|
HC LEAD MED ATTAIN 4396
|
Facility
|
IP
|
$6,750.00
|
|
|
Service Code
|
CPT C1900
|
| Hospital Charge Code |
906813659
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,350.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,350.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$3,037.50
|
| Rate for Payer: Cash Price |
$3,037.50
|
| Rate for Payer: Cigna of CA HMO |
$4,725.00
|
| Rate for Payer: Cigna of CA PPO |
$4,725.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,700.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,700.00
|
| Rate for Payer: Galaxy Health WC |
$5,737.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,050.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,502.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,571.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,178.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,620.00
|
| Rate for Payer: Multiplan Commercial |
$5,400.00
|
| Rate for Payer: Networks By Design Commercial |
$3,375.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,737.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,533.28
|
| Rate for Payer: United Healthcare All Other HMO |
$2,465.78
|
| Rate for Payer: United Healthcare HMO Rider |
$2,412.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,210.62
|
|
|
HC LEAD MED ATTAIN OTW 4194
|
Facility
|
IP
|
$4,875.00
|
|
|
Service Code
|
CPT C1900
|
| Hospital Charge Code |
906813552
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$975.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$975.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$2,193.75
|
| Rate for Payer: Cash Price |
$2,193.75
|
| Rate for Payer: Cigna of CA HMO |
$3,412.50
|
| Rate for Payer: Cigna of CA PPO |
$3,412.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,950.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,950.00
|
| Rate for Payer: Galaxy Health WC |
$4,143.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,925.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,251.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,857.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,017.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,170.00
|
| Rate for Payer: Multiplan Commercial |
$3,900.00
|
| Rate for Payer: Networks By Design Commercial |
$2,437.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,143.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,829.59
|
| Rate for Payer: United Healthcare All Other HMO |
$1,780.84
|
| Rate for Payer: United Healthcare HMO Rider |
$1,742.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,596.56
|
|
|
HC LEAD MED ATTAIN OTW 4194
|
Facility
|
OP
|
$4,875.00
|
|
|
Service Code
|
CPT C1900
|
| Hospital Charge Code |
906813552
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$975.00 |
| Max. Negotiated Rate |
$4,143.75 |
| Rate for Payer: Adventist Health Commercial |
$975.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,143.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,681.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,656.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,823.60
|
| Rate for Payer: Blue Shield of California Commercial |
$3,597.75
|
| Rate for Payer: Blue Shield of California EPN |
$2,369.25
|
| Rate for Payer: Cash Price |
$2,193.75
|
| Rate for Payer: Cigna of CA HMO |
$3,412.50
|
| Rate for Payer: Cigna of CA PPO |
$3,412.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,143.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,143.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,143.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,950.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,950.00
|
| Rate for Payer: Galaxy Health WC |
$4,143.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,925.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,251.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,857.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,017.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,170.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,412.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,412.50
|
| Rate for Payer: Multiplan Commercial |
$3,900.00
|
| Rate for Payer: Networks By Design Commercial |
$2,437.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,143.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,925.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,925.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,829.59
|
| Rate for Payer: United Healthcare All Other HMO |
$1,780.84
|
| Rate for Payer: United Healthcare HMO Rider |
$1,742.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,596.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,143.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,143.75
|
| Rate for Payer: Vantage Medical Group Senior |
$4,143.75
|
|
|
HC LEAD MED ATTAIN OTW 4196
|
Facility
|
IP
|
$6,750.00
|
|
|
Service Code
|
CPT C1900
|
| Hospital Charge Code |
906813634
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,350.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,350.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$3,037.50
|
| Rate for Payer: Cash Price |
$3,037.50
|
| Rate for Payer: Cigna of CA HMO |
$4,725.00
|
| Rate for Payer: Cigna of CA PPO |
$4,725.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,700.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,700.00
|
| Rate for Payer: Galaxy Health WC |
$5,737.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,050.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,502.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,571.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,178.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,620.00
|
| Rate for Payer: Multiplan Commercial |
$5,400.00
|
| Rate for Payer: Networks By Design Commercial |
