|
HC LEAD BIOTRONIK SETROX S
|
Facility
|
IP
|
$2,300.00
|
|
|
Service Code
|
CPT C1898
|
| Hospital Charge Code |
906813720
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$460.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$460.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,265.00
|
| Rate for Payer: Cash Price |
$1,265.00
|
| Rate for Payer: Cigna of CA HMO |
$1,610.00
|
| Rate for Payer: Cigna of CA PPO |
$1,610.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$920.00
|
| Rate for Payer: EPIC Health Plan Senior |
$920.00
|
| Rate for Payer: Galaxy Health WC |
$1,955.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,380.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,534.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$876.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,423.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$552.00
|
| Rate for Payer: Multiplan Commercial |
$1,840.00
|
| Rate for Payer: Networks By Design Commercial |
$1,150.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,955.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$863.19
|
| Rate for Payer: United Healthcare All Other HMO |
$840.19
|
| Rate for Payer: United Healthcare HMO Rider |
$822.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$753.25
|
|
|
HC LEAD BIOTRONIK SETROX S
|
Facility
|
OP
|
$2,300.00
|
|
|
Service Code
|
CPT C1898
|
| Hospital Charge Code |
906813720
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$460.00 |
| Max. Negotiated Rate |
$1,955.00 |
| Rate for Payer: Adventist Health Commercial |
$460.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,955.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,265.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,725.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,412.43
|
| Rate for Payer: Blue Shield of California Commercial |
$1,697.40
|
| Rate for Payer: Blue Shield of California EPN |
$1,117.80
|
| Rate for Payer: Cash Price |
$1,265.00
|
| Rate for Payer: Cigna of CA HMO |
$1,610.00
|
| Rate for Payer: Cigna of CA PPO |
$1,610.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,955.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,955.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,955.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$920.00
|
| Rate for Payer: EPIC Health Plan Senior |
$920.00
|
| Rate for Payer: Galaxy Health WC |
$1,955.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,380.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,534.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$876.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,423.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$552.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,610.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,610.00
|
| Rate for Payer: Multiplan Commercial |
$1,840.00
|
| Rate for Payer: Networks By Design Commercial |
$1,150.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,955.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,380.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,380.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$863.19
|
| Rate for Payer: United Healthcare All Other HMO |
$840.19
|
| Rate for Payer: United Healthcare HMO Rider |
$822.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$753.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,955.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,955.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,955.00
|
|
|
HC LEAD BIOTRONIK SOLIA S
|
Facility
|
IP
|
$2,300.00
|
|
|
Service Code
|
CPT C1898
|
| Hospital Charge Code |
906813786
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$460.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$460.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,265.00
|
| Rate for Payer: Cash Price |
$1,265.00
|
| Rate for Payer: Cigna of CA HMO |
$1,610.00
|
| Rate for Payer: Cigna of CA PPO |
$1,610.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$920.00
|
| Rate for Payer: EPIC Health Plan Senior |
$920.00
|
| Rate for Payer: Galaxy Health WC |
$1,955.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,380.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,534.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$876.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,423.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$552.00
|
| Rate for Payer: Multiplan Commercial |
$1,840.00
|
| Rate for Payer: Networks By Design Commercial |
$1,150.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,955.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$863.19
|
| Rate for Payer: United Healthcare All Other HMO |
$840.19
|
| Rate for Payer: United Healthcare HMO Rider |
$822.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$753.25
|
|
|
HC LEAD BIOTRONIK SOLIA S
|
Facility
|
OP
|
$2,300.00
|
|
|
Service Code
|
CPT C1898
|
| Hospital Charge Code |
906813786
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$460.00 |
| Max. Negotiated Rate |
$1,955.00 |
| Rate for Payer: Adventist Health Commercial |
$460.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,955.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,265.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,725.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,412.43
|
| Rate for Payer: Blue Shield of California Commercial |
$1,697.40
|
| Rate for Payer: Blue Shield of California EPN |
$1,117.80
|
| Rate for Payer: Cash Price |
$1,265.00
|
| Rate for Payer: Cigna of CA HMO |
$1,610.00
|
| Rate for Payer: Cigna of CA PPO |
$1,610.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,955.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,955.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,955.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$920.00
|
| Rate for Payer: EPIC Health Plan Senior |
$920.00
|
| Rate for Payer: Galaxy Health WC |
$1,955.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,380.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,534.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$876.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,423.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$552.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,610.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,610.00
