|
HC SUBDURAL TAP UNIL/BILAT INIT
|
Facility
|
OP
|
$2,619.00
|
|
|
Service Code
|
CPT 61000
|
| Hospital Charge Code |
900501225
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$474.04 |
| Max. Negotiated Rate |
$3,237.00 |
| Rate for Payer: Adventist Health Commercial |
$523.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,799.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$864.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$1,178.55
|
| Rate for Payer: Cash Price |
$1,178.55
|
| Rate for Payer: Cash Price |
$1,178.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,702.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$950.44
|
| Rate for Payer: Dignity Health Senior |
$864.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,702.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$864.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,773.06
|
| Rate for Payer: Heritage Provider Network Senior |
$1,773.06
|
| Rate for Payer: Humana Medicare |
$864.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$864.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,262.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$474.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,019.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$654.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,088.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,088.69
|
| Rate for Payer: Multiplan Commercial |
$1,964.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$950.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$875.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: Vantage Medical Group Senior |
$864.04
|
|
|
HC SUBDURAL TAP UNIL/BILAT INIT
|
Facility
|
IP
|
$2,619.00
|
|
|
Service Code
|
CPT 61000
|
| Hospital Charge Code |
900501225
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$474.04 |
| Max. Negotiated Rate |
$1,964.25 |
| Rate for Payer: Adventist Health Commercial |
$523.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,799.25
|
| Rate for Payer: Cash Price |
$1,178.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,773.06
|
| Rate for Payer: Heritage Provider Network Senior |
$1,773.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$474.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$654.75
|
| Rate for Payer: Multiplan Commercial |
$1,964.25
|
|
|
HC SUBQ ICD LEAD INSERT
|
Facility
|
IP
|
$23,070.00
|
|
|
Service Code
|
CPT 33271
|
| Hospital Charge Code |
950442236
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,175.67 |
| Max. Negotiated Rate |
$17,302.50 |
| Rate for Payer: Adventist Health Commercial |
$4,614.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15,849.09
|
| Rate for Payer: Cash Price |
$10,381.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$15,618.39
|
| Rate for Payer: Heritage Provider Network Senior |
$15,618.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,175.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,767.50
|
| Rate for Payer: Multiplan Commercial |
$17,302.50
|
|
|
HC SUBQ ICD LEAD INSERT
|
Facility
|
OP
|
$23,070.00
|
|
|
Service Code
|
CPT 33271
|
| Hospital Charge Code |
950442236
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$669.07 |
| Max. Negotiated Rate |
$20,168.10 |
| Rate for Payer: Adventist Health Commercial |
$4,614.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15,849.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15,922.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11,676.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,614.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| 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 |
$10,381.50
|
| Rate for Payer: Cash Price |
$10,381.50
|
| Rate for Payer: Cash Price |
$10,381.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14,995.50
|
| 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 |
$7,103.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$10,614.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$14,280.33
|
| Rate for Payer: Heritage Provider Network Senior |
$13,056.19
|
| Rate for Payer: Humana Medicare |
$10,614.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$669.07
|
| Rate for Payer: Inland Empire Health Plan (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 |
$4,175.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,525.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,767.50
|
| 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 |
$17,302.50
|
| 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 SUBQ ICD REMOVAL ONLY
|
Facility
|
IP
|
$9,777.00
|
|
|
Service Code
|
CPT 33272
|
| Hospital Charge Code |
950442237
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,769.64 |
| Max. Negotiated Rate |
$7,332.75 |
| Rate for Payer: Adventist Health Commercial |
$1,955.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,716.80
|
| Rate for Payer: Cash Price |
$4,399.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,619.03
|
| Rate for Payer: Heritage Provider Network Senior |
$6,619.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,769.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,444.25
|
| Rate for Payer: Multiplan Commercial |
$7,332.75
|
|
|
HC SUBQ ICD REMOVAL ONLY
|
Facility
|
OP
|
$9,777.00
|
|
|
Service Code
|
CPT 33272
|
| Hospital Charge Code |
950442237
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$493.08 |
| Max. Negotiated Rate |
$9,520.00 |
| Rate for Payer: Adventist Health Commercial |
$1,955.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,716.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,359.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,397.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,906.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,086.22
|
| Rate for Payer: Blue Shield of California EPN |
$933.56
|
| Rate for Payer: Cash Price |
$4,399.65
|
| Rate for Payer: Cash Price |
$4,399.65
|
| Rate for Payer: Cash Price |
$4,399.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,355.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,359.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,397.19
|
| Rate for Payer: Dignity Health Senior |
