|
HC PACER INSERT/RPL ONLY, DUAL
|
Facility
|
OP
|
$20,741.00
|
|
|
Service Code
|
CPT 33213
|
| Hospital Charge Code |
906811359
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,754.12 |
| Max. Negotiated Rate |
$25,541.72 |
| Rate for Payer: Adventist Health Commercial |
$4,148.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12,817.94
|
| 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 |
$11,108.00
|
| 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 |
$9,333.45
|
| Rate for Payer: Cash Price |
$9,333.45
|
| Rate for Payer: Cash Price |
$9,333.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13,481.65
|
| 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 |
$12,838.68
|
| 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 |
$3,754.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15,459.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,185.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18,013.63
|
| Rate for Payer: Multiplan Commercial |
$15,555.75
|
| 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 PACER INSERT/RPL ONLY, SINGLE
|
Facility
|
OP
|
$17,144.00
|
|
|
Service Code
|
CPT 33212
|
| Hospital Charge Code |
906811353
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,103.06 |
| Max. Negotiated Rate |
$20,222.71 |
| Rate for Payer: Adventist Health Commercial |
$3,428.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10,594.99
|
| 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 |
$11,108.00
|
| 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 |
$7,714.80
|
| Rate for Payer: Cash Price |
$7,714.80
|
| Rate for Payer: Cash Price |
$7,714.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11,143.60
|
| 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 |
$10,612.14
|
| 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 |
$3,103.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12,240.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,286.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$14,262.33
|
| Rate for Payer: Multiplan Commercial |
$12,858.00
|
| 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 |
$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 PACER INSERT/RPL ONLY, SINGLE
|
Facility
|
IP
|
$17,144.00
|
|
|
Service Code
|
CPT 33212
|
| Hospital Charge Code |
906811353
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,103.06 |
| Max. Negotiated Rate |
$12,858.00 |
| Rate for Payer: Adventist Health Commercial |
$3,428.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11,040.74
|
| Rate for Payer: Cash Price |
$7,714.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,606.49
|
| Rate for Payer: Heritage Provider Network Senior |
$11,606.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,103.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,286.00
|
| Rate for Payer: Multiplan Commercial |
$12,858.00
|
|
|
HC PACER INSERT/RPL, W A & V LEAD
|
Facility
|
IP
|
$21,339.00
|
|
|
Service Code
|
CPT 33208
|
| Hospital Charge Code |
906811352
|
|
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 PACER INSERT/RPL, W A & V LEAD
|
Facility
|
OP
|
$21,339.00
|
|
|
Service Code
|
CPT 33208
|
| Hospital Charge Code |
906811352
|
|
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 |
$9,136.00
|
| 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 |
$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 |
$18,767.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,783.00
|
| 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 PACER INSERT/RPL, WITH A-LEAD
|
Facility
|
OP
|
$21,339.00
|
|
|
Service Code
|
CPT 33206
|
| Hospital Charge Code |
906811350
|
|
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 |
$6,245.00
|
| 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 |
$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 PACER INSERT/RPL, WITH A-LEAD
|
Facility
|
IP
|
$21,339.00
|
|
|
Service Code
|
CPT 33206
|
| Hospital Charge Code |
906811350
|
|
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 PACER INSERT/RPL, WITH V-LEAD
|
Facility
|
OP
|
$21,339.00
|
|
|
Service Code
|
CPT 33207
|
| Hospital Charge Code |
906811351
|
|
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 |
$6,245.00
|
| 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 |
$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 PACER INSERT/RPL, WITH V-LEAD
|
Facility
|
IP
|
$21,339.00
|
|
|
Service Code
|
CPT 33207
|
| Hospital Charge Code |
906811351
|
|
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 PACER LEAD REMOVE, DUAL A & V
|
Facility
|
OP
|
$4,810.00
|
|
|
Service Code
|
CPT 33235
|
| Hospital Charge Code |
906811364
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$870.61 |
| Max. Negotiated Rate |
$10,001.00 |
| Rate for Payer: Adventist Health Commercial |
$962.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,972.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,209.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,286.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,806.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$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 |
$2,164.50
|
| Rate for Payer: Cash Price |
$2,164.50
|
| Rate for Payer: Cash Price |
$2,164.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,126.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,209.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,286.98
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,806.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,806.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,977.39
|
| Rate for Payer: Heritage Provider Network Senior |
$5,911.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,806.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$9,132.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$870.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,527.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,202.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,440.51
|
| Rate for Payer: Multiplan Commercial |
$3,607.50
|
| Rate for Payer: Multiplan WC |
$7,367.67
|
| Rate for Payer: TriValley Medical Group Commercial |
$5,286.98
|
| Rate for Payer: TriValley Medical Group Senior |
$5,286.98
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10,001.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,445.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,209.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,286.98
|
| Rate for Payer: Vantage Medical Group Senior |
$4,806.35
|
|
|
HC PACER LEAD REMOVE, DUAL A & V
|
Facility
|
IP
|
$4,810.00
|
|
|
Service Code
|
CPT 33235
|
| Hospital Charge Code |
906811364
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$870.61 |
| Max. Negotiated Rate |
$3,607.50 |
| Rate for Payer: Adventist Health Commercial |
$962.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,097.64
|