|
| Rate for Payer: Multiplan Commercial |
$1,840.00
|
| Rate for Payer: Networks By Design Commercial |
$1,150.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,955.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,380.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,380.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$863.19
|
| Rate for Payer: United Healthcare All Other HMO |
$840.19
|
| Rate for Payer: United Healthcare HMO Rider |
$822.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$753.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,955.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,955.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,955.00
|
|
|
HC LEAD B/S ACUITY 4554
|
Facility
|
IP
|
$6,725.00
|
|
|
Service Code
|
CPT C1900
|
| Hospital Charge Code |
906813591
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,345.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,345.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$3,698.75
|
| Rate for Payer: Cash Price |
$3,698.75
|
| Rate for Payer: Cigna of CA HMO |
$4,707.50
|
| Rate for Payer: Cigna of CA PPO |
$4,707.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,690.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,690.00
|
| Rate for Payer: Galaxy Health WC |
$5,716.25
|
| Rate for Payer: Global Benefits Group Commercial |
$4,035.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,485.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,562.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,162.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,614.00
|
| Rate for Payer: Multiplan Commercial |
$5,380.00
|
| Rate for Payer: Networks By Design Commercial |
$3,362.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,716.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,523.89
|
| Rate for Payer: United Healthcare All Other HMO |
$2,456.64
|
| Rate for Payer: United Healthcare HMO Rider |
$2,403.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,202.44
|
|
|
HC LEAD B/S ACUITY 4554
|
Facility
|
OP
|
$6,725.00
|
|
|
Service Code
|
CPT C1900
|
| Hospital Charge Code |
906813591
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,345.00 |
| Max. Negotiated Rate |
$5,716.25 |
| Rate for Payer: Adventist Health Commercial |
$1,345.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,716.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,698.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,043.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,895.12
|
| Rate for Payer: Blue Shield of California Commercial |
$4,963.05
|
| Rate for Payer: Blue Shield of California EPN |
$3,268.35
|
| Rate for Payer: Cash Price |
$3,698.75
|
| Rate for Payer: Cigna of CA HMO |
$4,707.50
|
| Rate for Payer: Cigna of CA PPO |
$4,707.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,716.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,716.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,716.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,690.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,690.00
|
| Rate for Payer: Galaxy Health WC |
$5,716.25
|
| Rate for Payer: Global Benefits Group Commercial |
$4,035.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,485.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,562.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,162.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,614.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,707.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,707.50
|
| Rate for Payer: Multiplan Commercial |
$5,380.00
|
| Rate for Payer: Networks By Design Commercial |
$3,362.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,716.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,035.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,035.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,523.89
|
| Rate for Payer: United Healthcare All Other HMO |
$2,456.64
|
| Rate for Payer: United Healthcare HMO Rider |
$2,403.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,202.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,716.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,716.25
|
| Rate for Payer: Vantage Medical Group Senior |
$5,716.25
|
|
|
HC LEAD B/S ACUITY 4555
|
Facility
|
OP
|
$6,725.00
|
|
|
Service Code
|
CPT C1900
|
| Hospital Charge Code |
906813628
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,345.00 |
| Max. Negotiated Rate |
$5,716.25 |
| Rate for Payer: Adventist Health Commercial |
$1,345.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,716.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,698.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,043.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,129.82
|
| Rate for Payer: Blue Shield of California Commercial |
$4,963.05
|
| Rate for Payer: Blue Shield of California EPN |
$3,268.35
|
| Rate for Payer: Cash Price |
$3,698.75
|
| Rate for Payer: Cigna of CA HMO |
$4,707.50
|
| Rate for Payer: Cigna of CA PPO |
$4,707.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,716.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,716.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,716.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,690.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,690.00
|
| Rate for Payer: Galaxy Health WC |
$5,716.25
|
| Rate for Payer: Global Benefits Group Commercial |
$4,035.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,485.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,562.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,162.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,614.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,707.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,707.50
|
| Rate for Payer: Multiplan Commercial |
$5,380.00
|
| Rate for Payer: Networks By Design Commercial |
$3,362.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,716.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,035.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,035.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,523.89
