|
HC SUBQ LEAD REPOSITION
|
Facility
|
IP
|
$8,344.00
|
|
|
Service Code
|
CPT 33273
|
| Hospital Charge Code |
950442238
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,510.26 |
| Max. Negotiated Rate |
$6,258.00 |
| Rate for Payer: Adventist Health Commercial |
$1,668.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,373.54
|
| Rate for Payer: Cash Price |
$3,754.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,648.89
|
| Rate for Payer: Heritage Provider Network Senior |
$5,648.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,510.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,086.00
|
| Rate for Payer: Multiplan Commercial |
$6,258.00
|
|
|
HC SUBSTERN ICD DFIB TEST
|
Facility
|
IP
|
$3,643.00
|
|
|
Service Code
|
CPT 0577T
|
| Hospital Charge Code |
906810577
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$659.38 |
| Max. Negotiated Rate |
$2,732.25 |
| Rate for Payer: Adventist Health Commercial |
$728.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,346.09
|
| Rate for Payer: Cash Price |
$1,639.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,466.31
|
| Rate for Payer: Heritage Provider Network Senior |
$2,466.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$659.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$910.75
|
| Rate for Payer: Multiplan Commercial |
$2,732.25
|
|
|
HC SUBSTERN ICD DFIB TEST
|
Facility
|
OP
|
$3,643.00
|
|
|
Service Code
|
CPT 0577T
|
| Hospital Charge Code |
906810577
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$659.38 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$728.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,251.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,348.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,722.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,565.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,822.23
|
| 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 |
$1,639.35
|
| Rate for Payer: Cash Price |
$1,639.35
|
| Rate for Payer: Cash Price |
$1,639.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,367.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,348.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,722.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,565.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,565.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,255.02
|
| Rate for Payer: Heritage Provider Network Senior |
$1,926.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,565.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,975.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$659.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,800.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$910.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,098.39
|
| Rate for Payer: Multiplan Commercial |
$2,732.25
|
| Rate for Payer: Multiplan WC |
$2,457.69
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,722.56
|
| Rate for Payer: TriValley Medical Group Senior |
$1,722.56
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,821.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,821.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,348.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,722.56
|
| Rate for Payer: Vantage Medical Group Senior |
$1,565.96
|
|
|
HC SUBSTERN ICD LEAD INSERT
|
Facility
|
OP
|
$58,366.00
|
|
|
Service Code
|
CPT 0572T
|
| Hospital Charge Code |
906810572
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$7,178.49 |
| Max. Negotiated Rate |
$43,774.50 |
| Rate for Payer: Adventist Health Commercial |
$11,673.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$36,070.19
|
| 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 |
$8,435.00
|
| 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 |
$26,264.70
|
| Rate for Payer: Cash Price |
$26,264.70
|
| Rate for Payer: Cash Price |
$26,264.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$37,937.90
|
| 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 |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$10,643.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$36,128.55
|
| 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 |
$10,564.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12,240.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14,591.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$14,262.33
|
| Rate for Payer: Multiplan Commercial |
$43,774.50
|
| 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 SUBSTERN ICD LEAD INSERT
|
Facility
|
IP
|
$58,366.00
|
|
|
Service Code
|
CPT 0572T
|
| Hospital Charge Code |
906810572
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$10,564.25 |
| Max. Negotiated Rate |
$43,774.50 |
| Rate for Payer: Adventist Health Commercial |
$11,673.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$37,587.70
|
| Rate for Payer: Cash Price |
$26,264.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$39,513.78
|
| Rate for Payer: Heritage Provider Network Senior |
$39,513.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10,564.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14,591.50
|
| Rate for Payer: Multiplan Commercial |
$43,774.50
|
|
|
HC SUBSTERN ICD LEAD REMOVE
|
Facility
|
OP
|
$58,366.00
|
|
|
Service Code
|
CPT 0573T
|
| Hospital Charge Code |
906810573
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,806.35 |
| Max. Negotiated Rate |
$43,774.50 |
| Rate for Payer: Adventist Health Commercial |
$11,673.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$36,070.19
|
| 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 |
$8,435.00
|
| 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 |
$26,264.70
|
| Rate for Payer: Cash Price |
$26,264.70
|
| Rate for Payer: Cash Price |
$26,264.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$37,937.90
|
| 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 |
$36,128.55
|
| 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 |
$10,564.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,527.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14,591.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,440.51
|
| Rate for Payer: Multiplan Commercial |
$43,774.50
|
| 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 SUBSTERN ICD LEAD REMOVE
|
Facility
|
IP
|
$58,366.00
|
|
|
Service Code
|
CPT 0573T
|
| Hospital Charge Code |
906810573
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$10,564.25 |
| Max. Negotiated Rate |
$43,774.50 |