$4,906.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,103.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,906.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,051.96
|
| Rate for Payer: Heritage Provider Network Senior |
$6,035.04
|
| Rate for Payer: Humana Medicare |
$4,906.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$493.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,906.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9,322.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,769.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,789.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,444.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,182.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,182.24
|
| Rate for Payer: Multiplan Commercial |
$7,332.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$5,397.19
|
| Rate for Payer: TriValley Medical Group Senior |
$5,397.19
|
| 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 |
$7,359.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,397.19
|
| Rate for Payer: Vantage Medical Group Senior |
$4,906.54
|
|
|
HC SUBQ LEAD REPOSITION
|
Facility
|
OP
|
$9,777.00
|
|
|
Service Code
|
CPT 33273
|
| Hospital Charge Code |
950442238
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$537.81 |
| Max. Negotiated Rate |
$9,520.00 |
| Rate for Payer: Adventist Health Commercial |
$1,955.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,716.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,359.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,397.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,906.54
|
| 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 |
$4,399.65
|
| Rate for Payer: Cash Price |
$4,399.65
|
| Rate for Payer: Cash Price |
$4,399.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,355.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,359.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,397.19
|
| Rate for Payer: Dignity Health Senior |
$4,906.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,103.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,906.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,051.96
|
| Rate for Payer: Heritage Provider Network Senior |
$6,035.04
|
| Rate for Payer: Humana Medicare |
$4,906.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$537.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,906.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9,322.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,769.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,789.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,444.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,182.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,182.24
|
| Rate for Payer: Multiplan Commercial |
$7,332.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$5,397.19
|
| Rate for Payer: TriValley Medical Group Senior |
$5,397.19
|
| 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 |
$7,359.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,397.19
|
| Rate for Payer: Vantage Medical Group Senior |
$4,906.54
|
|
|
HC SUBQ LEAD REPOSITION
|
Facility
|
IP
|
$9,777.00
|
|
|
Service Code
|
CPT 33273
|
| Hospital Charge Code |
950442238
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,769.64 |
| Max. Negotiated Rate |
$7,332.75 |
| Rate for Payer: Adventist Health Commercial |
$1,955.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,716.80
|
| Rate for Payer: Cash Price |
$4,399.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,619.03
|
| Rate for Payer: Heritage Provider Network Senior |
$6,619.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,769.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,444.25
|
| Rate for Payer: Multiplan Commercial |
$7,332.75
|
|
|
HC SUBSTERN ICD DFIB TEST
|
Facility
|
OP
|
$4,152.00
|
|
|
Service Code
|
CPT 0577T
|
| Hospital Charge Code |
906810577
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$751.51 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$830.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,852.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,230.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,635.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,486.99
|
| Rate for Payer: Blue Shield of California Commercial |
$1,086.22
|
| Rate for Payer: Blue Shield of California EPN |
$933.56
|
| Rate for Payer: Cash Price |
$1,868.40
|
| Rate for Payer: Cash Price |
$1,868.40
|
| Rate for Payer: Cash Price |
$1,868.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,698.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,230.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,635.69
|
| Rate for Payer: Dignity Health Senior |
$1,486.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,486.99
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,570.09
|
| Rate for Payer: Heritage Provider Network Senior |
$1,829.00
|
| Rate for Payer: Humana Medicare |
$1,486.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,486.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,825.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$751.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,754.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,038.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,873.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,873.61
|
| Rate for Payer: Multiplan Commercial |
$3,114.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,635.69
|
| Rate for Payer: TriValley Medical Group Senior |
$1,635.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,230.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,635.69
|
| Rate for Payer: Vantage Medical Group Senior |
$1,486.99
|
|
|
HC SUBSTERN ICD DFIB TEST
|
Facility
|
OP
|
$4,152.00
|
|
|
Service Code
|
CPT 0577T
|
| Hospital Charge Code |
906820278
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$751.51 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$830.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,852.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,230.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,635.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,486.99
|