|
| Rate for Payer: United Healthcare All Other HMO |
$2,456.64
|
| Rate for Payer: United Healthcare HMO Rider |
$2,403.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,202.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,716.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,716.25
|
| Rate for Payer: Vantage Medical Group Senior |
$5,716.25
|
|
|
HC LEAD B/S ACUITY 4555
|
Facility
|
IP
|
$6,725.00
|
|
|
Service Code
|
CPT C1900
|
| Hospital Charge Code |
906813628
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,345.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,345.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$3,698.75
|
| Rate for Payer: Cash Price |
$3,698.75
|
| Rate for Payer: Cigna of CA HMO |
$4,707.50
|
| Rate for Payer: Cigna of CA PPO |
$4,707.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,690.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,690.00
|
| Rate for Payer: Galaxy Health WC |
$5,716.25
|
| Rate for Payer: Global Benefits Group Commercial |
$4,035.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,485.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,562.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,162.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,614.00
|
| Rate for Payer: Multiplan Commercial |
$5,380.00
|
| Rate for Payer: Networks By Design Commercial |
$3,362.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,716.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,523.89
|
| Rate for Payer: United Healthcare All Other HMO |
$2,456.64
|
| Rate for Payer: United Healthcare HMO Rider |
$2,403.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,202.44
|
|
|
HC LEAD B/S ACUITY 4674
|
Facility
|
OP
|
$7,250.00
|
|
|
Service Code
|
CPT C1900
|
| Hospital Charge Code |
906813803
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,450.00 |
| Max. Negotiated Rate |
$6,162.50 |
| Rate for Payer: Adventist Health Commercial |
$1,450.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,162.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,987.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,437.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,199.20
|
| Rate for Payer: Blue Shield of California Commercial |
$5,350.50
|
| Rate for Payer: Blue Shield of California EPN |
$3,523.50
|
| Rate for Payer: Cash Price |
$3,987.50
|
| Rate for Payer: Cigna of CA HMO |
$5,075.00
|
| Rate for Payer: Cigna of CA PPO |
$5,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,162.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,162.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,162.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,900.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,900.00
|
| Rate for Payer: Galaxy Health WC |
$6,162.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,350.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,835.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,762.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,487.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,740.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,075.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,075.00
|
| Rate for Payer: Multiplan Commercial |
$5,800.00
|
| Rate for Payer: Networks By Design Commercial |
$3,625.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,162.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,350.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,350.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,720.93
|
| Rate for Payer: United Healthcare All Other HMO |
$2,648.43
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,162.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,162.50
|
| Rate for Payer: Vantage Medical Group Senior |
$6,162.50
|
|
|
HC LEAD B/S ACUITY 4674
|
Facility
|
IP
|
$7,250.00
|
|
|
Service Code
|
CPT C1900
|
| Hospital Charge Code |
906813803
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,450.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,450.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$3,987.50
|
| Rate for Payer: Cash Price |
$3,987.50
|
| Rate for Payer: Cigna of CA HMO |
$5,075.00
|
| Rate for Payer: Cigna of CA PPO |
$5,075.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,900.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,900.00
|
| Rate for Payer: Galaxy Health WC |
$6,162.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,350.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,835.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,762.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,487.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,740.00
|
| Rate for Payer: Multiplan Commercial |
$5,800.00
|
| Rate for Payer: Networks By Design Commercial |
$3,625.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,162.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,720.93
|
| Rate for Payer: United Healthcare All Other HMO |
$2,648.43
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.38
|
|
|
HC LEAD B/S ACUITY SPIRAL 4592
|
Facility
|
IP
|
$21,735.00
|
|
|
Service Code
|
CPT C1900
|
| Hospital Charge Code |
906813609
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,347.00 |
| Max. Negotiated Rate |
$18,474.75 |
| Rate for Payer: Adventist Health Commercial |
$4,347.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$11,954.25
|
| Rate for Payer: Cash Price |
$11,954.25
|
| Rate for Payer: Cigna of CA HMO |
$15,214.50
|
| Rate for Payer: Cigna of CA PPO |
$15,214.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,694.00
|
| Rate for Payer: EPIC Health Plan Senior |
$8,694.00
|
| Rate for Payer: Galaxy Health WC |
$18,474.75
|
| Rate for Payer: Global Benefits Group Commercial |
$13,041.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,497.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,281.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,453.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,216.40
|
| Rate for Payer: Multiplan Commercial |
$17,388.00
|
| Rate for Payer: Networks By Design Commercial |
$10,867.50
|
| Rate for Payer: Prime Health Services Commercial |
