|
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 |
$4,837.50
|
| 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 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 |
$4,837.50
|
| Rate for Payer: Cash Price |
$4,837.50
|
| 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 |
$4,837.50
|
| 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 |
$4,837.50
|
| 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 |
$4,837.50
|
| Rate for Payer: Cash Price |
$4,837.50
|
| 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
|
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 |
$4,500.00
|
| Rate for Payer: Cash Price |
$4,500.00
|
| 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 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 |
$4,500.00
|
| 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
|
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 |
$4,500.00
|
| 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 |
$4,500.00
|
| Rate for Payer: Cash Price |
$4,500.00
|
| 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 GORE DF4 276
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT C1895
|
| Hospital Charge Code |
906813683
|
|
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 |
$4,500.00
|
| 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 GORE DF4 276
|
Facility
|
IP
|
$10,000.00
|
|
|
Service Code
|
CPT C1895
|
| Hospital Charge Code |
906813683
|
|
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 |
$4,500.00
|
| Rate for Payer: Cash Price |
$4,500.00
|
| 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 GORE DF4 282
|
Facility
|
IP
|
$10,750.00
|
|
|
Service Code
|
CPT C1777
|
| Hospital Charge Code |
906813665
|
|
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 |
$4,837.50
|
| Rate for Payer: Cash Price |
$4,837.50
|
| 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 GORE DF4 282
|
Facility
|
OP
|
$10,750.00
|
|
|
Service Code
|
CPT C1777
|
| Hospital Charge Code |
906813665
|
|
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 |
$4,837.50
|
| 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 GORE DF4 283
|
Facility
|
IP
|
$10,750.00
|
|
|
Service Code
|
CPT C1777
|
| Hospital Charge Code |
906813680
|
|
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 |
$4,837.50
|
| Rate for Payer: Cash Price |
$4,837.50
|
| 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 GORE DF4 283
|
Facility
|
OP
|
$10,750.00
|
|
|
Service Code
|
CPT C1777
|
| Hospital Charge Code |
906813680
|
|
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 |
$4,837.50
|
| 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 GORE DF4 285
|
Facility
|
IP
|
$10,750.00
|
|
|
Service Code
|
CPT C1777
|
| Hospital Charge Code |
906813681
|
|
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 |
$4,837.50
|
| Rate for Payer: Cash Price |
$4,837.50
|
| 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 GORE DF4 285
|
Facility
|
OP
|
$10,750.00
|
|
|
Service Code
|
CPT C1777
|
| Hospital Charge Code |
906813681
|
|
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 |
$4,837.50
|
| 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 GORE DF4 286
|
Facility
|
OP
|
$10,750.00
|
|
|
Service Code
|
CPT C1777
|
| Hospital Charge Code |
906813682
|
|
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 |
$4,837.50
|
| 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 GORE DF4 286
|
Facility
|
IP
|
$10,750.00
|
|
|
Service Code
|
CPT C1777
|
| Hospital Charge Code |
906813682
|
|
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 |
$4,837.50
|
| Rate for Payer: Cash Price |
$4,837.50
|
| 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 GORE DF4 292
|
Facility
|
OP
|
$10,750.00
|
|
|
Service Code
|
CPT C1777
|
| Hospital Charge Code |
906813664
|
|
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 |
$4,837.50
|
| 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 GORE DF4 292
|
Facility
|
IP
|
$10,750.00
|
|
|
Service Code
|
CPT C1777
|
| Hospital Charge Code |
906813664
|
|
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 |
$4,837.50
|
| Rate for Payer: Cash Price |
$4,837.50
|
| 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 GORE DF4 293
|
Facility
|
IP
|
$10,750.00
|
|
|
Service Code
|
CPT C1777
|
| Hospital Charge Code |
906813677
|
|
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 |
$4,837.50
|
| Rate for Payer: Cash Price |
$4,837.50
|
| 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 GORE DF4 293
|
Facility
|
OP
|
$10,750.00
|
|
|
Service Code
|
CPT C1777
|
| Hospital Charge Code |
906813677
|
|
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 |
$4,837.50
|
| 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 GORE DF4 295
|
Facility
|
OP
|
$10,750.00
|
|
|
Service Code
|
CPT C1777
|
| Hospital Charge Code |
906813678
|
|
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 |
$4,837.50
|
| 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 GORE DF4 295
|
Facility
|
IP
|
$10,750.00
|
|
|
Service Code
|
CPT C1777
|
| Hospital Charge Code |
906813678
|
|
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 |
$4,837.50
|
| Rate for Payer: Cash Price |
$4,837.50
|
| 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
|
|