| Rate for Payer: Blue Shield of California Commercial |
$1,086.22
|
| Rate for Payer: Blue Shield of California EPN |
$933.56
|
| Rate for Payer: Cash Price |
$1,868.40
|
| Rate for Payer: Cash Price |
$1,868.40
|
| Rate for Payer: Cash Price |
$1,868.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,698.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,230.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,635.69
|
| Rate for Payer: Dignity Health Senior |
$1,486.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,486.99
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,570.09
|
| Rate for Payer: Heritage Provider Network Senior |
$1,829.00
|
| Rate for Payer: Humana Medicare |
$1,486.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,486.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,825.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$751.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,754.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,038.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,873.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,873.61
|
| Rate for Payer: Multiplan Commercial |
$3,114.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,635.69
|
| Rate for Payer: TriValley Medical Group Senior |
$1,635.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,230.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,635.69
|
| Rate for Payer: Vantage Medical Group Senior |
$1,486.99
|
|
|
HC SUBSTERN ICD DFIB TEST
|
Facility
|
IP
|
$4,152.00
|
|
|
Service Code
|
CPT 0577T
|
| Hospital Charge Code |
906810577
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$751.51 |
| Max. Negotiated Rate |
$3,114.00 |
| Rate for Payer: Adventist Health Commercial |
$830.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,852.42
|
| Rate for Payer: Cash Price |
$1,868.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,810.90
|
| Rate for Payer: Heritage Provider Network Senior |
$2,810.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$751.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,038.00
|
| Rate for Payer: Multiplan Commercial |
$3,114.00
|
|
|
HC SUBSTERN ICD DFIB TEST
|
Facility
|
IP
|
$4,152.00
|
|
|
Service Code
|
CPT 0577T
|
| Hospital Charge Code |
906820278
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$751.51 |
| Max. Negotiated Rate |
$3,114.00 |
| Rate for Payer: Adventist Health Commercial |
$830.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,852.42
|
| Rate for Payer: Cash Price |
$1,868.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,810.90
|
| Rate for Payer: Heritage Provider Network Senior |
$2,810.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$751.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,038.00
|
| Rate for Payer: Multiplan Commercial |
$3,114.00
|
|
|
HC SUBSTERN ICD LEAD INSERT
|
Facility
|
IP
|
$68,385.00
|
|
|
Service Code
|
CPT 0572T
|
| Hospital Charge Code |
906810572
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$12,377.68 |
| Max. Negotiated Rate |
$51,288.75 |
| Rate for Payer: Adventist Health Commercial |
$13,677.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$46,980.50
|
| Rate for Payer: Cash Price |
$30,773.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$46,296.64
|
| Rate for Payer: Heritage Provider Network Senior |
$46,296.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,377.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17,096.25
|
| Rate for Payer: Multiplan Commercial |
$51,288.75
|
|
|
HC SUBSTERN ICD LEAD INSERT
|
Facility
|
IP
|
$79,658.00
|
|
|
Service Code
|
CPT 0572T
|
| Hospital Charge Code |
906820275
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$14,418.10 |
| Max. Negotiated Rate |
$59,743.50 |
| Rate for Payer: Adventist Health Commercial |
$15,931.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$54,725.05
|
| Rate for Payer: Cash Price |
$35,846.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$53,928.47
|
| Rate for Payer: Heritage Provider Network Senior |
$53,928.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,418.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19,914.50
|
| Rate for Payer: Multiplan Commercial |
$59,743.50
|
|
|
HC SUBSTERN ICD LEAD INSERT
|
Facility
|
OP
|
$79,658.00
|
|
|
Service Code
|
CPT 0572T
|
| Hospital Charge Code |
906820275
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$933.56 |
| Max. Negotiated Rate |
$59,743.50 |
| Rate for Payer: Adventist Health Commercial |
$15,931.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$54,725.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15,922.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11,676.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,614.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,086.22
|
| Rate for Payer: Blue Shield of California EPN |
$933.56
|
| Rate for Payer: Cash Price |
$35,846.10
|
| Rate for Payer: Cash Price |
$35,846.10
|
| Rate for Payer: Cash Price |
$35,846.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$51,777.70
|
| 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 |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$10,614.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$49,308.30
|
| Rate for Payer: Heritage Provider Network Senior |
$13,056.19
|
| Rate for Payer: Humana Medicare |
$10,614.79
|
| Rate for Payer: Inland Empire Health Plan (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 |
$14,418.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,525.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19,914.50
|
| 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 |
$59,743.50
|
| 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 SUBSTERN ICD LEAD INSERT
|
Facility
|
OP
|
$68,385.00
|
|
|
Service Code
|
CPT 0572T
|
| Hospital Charge Code |
906810572
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$933.56 |
| Max. Negotiated Rate |
$51,288.75 |
| Rate for Payer: Adventist Health Commercial |
$13,677.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$46,980.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15,922.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11,676.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,614.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,086.22