$3,375.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,737.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,533.28
|
| Rate for Payer: United Healthcare All Other HMO |
$2,465.78
|
| Rate for Payer: United Healthcare HMO Rider |
$2,412.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,210.62
|
|
|
HC LEAD MED ATTAIN OTW 4196
|
Facility
|
OP
|
$6,750.00
|
|
|
Service Code
|
CPT C1900
|
| Hospital Charge Code |
906813634
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,350.00 |
| Max. Negotiated Rate |
$5,737.50 |
| Rate for Payer: Adventist Health Commercial |
$1,350.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,737.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,712.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,062.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,909.60
|
| Rate for Payer: Blue Shield of California Commercial |
$4,981.50
|
| Rate for Payer: Blue Shield of California EPN |
$3,280.50
|
| Rate for Payer: Cash Price |
$3,037.50
|
| Rate for Payer: Cigna of CA HMO |
$4,725.00
|
| Rate for Payer: Cigna of CA PPO |
$4,725.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,737.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,737.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,737.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,700.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,700.00
|
| Rate for Payer: Galaxy Health WC |
$5,737.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,050.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,502.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,571.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,178.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,620.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,725.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,725.00
|
| Rate for Payer: Multiplan Commercial |
$5,400.00
|
| Rate for Payer: Networks By Design Commercial |
$3,375.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,737.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,050.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,050.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,533.28
|
| Rate for Payer: United Healthcare All Other HMO |
$2,465.78
|
| Rate for Payer: United Healthcare HMO Rider |
$2,412.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,210.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,737.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,737.50
|
| Rate for Payer: Vantage Medical Group Senior |
$5,737.50
|
|
|
HC LEAD MED ATTAIN OTW 4296
|
Facility
|
OP
|
$6,750.00
|
|
|
Service Code
|
CPT C1900
|
| Hospital Charge Code |
906813655
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,350.00 |
| Max. Negotiated Rate |
$5,737.50 |
| Rate for Payer: Adventist Health Commercial |
$1,350.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,737.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,712.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,062.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,145.18
|
| Rate for Payer: Blue Shield of California Commercial |
$4,981.50
|
| Rate for Payer: Blue Shield of California EPN |
$3,280.50
|
| Rate for Payer: Cash Price |
$3,037.50
|
| Rate for Payer: Cigna of CA HMO |
$4,725.00
|
| Rate for Payer: Cigna of CA PPO |
$4,725.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,737.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,737.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,737.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,700.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,700.00
|
| Rate for Payer: Galaxy Health WC |
$5,737.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,050.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,502.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,571.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,178.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,620.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,725.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,725.00
|
| Rate for Payer: Multiplan Commercial |
$5,400.00
|
| Rate for Payer: Networks By Design Commercial |
$3,375.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,737.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,050.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,050.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,533.28
|
| Rate for Payer: United Healthcare All Other HMO |
$2,465.78
|
| Rate for Payer: United Healthcare HMO Rider |
$2,412.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,210.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,737.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,737.50
|
| Rate for Payer: Vantage Medical Group Senior |
$5,737.50
|
|
|
HC LEAD MED ATTAIN OTW 4296
|
Facility
|
IP
|
$6,750.00
|
|
|
Service Code
|
CPT C1900
|
| Hospital Charge Code |
906813655
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,350.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,350.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$3,037.50
|
| Rate for Payer: Cash Price |
$3,037.50
|
| Rate for Payer: Cigna of CA HMO |
$4,725.00
|
| Rate for Payer: Cigna of CA PPO |
$4,725.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,700.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,700.00
|
| Rate for Payer: Galaxy Health WC |
$5,737.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,050.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,502.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,571.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,178.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,620.00
|
| Rate for Payer: Multiplan Commercial |
$5,400.00
|
| Rate for Payer: Networks By Design Commercial |