| Rate for Payer: Adventist Health Commercial |
$11,673.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$37,587.70
|
| Rate for Payer: Cash Price |
$26,264.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$39,513.78
|
| Rate for Payer: Heritage Provider Network Senior |
$39,513.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10,564.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14,591.50
|
| Rate for Payer: Multiplan Commercial |
$43,774.50
|
|
|
HC SUBSTERN ICD LEAD REPOS
|
Facility
|
OP
|
$58,366.00
|
|
|
Service Code
|
CPT 0574T
|
| Hospital Charge Code |
906810574
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,806.35 |
| Max. Negotiated Rate |
$43,774.50 |
| Rate for Payer: Adventist Health Commercial |
$11,673.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$36,070.19
|
| 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 |
$26,264.70
|
| Rate for Payer: Cash Price |
$26,264.70
|
| Rate for Payer: Cash Price |
$26,264.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$37,937.90
|
| 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 |
$36,128.55
|
| 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 |
$10,564.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,527.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14,591.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,440.51
|
| Rate for Payer: Multiplan Commercial |
$43,774.50
|
| 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 SUBSTERN ICD LEAD REPOS
|
Facility
|
IP
|
$58,366.00
|
|
|
Service Code
|
CPT 0574T
|
| Hospital Charge Code |
906810574
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$10,564.25 |
| Max. Negotiated Rate |
$43,774.50 |
| Rate for Payer: Adventist Health Commercial |
$11,673.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$37,587.70
|
| Rate for Payer: Cash Price |
$26,264.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$39,513.78
|
| Rate for Payer: Heritage Provider Network Senior |
$39,513.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10,564.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14,591.50
|
| Rate for Payer: Multiplan Commercial |
$43,774.50
|
|
|
HC SUBSTERN ICD REMOVE
|
Facility
|
OP
|
$4,810.00
|
|
|
Service Code
|
CPT 0580T
|
| Hospital Charge Code |
906810580
|
|
Hospital Revenue Code
|
360
|
| 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 |
$8,435.00
|
| 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 SUBSTERN ICD REMOVE
|
Facility
|
IP
|
$4,810.00
|
|
|
Service Code
|
CPT 0580T
|
| Hospital Charge Code |
906810580
|
|
Hospital Revenue Code
|
360
|
| 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 SUBSTERN LEAD W/ICD INST/REPL
|
Facility
|
IP
|
$58,366.00
|
|
|
Service Code
|
CPT 0571T
|
| Hospital Charge Code |
906810571
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$10,564.25 |
| Max. Negotiated Rate |
$43,774.50 |
| Rate for Payer: Adventist Health Commercial |
$11,673.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$37,587.70
|
| Rate for Payer: Cash Price |
$26,264.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$39,513.78
|
| Rate for Payer: Heritage Provider Network Senior |
$39,513.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10,564.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14,591.50
|
| Rate for Payer: Multiplan Commercial |
$43,774.50
|
|
|
HC SUBSTERN LEAD W/ICD INST/REPL
|
Facility
|
OP
|
$58,366.00
|
|
|
Service Code
|
CPT 0571T
|
| Hospital Charge Code |
906810571
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$7,178.49 |
| Max. Negotiated Rate |
$76,705.51 |
| Rate for Payer: Adventist Health Commercial |
$11,673.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$36,070.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$60,556.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$44,408.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$40,371.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,136.00
|
| 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 |
$26,264.70
|
| Rate for Payer: Cash Price |
$26,264.70
|
| Rate for Payer: Cash Price |
$26,264.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$37,937.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$60,556.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$44,408.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$40,371.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$40,371.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$36,128.55
|
| Rate for Payer: Heritage Provider Network Senior |
$49,656.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$40,371.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$76,705.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10,564.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$46,427.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14,591.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$54,097.57
|
| Rate for Payer: Multiplan Commercial |
$43,774.50
|
| Rate for Payer: Multiplan WC |
$64,907.85
|
| Rate for Payer: TriValley Medical Group Commercial |
$44,408.45
|
| Rate for Payer: TriValley Medical Group Senior |
$44,408.45
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$66,017.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$55,527.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$60,556.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$44,408.45
|
| Rate for Payer: Vantage Medical Group Senior |
$40,371.32
|
|
|
HC SUDAN BLACK B
|
Facility
|
IP
|
$634.00
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
900910057
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$114.75 |
| Max. Negotiated Rate |
$475.50 |
| Rate for Payer: Adventist Health Commercial |
$126.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$408.30
|
| Rate for Payer: Cash Price |
$285.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$429.22
|
| Rate for Payer: Heritage Provider Network Senior |
$429.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$114.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$158.50
|
| Rate for Payer: Multiplan Commercial |
$475.50
|
|
|
HC SUDAN BLACK B
|
Facility
|
IP
|
$428.00
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
903800259
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$77.47 |
| Max. Negotiated Rate |
$321.00 |
| Rate for Payer: Adventist Health Commercial |
$85.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$275.63
|
| Rate for Payer: Cash Price |
$192.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$289.76
|
