|
HC OXYGEN PER HOUR
|
Facility
|
OP
|
$29.00
|
|
| Hospital Charge Code |
900802001
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5.25 |
| Max. Negotiated Rate |
$24.65 |
| Rate for Payer: Adventist Health Commercial |
$5.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.51
|
| Rate for Payer: Blue Shield of California Commercial |
$17.69
|
| Rate for Payer: Blue Shield of California EPN |
$14.15
|
| Rate for Payer: Cash Price |
$13.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$18.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.95
|
| Rate for Payer: Heritage Provider Network Senior |
$17.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$13.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$20.30
|
| Rate for Payer: Multiplan Commercial |
$21.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.65
|
| Rate for Payer: Vantage Medical Group Senior |
$24.65
|
|
|
HC OXYGEN PER HOUR
|
Facility
|
OP
|
$30.00
|
|
| Hospital Charge Code |
900800650
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5.43 |
| Max. Negotiated Rate |
$25.50 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.01
|
| Rate for Payer: Blue Shield of California Commercial |
$18.30
|
| Rate for Payer: Blue Shield of California EPN |
$14.64
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$19.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.57
|
| Rate for Payer: Heritage Provider Network Senior |
$18.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$14.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$21.00
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.50
|
| Rate for Payer: Vantage Medical Group Senior |
$25.50
|
|
|
HC OXYGEN PER HOUR
|
Facility
|
IP
|
$30.00
|
|
| Hospital Charge Code |
900800650
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5.43 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19.32
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$20.31
|
| Rate for Payer: Heritage Provider Network Senior |
$20.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.50
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
|
|
HC OXYGEN PER HOUR
|
Facility
|
IP
|
$29.00
|
|
| Hospital Charge Code |
900802001
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5.25 |
| Max. Negotiated Rate |
$21.75 |
| Rate for Payer: Adventist Health Commercial |
$5.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18.68
|
| Rate for Payer: Cash Price |
$13.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.63
|
| Rate for Payer: Heritage Provider Network Senior |
$19.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.25
|
| Rate for Payer: Multiplan Commercial |
$21.75
|
|
|
HC OXYGEN PER HOUR PACU
|
Facility
|
IP
|
$49.00
|
|
| Hospital Charge Code |
900100043
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$8.87 |
| Max. Negotiated Rate |
$36.75 |
| Rate for Payer: Adventist Health Commercial |
$9.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$31.56
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.17
|
| Rate for Payer: Heritage Provider Network Senior |
$33.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.25
|
| Rate for Payer: Multiplan Commercial |
$36.75
|
|
|
HC OXYGEN PER HOUR PACU
|
Facility
|
OP
|
$49.00
|
|
| Hospital Charge Code |
900100043
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$8.87 |
| Max. Negotiated Rate |
$41.65 |
| Rate for Payer: Adventist Health Commercial |
$9.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$30.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$41.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$36.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.51
|
| Rate for Payer: Blue Shield of California Commercial |
$29.89
|
| Rate for Payer: Blue Shield of California EPN |
$23.91
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$31.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$41.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$41.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$41.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.33
|
| Rate for Payer: Heritage Provider Network Senior |
$30.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$23.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$34.30
|
| Rate for Payer: Multiplan Commercial |
$36.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$24.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$24.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$41.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41.65
|
| Rate for Payer: Vantage Medical Group Senior |
$41.65
|
|
|
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: Aetna of CA Non-Gatekeeper |
$22,012.56
|
| Rate for Payer: Cash Price |
$15,381.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$23,140.54
|
| Rate for Payer: Heritage Provider Network Senior |
$23,140.54
|
| Rate for Payer: Kaiser Foundation Hospitals 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 |
$1,746.16 |
| Max. Negotiated Rate |
$29,053.85 |
| Rate for Payer: Adventist Health Commercial |
$6,836.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21,123.86
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$1,746.16
|
| 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 |
$15,381.45
|
| Rate for Payer: Cash Price |
$15,381.45
|
| 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 Medicare Advantage |
$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: Kaiser Foundation Hospitals Commercial |
$16,304.34
|
| Rate for Payer: Kaiser Foundation Hospitals 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/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: Aetna of CA Non-Gatekeeper |
$3,813.77
|
| Rate for Payer: Cash Price |
$2,664.90
|
| 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 Foundation Hospitals 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 |
$172.48 |
| Max. Negotiated Rate |
$4,441.50 |
| Rate for Payer: Adventist Health Commercial |
$1,184.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,659.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$347.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$306.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$172.48
|
| 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 |
$2,664.90
|
| Rate for Payer: Cash Price |
$2,664.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,849.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$347.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$306.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,790.08
|
| Rate for Payer: EPIC Health Plan Medicare |
$278.24
