|
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: AlphaCare Medical Group Commercial/Exchange |
$7,359.81
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5,397.19
|
| Rate for Payer: AlphaCare 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: 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
|
$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: AlphaCare Medical Group Commercial/Exchange |
$7,359.81
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5,397.19
|
| Rate for Payer: AlphaCare 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: 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
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: AlphaCare Medical Group Commercial/Exchange |
$7,359.81
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5,397.19
|
| Rate for Payer: AlphaCare 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: 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 REMOVE
|
Facility
IP
|
$5,957.00
|
|
|
Service Code
|
CPT 0580T
|
| Hospital Charge Code |
906820279
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,078.22 |
| Max. Negotiated Rate |
$4,467.75 |
| Rate for Payer: Adventist Health Commercial |
$1,191.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,092.46
|
| Rate for Payer: Cash Price |
$2,680.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,032.89
|
| Rate for Payer: Heritage Provider Network Senior |
$4,032.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,078.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,489.25
|
| Rate for Payer: Multiplan Commercial |
$4,467.75
|
|
|
HC SUBSTERN ICD REMOVE
|
Facility
OP
|
$12,150.00
|
|
|
Service Code
|
CPT 0580T
|
| Hospital Charge Code |
906810580
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$933.56 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$2,430.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,347.05
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7,359.81
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5,397.19
|
| Rate for Payer: AlphaCare 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 |
$5,467.50
|
| Rate for Payer: Cash Price |
$5,467.50
|
| Rate for Payer: Cash Price |
$5,467.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,897.50
|
| 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 |
$7,520.85
|
| Rate for Payer: Heritage Provider Network Senior |
$6,035.04
|
| Rate for Payer: Humana Medicare |
$4,906.54
|
| Rate for Payer: 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 |
$2,199.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,789.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,037.50
|
| 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 |
$9,112.50
|
| 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
OP
|
$5,957.00
|
|
|
Service Code
|
CPT 0580T
|
| Hospital Charge Code |
906820279
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$933.56 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,191.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,092.46
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7,359.81
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5,397.19
|
| Rate for Payer: AlphaCare 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 |
$2,680.65
|
| Rate for Payer: Cash Price |
$2,680.65
|
| Rate for Payer: Cash Price |
$2,680.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,872.05
|
| 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 |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,906.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,687.38
|
| Rate for Payer: Heritage Provider Network Senior |
$6,035.04
|
| Rate for Payer: Humana Medicare |
$4,906.54
|
| Rate for Payer: 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 |
$1,078.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,789.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,489.25
|
| 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 |
$4,467.75
|
| 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 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
|
|
|
HC SUBSTERN LEAD W/ICD INST/REPL
|
Facility
OP
|
$79,658.00
|
|
|
Service Code
|
CPT 0571T
|
| Hospital Charge Code |
906820274
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$933.56 |
| Max. Negotiated Rate |
$78,099.96 |
| Rate for Payer: Adventist Health Commercial |
$15,931.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,420.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$54,725.05
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$61,657.86
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$45,215.76
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$41,105.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,054.00
|
| 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 |
$61,657.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$45,215.76
|
| Rate for Payer: Dignity Health Senior |
$41,105.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$41,105.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$49,308.30
|
| Rate for Payer: Heritage Provider Network Senior |
$50,559.45
|
| Rate for Payer: Humana Medicare |
$41,105.24
|
| Rate for Payer: IEHP Medicare Advantage |
$41,105.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$78,099.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,418.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$48,504.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19,914.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$51,792.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$51,792.60
|
| Rate for Payer: Multiplan Commercial |
$59,743.50
|
| Rate for Payer: Multiplan WC |
$56,196.73
|
| Rate for Payer: TriValley Medical Group Commercial |
$45,215.76
|
| Rate for Payer: TriValley Medical Group Senior |
$45,215.76
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$62,843.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$52,858.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$61,657.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45,215.76
|
| Rate for Payer: Vantage Medical Group Senior |
