|
HC LEAD B/S EASYTRAK 4549
|
Facility
|
OP
|
$5,775.00
|
|
|
Service Code
|
CPT C1900
|
| Hospital Charge Code |
906813563
|
|
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 EMBLEM 3401
|
Facility
|
OP
|
$12,500.00
|
|
|
Service Code
|
CPT C1896
|
| Hospital Charge Code |
906813756
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,500.00 |
| Max. Negotiated Rate |
$10,625.00 |
| Rate for Payer: Adventist Health Commercial |
$2,500.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,625.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,875.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,375.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,676.25
|
| Rate for Payer: Blue Shield of California Commercial |
$9,225.00
|
| Rate for Payer: Blue Shield of California EPN |
$6,075.00
|
| Rate for Payer: Cash Price |
$6,875.00
|
| Rate for Payer: Cigna of CA HMO |
$8,750.00
|
| Rate for Payer: Cigna of CA PPO |
$8,750.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,625.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,625.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,625.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,000.00
|
| Rate for Payer: Galaxy Health WC |
$10,625.00
|
| Rate for Payer: Global Benefits Group Commercial |
$7,500.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,337.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,737.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,000.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,750.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,750.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Networks By Design Commercial |
$6,250.00
|
| Rate for Payer: Prime Health Services Commercial |
$10,625.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,500.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,500.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,691.25
|
| Rate for Payer: United Healthcare All Other HMO |
$4,566.25
|
| Rate for Payer: United Healthcare HMO Rider |
$4,467.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,093.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,625.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,625.00
|
| Rate for Payer: Vantage Medical Group Senior |
$10,625.00
|
|
|
HC LEAD B/S EMBLEM 3401
|
Facility
|
IP
|
$12,500.00
|
|
|
Service Code
|
CPT C1896
|
| Hospital Charge Code |
906813756
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,500.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$2,500.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$6,875.00
|
| Rate for Payer: Cash Price |
$6,875.00
|
| Rate for Payer: Cigna of CA HMO |
$8,750.00
|
| Rate for Payer: Cigna of CA PPO |
$8,750.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,000.00
|
| Rate for Payer: Galaxy Health WC |
$10,625.00
|
| Rate for Payer: Global Benefits Group Commercial |
$7,500.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,337.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,762.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,737.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Networks By Design Commercial |
$6,250.00
|
| Rate for Payer: Prime Health Services Commercial |
$10,625.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,691.25
|
| Rate for Payer: United Healthcare All Other HMO |
$4,566.25
|
| Rate for Payer: United Healthcare HMO Rider |
$4,467.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,093.75
|
|
|
HC LEAD B/S ENDOTAK XP SQ 0085
|
Facility
|
OP
|
$6,250.00
|
|
|
Service Code
|
CPT C1896
|
| Hospital Charge Code |
906813601
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,250.00 |
| Max. Negotiated Rate |
$5,312.50 |
| Rate for Payer: Adventist Health Commercial |
$1,250.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,312.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,437.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,687.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,620.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,612.50
|
| Rate for Payer: Blue Shield of California EPN |
$3,037.50
|
| Rate for Payer: Cash Price |
$3,437.50
|
| Rate for Payer: Cigna of CA HMO |
$4,375.00
|
| Rate for Payer: Cigna of CA PPO |
$4,375.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,312.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,312.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,312.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,500.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,500.00
|
| Rate for Payer: Galaxy Health WC |
$5,312.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,750.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,168.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,868.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,500.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,375.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,375.00
|
| Rate for Payer: Multiplan Commercial |
$5,000.00
|
| Rate for Payer: Networks By Design Commercial |
$3,125.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,312.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,750.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,750.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,345.62
|
| Rate for Payer: United Healthcare All Other HMO |
$2,283.12
|
| Rate for Payer: United Healthcare HMO Rider |
$2,233.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,046.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,312.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,312.50
|
| Rate for Payer: Vantage Medical Group Senior |
$5,312.50
|
|
|
HC LEAD B/S ENDOTAK XP SQ 0085
|
Facility
|
IP
|
$6,250.00
|
|
|
Service Code
|
CPT C1896
|
| Hospital Charge Code |
906813601
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,250.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,250.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$3,437.50