$18,474.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,157.15
|
| Rate for Payer: United Healthcare All Other HMO |
$7,939.80
|
| Rate for Payer: United Healthcare HMO Rider |
$7,768.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,118.21
|
|
|
HC LEAD B/S ACUITY SPIRAL 4592
|
Facility
|
OP
|
$21,735.00
|
|
|
Service Code
|
CPT C1900
|
| Hospital Charge Code |
906813609
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,347.00 |
| Max. Negotiated Rate |
$18,474.75 |
| Rate for Payer: Adventist Health Commercial |
$4,347.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18,474.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11,954.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16,301.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,588.91
|
| Rate for Payer: Blue Shield of California Commercial |
$16,040.43
|
| Rate for Payer: Blue Shield of California EPN |
$10,563.21
|
| Rate for Payer: Cash Price |
$11,954.25
|
| Rate for Payer: Cigna of CA HMO |
$15,214.50
|
| Rate for Payer: Cigna of CA PPO |
$15,214.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18,474.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$18,474.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18,474.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,694.00
|
| Rate for Payer: EPIC Health Plan Senior |
$8,694.00
|
| Rate for Payer: Galaxy Health WC |
$18,474.75
|
| Rate for Payer: Global Benefits Group Commercial |
$13,041.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,497.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,281.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,453.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,216.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15,214.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15,214.50
|
| Rate for Payer: Multiplan Commercial |
$17,388.00
|
| Rate for Payer: Networks By Design Commercial |
$10,867.50
|
| Rate for Payer: Prime Health Services Commercial |
$18,474.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13,041.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13,041.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,157.15
|
| Rate for Payer: United Healthcare All Other HMO |
$7,939.80
|
| Rate for Payer: United Healthcare HMO Rider |
$7,768.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,118.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18,474.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18,474.75
|
| Rate for Payer: Vantage Medical Group Senior |
$18,474.75
|
|
|
HC LEAD B/S ACUITY X4 SPIRAL 4677
|
Facility
|
OP
|
$7,250.00
|
|
|
Service Code
|
CPT C1900
|
| Hospital Charge Code |
906813763
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,450.00 |
| Max. Negotiated Rate |
$6,162.50 |
| Rate for Payer: Adventist Health Commercial |
$1,450.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,162.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,987.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,437.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,452.23
|
| Rate for Payer: Blue Shield of California Commercial |
$5,350.50
|
| Rate for Payer: Blue Shield of California EPN |
$3,523.50
|
| Rate for Payer: Cash Price |
$3,987.50
|
| Rate for Payer: Cigna of CA HMO |
$5,075.00
|
| Rate for Payer: Cigna of CA PPO |
$5,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,162.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,162.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,162.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,900.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,900.00
|
| Rate for Payer: Galaxy Health WC |
$6,162.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,350.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,835.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,762.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,487.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,740.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,075.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,075.00
|
| Rate for Payer: Multiplan Commercial |
$5,800.00
|
| Rate for Payer: Networks By Design Commercial |
$3,625.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,162.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,350.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,350.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,720.93
|
| Rate for Payer: United Healthcare All Other HMO |
$2,648.43
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,162.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,162.50
|
| Rate for Payer: Vantage Medical Group Senior |
$6,162.50
|
|
|
HC LEAD B/S ACUITY X4 SPIRAL 4677
|
Facility
|
IP
|
$7,250.00
|
|
|
Service Code
|
CPT C1900
|
| Hospital Charge Code |
906813763
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,450.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,450.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$3,987.50
|
| Rate for Payer: Cash Price |
$3,987.50
|
| Rate for Payer: Cigna of CA HMO |
$5,075.00
|
| Rate for Payer: Cigna of CA PPO |
$5,075.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,900.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,900.00
|
| Rate for Payer: Galaxy Health WC |
$6,162.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,350.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,835.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,762.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,487.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,740.00
|
| Rate for Payer: Multiplan Commercial |
$5,800.00
|
| Rate for Payer: Networks By Design Commercial |
$3,625.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,162.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,720.93
|
| Rate for Payer: United Healthcare All Other HMO |
$2,648.43
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.38
|
|
|
HC LEAD B/S DEXTRUS 4135
|
Facility
|
OP
|
$2,300.00
|
|
|
Service Code
|
CPT C1898
|
| Hospital Charge Code |
906813630
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$460.00 |
| Max. Negotiated Rate |
$1,955.00 |
| Rate for Payer: Adventist Health Commercial |