$41,105.24
|
|
|
HC SUBSTERN LEAD W/ICD INST/REPL
|
Facility
IP
|
$68,385.00
|
|
|
Service Code
|
CPT 0571T
|
| Hospital Charge Code |
906810571
|
|
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 LEAD W/ICD INST/REPL
|
Facility
IP
|
$79,658.00
|
|
|
Service Code
|
CPT 0571T
|
| Hospital Charge Code |
906820274
|
|
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 LEAD W/ICD INST/REPL
|
Facility
OP
|
$68,385.00
|
|
|
Service Code
|
CPT 0571T
|
| Hospital Charge Code |
906810571
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$933.56 |
| Max. Negotiated Rate |
$78,099.96 |
| Rate for Payer: Adventist Health Commercial |
$13,677.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,420.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$46,980.50
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$61,657.86
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$45,215.76
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$41,105.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,054.00
|
| 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 |
$61,657.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$45,215.76
|
| Rate for Payer: Dignity Health Senior |
$41,105.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$41,105.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$42,330.32
|
| Rate for Payer: Heritage Provider Network Senior |
$50,559.45
|
| Rate for Payer: Humana Medicare |
$41,105.24
|
| Rate for Payer: IEHP Medicare Advantage |
$41,105.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$78,099.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,377.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$48,504.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17,096.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$51,792.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$51,792.60
|
| Rate for Payer: Multiplan Commercial |
$51,288.75
|
| Rate for Payer: Multiplan WC |
$56,196.73
|
| Rate for Payer: TriValley Medical Group Commercial |
$45,215.76
|
| Rate for Payer: TriValley Medical Group Senior |
$45,215.76
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$62,843.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$52,858.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$61,657.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45,215.76
|
| Rate for Payer: Vantage Medical Group Senior |
$41,105.24
|
|
|
HC SUDAN BLACK B
|
Facility
OP
|
$118.00
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
900910057
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$21.36 |
| Max. Negotiated Rate |
$147.28 |
| Rate for Payer: Adventist Health Commercial |
$23.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$147.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$81.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$76.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.34
|
| Rate for Payer: Blue Shield of California Commercial |
$73.28
|
| Rate for Payer: Blue Shield of California EPN |
$69.27
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$76.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$114.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$84.06
|
| Rate for Payer: Dignity Health Senior |
$76.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$76.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$73.04
|
| Rate for Payer: Heritage Provider Network Senior |
$73.04
|
| Rate for Payer: Humana Medicare |
$76.42
|
| Rate for Payer: IEHP Medi-Cal |
$53.45
|
| Rate for Payer: IEHP Medicare Advantage |
$76.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$145.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$90.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$96.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$96.29
|
| Rate for Payer: Multiplan Commercial |
$88.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$76.42
|
| Rate for Payer: TriValley Medical Group Senior |
$76.42
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$37.33
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$37.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Vantage Medical Group Senior |
$76.42
|
|
|
HC SUDAN BLACK B
|
Facility
IP
|
$551.00
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
900910057
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$99.73 |
| Max. Negotiated Rate |
$413.25 |
| Rate for Payer: Adventist Health Commercial |
$110.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$378.54
|
| Rate for Payer: Cash Price |
$247.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$373.03
|
| Rate for Payer: Heritage Provider Network Senior |
$373.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$99.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$137.75
|
| Rate for Payer: Multiplan Commercial |
$413.25
|
|
|
HC SUPERION IDS 10MM
|
Facility
OP
|
$34,225.00
|
|
|
Service Code
|
CPT C1821
|
| Hospital Charge Code |
909001823
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,845.00 |
| Max. Negotiated Rate |
$29,091.25 |
| Rate for Payer: Adventist Health Commercial |
$6,845.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$16,428.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$23,512.58
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$29,091.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$18,823.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$25,668.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$21,253.72
|
| Rate for Payer: Blue Shield of California EPN |
$20,090.08
|
| Rate for Payer: Cash Price |
$15,401.25
|
| Rate for Payer: Cash Price |
$15,401.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15,743.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29,091.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$29,091.25
|
| Rate for Payer: Dignity Health Senior |
$29,091.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$21,904.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$15,846.18
|
| Rate for Payer: Heritage Provider Network Senior |