| Rate for Payer: Cash Price |
$2,164.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,256.37
|
| Rate for Payer: Heritage Provider Network Senior |
$3,256.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$870.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,202.50
|
| Rate for Payer: Multiplan Commercial |
$3,607.50
|
|
|
HC 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 |
$870.61 |
| Max. Negotiated Rate |
$10,001.00 |
| Rate for Payer: Adventist Health Commercial |
$962.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,972.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,209.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,286.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,806.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$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 |
$2,164.50
|
| Rate for Payer: Cash Price |
$2,164.50
|
| Rate for Payer: Cash Price |
$2,164.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,126.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,209.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,286.98
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,806.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,806.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,977.39
|
| Rate for Payer: Heritage Provider Network Senior |
$5,911.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,806.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$9,132.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$870.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,527.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,202.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,440.51
|
| Rate for Payer: Multiplan Commercial |
$3,607.50
|
| Rate for Payer: Multiplan WC |
$7,367.67
|
| Rate for Payer: TriValley Medical Group Commercial |
$5,286.98
|
| Rate for Payer: TriValley Medical Group Senior |
$5,286.98
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10,001.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,445.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,209.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,286.98
|
| Rate for Payer: Vantage Medical Group Senior |
$4,806.35
|
|
|
HC 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: Aetna of CA Non-Gatekeeper |
$3,097.64
|
| Rate for Payer: Cash Price |
$2,164.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,256.37
|
| Rate for Payer: Heritage Provider Network Senior |
$3,256.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$870.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,202.50
|
| Rate for Payer: Multiplan Commercial |
$3,607.50
|
|
|
HC PACER POCKET REVISION/RELOCATE
|
Facility
|
OP
|
$3,582.00
|
|
|
Service Code
|
CPT 33222
|
| Hospital Charge Code |
906811357
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$648.34 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$716.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,213.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,919.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,653.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,245.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$1,611.90
|
| Rate for Payer: Cash Price |
$1,611.90
|
| Rate for Payer: Cash Price |
$1,611.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,328.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,919.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,653.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,653.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,217.26
|
| Rate for Payer: Heritage Provider Network Senior |
$3,264.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,653.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$5,042.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$648.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,051.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$895.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,555.98
|
| Rate for Payer: Multiplan Commercial |
$2,686.50
|
| Rate for Payer: Multiplan WC |
$3,703.23
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,919.09
|
| Rate for Payer: TriValley Medical Group Senior |
$2,919.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,919.09
|
| Rate for Payer: Vantage Medical Group Senior |
$2,653.72
|
|
|
HC 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: Aetna of CA Non-Gatekeeper |
$2,306.81
|
| Rate for Payer: Cash Price |
$1,611.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,425.01
|
| Rate for Payer: Heritage Provider Network Senior |
$2,425.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$648.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$895.50
|
| Rate for Payer: Multiplan Commercial |
$2,686.50
|
|
|
HC 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 |
$4,780.39 |
| Max. Negotiated Rate |
$25,541.72 |
| Rate for Payer: Adventist Health Commercial |
$5,282.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16,322.00
|
| 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 |
$6,245.00
|
| 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 |
$11,884.95
|
| Rate for Payer: Cash Price |
$11,884.95
|
| Rate for Payer: Cash Price |
$11,884.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$17,167.15
|
| 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 |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$13,443.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$16,348.41
|
| 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 |
$4,780.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15,459.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,602.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18,013.63
|
| Rate for Payer: Multiplan Commercial |
$19,808.25
|
| 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 |
$18,767.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,783.00
|
| 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 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: Aetna of CA Non-Gatekeeper |
$17,008.68
|
| Rate for Payer: Cash Price |
$11,884.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$17,880.25
|
| Rate for Payer: Heritage Provider Network Senior |
$17,880.25
|
| Rate for Payer: Kaiser Foundation Hospitals 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 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 |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$2,617.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,428.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| 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 |
$5,889.38
|
| Rate for Payer: Cash Price |
$5,889.38
|
| 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 Foundation Hospitals 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 Non-Gatekeeper |
$8,088.07