|
| Rate for Payer: Cash Price |
$3,437.50
|
| Rate for Payer: Cigna of CA HMO |
$4,375.00
|
| Rate for Payer: Cigna of CA PPO |
$4,375.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,500.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,500.00
|
| Rate for Payer: Galaxy Health WC |
$5,312.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,750.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,168.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,381.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,868.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,500.00
|
| Rate for Payer: Multiplan Commercial |
$5,000.00
|
| Rate for Payer: Networks By Design Commercial |
$3,125.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,312.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,345.62
|
| Rate for Payer: United Healthcare All Other HMO |
$2,283.12
|
| Rate for Payer: United Healthcare HMO Rider |
$2,233.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,046.88
|
|
|
HC LEAD B/S INGEVITY 7735
|
Facility
|
IP
|
$2,300.00
|
|
|
Service Code
|
CPT C1898
|
| Hospital Charge Code |
906813829
|
|
Hospital Revenue Code
|
278
|
| 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 INGEVITY 7735
|
Facility
|
OP
|
$2,300.00
|
|
|
Service Code
|
CPT C1898
|
| Hospital Charge Code |
906813829
|
|
Hospital Revenue Code
|
278
|
| 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 |
$1,332.16
|
| 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 INGEVITY 7742
|
Facility
|
IP
|
$2,300.00
|
|
|
Service Code
|
CPT C1898
|
| Hospital Charge Code |
906813777
|
|
Hospital Revenue Code
|
278
|
| 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 INGEVITY 7742
|
Facility
|
OP
|
$2,300.00
|
|
|
Service Code
|
CPT C1898
|
| Hospital Charge Code |
906813777
|
|
Hospital Revenue Code
|
278
|
| 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 |
$1,332.16
|
| 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 OPTISURE 210Q
|
Facility
|
OP
|
$7,363.00
|
|
|
Service Code
|
CPT C1777
|
| Hospital Charge Code |
906813808
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,472.60 |
| Max. Negotiated Rate |
$6,258.55 |
| Rate for Payer: Adventist Health Commercial |
$1,472.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,258.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,049.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,522.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,264.65
|
| Rate for Payer: Blue Shield of California Commercial |
$5,433.89
|
| Rate for Payer: Blue Shield of California EPN |
$3,578.42
|
| Rate for Payer: Cash Price |
$4,049.65
|
| Rate for Payer: Cigna of CA HMO |
$5,154.10
|
| Rate for Payer: Cigna of CA PPO |
$5,154.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,258.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,258.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,258.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,945.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,945.20
|
| Rate for Payer: Galaxy Health WC |
$6,258.55
|
| Rate for Payer: Global Benefits Group Commercial |
$4,417.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,911.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,557.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,767.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,154.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,154.10
|
| Rate for Payer: Multiplan Commercial |
$5,890.40
|
| Rate for Payer: Networks By Design Commercial |
$3,681.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,258.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,417.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,417.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,763.33
|
| Rate for Payer: United Healthcare All Other HMO |
$2,689.70
|
| Rate for Payer: United Healthcare HMO Rider |
$2,631.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,411.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,258.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,258.55
|
| Rate for Payer: Vantage Medical Group Senior |
$6,258.55
|
|
|
HC LEAD B/S OPTISURE 210Q
|
Facility
|
IP
|
$7,363.00
|
|
|
Service Code
|
CPT C1777
|
| Hospital Charge Code |
906813808
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,472.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,472.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$4,049.65
|
| Rate for Payer: Cash Price |
$4,049.65
|
| Rate for Payer: Cigna of CA HMO |
$5,154.10
|
| Rate for Payer: Cigna of CA PPO |
$5,154.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,945.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,945.20
|
| Rate for Payer: Galaxy Health WC |
$6,258.55
|
| Rate for Payer: Global Benefits Group Commercial |
$4,417.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,911.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,805.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,557.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,767.12
|
| Rate for Payer: Multiplan Commercial |
$5,890.40
|
| Rate for Payer: Networks By Design Commercial |
$3,681.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,258.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,763.33
|
| Rate for Payer: United Healthcare All Other HMO |
$2,689.70
|
| Rate for Payer: United Healthcare HMO Rider |
$2,631.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,411.38
|
|
|
HC LEAD BS Q TRAK 3400
|
Facility
|
OP
|
$11,250.00
|
|
|
Service Code
|
CPT C1896
|
| Hospital Charge Code |
906813721
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,250.00 |
| Max. Negotiated Rate |
$9,562.50 |
| Rate for Payer: Adventist Health Commercial |
$2,250.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,562.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,187.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,437.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,908.62