|
| 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) Medicare Advantage |
$278.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,824.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,071.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$319.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,480.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$372.84
|
| Rate for Payer: Multiplan Commercial |
$4,441.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$306.06
|
| Rate for Payer: TriValley Medical Group Senior |
$278.24
|
| 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 |
$347.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$306.06
|
| Rate for Payer: Vantage Medical Group Senior |
$306.06
|
|
|
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 |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$2,065.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,649.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| 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 |
$4,646.25
|
| Rate for Payer: Cash Price |
$4,646.25
|
| 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 Foundation Hospitals 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 Non-Gatekeeper |
$6,380.85
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$5,164.56
|
| 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 |
$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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$4,925.02
|
| Rate for Payer: Kaiser Foundation Hospitals 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/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 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 |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$3,641.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11,725.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| 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 |
$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 |
$8,430.30
|
| Rate for Payer: Heritage Provider Network Senior |
$8,430.30
|
| Rate for Payer: Kaiser Foundation Hospitals 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 Non-Gatekeeper |
$11,252.54
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$9,107.64
|
| 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 |
$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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$8,685.22
|
| Rate for Payer: Kaiser Foundation Hospitals 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/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 |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$3,641.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11,725.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| 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 |
$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 |
$8,430.30
|
| Rate for Payer: Heritage Provider Network Senior |
$8,430.30
|
| Rate for Payer: Kaiser Foundation Hospitals 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 Non-Gatekeeper |
$11,252.54
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$9,107.64
|
| 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 |
$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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$8,685.22
|
| Rate for Payer: Kaiser Foundation Hospitals 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/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 |
$3,862.36 |
| Max. Negotiated Rate |
$25,541.72 |
| Rate for Payer: Adventist Health Commercial |
$4,267.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13,187.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20,164.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14,787.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,443.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$9,602.55
|
| Rate for Payer: Cash Price |
$9,602.55
|
| Rate for Payer: Cash Price |
$9,602.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13,870.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20,164.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$14,787.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13,443.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,556.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$13,443.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$13,208.84
|
| Rate for Payer: Heritage Provider Network Senior |
$16,534.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13,443.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$25,541.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,862.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15,459.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,334.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18,013.63
|
| Rate for Payer: Multiplan Commercial |
$16,004.25
|
| Rate for Payer: Multiplan WC |
$21,186.79
|
| Rate for Payer: TriValley Medical Group Commercial |
$14,787.31
|
| Rate for Payer: TriValley Medical Group Senior |
$14,787.31
|
| 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 |
$20,164.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14,787.31
|
| Rate for Payer: Vantage Medical Group Senior |
$13,443.01
|
|
|
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: Aetna of CA Non-Gatekeeper |
$13,742.32
|
| Rate for Payer: Cash Price |
$9,602.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$14,446.50
|
| Rate for Payer: Heritage Provider Network Senior |
$14,446.50
|
| Rate for Payer: Kaiser Foundation Hospitals 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 MULT LEADS
|
Facility
|
OP
|
$22,058.00
|
|
|
Service Code
|
CPT 33229
|
| Hospital Charge Code |
906811420
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,992.50 |
| Max. Negotiated Rate |
$47,070.12 |
| Rate for Payer: Adventist Health Commercial |
$4,411.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13,631.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37,160.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27,251.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24,773.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$9,926.10
|
| Rate for Payer: Cash Price |
$9,926.10
|
| Rate for Payer: Cash Price |
$9,926.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14,337.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37,160.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$27,251.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24,773.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,556.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$24,773.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$13,653.90