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$6,546.37
|
| 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 |
$5,889.38
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$6,242.74
|
| Rate for Payer: Kaiser Foundation Hospitals 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/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
|
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: Aetna of CA Non-Gatekeeper |
$103.04
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.00
|
| Rate for Payer: Multiplan Commercial |
$120.00
|
|
|
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 Non-Gatekeeper |
$98.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$80.03
|
| 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 |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$104.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$75.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$94.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$75.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$99.04
|
| Rate for Payer: Heritage Provider Network Senior |
$93.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$144.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$87.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$101.67
|
| Rate for Payer: Multiplan Commercial |
$120.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$83.46
|
| Rate for Payer: TriValley Medical Group Senior |
$75.87
|
| 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 |
$113.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.46
|
| Rate for Payer: Vantage Medical Group Senior |
$75.87
|
|
|
HC PANCREAS BIOPSY PERCUTANEOUS
|
Facility
|
OP
|
$4,661.00
|
|
|
Service Code
|
CPT 48102
|
| Hospital Charge Code |
909000153
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$843.64 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$932.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,880.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,124.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$2,097.45
|
| Rate for Payer: Cash Price |
$2,097.45
|
| Rate for Payer: Cash Price |
$2,097.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,029.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,336.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,124.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,124.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,885.16
|
| Rate for Payer: Heritage Provider Network Senior |
$2,612.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,124.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4,036.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$843.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,442.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,165.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,846.47
|
| Rate for Payer: Multiplan Commercial |
$3,495.75
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,336.65
|
| Rate for Payer: TriValley Medical Group Senior |
$2,336.65
|
| 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 |
$3,186.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,124.23
|
|
|
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: Aetna of CA Non-Gatekeeper |
$3,001.68
|
| Rate for Payer: Cash Price |
$2,097.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,155.50
|
| Rate for Payer: Heritage Provider Network Senior |
$3,155.50
|
| Rate for Payer: Kaiser Foundation Hospitals 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
|
IP
|
$2,360.00
|
|
|
Service Code
|
CPT 48999
|
| Hospital Charge Code |
906748999
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$427.16 |
| Max. Negotiated Rate |
$1,770.00 |
| Rate for Payer: Adventist Health Commercial |
$472.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,519.84
|
| Rate for Payer: Cash Price |
$1,062.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,597.72
|
| Rate for Payer: Heritage Provider Network Senior |
$1,597.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$427.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$590.00
|
| Rate for Payer: Multiplan Commercial |
$1,770.00
|
|
|
HC PANCREAS CELLVIZIO
|
Facility
|
OP
|
$2,360.00
|
|
|
Service Code
|
CPT 48999
|
| Hospital Charge Code |
906748999
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$425.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$472.00
|
| Rate for Payer: Adventist Health Commercial |
$250.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$772.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,458.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$910.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$910.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,180.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$625.25
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| 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: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$1,062.00
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cash Price |
$1,062.00
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cash Price |
$1,062.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$812.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,534.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,001.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,001.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$910.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$910.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$910.78
|
| Rate for Payer: EPIC Health Plan Medicare |
$910.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,460.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$773.75
|
| Rate for Payer: Heritage Provider Network Senior |
$1,120.26
|
| Rate for Payer: Heritage Provider Network Senior |
$1,120.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$910.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$910.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$596.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,125.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$427.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$226.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,047.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,047.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$312.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$590.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,220.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,220.45
|
| Rate for Payer: Multiplan Commercial |
$1,770.00
|
| Rate for Payer: Multiplan Commercial |
$937.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$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 All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Vantage Medical Group Senior |
$910.78
|
| Rate for Payer: Vantage Medical Group Senior |
$910.78
|
|