$460.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,955.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,265.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,725.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,412.43
|
| Rate for Payer: Blue Shield of California Commercial |
$1,697.40
|
| Rate for Payer: Blue Shield of California EPN |
$1,117.80
|
| Rate for Payer: Cash Price |
$1,265.00
|
| Rate for Payer: Cigna of CA HMO |
$1,610.00
|
| Rate for Payer: Cigna of CA PPO |
$1,610.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,955.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,955.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,955.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$920.00
|
| Rate for Payer: EPIC Health Plan Senior |
$920.00
|
| Rate for Payer: Galaxy Health WC |
$1,955.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,380.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,534.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$876.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,423.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$552.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,610.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,610.00
|
| Rate for Payer: Multiplan Commercial |
$1,840.00
|
| Rate for Payer: Networks By Design Commercial |
$1,150.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,955.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,380.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,380.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$863.19
|
| Rate for Payer: United Healthcare All Other HMO |
$840.19
|
| Rate for Payer: United Healthcare HMO Rider |
$822.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$753.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,955.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,955.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,955.00
|
|
|
HC LEAD B/S DEXTRUS 4135
|
Facility
|
IP
|
$2,300.00
|
|
|
Service Code
|
CPT C1898
|
| Hospital Charge Code |
906813630
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$460.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$460.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,265.00
|
| Rate for Payer: Cash Price |
$1,265.00
|
| Rate for Payer: Cigna of CA HMO |
$1,610.00
|
| Rate for Payer: Cigna of CA PPO |
$1,610.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$920.00
|
| Rate for Payer: EPIC Health Plan Senior |
$920.00
|
| Rate for Payer: Galaxy Health WC |
$1,955.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,380.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,534.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$876.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,423.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$552.00
|
| Rate for Payer: Multiplan Commercial |
$1,840.00
|
| Rate for Payer: Networks By Design Commercial |
$1,150.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,955.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$863.19
|
| Rate for Payer: United Healthcare All Other HMO |
$840.19
|
| Rate for Payer: United Healthcare HMO Rider |
$822.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$753.25
|
|
|
HC LEAD B/S DEXTRUS 4136
|
Facility
|
IP
|
$2,300.00
|
|
|
Service Code
|
CPT C1898
|
| Hospital Charge Code |
906813627
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$460.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$460.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,265.00
|
| Rate for Payer: Cash Price |
$1,265.00
|
| Rate for Payer: Cigna of CA HMO |
$1,610.00
|
| Rate for Payer: Cigna of CA PPO |
$1,610.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$920.00
|
| Rate for Payer: EPIC Health Plan Senior |
$920.00
|
| Rate for Payer: Galaxy Health WC |
$1,955.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,380.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,534.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$876.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,423.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$552.00
|
| Rate for Payer: Multiplan Commercial |
$1,840.00
|
| Rate for Payer: Networks By Design Commercial |
$1,150.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,955.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$863.19
|
| Rate for Payer: United Healthcare All Other HMO |
$840.19
|
| Rate for Payer: United Healthcare HMO Rider |
$822.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$753.25
|
|
|
HC LEAD B/S DEXTRUS 4136
|
Facility
|
OP
|
$2,300.00
|
|
|
Service Code
|
CPT C1898
|
| Hospital Charge Code |
906813627
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$460.00 |
| Max. Negotiated Rate |
$1,955.00 |
| Rate for Payer: Adventist Health Commercial |
$460.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,955.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,265.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,725.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,412.43
|
| Rate for Payer: Blue Shield of California Commercial |
$1,697.40
|
| Rate for Payer: Blue Shield of California EPN |
$1,117.80
|
| Rate for Payer: Cash Price |
$1,265.00
|
| Rate for Payer: Cigna of CA HMO |
$1,610.00
|
| Rate for Payer: Cigna of CA PPO |
$1,610.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,955.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,955.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,955.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$920.00
|
| Rate for Payer: EPIC Health Plan Senior |
$920.00
|
| Rate for Payer: Galaxy Health WC |
$1,955.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,380.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,534.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$876.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,423.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$552.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,610.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,610.00
|
| Rate for Payer: Multiplan Commercial |
$1,840.00
|
| Rate for Payer: Networks By Design Commercial |