| Rate for Payer: Heritage Provider Network Senior |
$289.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$77.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.00
|
| Rate for Payer: Multiplan Commercial |
$321.00
|
|
|
HC SUDAN BLACK B
|
Facility
|
OP
|
$634.00
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
900910057
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$27.61 |
| Max. Negotiated Rate |
$475.50 |
| Rate for Payer: Cash Price |
$285.30
|
| Rate for Payer: Adventist Health Commercial |
$126.80
|
| Rate for Payer: Adventist Health Commercial |
$27.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$84.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$391.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.61
|
| Rate for Payer: Blue Shield of California Commercial |
$199.39
|
| Rate for Payer: Blue Shield of California Commercial |
$199.39
|
| Rate for Payer: Blue Shield of California EPN |
$160.34
|
| Rate for Payer: Blue Shield of California EPN |
$160.34
|
| Rate for Payer: Cash Price |
$285.30
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$88.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$412.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$256.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$256.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$412.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$88.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$171.12
|
| Rate for Payer: EPIC Health Plan Medicare |
$171.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$84.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$392.45
|
| Rate for Payer: Heritage Provider Network Senior |
$84.18
|
| Rate for Payer: Heritage Provider Network Senior |
$392.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$64.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$302.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$114.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$196.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$196.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$158.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$229.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$229.30
|
| Rate for Payer: Multiplan Commercial |
$102.00
|
| Rate for Payer: Multiplan Commercial |
$475.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$171.12
|
| Rate for Payer: TriValley Medical Group Commercial |
$171.12
|
| Rate for Payer: TriValley Medical Group Senior |
$171.12
|
| Rate for Payer: TriValley Medical Group Senior |
$171.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$37.33
|
| 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: United Healthcare Navigate/Select/Select+ |
$37.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Vantage Medical Group Senior |
$171.12
|
| Rate for Payer: Vantage Medical Group Senior |
$171.12
|
|
|
HC SUDAN BLACK B
|
Facility
|
OP
|
$428.00
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
903800259
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$27.61 |
| Max. Negotiated Rate |
$321.00 |
| Rate for Payer: Adventist Health Commercial |
$85.60
|
| Rate for Payer: Adventist Health Commercial |
$27.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$84.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$264.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.61
|
| Rate for Payer: Blue Shield of California Commercial |
$199.39
|
| Rate for Payer: Blue Shield of California Commercial |
$199.39
|
| Rate for Payer: Blue Shield of California EPN |
$160.34
|
| Rate for Payer: Blue Shield of California EPN |
$160.34
|
| Rate for Payer: Cash Price |
$192.60
|
| Rate for Payer: Cash Price |
$192.60
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$88.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$278.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$256.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$256.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$278.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$88.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$171.12
|
| Rate for Payer: EPIC Health Plan Medicare |
$171.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$84.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$264.93
|
| Rate for Payer: Heritage Provider Network Senior |
$84.18
|
| Rate for Payer: Heritage Provider Network Senior |
$264.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$64.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$204.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$77.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$196.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$196.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$229.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$229.30
|
| Rate for Payer: Multiplan Commercial |
$102.00
|
| Rate for Payer: Multiplan Commercial |
$321.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$171.12
|
| Rate for Payer: TriValley Medical Group Commercial |
$171.12
|
| Rate for Payer: TriValley Medical Group Senior |
$171.12
|
| Rate for Payer: TriValley Medical Group Senior |
$171.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$37.33
|
| 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: United Healthcare Navigate/Select/Select+ |
$37.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Vantage Medical Group Senior |
$171.12
|
| Rate for Payer: Vantage Medical Group Senior |
$171.12
|
|
|
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 Non-Gatekeeper |
$21,151.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29,091.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18,823.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25,668.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$13,758.45
|
| Rate for Payer: Blue Shield of California EPN |
$13,758.45
|
| 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 Medicare Advantage |
$29,091.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$21,904.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$15,846.17
|
| Rate for Payer: Heritage Provider Network Senior |
$15,846.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$17,112.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17,112.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17,112.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,556.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$23,957.50
|
| Rate for Payer: Multiplan Commercial |