|
| Rate for Payer: Blue Shield of California EPN |
$933.56
|
| Rate for Payer: Cash Price |
$30,773.25
|
| Rate for Payer: Cash Price |
$30,773.25
|
| Rate for Payer: Cash Price |
$30,773.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$44,450.25
|
| 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 |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$10,614.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$42,330.32
|
| Rate for Payer: Heritage Provider Network Senior |
$13,056.19
|
| Rate for Payer: Humana Medicare |
$10,614.79
|
| Rate for Payer: Inland Empire Health Plan (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 |
$12,377.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,525.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17,096.25
|
| 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 |
$51,288.75
|
| 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 SUBSTERN ICD LEAD REMOVE
|
Facility
|
IP
|
$68,385.00
|
|
|
Service Code
|
CPT 0573T
|
| Hospital Charge Code |
906810573
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$12,377.68 |
| Max. Negotiated Rate |
$51,288.75 |
| Rate for Payer: Adventist Health Commercial |
$13,677.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$46,980.50
|
| Rate for Payer: Cash Price |
$30,773.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$46,296.64
|
| Rate for Payer: Heritage Provider Network Senior |
$46,296.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,377.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17,096.25
|
| Rate for Payer: Multiplan Commercial |
$51,288.75
|
|
|
HC SUBSTERN ICD LEAD REMOVE
|
Facility
|
OP
|
$68,385.00
|
|
|
Service Code
|
CPT 0573T
|
| Hospital Charge Code |
906810573
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$933.56 |
| Max. Negotiated Rate |
$51,288.75 |
| Rate for Payer: Adventist Health Commercial |
$13,677.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$46,980.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,359.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,397.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,906.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,086.22
|
| Rate for Payer: Blue Shield of California EPN |
$933.56
|
| Rate for Payer: Cash Price |
$30,773.25
|
| Rate for Payer: Cash Price |
$30,773.25
|
| Rate for Payer: Cash Price |
$30,773.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$44,450.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,359.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,397.19
|
| Rate for Payer: Dignity Health Senior |
$4,906.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,906.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$42,330.32
|
| Rate for Payer: Heritage Provider Network Senior |
$6,035.04
|
| Rate for Payer: Humana Medicare |
$4,906.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,906.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9,322.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,377.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,789.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17,096.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,182.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,182.24
|
| Rate for Payer: Multiplan Commercial |
$51,288.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$5,397.19
|
| Rate for Payer: TriValley Medical Group Senior |
$5,397.19
|
| 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 |
$7,359.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,397.19
|
| Rate for Payer: Vantage Medical Group Senior |
$4,906.54
|
|
|
HC SUBSTERN ICD LEAD REMOVE
|
Facility
|
IP
|
$79,658.00
|
|
|
Service Code
|
CPT 0573T
|
| Hospital Charge Code |
906820276
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$14,418.10 |
| Max. Negotiated Rate |
$59,743.50 |
| Rate for Payer: Adventist Health Commercial |
$15,931.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$54,725.05
|
| Rate for Payer: Cash Price |
$35,846.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$53,928.47
|
| Rate for Payer: Heritage Provider Network Senior |
$53,928.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,418.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19,914.50
|
| Rate for Payer: Multiplan Commercial |
$59,743.50
|
|
|
HC SUBSTERN ICD LEAD REMOVE
|
Facility
|
OP
|
$79,658.00
|
|
|
Service Code
|
CPT 0573T
|
| Hospital Charge Code |
906820276
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$933.56 |
| Max. Negotiated Rate |
$59,743.50 |
| Rate for Payer: Adventist Health Commercial |
$15,931.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$54,725.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,359.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,397.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,906.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,086.22
|
| Rate for Payer: Blue Shield of California EPN |
$933.56
|
| Rate for Payer: Cash Price |
$35,846.10
|
| Rate for Payer: Cash Price |
$35,846.10
|
| Rate for Payer: Cash Price |
$35,846.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$51,777.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,359.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,397.19
|
| Rate for Payer: Dignity Health Senior |
$4,906.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,906.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$49,308.30
|
| Rate for Payer: Heritage Provider Network Senior |
$6,035.04
|
| Rate for Payer: Humana Medicare |
$4,906.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,906.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9,322.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,418.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,789.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19,914.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,182.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,182.24
|
| Rate for Payer: Multiplan Commercial |
$59,743.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$5,397.19
|
| Rate for Payer: TriValley Medical Group Senior |
$5,397.19
|
| 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 |