|
| Rate for Payer: Blue Shield of California Commercial |
$8,302.50
|
| Rate for Payer: Blue Shield of California EPN |
$5,467.50
|
| Rate for Payer: Cash Price |
$6,187.50
|
| Rate for Payer: Cigna of CA HMO |
$7,875.00
|
| Rate for Payer: Cigna of CA PPO |
$7,875.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,562.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,562.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,562.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,500.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,500.00
|
| Rate for Payer: Galaxy Health WC |
$9,562.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6,750.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,503.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,963.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,700.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,875.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,875.00
|
| Rate for Payer: Multiplan Commercial |
$9,000.00
|
| Rate for Payer: Networks By Design Commercial |
$5,625.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,562.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,750.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,750.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,222.12
|
| Rate for Payer: United Healthcare All Other HMO |
$4,109.62
|
| Rate for Payer: United Healthcare HMO Rider |
$4,020.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,684.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,562.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,562.50
|
| Rate for Payer: Vantage Medical Group Senior |
$9,562.50
|
|
|
HC LEAD BS Q TRAK 3400
|
Facility
|
IP
|
$11,250.00
|
|
|
Service Code
|
CPT C1896
|
| Hospital Charge Code |
906813721
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,250.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$2,250.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$6,187.50
|
| Rate for Payer: Cash Price |
$6,187.50
|
| Rate for Payer: Cigna of CA HMO |
$7,875.00
|
| Rate for Payer: Cigna of CA PPO |
$7,875.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,500.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,500.00
|
| Rate for Payer: Galaxy Health WC |
$9,562.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6,750.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,503.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,286.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,963.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,700.00
|
| Rate for Payer: Multiplan Commercial |
$9,000.00
|
| Rate for Payer: Networks By Design Commercial |
$5,625.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,562.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,222.12
|
| Rate for Payer: United Healthcare All Other HMO |
$4,109.62
|
| Rate for Payer: United Healthcare HMO Rider |
$4,020.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,684.38
|
|
|
HC LEAD B/S RELIANCE 0186
|
Facility
|
OP
|
$10,750.00
|
|
|
Service Code
|
CPT C1895
|
| Hospital Charge Code |
906813642
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,150.00 |
| Max. Negotiated Rate |
$9,137.50 |
| Rate for Payer: Adventist Health Commercial |
$2,150.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,137.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,912.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,062.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,226.40
|
| Rate for Payer: Blue Shield of California Commercial |
$7,933.50
|
| Rate for Payer: Blue Shield of California EPN |
$5,224.50
|
| Rate for Payer: Cash Price |
$5,912.50
|
| Rate for Payer: Cigna of CA HMO |
$7,525.00
|
| Rate for Payer: Cigna of CA PPO |
$7,525.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,137.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,137.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,137.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,300.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,300.00
|
| Rate for Payer: Galaxy Health WC |
$9,137.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6,450.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,170.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,654.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,580.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,525.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,525.00
|
| Rate for Payer: Multiplan Commercial |
$8,600.00
|
| Rate for Payer: Networks By Design Commercial |
$5,375.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,137.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,450.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,450.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,034.47
|
| Rate for Payer: United Healthcare All Other HMO |
$3,926.97
|
| Rate for Payer: United Healthcare HMO Rider |
$3,842.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,520.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,137.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,137.50
|
| Rate for Payer: Vantage Medical Group Senior |
$9,137.50
|
|
|
HC LEAD B/S RELIANCE 0186
|
Facility
|
IP
|
$10,750.00
|
|
|
Service Code
|
CPT C1895
|
| Hospital Charge Code |
906813642
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,150.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$2,150.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$5,912.50
|
| Rate for Payer: Cash Price |
$5,912.50
|
| Rate for Payer: Cigna of CA HMO |
$7,525.00
|
| Rate for Payer: Cigna of CA PPO |
$7,525.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,300.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,300.00
|
| Rate for Payer: Galaxy Health WC |