$3,375.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,737.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,533.28
|
| Rate for Payer: United Healthcare All Other HMO |
$2,465.78
|
| Rate for Payer: United Healthcare HMO Rider |
$2,412.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,210.62
|
|
|
HC LEAD MED ATTAIN PERFORMA 4298
|
Facility
|
IP
|
$8,750.00
|
|
|
Service Code
|
CPT C1900
|
| Hospital Charge Code |
906813734
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,750.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,750.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$3,937.50
|
| Rate for Payer: Cash Price |
$3,937.50
|
| Rate for Payer: Cigna of CA HMO |
$6,125.00
|
| Rate for Payer: Cigna of CA PPO |
$6,125.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,500.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,500.00
|
| Rate for Payer: Galaxy Health WC |
$7,437.50
|
| Rate for Payer: Global Benefits Group Commercial |
$5,250.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,836.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,333.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,416.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,100.00
|
| Rate for Payer: Multiplan Commercial |
$7,000.00
|
| Rate for Payer: Networks By Design Commercial |
$4,375.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,437.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,283.88
|
| Rate for Payer: United Healthcare All Other HMO |
$3,196.38
|
| Rate for Payer: United Healthcare HMO Rider |
$3,127.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,865.62
|
|
|
HC LEAD MED ATTAIN PERFORMA 4298
|
Facility
|
OP
|
$8,750.00
|
|
|
Service Code
|
CPT C1900
|
| Hospital Charge Code |
906813734
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,750.00 |
| Max. Negotiated Rate |
$7,437.50 |
| Rate for Payer: Adventist Health Commercial |
$1,750.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,437.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,812.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,562.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,373.38
|
| Rate for Payer: Blue Shield of California Commercial |
$6,457.50
|
| Rate for Payer: Blue Shield of California EPN |
$4,252.50
|
| Rate for Payer: Cash Price |
$3,937.50
|
| Rate for Payer: Cigna of CA HMO |
$6,125.00
|
| Rate for Payer: Cigna of CA PPO |
$6,125.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,437.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,437.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,437.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,500.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,500.00
|
| Rate for Payer: Galaxy Health WC |
$7,437.50
|
| Rate for Payer: Global Benefits Group Commercial |
$5,250.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,836.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,333.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,416.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,100.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,125.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,125.00
|
| Rate for Payer: Multiplan Commercial |
$7,000.00
|
| Rate for Payer: Networks By Design Commercial |
$4,375.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,437.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,250.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,250.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,283.88
|
| Rate for Payer: United Healthcare All Other HMO |
$3,196.38
|
| Rate for Payer: United Healthcare HMO Rider |
$3,127.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,865.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,437.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,437.50
|
| Rate for Payer: Vantage Medical Group Senior |
$7,437.50
|
|
|
HC LEAD MED ATTAIN PERFORMA 4598
|
Facility
|
OP
|
$8,750.00
|
|
|
Service Code
|
CPT C1900
|
| Hospital Charge Code |
906813778
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,750.00 |
| Max. Negotiated Rate |
$7,437.50 |
| Rate for Payer: Adventist Health Commercial |
$1,750.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,437.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,812.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,562.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,068.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,457.50
|
| Rate for Payer: Blue Shield of California EPN |
$4,252.50
|
| Rate for Payer: Cash Price |
$3,937.50
|
| Rate for Payer: Cigna of CA HMO |
$6,125.00
|
| Rate for Payer: Cigna of CA PPO |
$6,125.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,437.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,437.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,437.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,500.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,500.00
|
| Rate for Payer: Galaxy Health WC |
$7,437.50
|
| Rate for Payer: Global Benefits Group Commercial |
$5,250.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,836.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,333.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,416.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,100.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,125.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,125.00
|
| Rate for Payer: Multiplan Commercial |
$7,000.00
|
| Rate for Payer: Networks By Design Commercial |
$4,375.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,437.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,250.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,250.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,283.88
|
| Rate for Payer: United Healthcare All Other HMO |
$3,196.38
|
| Rate for Payer: United Healthcare HMO Rider |
