rate for Payer: Blue Shield of California EPN |
$4,045.41
|
| Rate for Payer: Cash Price |
$10,229.85
|
| Rate for Payer: Cash Price |
$10,229.85
|
| Rate for Payer: Cash Price |
$10,229.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14,776.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15,922.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,676.27
|
| Rate for Payer: Dignity Health Senior |
$10,614.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,556.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$10,614.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$14,071.73
|
| Rate for Payer: Heritage Provider Network Senior |
$13,056.19
|
| Rate for Payer: Humana Medicare |
$10,614.79
|
| Rate for Payer: IEHP Medi-Cal |
$433.84
|
| Rate for Payer: IEHP Medicare Advantage |
$10,614.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$20,168.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,114.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,525.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,683.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13,374.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13,374.64
|
| Rate for Payer: Multiplan Commercial |
$17,049.75
|
| Rate for Payer: Multiplan WC |
$14,511.92
|
| Rate for Payer: TriValley Medical Group Commercial |
$11,676.27
|
| Rate for Payer: TriValley Medical Group Senior |
$11,676.27
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,002.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14,303.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15,922.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,676.27
|
| Rate for Payer: Vantage Medical Group Senior |
$10,614.79
|
|
|
HC PACE REMV REPL EX SINGLE LEAD
|
Facility
OP
|
$23,148.00
|
|
|
Service Code
|
CPT 33227
|
| Hospital Charge Code |
906811418
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$433.84 |
| Max. Negotiated Rate |
$20,168.10 |
| Rate for Payer: Adventist Health Commercial |
$4,629.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15,902.68
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$15,922.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$11,676.27
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$10,614.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,706.95
|
| Rate for Payer: Blue Shield of California EPN |
$4,045.41
|
| Rate for Payer: Cash Price |
$10,416.60
|
| Rate for Payer: Cash Price |
$10,416.60
|
| Rate for Payer: Cash Price |
$10,416.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15,046.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15,922.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,676.27
|
| Rate for Payer: Dignity Health Senior |
$10,614.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,556.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$10,614.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$14,328.61
|
| Rate for Payer: Heritage Provider Network Senior |
$13,056.19
|
| Rate for Payer: Humana Medicare |
$10,614.79
|
| Rate for Payer: IEHP Medi-Cal |
$433.84
|
| Rate for Payer: IEHP Medicare Advantage |
$10,614.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$20,168.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,189.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,525.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,787.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13,374.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13,374.64
|
| Rate for Payer: Multiplan Commercial |
$17,361.00
|
| Rate for Payer: Multiplan WC |
$14,511.92
|
| Rate for Payer: TriValley Medical Group Commercial |
$11,676.27
|
| Rate for Payer: TriValley Medical Group Senior |
$11,676.27
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,002.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14,303.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15,922.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,676.27
|
| Rate for Payer: Vantage Medical Group Senior |
$10,614.79
|
|
|
HC PACE REMV REPL EX SINGLE LEAD
|
Facility
IP
|
$23,148.00
|
|
|
Service Code
|
CPT 33227
|
| Hospital Charge Code |
906811418
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,189.79 |
| Max. Negotiated Rate |
$17,361.00 |
| Rate for Payer: Adventist Health Commercial |
$4,629.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15,902.68
|
| Rate for Payer: Cash Price |
$10,416.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$15,671.20
|
| Rate for Payer: Heritage Provider Network Senior |
$15,671.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,189.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,787.00
|
| Rate for Payer: Multiplan Commercial |
$17,361.00
|
|
|
HC PACER GENERATOR REMOVAL
|
Facility
IP
|
$9,779.00
|
|
|
Service Code
|
CPT 33233
|
| Hospital Charge Code |
906820115
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,770.00 |
| Max. Negotiated Rate |
$7,334.25 |
| Rate for Payer: Adventist Health Commercial |
$1,955.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,718.17
|
| Rate for Payer: Cash Price |
$4,400.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,620.38
|
| Rate for Payer: Heritage Provider Network Senior |
$6,620.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,770.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,444.75
|
| Rate for Payer: Multiplan Commercial |
$7,334.25
|
|
|
HC PACER GENERATOR REMOVAL
|
Facility
OP
|
$9,720.00
|
|
|
Service Code
|
CPT 33233
|
| Hospital Charge Code |
906811358
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$242.77 |
| Max. Negotiated Rate |
$20,168.10 |
| Rate for Payer: Adventist Health Commercial |
$1,944.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,677.64
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$15,922.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$11,676.27
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$10,614.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,379.37
|
| Rate for Payer: Blue Shield of California EPN |
$4,623.32
|
| Rate for Payer: Cash Price |
$4,374.00
|
| Rate for Payer: Cash Price |
$4,374.00
|
| Rate for Payer: Cash Price |
$4,374.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,318.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15,922.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,676.27
|
| Rate for Payer: Dignity Health Senior |
$10,614.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,556.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$10,614.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,016.68
|
| Rate for Payer: Heritage Provider Network Senior |
$13,056.19
|
| Rate for Payer: Humana Medicare |
$10,614.79
|
| Rate for Payer: IEHP Medi-Cal |
$242.77
|
| Rate for Payer: IEHP Medicare Advantage |
$10,614.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$20,168.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,759.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,525.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,430.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13,374.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13,374.64
|
| Rate for Payer: Multiplan Commercial |
$7,290.00
|
| Rate for Payer: Multiplan WC |
$14,511.92
|
| Rate for Payer: TriValley Medical Group Commercial |
$11,676.27
|
| Rate for Payer: TriValley Medical Group Senior |
$11,676.27
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9,520.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,039.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15,922.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,676.27
|
| Rate for Payer: Vantage Medical Group Senior |
$10,614.79
|
|
|
HC PACER GENERATOR REMOVAL