$25,668.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12,365.49
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,331.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29,091.25
|
| 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 Non-Gatekeeper |
$22,040.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$13,758.45
|
| Rate for Payer: Blue Shield of California EPN |
$13,758.45
|
| 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 |
$15,846.17
|
| Rate for Payer: Heritage Provider Network Senior |
$15,846.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$17,112.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17,112.50
|
| Rate for Payer: Kaiser Foundation Hospitals 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 |
$12,365.49
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,331.90
|
|
|
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 Non-Gatekeeper |
$22,700.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31,222.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20,202.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27,549.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$14,766.47
|
| Rate for Payer: Blue Shield of California EPN |
$14,766.47
|
| Rate for Payer: Cash Price |
$16,529.62
|
| Rate for Payer: Cash Price |
$16,529.62
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$18,366.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18,366.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18,366.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,183.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$25,712.75
|
| Rate for Payer: Multiplan Commercial |
$27,549.38
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13,271.45
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12,162.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31,222.62
|
| 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 Non-Gatekeeper |
$23,655.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$14,766.47
|
| Rate for Payer: Blue Shield of California EPN |
$14,766.47
|
| Rate for Payer: Cash Price |
$16,529.62
|
| Rate for Payer: Cash Price |
$16,529.62
|
| 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 |
$17,007.15
|
| Rate for Payer: Heritage Provider Network Senior |
$17,007.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$18,366.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18,366.25
|
| Rate for Payer: Kaiser Foundation Hospitals 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 |
$13,271.45
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12,162.13
|
|
|
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 Non-Gatekeeper |
$21,151.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29,091.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18,823.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25,668.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$13,758.45
|
| Rate for Payer: Blue Shield of California EPN |
$13,758.45
|
| 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 Medicare Advantage |
$29,091.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$21,904.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$15,846.17
|
| Rate for Payer: Heritage Provider Network Senior |
$15,846.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$17,112.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17,112.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17,112.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,556.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$23,957.50
|
| Rate for Payer: Multiplan Commercial |
$25,668.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12,365.49
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,331.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29,091.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29,091.25
|
| Rate for Payer: Vantage Medical Group Senior |
$29,091.25
|
|
|
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 Non-Gatekeeper |
$22,040.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$13,758.45
|
| Rate for Payer: Blue Shield of California EPN |
$13,758.45
|
| 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 |
$15,846.17
|
| Rate for Payer: Heritage Provider Network Senior |
$15,846.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$17,112.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17,112.50
|
| Rate for Payer: Kaiser Foundation Hospitals 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 |
$12,365.49
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,331.90
|
|
|
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 Non-Gatekeeper |
$22,040.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$13,758.45
|
| Rate for Payer: Blue Shield of California EPN |
$13,758.45
|
| 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 |
$15,846.17
|
| Rate for Payer: Heritage Provider Network Senior |
$15,846.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$17,112.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17,112.50
|
| Rate for Payer: Kaiser Foundation Hospitals 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 |
$12,365.49
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,331.90
|
|
|
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 Non-Gatekeeper |
$21,151.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29,091.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18,823.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25,668.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$13,758.45
|
| Rate for Payer: Blue Shield of California EPN |
$13,758.45
|
| 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 Medicare Advantage |
$29,091.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$21,904.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$15,846.17
|
| Rate for Payer: Heritage Provider Network Senior |
$15,846.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$17,112.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17,112.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17,112.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,556.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$23,957.50
|
| Rate for Payer: Multiplan Commercial |
$25,668.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12,365.49
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,331.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29,091.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29,091.25
|
| Rate for Payer: Vantage Medical Group Senior |
$29,091.25
|
|