$15,846.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$17,112.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17,112.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17,112.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,556.25
|
| Rate for Payer: Multiplan Commercial |
$25,668.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12,478.44
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,434.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29,091.25
|
| Rate for Payer: Vantage Medical Group Senior |
$29,091.25
|
|
|
HC SUPERION IDS 10MM
|
Facility
IP
|
$34,225.00
|
|
|
Service Code
|
CPT C1821
|
| Hospital Charge Code |
909001823
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,845.00 |
| Max. Negotiated Rate |
$25,668.75 |
| Rate for Payer: Adventist Health Commercial |
$6,845.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$16,428.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$23,512.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$15,401.25
|
| Rate for Payer: Cash Price |
$15,401.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15,743.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,481.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$23,170.32
|
| Rate for Payer: Heritage Provider Network Senior |
$23,170.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$17,112.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17,112.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17,112.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,556.25
|
| Rate for Payer: Multiplan Commercial |
$25,668.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12,478.44
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,434.57
|
|
|
HC SUPERION IDS 12MM
|
Facility
OP
|
$36,732.50
|
|
|
Service Code
|
CPT C1821
|
| Hospital Charge Code |
909001821
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,346.50 |
| Max. Negotiated Rate |
$31,222.62 |
| Rate for Payer: Adventist Health Commercial |
$7,346.50
|
| Rate for Payer: Aetna of CA Gatekeeper |
$17,631.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$25,235.23
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$31,222.62
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$20,202.88
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$27,549.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$22,810.88
|
| Rate for Payer: Blue Shield of California EPN |
$21,561.98
|
| Rate for Payer: Cash Price |
$16,529.63
|
| Rate for Payer: Cash Price |
$16,529.63
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16,896.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31,222.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$31,222.62
|
| Rate for Payer: Dignity Health Senior |
$31,222.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$23,508.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$17,007.15
|
| Rate for Payer: Heritage Provider Network Senior |
$17,007.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$18,366.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18,366.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18,366.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,183.12
|
| Rate for Payer: Multiplan Commercial |
$27,549.38
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13,392.67
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12,272.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31,222.62
|
| Rate for Payer: Vantage Medical Group Senior |
$31,222.62
|
|
|
HC SUPERION IDS 12MM
|
Facility
IP
|
$36,732.50
|
|
|
Service Code
|
CPT C1821
|
| Hospital Charge Code |
909001821
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,346.50 |
| Max. Negotiated Rate |
$27,549.38 |
| Rate for Payer: Adventist Health Commercial |
$7,346.50
|
| Rate for Payer: Aetna of CA Gatekeeper |
$17,631.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$25,235.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$16,529.63
|
| Rate for Payer: Cash Price |
$16,529.63
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16,896.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,835.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$24,867.90
|
| Rate for Payer: Heritage Provider Network Senior |
$24,867.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$18,366.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18,366.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18,366.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,183.12
|
| Rate for Payer: Multiplan Commercial |
$27,549.38
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13,392.67
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12,272.33
|
|
|
HC SUPERION IDS 14MM
|
Facility
IP
|
$34,225.00
|
|
|
Service Code
|
CPT C1821
|
| Hospital Charge Code |
909001824
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,845.00 |
| Max. Negotiated Rate |
$25,668.75 |
| Rate for Payer: Adventist Health Commercial |
$6,845.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$16,428.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$23,512.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$15,401.25
|
| Rate for Payer: Cash Price |
$15,401.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15,743.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,481.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$23,170.32
|
| Rate for Payer: Heritage Provider Network Senior |
$23,170.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$17,112.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17,112.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17,112.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,556.25
|
| Rate for Payer: Multiplan Commercial |
$25,668.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12,478.44
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,434.57
|
|
|
HC SUPERION IDS 14MM
|
Facility
OP
|
$34,225.00
|
|
|
Service Code
|
CPT C1821
|
| Hospital Charge Code |
909001824
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,845.00 |
| Max. Negotiated Rate |
$29,091.25 |
| Rate for Payer: Adventist Health Commercial |
$6,845.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$16,428.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$23,512.58