|
Facility
IP
|
$9,720.00
|
|
|
Service Code
|
CPT 33233
|
| Hospital Charge Code |
906811358
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,759.32 |
| Max. Negotiated Rate |
$7,290.00 |
| Rate for Payer: Adventist Health Commercial |
$1,944.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,677.64
|
| Rate for Payer: Cash Price |
$4,374.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,580.44
|
| Rate for Payer: Heritage Provider Network Senior |
$6,580.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,759.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,430.00
|
| Rate for Payer: Multiplan Commercial |
$7,290.00
|
|
|
HC PACER GENERATOR REMOVAL
|
Facility
OP
|
$9,779.00
|
|
|
Service Code
|
CPT 33233
|
| Hospital Charge Code |
906820115
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$242.77 |
| Max. Negotiated Rate |
$20,168.10 |
| Rate for Payer: Adventist Health Commercial |
$1,955.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,718.17
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$15,922.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$11,676.27
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$10,614.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,379.37
|
| Rate for Payer: Blue Shield of California EPN |
$4,623.32
|
| Rate for Payer: Cash Price |
$4,400.55
|
| Rate for Payer: Cash Price |
$4,400.55
|
| Rate for Payer: Cash Price |
$4,400.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,356.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15,922.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,676.27
|
| Rate for Payer: Dignity Health Senior |
$10,614.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,556.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$10,614.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,053.20
|
| Rate for Payer: Heritage Provider Network Senior |
$13,056.19
|
| Rate for Payer: Humana Medicare |
$10,614.79
|
| Rate for Payer: IEHP Medi-Cal |
$242.77
|
| Rate for Payer: IEHP Medicare Advantage |
$10,614.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$20,168.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,770.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,525.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,444.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13,374.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13,374.64
|
| Rate for Payer: Multiplan Commercial |
$7,334.25
|
| Rate for Payer: Multiplan WC |
$14,511.92
|
| Rate for Payer: TriValley Medical Group Commercial |
$11,676.27
|
| Rate for Payer: TriValley Medical Group Senior |
$11,676.27
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9,520.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,039.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15,922.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,676.27
|
| Rate for Payer: Vantage Medical Group Senior |
$10,614.79
|
|
|
HC PACER INSERT/RPL ONLY, DUAL
|
Facility
OP
|
$27,343.00
|
|
|
Service Code
|
CPT 33213
|
| Hospital Charge Code |
906820116
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$555.24 |
| Max. Negotiated Rate |
$25,349.38 |
| Rate for Payer: Adventist Health Commercial |
$5,468.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18,784.64
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$20,012.67
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14,675.96
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13,341.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,792.00
|
| Rate for Payer: Blue Shield of California Commercial |
$14,131.19
|
| Rate for Payer: Blue Shield of California EPN |
$12,145.11
|
| Rate for Payer: Cash Price |
$12,304.35
|
| Rate for Payer: Cash Price |
$12,304.35
|
| Rate for Payer: Cash Price |
$12,304.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$17,772.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20,012.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$14,675.96
|
| Rate for Payer: Dignity Health Senior |
$13,341.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,556.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$13,341.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$16,925.32
|
| Rate for Payer: Heritage Provider Network Senior |
$16,410.39
|
| Rate for Payer: Humana Medicare |
$13,341.78
|
| Rate for Payer: IEHP Medi-Cal |
$555.24
|
| Rate for Payer: IEHP Medicare Advantage |
$13,341.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$25,349.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,949.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,743.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,835.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16,810.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16,810.64
|
| Rate for Payer: Multiplan Commercial |
$20,507.25
|
| Rate for Payer: Multiplan WC |
$18,240.12
|
| Rate for Payer: TriValley Medical Group Commercial |
$14,675.96
|
| Rate for Payer: TriValley Medical Group Senior |
$14,675.96
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,002.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14,303.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20,012.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14,675.96
|
| Rate for Payer: Vantage Medical Group Senior |
$13,341.78
|
|
|
HC PACER INSERT/RPL ONLY, DUAL
|
Facility
OP
|
$24,301.00
|
|
|
Service Code
|
CPT 33213
|
| Hospital Charge Code |
906811359
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$555.24 |
| Max. Negotiated Rate |
$25,349.38 |
| Rate for Payer: Adventist Health Commercial |
$4,860.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16,694.79
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$20,012.67
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14,675.96
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13,341.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,792.00
|
| Rate for Payer: Blue Shield of California Commercial |
$14,131.19
|
| Rate for Payer: Blue Shield of California EPN |
$12,145.11
|
| Rate for Payer: Cash Price |
$10,935.45
|
| Rate for Payer: Cash Price |
$10,935.45
|
| Rate for Payer: Cash Price |
$10,935.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15,795.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20,012.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$14,675.96
|
| Rate for Payer: Dignity Health Senior |
$13,341.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,556.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$13,341.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$15,042.32
|
| Rate for Payer: Heritage Provider Network Senior |
$16,410.39
|
| Rate for Payer: Humana Medicare |
$13,341.78
|
| Rate for Payer: IEHP Medi-Cal |
$555.24
|
| Rate for Payer: IEHP Medicare Advantage |
$13,341.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$25,349.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,398.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,743.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,075.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16,810.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16,810.64
|
| Rate for Payer: Multiplan Commercial |
$18,225.75
|
| Rate for Payer: Multiplan WC |
$18,240.12
|
| Rate for Payer: TriValley Medical Group Commercial |
$14,675.96
|
| Rate for Payer: TriValley Medical Group Senior |
$14,675.96
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,002.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14,303.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20,012.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14,675.96
|
| Rate for Payer: Vantage Medical Group Senior |
$13,341.78
|
|