$9,137.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6,450.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,170.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,095.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,654.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,580.00
|
| Rate for Payer: Multiplan Commercial |
$8,600.00
|
| Rate for Payer: Networks By Design Commercial |
$5,375.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,137.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,034.47
|
| Rate for Payer: United Healthcare All Other HMO |
$3,926.97
|
| Rate for Payer: United Healthcare HMO Rider |
$3,842.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,520.62
|
|
|
HC LEAD B/S RELIANCE 180
|
Facility
|
OP
|
$10,750.00
|
|
|
Service Code
|
CPT C1895
|
| Hospital Charge Code |
906813554
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,150.00 |
| Max. Negotiated Rate |
$9,137.50 |
| Rate for Payer: Adventist Health Commercial |
$2,150.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,137.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,912.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,062.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,226.40
|
| Rate for Payer: Blue Shield of California Commercial |
$7,933.50
|
| Rate for Payer: Blue Shield of California EPN |
$5,224.50
|
| Rate for Payer: Cash Price |
$5,912.50
|
| Rate for Payer: Cigna of CA HMO |
$7,525.00
|
| Rate for Payer: Cigna of CA PPO |
$7,525.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,137.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,137.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,137.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,300.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,300.00
|
| Rate for Payer: Galaxy Health WC |
$9,137.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6,450.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,170.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,654.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,580.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,525.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,525.00
|
| Rate for Payer: Multiplan Commercial |
$8,600.00
|
| Rate for Payer: Networks By Design Commercial |
$5,375.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,137.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,450.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,450.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,034.47
|
| Rate for Payer: United Healthcare All Other HMO |
$3,926.97
|
| Rate for Payer: United Healthcare HMO Rider |
$3,842.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,520.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,137.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,137.50
|
| Rate for Payer: Vantage Medical Group Senior |
$9,137.50
|
|
|
HC LEAD B/S RELIANCE 180
|
Facility
|
IP
|
$10,750.00
|
|
|
Service Code
|
CPT C1895
|
| Hospital Charge Code |
906813554
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,150.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$2,150.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$5,912.50
|
| Rate for Payer: Cash Price |
$5,912.50
|
| Rate for Payer: Cigna of CA HMO |
$7,525.00
|
| Rate for Payer: Cigna of CA PPO |
$7,525.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,300.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,300.00
|
| Rate for Payer: Galaxy Health WC |
$9,137.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6,450.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,170.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,095.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,654.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,580.00
|
| Rate for Payer: Multiplan Commercial |
$8,600.00
|
| Rate for Payer: Networks By Design Commercial |
$5,375.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,137.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,034.47
|
| Rate for Payer: United Healthcare All Other HMO |
$3,926.97
|
| Rate for Payer: United Healthcare HMO Rider |
$3,842.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,520.62
|
|
|
HC LEAD B/S RELIANCE 185
|
Facility
|
IP
|
$10,750.00
|
|
|
Service Code
|
CPT C1895
|
| Hospital Charge Code |
906813522
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,150.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$2,150.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$5,912.50
|
| Rate for Payer: Cash Price |
$5,912.50
|
| Rate for Payer: Cigna of CA HMO |
$7,525.00
|
| Rate for Payer: Cigna of CA PPO |
$7,525.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,300.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,300.00
|
| Rate for Payer: Galaxy Health WC |
$9,137.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6,450.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,170.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,095.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,654.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,580.00
|
| Rate for Payer: Multiplan Commercial |
$8,600.00
|
| Rate for Payer: Networks By Design Commercial |
$5,375.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,137.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,034.47
|
| Rate for Payer: United Healthcare All Other HMO |
$3,926.97
|
| Rate for Payer: United Healthcare HMO Rider |
$3,842.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,520.62
|
|
|
HC LEAD B/S RELIANCE 185
|
Facility
|
OP
|
$10,750.00
|
|
|
Service Code
|
CPT C1895
|
| Hospital Charge Code |
906813522
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,150.00 |
| Max. Negotiated Rate |
$9,137.50 |
| Rate for Payer: Adventist Health Commercial |
$2,150.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,137.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,912.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,062.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,226.40
|