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$29,091.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$18,823.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$25,668.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$21,253.72
|
| Rate for Payer: Blue Shield of California EPN |
$20,090.08
|
| Rate for Payer: Cash Price |
$15,401.25
|
| Rate for Payer: Cash Price |
$15,401.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15,743.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29,091.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$29,091.25
|
| Rate for Payer: Dignity Health Senior |
$29,091.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$21,904.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$15,846.18
|
| Rate for Payer: Heritage Provider Network Senior |
$15,846.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$17,112.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17,112.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17,112.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,556.25
|
| Rate for Payer: Multiplan Commercial |
$25,668.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12,478.44
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,434.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29,091.25
|
| Rate for Payer: Vantage Medical Group Senior |
$29,091.25
|
|
|
HC SUPERION IDS 16MM
|
Facility
OP
|
$34,225.00
|
|
|
Service Code
|
CPT C1821
|
| Hospital Charge Code |
909001825
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,845.00 |
| Max. Negotiated Rate |
$29,091.25 |
| Rate for Payer: Adventist Health Commercial |
$6,845.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$16,428.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$23,512.58
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$29,091.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$18,823.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$25,668.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$21,253.72
|
| Rate for Payer: Blue Shield of California EPN |
$20,090.08
|
| Rate for Payer: Cash Price |
$15,401.25
|
| Rate for Payer: Cash Price |
$15,401.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15,743.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29,091.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$29,091.25
|
| Rate for Payer: Dignity Health Senior |
$29,091.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$21,904.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$15,846.18
|
| Rate for Payer: Heritage Provider Network Senior |
$15,846.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$17,112.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17,112.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17,112.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,556.25
|
| Rate for Payer: Multiplan Commercial |
$25,668.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12,478.44
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,434.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29,091.25
|
| Rate for Payer: Vantage Medical Group Senior |
$29,091.25
|
|
|
HC SUPERION IDS 16MM
|
Facility
IP
|
$34,225.00
|
|
|
Service Code
|
CPT C1821
|
| Hospital Charge Code |
909001825
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,845.00 |
| Max. Negotiated Rate |
$25,668.75 |
| Rate for Payer: Adventist Health Commercial |
$6,845.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$16,428.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$23,512.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$15,401.25
|
| Rate for Payer: Cash Price |
$15,401.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15,743.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,481.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$23,170.32
|
| Rate for Payer: Heritage Provider Network Senior |
$23,170.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$17,112.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17,112.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17,112.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,556.25
|
| Rate for Payer: Multiplan Commercial |
$25,668.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12,478.44
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,434.57
|
|
|
HC SUPERION IDS 8MM
|
Facility
OP
|
$34,225.00
|
|
|
Service Code
|
CPT C1821
|
| Hospital Charge Code |
909001822
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,845.00 |
| Max. Negotiated Rate |
$29,091.25 |
| Rate for Payer: Adventist Health Commercial |
$6,845.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$16,428.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$23,512.58
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$29,091.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$18,823.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$25,668.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$21,253.72
|
| Rate for Payer: Blue Shield of California EPN |
$20,090.08
|
| Rate for Payer: Cash Price |
$15,401.25
|
| Rate for Payer: Cash Price |
$15,401.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15,743.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29,091.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$29,091.25
|
| Rate for Payer: Dignity Health Senior |
$29,091.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$21,904.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$15,846.18
|
| Rate for Payer: Heritage Provider Network Senior |
$15,846.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$17,112.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17,112.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17,112.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,556.25
|
| Rate for Payer: Multiplan Commercial |
$25,668.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12,478.44
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,434.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29,091.25
|
| Rate for Payer: Vantage Medical Group Senior |
$29,091.25
|
|