$3,127.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,865.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,437.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,437.50
|
| Rate for Payer: Vantage Medical Group Senior |
$7,437.50
|
|
|
HC LEAD MED ATTAIN PERFORMA 4598
|
Facility
|
IP
|
$8,750.00
|
|
|
Service Code
|
CPT C1900
|
| Hospital Charge Code |
906813778
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,750.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,750.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$3,937.50
|
| Rate for Payer: Cash Price |
$3,937.50
|
| Rate for Payer: Cigna of CA HMO |
$6,125.00
|
| Rate for Payer: Cigna of CA PPO |
$6,125.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,500.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,500.00
|
| Rate for Payer: Galaxy Health WC |
$7,437.50
|
| Rate for Payer: Global Benefits Group Commercial |
$5,250.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,836.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,333.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,416.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,100.00
|
| Rate for Payer: Multiplan Commercial |
$7,000.00
|
| Rate for Payer: Networks By Design Commercial |
$4,375.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,437.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,283.88
|
| Rate for Payer: United Healthcare All Other HMO |
$3,196.38
|
| Rate for Payer: United Healthcare HMO Rider |
$3,127.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,865.62
|
|
|
HC LEAD MED CAPSURE FIX 5568
|
Facility
|
IP
|
$2,262.00
|
|
|
Service Code
|
CPT C1898
|
| Hospital Charge Code |
906813303
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$452.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Cigna of CA PPO |
$1,583.40
|
| Rate for Payer: Adventist Health Commercial |
$452.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,017.90
|
| Rate for Payer: Cash Price |
$1,017.90
|
| Rate for Payer: Cigna of CA HMO |
$1,583.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$904.80
|
| Rate for Payer: EPIC Health Plan Senior |
$904.80
|
| Rate for Payer: Galaxy Health WC |
$1,922.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,357.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,508.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$861.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,400.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$542.88
|
| Rate for Payer: Multiplan Commercial |
$1,809.60
|
| Rate for Payer: Networks By Design Commercial |
$1,131.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,922.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$848.93
|
| Rate for Payer: United Healthcare All Other HMO |
$826.31
|
| Rate for Payer: United Healthcare HMO Rider |
$808.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$740.80
|
|
|
HC LEAD MED CAPSURE FIX 5568
|
Facility
|
OP
|
$2,262.00
|
|
|
Service Code
|
CPT C1898
|
| Hospital Charge Code |
906813303
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$452.40 |
| Max. Negotiated Rate |
$1,922.70 |
| Rate for Payer: Adventist Health Commercial |
$452.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,922.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,244.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,696.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,389.09
|
| Rate for Payer: Blue Shield of California Commercial |
$1,669.36
|
| Rate for Payer: Blue Shield of California EPN |
$1,099.33
|
| Rate for Payer: Cash Price |
$1,017.90
|
| Rate for Payer: Cigna of CA HMO |
$1,583.40
|
| Rate for Payer: Cigna of CA PPO |
$1,583.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,922.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,922.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,922.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$904.80
|
| Rate for Payer: EPIC Health Plan Senior |
$904.80
|
| Rate for Payer: Galaxy Health WC |
$1,922.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,357.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,508.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$861.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,400.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$542.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,583.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,583.40
|
| Rate for Payer: Multiplan Commercial |
$1,809.60
|
| Rate for Payer: Networks By Design Commercial |
$1,131.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,922.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,357.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,357.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$848.93
|
| Rate for Payer: United Healthcare All Other HMO |
$826.31
|
| Rate for Payer: United Healthcare HMO Rider |
$808.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$740.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,922.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,922.70
|
| Rate for Payer: Vantage Medical Group Senior |
$1,922.70
|
|
|
HC LEAD MED CAPSURE FIX MRI 5086
|
Facility
|
OP
|
$3,299.00
|
|
|
Service Code
|
CPT C1898
|
| Hospital Charge Code |
906813645
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$659.80 |
| Max. Negotiated Rate |
$2,804.15 |
| Rate for Payer: Adventist Health Commercial |
$659.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,804.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,814.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,474.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,910.78
|
| Rate for Payer: Blue Shield of California Commercial |
$2,434.66
|
| Rate for Payer: Blue Shield of California EPN |
$1,603.31
|
| Rate for Payer: Cash Price |
$1,484.55
|