| Rate for Payer: Blue Shield of California Commercial |
$7,933.50
|
| Rate for Payer: Blue Shield of California EPN |
$5,224.50
|
| Rate for Payer: Cash Price |
$5,912.50
|
| Rate for Payer: Cigna of CA HMO |
$7,525.00
|
| Rate for Payer: Cigna of CA PPO |
$7,525.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,137.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,137.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,137.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,300.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,300.00
|
| Rate for Payer: Galaxy Health WC |
$9,137.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6,450.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,170.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,654.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,580.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,525.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,525.00
|
| Rate for Payer: Multiplan Commercial |
$8,600.00
|
| Rate for Payer: Networks By Design Commercial |
$5,375.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,137.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,450.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,450.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,034.47
|
| Rate for Payer: United Healthcare All Other HMO |
$3,926.97
|
| Rate for Payer: United Healthcare HMO Rider |
$3,842.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,520.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,137.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,137.50
|
| Rate for Payer: Vantage Medical Group Senior |
$9,137.50
|
|
|
HC LEAD B/S RELIANCE 292
|
Facility
|
OP
|
$10,750.00
|
|
|
Service Code
|
CPT C1777
|
| Hospital Charge Code |
906813802
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,150.00 |
| Max. Negotiated Rate |
$9,137.50 |
| Rate for Payer: Adventist Health Commercial |
$2,150.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,137.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,912.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,062.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,601.57
|
| Rate for Payer: Blue Shield of California Commercial |
$7,933.50
|
| Rate for Payer: Blue Shield of California EPN |
$5,224.50
|
| Rate for Payer: Cash Price |
$5,912.50
|
| Rate for Payer: Cigna of CA HMO |
$7,525.00
|
| Rate for Payer: Cigna of CA PPO |
$7,525.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,137.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,137.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,137.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,300.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,300.00
|
| Rate for Payer: Galaxy Health WC |
$9,137.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6,450.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,170.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,654.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,580.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,525.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,525.00
|
| Rate for Payer: Multiplan Commercial |
$8,600.00
|
| Rate for Payer: Networks By Design Commercial |
$5,375.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,137.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,450.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,450.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,034.47
|
| Rate for Payer: United Healthcare All Other HMO |
$3,926.97
|
| Rate for Payer: United Healthcare HMO Rider |
$3,842.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,520.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,137.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,137.50
|
| Rate for Payer: Vantage Medical Group Senior |
$9,137.50
|
|
|
HC LEAD B/S RELIANCE 292
|
Facility
|
IP
|
$10,750.00
|
|
|
Service Code
|
CPT C1777
|
| Hospital Charge Code |
906813802
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,150.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$2,150.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$5,912.50
|
| Rate for Payer: Cash Price |
$5,912.50
|
| Rate for Payer: Cigna of CA HMO |
$7,525.00
|
| Rate for Payer: Cigna of CA PPO |
$7,525.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,300.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,300.00
|
| Rate for Payer: Galaxy Health WC |
$9,137.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6,450.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,170.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,095.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,654.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,580.00
|
| Rate for Payer: Multiplan Commercial |
$8,600.00
|
| Rate for Payer: Networks By Design Commercial |
$5,375.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,137.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,034.47
|
| Rate for Payer: United Healthcare All Other HMO |
$3,926.97
|
| Rate for Payer: United Healthcare HMO Rider |
$3,842.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,520.62
|
|
|
HC LEAD B/S RELIANCE DF4 265
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT C1895
|
| Hospital Charge Code |
906813667
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,000.00 |
| Max. Negotiated Rate |
$8,500.00 |
| Rate for Payer: Adventist Health Commercial |
$2,000.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,500.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,500.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,500.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,141.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,380.00
|
| Rate for Payer: Blue Shield of California EPN |
$4,860.00
|
| Rate for Payer: Cash Price |
$5,500.00
|
| Rate for Payer: Cigna of CA HMO |
$7,000.00
|
| Rate for Payer: Cigna of CA PPO |