|
| Rate for Payer: Heritage Provider Network Senior |
$30,471.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24,773.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$47,070.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,992.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28,489.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,514.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$33,196.82
|
| Rate for Payer: Multiplan Commercial |
$16,543.50
|
| Rate for Payer: Multiplan WC |
$38,609.08
|
| Rate for Payer: TriValley Medical Group Commercial |
$27,251.12
|
| Rate for Payer: TriValley Medical Group Senior |
$27,251.12
|
| 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 |
$37,160.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27,251.12
|
| Rate for Payer: Vantage Medical Group Senior |
$24,773.75
|
|
|
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: Aetna of CA Non-Gatekeeper |
$14,205.35
|
| Rate for Payer: Cash Price |
$9,926.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$14,933.27
|
| Rate for Payer: Heritage Provider Network Senior |
$14,933.27
|
| Rate for Payer: Kaiser Foundation Hospitals 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 SINGLE LEAD
|
Facility
|
OP
|
$18,357.00
|
|
|
Service Code
|
CPT 33227
|
| Hospital Charge Code |
906811418
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,322.62 |
| Max. Negotiated Rate |
$20,222.71 |
| Rate for Payer: Adventist Health Commercial |
$3,671.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11,344.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15,965.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11,707.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,643.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$8,260.65
|
| Rate for Payer: Cash Price |
$8,260.65
|
| Rate for Payer: Cash Price |
$8,260.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11,932.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15,965.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,707.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,643.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,556.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$10,643.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,362.98
|
| Rate for Payer: Heritage Provider Network Senior |
$13,091.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10,643.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$20,222.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,322.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12,240.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,589.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$14,262.33
|
| Rate for Payer: Multiplan Commercial |
$13,767.75
|
| Rate for Payer: Multiplan WC |
$16,754.51
|
| Rate for Payer: TriValley Medical Group Commercial |
$11,707.88
|
| Rate for Payer: TriValley Medical Group Senior |
$11,707.88
|
| 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 |
$15,965.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,707.88
|
| Rate for Payer: Vantage Medical Group Senior |
$10,643.53
|
|
|
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: Aetna of CA Non-Gatekeeper |
$11,821.91
|
| Rate for Payer: Cash Price |
$8,260.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$12,427.69
|
| Rate for Payer: Heritage Provider Network Senior |
$12,427.69
|
| Rate for Payer: Kaiser Foundation Hospitals 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 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: Aetna of CA Non-Gatekeeper |
$5,342.62
|
| Rate for Payer: Cash Price |
$3,733.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,616.39
|
| Rate for Payer: Heritage Provider Network Senior |
$5,616.39
|
| Rate for Payer: Kaiser Foundation Hospitals 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
|
|
|
HC PACER GENERATOR REMOVAL
|
Facility
|
OP
|
$8,296.00
|
|
|
Service Code
|
CPT 33233
|
| Hospital Charge Code |
906811358
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,501.58 |
| Max. Negotiated Rate |
$20,222.71 |
| Rate for Payer: Adventist Health Commercial |
$1,659.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,126.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15,965.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11,707.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,643.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$3,733.20
|
| Rate for Payer: Cash Price |
$3,733.20
|
| Rate for Payer: Cash Price |
$3,733.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,392.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15,965.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,707.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,643.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,556.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$10,643.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,135.22
|
| Rate for Payer: Heritage Provider Network Senior |
$13,091.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10,643.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$20,222.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,501.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12,240.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,074.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$14,262.33
|
| Rate for Payer: Multiplan Commercial |
$6,222.00
|
| Rate for Payer: Multiplan WC |
$16,754.51
|
| Rate for Payer: TriValley Medical Group Commercial |
$11,707.88
|
| Rate for Payer: TriValley Medical Group Senior |
$11,707.88
|
| 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 |
$15,965.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,707.88
|
| Rate for Payer: Vantage Medical Group Senior |
$10,643.53
|
|
|
HC PACER INSERT/RPL ONLY, DUAL
|
Facility
|
IP
|
$20,741.00
|
|
|
Service Code
|
CPT 33213
|
| Hospital Charge Code |
906811359
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,754.12 |
| Max. Negotiated Rate |
$15,555.75 |
| Rate for Payer: Adventist Health Commercial |
$4,148.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13,357.20
|
| Rate for Payer: Cash Price |
$9,333.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$14,041.66
|
| Rate for Payer: Heritage Provider Network Senior |
$14,041.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,754.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,185.25
|
| Rate for Payer: Multiplan Commercial |
$15,555.75
|
|