| Rate for Payer: Cigna of CA HMO |
$2,309.30
|
| Rate for Payer: Cigna of CA PPO |
$2,309.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,804.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,804.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,804.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,319.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,319.60
|
| Rate for Payer: Galaxy Health WC |
$2,804.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,979.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,200.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,256.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,042.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$791.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,309.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,309.30
|
| Rate for Payer: Multiplan Commercial |
$2,639.20
|
| Rate for Payer: Networks By Design Commercial |
$1,649.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,804.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,979.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,979.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,238.11
|
| Rate for Payer: United Healthcare All Other HMO |
$1,205.12
|
| Rate for Payer: United Healthcare HMO Rider |
$1,179.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,080.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,804.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,804.15
|
| Rate for Payer: Vantage Medical Group Senior |
$2,804.15
|
|
|
HC LEAD MED CAPSURE FIX MRI 5086
|
Facility
|
IP
|
$3,299.00
|
|
|
Service Code
|
CPT C1898
|
| Hospital Charge Code |
906813645
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$659.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$659.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,484.55
|
| Rate for Payer: Cash Price |
$1,484.55
|
| Rate for Payer: Cigna of CA HMO |
$2,309.30
|
| Rate for Payer: Cigna of CA PPO |
$2,309.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,319.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,319.60
|
| Rate for Payer: Galaxy Health WC |
$2,804.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,979.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,200.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,256.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,042.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$791.76
|
| Rate for Payer: Multiplan Commercial |
$2,639.20
|
| Rate for Payer: Networks By Design Commercial |
$1,649.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,804.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,238.11
|
| Rate for Payer: United Healthcare All Other HMO |
$1,205.12
|
| Rate for Payer: United Healthcare HMO Rider |
$1,179.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,080.42
|
|
|
HC LEAD MED CAPSURE SENSE 4574
|
Facility
|
IP
|
$2,300.00
|
|
|
Service Code
|
CPT C1898
|
| Hospital Charge Code |
906813827
|
|
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 |
$1,035.00
|
| Rate for Payer: Cash Price |
$1,035.00
|
| 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 MED CAPSURE SENSE 4574
|
Facility
|
OP
|
$2,300.00
|
|
|
Service Code
|
CPT C1898
|
| Hospital Charge Code |
906813827
|
|
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 |
$1,035.00
|
| 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 MED CAPSURE SP NOV 5092
|
Facility
|
IP
|
$2,262.00
|
|
|
Service Code
|
CPT C1898
|
| Hospital Charge Code |
906813251
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$452.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$452.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,017.90
|
| Rate for Payer: Cash Price |
$1,017.90
|
| Rate for Payer: Cigna of CA HMO |
$1,583.40
|
| Rate for Payer: Cigna of CA PPO |
$1,583.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$904.80
|
| Rate for Payer: EPIC Health Plan Senior |
$904.80
|
| Rate for Payer: Galaxy Health WC |
$1,922.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,357.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,508.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$861.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,400.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$542.88
|
| Rate for Payer: Multiplan Commercial |
$1,809.60
|
| Rate for Payer: Networks By Design Commercial |
$1,131.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,922.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$848.93
|
| Rate for Payer: United Healthcare All Other HMO |
$826.31
|
| Rate for Payer: United Healthcare HMO Rider |
$808.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$740.80
|
|
|
HC LEAD MED CAPSURE SP NOV 5092
|
Facility
|
OP
|
$2,262.00
|
|
|
Service Code
|
CPT C1898
|
| Hospital Charge Code |
906813251
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$452.40 |
| Max. Negotiated Rate |
$1,922.70 |
| Rate for Payer: Adventist Health Commercial |
$452.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,922.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,244.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,696.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,389.09
|
| Rate for Payer: Blue Shield of California Commercial |
$1,669.36
|
| Rate for Payer: Blue Shield of California EPN |
$1,099.33
|
| Rate for Payer: Cash Price |
$1,017.90
|
| Rate for Payer: Cigna of CA HMO |
$1,583.40
|
| Rate for Payer: Cigna of CA PPO |
$1,583.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,922.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,922.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,922.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$904.80
|
| Rate for Payer: EPIC Health Plan Senior |
$904.80
|
| Rate for Payer: Galaxy Health WC |