$7,000.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,500.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,500.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,500.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,000.00
|
| Rate for Payer: Galaxy Health WC |
$8,500.00
|
| Rate for Payer: Global Benefits Group Commercial |
$6,000.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,670.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,190.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,400.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,000.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,000.00
|
| Rate for Payer: Multiplan Commercial |
$8,000.00
|
| Rate for Payer: Networks By Design Commercial |
$5,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$8,500.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,000.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,000.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,753.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,653.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,574.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,275.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,500.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,500.00
|
| Rate for Payer: Vantage Medical Group Senior |
$8,500.00
|
|
|
HC LEAD B/S RELIANCE DF4 265
|
Facility
|
IP
|
$10,000.00
|
|
|
Service Code
|
CPT C1895
|
| Hospital Charge Code |
906813667
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,000.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$2,000.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$5,500.00
|
| Rate for Payer: Cash Price |
$5,500.00
|
| Rate for Payer: Cigna of CA HMO |
$7,000.00
|
| Rate for Payer: Cigna of CA PPO |
$7,000.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,000.00
|
| Rate for Payer: Galaxy Health WC |
$8,500.00
|
| Rate for Payer: Global Benefits Group Commercial |
$6,000.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,670.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,810.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,190.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,400.00
|
| Rate for Payer: Multiplan Commercial |
$8,000.00
|
| Rate for Payer: Networks By Design Commercial |
$5,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$8,500.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,753.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,653.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,574.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,275.00
|
|
|
HC LEAD B/S RELIANCE DF4 275
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT C1895
|
| Hospital Charge Code |
906813666
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,000.00 |
| Max. Negotiated Rate |
$8,500.00 |
| Rate for Payer: Adventist Health Commercial |
$2,000.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,500.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,500.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,500.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,141.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,380.00
|
| Rate for Payer: Blue Shield of California EPN |
$4,860.00
|
| Rate for Payer: Cash Price |
$5,500.00
|
| Rate for Payer: Cigna of CA HMO |
$7,000.00
|
| Rate for Payer: Cigna of CA PPO |
$7,000.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,500.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,500.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,500.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,000.00
|
| Rate for Payer: Galaxy Health WC |
$8,500.00
|
| Rate for Payer: Global Benefits Group Commercial |
$6,000.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,670.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,190.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,400.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,000.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,000.00
|
| Rate for Payer: Multiplan Commercial |
$8,000.00
|
| Rate for Payer: Networks By Design Commercial |
$5,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$8,500.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,000.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,000.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,753.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,653.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,574.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,275.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,500.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,500.00
|
| Rate for Payer: Vantage Medical Group Senior |
$8,500.00
|
|
|
HC LEAD B/S RELIANCE DF4 275
|
Facility
|
IP
|
$10,000.00
|
|
|
Service Code
|
CPT C1895
|
| Hospital Charge Code |
906813666
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,000.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$2,000.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$5,500.00
|
| Rate for Payer: Cash Price |
$5,500.00
|
| Rate for Payer: Cigna of CA HMO |
$7,000.00
|
| Rate for Payer: Cigna of CA PPO |
$7,000.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,000.00
|
| Rate for Payer: Galaxy Health WC |
$8,500.00
|
| Rate for Payer: Global Benefits Group Commercial |
$6,000.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,670.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,810.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,190.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,400.00
|
| Rate for Payer: Multiplan Commercial |
$8,000.00
|
| Rate for Payer: Networks By Design Commercial |
$5,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$8,500.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,753.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,653.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,574.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,275.00
|
|