$1,150.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,955.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,380.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,380.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$863.19
|
| Rate for Payer: United Healthcare All Other HMO |
$840.19
|
| Rate for Payer: United Healthcare HMO Rider |
$822.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$753.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,955.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,955.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,955.00
|
|
|
HC LEAD B/S DEXTRUS 4137
|
Facility
|
OP
|
$2,300.00
|
|
|
Service Code
|
CPT C1898
|
| Hospital Charge Code |
906813593
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$460.00 |
| Max. Negotiated Rate |
$1,955.00 |
| Rate for Payer: Adventist Health Commercial |
$460.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,955.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,265.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,725.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,412.43
|
| Rate for Payer: Blue Shield of California Commercial |
$1,697.40
|
| Rate for Payer: Blue Shield of California EPN |
$1,117.80
|
| Rate for Payer: Cash Price |
$1,265.00
|
| Rate for Payer: Cigna of CA HMO |
$1,610.00
|
| Rate for Payer: Cigna of CA PPO |
$1,610.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,955.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,955.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,955.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$920.00
|
| Rate for Payer: EPIC Health Plan Senior |
$920.00
|
| Rate for Payer: Galaxy Health WC |
$1,955.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,380.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,534.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$876.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,423.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$552.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,610.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,610.00
|
| Rate for Payer: Multiplan Commercial |
$1,840.00
|
| Rate for Payer: Networks By Design Commercial |
$1,150.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,955.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,380.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,380.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$863.19
|
| Rate for Payer: United Healthcare All Other HMO |
$840.19
|
| Rate for Payer: United Healthcare HMO Rider |
$822.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$753.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,955.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,955.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,955.00
|
|
|
HC LEAD B/S DEXTRUS 4137
|
Facility
|
IP
|
$2,300.00
|
|
|
Service Code
|
CPT C1898
|
| Hospital Charge Code |
906813593
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$460.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$460.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,265.00
|
| Rate for Payer: Cash Price |
$1,265.00
|
| Rate for Payer: Cigna of CA HMO |
$1,610.00
|
| Rate for Payer: Cigna of CA PPO |
$1,610.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$920.00
|
| Rate for Payer: EPIC Health Plan Senior |
$920.00
|
| Rate for Payer: Galaxy Health WC |
$1,955.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,380.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,534.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$876.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,423.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$552.00
|
| Rate for Payer: Multiplan Commercial |
$1,840.00
|
| Rate for Payer: Networks By Design Commercial |
$1,150.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,955.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$863.19
|
| Rate for Payer: United Healthcare All Other HMO |
$840.19
|
| Rate for Payer: United Healthcare HMO Rider |
$822.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$753.25
|
|
|
HC LEAD B/S EASYTRAK 2 4542
|
Facility
|
OP
|
$5,775.00
|
|
|
Service Code
|
CPT C1900
|
| Hospital Charge Code |
906813639
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,155.00 |
| Max. Negotiated Rate |
$4,908.75 |
| Rate for Payer: Adventist Health Commercial |
$1,155.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,908.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,176.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,331.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,344.88
|
| Rate for Payer: Blue Shield of California Commercial |
$4,261.95
|
| Rate for Payer: Blue Shield of California EPN |
$2,806.65
|
| Rate for Payer: Cash Price |
$3,176.25
|
| Rate for Payer: Cigna of CA HMO |
$4,042.50
|
| Rate for Payer: Cigna of CA PPO |
$4,042.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,908.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,908.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,908.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,310.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,310.00
|
| Rate for Payer: Galaxy Health WC |
$4,908.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,465.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,851.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,200.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,574.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,386.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,042.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,042.50
|
| Rate for Payer: Multiplan Commercial |
$4,620.00
|
| Rate for Payer: Networks By Design Commercial |
$2,887.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,908.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,465.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,465.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,167.36
|
| Rate for Payer: United Healthcare All Other HMO |
$2,109.61
|
| Rate for Payer: United Healthcare HMO Rider |
$2,063.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,891.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,908.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,908.75
|