$1,922.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,357.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,508.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$861.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,400.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$542.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,583.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,583.40
|
| Rate for Payer: Multiplan Commercial |
$1,809.60
|
| Rate for Payer: Networks By Design Commercial |
$1,131.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,922.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,357.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,357.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$848.93
|
| Rate for Payer: United Healthcare All Other HMO |
$826.31
|
| Rate for Payer: United Healthcare HMO Rider |
$808.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$740.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,922.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,922.70
|
| Rate for Payer: Vantage Medical Group Senior |
$1,922.70
|
|
|
HC LEAD MED CAPSURE SP NOV 5592
|
Facility
|
IP
|
$2,262.00
|
|
|
Service Code
|
CPT C1898
|
| Hospital Charge Code |
906813255
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$452.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$452.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,017.90
|
| Rate for Payer: Cash Price |
$1,017.90
|
| Rate for Payer: Cigna of CA HMO |
$1,583.40
|
| Rate for Payer: Cigna of CA PPO |
$1,583.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$904.80
|
| Rate for Payer: EPIC Health Plan Senior |
$904.80
|
| Rate for Payer: Galaxy Health WC |
$1,922.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,357.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,508.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$861.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,400.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$542.88
|
| Rate for Payer: Multiplan Commercial |
$1,809.60
|
| Rate for Payer: Networks By Design Commercial |
$1,131.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,922.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$848.93
|
| Rate for Payer: United Healthcare All Other HMO |
$826.31
|
| Rate for Payer: United Healthcare HMO Rider |
$808.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$740.80
|
|
|
HC LEAD MED CAPSURE SP NOV 5592
|
Facility
|
OP
|
$2,262.00
|
|
|
Service Code
|
CPT C1898
|
| Hospital Charge Code |
906813255
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$452.40 |
| Max. Negotiated Rate |
$1,922.70 |
| Rate for Payer: Adventist Health Commercial |
$452.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,922.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,244.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,696.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,389.09
|
| Rate for Payer: Blue Shield of California Commercial |
$1,669.36
|
| Rate for Payer: Blue Shield of California EPN |
$1,099.33
|
| Rate for Payer: Cash Price |
$1,017.90
|
| Rate for Payer: Cigna of CA HMO |
$1,583.40
|
| Rate for Payer: Cigna of CA PPO |
$1,583.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,922.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,922.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,922.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$904.80
|
| Rate for Payer: EPIC Health Plan Senior |
$904.80
|
| Rate for Payer: Galaxy Health WC |
$1,922.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,357.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,508.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$861.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,400.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$542.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,583.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,583.40
|
| Rate for Payer: Multiplan Commercial |
$1,809.60
|
| Rate for Payer: Networks By Design Commercial |
$1,131.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,922.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,357.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,357.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$848.93
|
| Rate for Payer: United Healthcare All Other HMO |
$826.31
|
| Rate for Payer: United Healthcare HMO Rider |
$808.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$740.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,922.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,922.70
|
| Rate for Payer: Vantage Medical Group Senior |
$1,922.70
|
|
|
HC LEAD MED CAPSURE VDD 5038
|
Facility
|
IP
|
$2,126.00
|
|
|
Service Code
|
CPT C1779
|
| Hospital Charge Code |
906813341
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$425.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$425.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$956.70
|
| Rate for Payer: Cash Price |
$956.70
|
| Rate for Payer: Cigna of CA HMO |
$1,488.20
|
| Rate for Payer: Cigna of CA PPO |
$1,488.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$850.40
|
| Rate for Payer: EPIC Health Plan Senior |
$850.40
|
| Rate for Payer: Galaxy Health WC |
$1,807.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,275.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,418.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$810.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,315.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$510.24
|
| Rate for Payer: Multiplan Commercial |
$1,700.80
|
| Rate for Payer: Networks By Design Commercial |
$1,063.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,807.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$797.89
|
| Rate for Payer: United Healthcare All Other HMO |
$776.63
|
| Rate for Payer: United Healthcare HMO Rider |