$7,359.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,397.19
|
| Rate for Payer: Vantage Medical Group Senior |
$4,906.54
|
|
|
HC SUBSTERN ICD LEAD REPOS
|
Facility
|
IP
|
$68,385.00
|
|
|
Service Code
|
CPT 0574T
|
| Hospital Charge Code |
906810574
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$12,377.68 |
| Max. Negotiated Rate |
$51,288.75 |
| Rate for Payer: Adventist Health Commercial |
$13,677.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$46,980.50
|
| Rate for Payer: Cash Price |
$30,773.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$46,296.64
|
| Rate for Payer: Heritage Provider Network Senior |
$46,296.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,377.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17,096.25
|
| Rate for Payer: Multiplan Commercial |
$51,288.75
|
|
|
HC SUBSTERN ICD LEAD REPOS
|
Facility
|
IP
|
$79,658.00
|
|
|
Service Code
|
CPT 0574T
|
| Hospital Charge Code |
906820277
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$14,418.10 |
| Max. Negotiated Rate |
$59,743.50 |
| Rate for Payer: Adventist Health Commercial |
$15,931.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$54,725.05
|
| Rate for Payer: Cash Price |
$35,846.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$53,928.47
|
| Rate for Payer: Heritage Provider Network Senior |
$53,928.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,418.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19,914.50
|
| Rate for Payer: Multiplan Commercial |
$59,743.50
|
|
|
HC SUBSTERN ICD LEAD REPOS
|
Facility
|
OP
|
$68,385.00
|
|
|
Service Code
|
CPT 0574T
|
| Hospital Charge Code |
906810574
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$933.56 |
| Max. Negotiated Rate |
$51,288.75 |
| Rate for Payer: Adventist Health Commercial |
$13,677.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$46,980.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,359.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,397.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,906.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,086.22
|
| Rate for Payer: Blue Shield of California EPN |
$933.56
|
| Rate for Payer: Cash Price |
$30,773.25
|
| Rate for Payer: Cash Price |
$30,773.25
|
| Rate for Payer: Cash Price |
$30,773.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$44,450.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,359.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,397.19
|
| Rate for Payer: Dignity Health Senior |
$4,906.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,906.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$42,330.32
|
| Rate for Payer: Heritage Provider Network Senior |
$6,035.04
|
| Rate for Payer: Humana Medicare |
$4,906.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,906.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9,322.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,377.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,789.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17,096.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,182.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,182.24
|
| Rate for Payer: Multiplan Commercial |
$51,288.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$5,397.19
|
| Rate for Payer: TriValley Medical Group Senior |
$5,397.19
|
| 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 |
$7,359.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,397.19
|
| Rate for Payer: Vantage Medical Group Senior |
$4,906.54
|
|
|
HC SUBSTERN ICD LEAD REPOS
|
Facility
|
OP
|
$79,658.00
|
|
|
Service Code
|
CPT 0574T
|
| Hospital Charge Code |
906820277
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$933.56 |
| Max. Negotiated Rate |
$59,743.50 |
| Rate for Payer: Adventist Health Commercial |
$15,931.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$54,725.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,359.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,397.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,906.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,086.22
|
| Rate for Payer: Blue Shield of California EPN |
$933.56
|
| Rate for Payer: Cash Price |
$35,846.10
|
| Rate for Payer: Cash Price |
$35,846.10
|
| Rate for Payer: Cash Price |
$35,846.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$51,777.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,359.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,397.19
|
| Rate for Payer: Dignity Health Senior |
$4,906.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,906.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$49,308.30
|
| Rate for Payer: Heritage Provider Network Senior |
$6,035.04
|
| Rate for Payer: Humana Medicare |
$4,906.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,906.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9,322.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,418.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,789.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19,914.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,182.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,182.24
|
| Rate for Payer: Multiplan Commercial |
$59,743.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$5,397.19
|
| Rate for Payer: TriValley Medical Group Senior |
$5,397.19
|
| 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 |
$7,359.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,397.19
|
| Rate for Payer: Vantage Medical Group Senior |
$4,906.54
|
|
|
HC SUBSTERN ICD REMOVE
|
Facility
|
IP
|
$12,150.00
|
|
|
Service Code
|
CPT 0580T
|
| Hospital Charge Code |
906810580
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,199.15 |
| Max. Negotiated Rate |
$9,112.50 |
| Rate for Payer: Adventist Health Commercial |
$2,430.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,347.05
|
| Rate for Payer: Cash Price |
$5,467.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,225.55
|
| Rate for Payer: Heritage Provider Network Senior |
$8,225.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,199.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,037.50
|
| Rate for Payer: Multiplan Commercial |
$9,112.50
|
|