| Rate for Payer: Vantage Medical Group Senior |
$4,908.75
|
|
|
HC LEAD B/S EASYTRAK 2 4542
|
Facility
|
IP
|
$5,775.00
|
|
|
Service Code
|
CPT C1900
|
| Hospital Charge Code |
906813639
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,155.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,155.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$3,176.25
|
| Rate for Payer: Cash Price |
$3,176.25
|
| Rate for Payer: Cigna of CA HMO |
$4,042.50
|
| Rate for Payer: Cigna of CA PPO |
$4,042.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,310.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,310.00
|
| Rate for Payer: Galaxy Health WC |
$4,908.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,465.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,851.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,200.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,574.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,386.00
|
| Rate for Payer: Multiplan Commercial |
$4,620.00
|
| Rate for Payer: Networks By Design Commercial |
$2,887.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,908.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,167.36
|
| Rate for Payer: United Healthcare All Other HMO |
$2,109.61
|
| Rate for Payer: United Healthcare HMO Rider |
$2,063.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,891.31
|
|
|
HC LEAD B/S EASYTRAK 4543
|
Facility
|
IP
|
$5,775.00
|
|
|
Service Code
|
CPT C1900
|
| Hospital Charge Code |
906813562
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,155.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,155.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$3,176.25
|
| Rate for Payer: Cash Price |
$3,176.25
|
| Rate for Payer: Cigna of CA HMO |
$4,042.50
|
| Rate for Payer: Cigna of CA PPO |
$4,042.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,310.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,310.00
|
| Rate for Payer: Galaxy Health WC |
$4,908.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,465.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,851.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,200.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,574.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,386.00
|
| Rate for Payer: Multiplan Commercial |
$4,620.00
|
| Rate for Payer: Networks By Design Commercial |
$2,887.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,908.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,167.36
|
| Rate for Payer: United Healthcare All Other HMO |
$2,109.61
|
| Rate for Payer: United Healthcare HMO Rider |
$2,063.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,891.31
|
|
|
HC LEAD B/S EASYTRAK 4543
|
Facility
|
OP
|
$5,775.00
|
|
|
Service Code
|
CPT C1900
|
| Hospital Charge Code |
906813562
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,155.00 |
| Max. Negotiated Rate |
$4,908.75 |
| Rate for Payer: Adventist Health Commercial |
$1,155.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,908.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,176.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,331.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,546.43
|
| Rate for Payer: Blue Shield of California Commercial |
$4,261.95
|
| Rate for Payer: Blue Shield of California EPN |
$2,806.65
|
| Rate for Payer: Cash Price |
$3,176.25
|
| Rate for Payer: Cigna of CA HMO |
$4,042.50
|
| Rate for Payer: Cigna of CA PPO |
$4,042.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,908.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,908.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,908.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,310.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,310.00
|
| Rate for Payer: Galaxy Health WC |
$4,908.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,465.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,851.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,200.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,574.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,386.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,042.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,042.50
|
| Rate for Payer: Multiplan Commercial |
$4,620.00
|
| Rate for Payer: Networks By Design Commercial |
$2,887.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,908.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,465.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,465.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,167.36
|
| Rate for Payer: United Healthcare All Other HMO |
$2,109.61
|
| Rate for Payer: United Healthcare HMO Rider |
$2,063.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,891.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,908.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,908.75
|
| Rate for Payer: Vantage Medical Group Senior |
$4,908.75
|
|
|
HC LEAD B/S EASYTRAK 4549
|
Facility
|
IP
|
$5,775.00
|
|
|
Service Code
|
CPT C1900
|
| Hospital Charge Code |
906813563
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,155.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,155.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$3,176.25
|
| Rate for Payer: Cash Price |
$3,176.25
|
| Rate for Payer: Cigna of CA HMO |
$4,042.50
|
| Rate for Payer: Cigna of CA PPO |
$4,042.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,310.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,310.00
|
| Rate for Payer: Galaxy Health WC |
$4,908.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,465.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,851.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,200.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,574.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,386.00
|
| Rate for Payer: Multiplan Commercial |
$4,620.00
|
| Rate for Payer: Networks By Design Commercial |
$2,887.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,908.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,167.36
|
| Rate for Payer: United Healthcare All Other HMO |
$2,109.61
|
| Rate for Payer: United Healthcare HMO Rider |
$2,063.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,891.31
|
|