$759.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$696.26
|
|
|
HC LEAD MED CAPSURE VDD 5038
|
Facility
|
OP
|
$2,126.00
|
|
|
Service Code
|
CPT C1779
|
| Hospital Charge Code |
906813341
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$425.20 |
| Max. Negotiated Rate |
$1,807.10 |
| Rate for Payer: Adventist Health Commercial |
$425.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,807.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,169.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,594.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,305.58
|
| Rate for Payer: Blue Shield of California Commercial |
$1,568.99
|
| Rate for Payer: Blue Shield of California EPN |
$1,033.24
|
| Rate for Payer: Cash Price |
$956.70
|
| Rate for Payer: Cigna of CA HMO |
$1,488.20
|
| Rate for Payer: Cigna of CA PPO |
$1,488.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,807.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,807.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,807.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$850.40
|
| Rate for Payer: EPIC Health Plan Senior |
$850.40
|
| Rate for Payer: Galaxy Health WC |
$1,807.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,275.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,418.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$810.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,315.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$510.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,488.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,488.20
|
| Rate for Payer: Multiplan Commercial |
$1,700.80
|
| Rate for Payer: Networks By Design Commercial |
$1,063.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,807.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,275.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,275.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$797.89
|
| Rate for Payer: United Healthcare All Other HMO |
$776.63
|
| Rate for Payer: United Healthcare HMO Rider |
$759.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$696.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,807.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,807.10
|
| Rate for Payer: Vantage Medical Group Senior |
$1,807.10
|
|
|
HC LEAD MED SELECT SECURE 3830
|
Facility
|
OP
|
$2,126.00
|
|
|
Service Code
|
CPT C1898
|
| Hospital Charge Code |
906813631
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$425.20 |
| Max. Negotiated Rate |
$1,807.10 |
| Rate for Payer: Adventist Health Commercial |
$425.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,807.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,169.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,594.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,305.58
|
| Rate for Payer: Blue Shield of California Commercial |
$1,568.99
|
| Rate for Payer: Blue Shield of California EPN |
$1,033.24
|
| Rate for Payer: Cash Price |
$956.70
|
| Rate for Payer: Cigna of CA HMO |
$1,488.20
|
| Rate for Payer: Cigna of CA PPO |
$1,488.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,807.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,807.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,807.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$850.40
|
| Rate for Payer: EPIC Health Plan Senior |
$850.40
|
| Rate for Payer: Galaxy Health WC |
$1,807.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,275.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,418.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$810.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,315.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$510.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,488.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,488.20
|
| Rate for Payer: Multiplan Commercial |
$1,700.80
|
| Rate for Payer: Networks By Design Commercial |
$1,063.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,807.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,275.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,275.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$797.89
|
| Rate for Payer: United Healthcare All Other HMO |
$776.63
|
| Rate for Payer: United Healthcare HMO Rider |
$759.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$696.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,807.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,807.10
|
| Rate for Payer: Vantage Medical Group Senior |
$1,807.10
|
|
|
HC LEAD MED SELECT SECURE 3830
|
Facility
|
IP
|
$2,126.00
|
|
|
Service Code
|
CPT C1898
|
| Hospital Charge Code |
906813631
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$425.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$425.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$956.70
|
| Rate for Payer: Cash Price |
$956.70
|
| Rate for Payer: Cigna of CA HMO |
$1,488.20
|
| Rate for Payer: Cigna of CA PPO |
$1,488.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$850.40
|
| Rate for Payer: EPIC Health Plan Senior |
$850.40
|
| Rate for Payer: Galaxy Health WC |
$1,807.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,275.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,418.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$810.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,315.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$510.24
|
| Rate for Payer: Multiplan Commercial |
$1,700.80
|
| Rate for Payer: Networks By Design Commercial |
$1,063.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,807.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$797.89
|
| Rate for Payer: United Healthcare All Other HMO |
$776.63
|
| Rate for Payer: United Healthcare HMO Rider |
$759.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$696.26
|
|
