|
HC LEAD MED STARFIX CS 4195
|
Facility
|
OP
|
$6,750.00
|
|
|
Service Code
|
CPT C1900
|
| Hospital Charge Code |
906813616
|
|
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 |
$3,712.50
|
| 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 QUARTET 1456Q
|
Facility
|
OP
|
$9,500.00
|
|
|
Service Code
|
CPT C1900
|
| Hospital Charge Code |
906813821
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,900.00 |
| Max. Negotiated Rate |
$8,075.00 |
| Rate for Payer: Adventist Health Commercial |
$1,900.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,075.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,225.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,125.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,502.40
|
| Rate for Payer: Blue Shield of California Commercial |
$7,011.00
|
| Rate for Payer: Blue Shield of California EPN |
$4,617.00
|
| Rate for Payer: Cash Price |
$5,225.00
|
| Rate for Payer: Cigna of CA HMO |
$6,650.00
|
| Rate for Payer: Cigna of CA PPO |
$6,650.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,075.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,075.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,075.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,800.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,800.00
|
| Rate for Payer: Galaxy Health WC |
$8,075.00
|
| Rate for Payer: Global Benefits Group Commercial |
$5,700.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,336.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,619.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,880.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,280.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,650.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,650.00
|
| Rate for Payer: Multiplan Commercial |
$7,600.00
|
| Rate for Payer: Networks By Design Commercial |
$4,750.00
|
| Rate for Payer: Prime Health Services Commercial |
$8,075.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,700.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,700.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,565.35
|
| Rate for Payer: United Healthcare All Other HMO |
$3,470.35
|
| Rate for Payer: United Healthcare HMO Rider |
$3,395.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,111.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,075.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,075.00
|
| Rate for Payer: Vantage Medical Group Senior |
$8,075.00
|
|
|
HC LEAD QUARTET 1456Q
|
Facility
|
IP
|
$9,500.00
|
|
|
Service Code
|
CPT C1900
|
| Hospital Charge Code |
906813821
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,900.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,900.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$5,225.00
|
| Rate for Payer: Cash Price |
$5,225.00
|
| Rate for Payer: Cigna of CA HMO |
$6,650.00
|
| Rate for Payer: Cigna of CA PPO |
$6,650.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,800.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,800.00
|
| Rate for Payer: Galaxy Health WC |
$8,075.00
|
| Rate for Payer: Global Benefits Group Commercial |
$5,700.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,336.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,619.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,880.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,280.00
|
| Rate for Payer: Multiplan Commercial |
$7,600.00
|
| Rate for Payer: Networks By Design Commercial |
$4,750.00
|
| Rate for Payer: Prime Health Services Commercial |
$8,075.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,565.35
|
| Rate for Payer: United Healthcare All Other HMO |
$3,470.35
|
| Rate for Payer: United Healthcare HMO Rider |
$3,395.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,111.25
|
|
|
HC LEAD REPAIR DUAL A & V
|
Facility
|
IP
|
$12,940.00
|
|
|
Service Code
|
CPT 33220
|
| Hospital Charge Code |
906811361
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,588.00 |
| Max. Negotiated Rate |
$10,999.00 |
| Rate for Payer: Adventist Health Commercial |
$2,588.00
|
| Rate for Payer: Cash Price |
$7,117.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,176.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,176.00
|
| Rate for Payer: Galaxy Health WC |
$10,999.00
|
| Rate for Payer: Global Benefits Group Commercial |
$7,764.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,630.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,930.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,009.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,105.60
|
| Rate for Payer: Multiplan Commercial |
$10,352.00
|
| Rate for Payer: Networks By Design Commercial |
$8,411.00
|
| Rate for Payer: Prime Health Services Commercial |
$10,999.00
|
|
|
HC LEAD REPAIR DUAL A & V
|
Facility
|
IP
|
$12,576.00
|
|
|
Service Code
|
CPT 33220
|
| Hospital Charge Code |
906820118
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,515.20 |
| Max. Negotiated Rate |
$10,689.60 |
| Rate for Payer: Adventist Health Commercial |
$2,515.20
|
| Rate for Payer: Cash Price |
$6,916.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,030.40
|
| Rate for Payer: EPIC Health Plan Senior |
$5,030.40
|
| Rate for Payer: Galaxy Health WC |
$10,689.60
|
| Rate for Payer: Global Benefits Group Commercial |
$7,545.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,388.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,791.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,784.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,018.24
|
| Rate for Payer: Multiplan Commercial |
$10,060.80
|
| Rate for Payer: Networks By Design Commercial |
$8,174.40
|
| Rate for Payer: Prime Health Services Commercial |
$10,689.60
|
|
|
HC LEAD REPAIR DUAL A & V
|
Facility
|
OP
|
$12,940.00
|
|
|
Service Code
|
CPT 33220
|
| Hospital Charge Code |
906811361
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$495.99 |
| Max. Negotiated Rate |
$20,902.00 |
| Rate for Payer: Adventist Health Commercial |
$2,588.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,936.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,086.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,624.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$7,415.66
|
| Rate for Payer: Cash Price |
$7,117.00
|
| Rate for Payer: Cash Price |
$7,117.00
|
| Rate for Payer: Cash Price |
$7,117.00
|
| Rate for Payer: Cigna of CA HMO |
$8,281.60
|
| Rate for Payer: Cigna of CA PPO |
$9,575.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,936.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,086.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,624.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,242.52
|
| Rate for Payer: EPIC Health Plan Senior |
$4,624.09
|
| Rate for Payer: Galaxy Health WC |
$10,999.00
|
| Rate for Payer: Global Benefits Group Commercial |
$7,764.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,583.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$495.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,624.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,630.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$560.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,624.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,105.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,826.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,196.28
|
| Rate for Payer: Multiplan Commercial |
$10,352.00
|
| Rate for Payer: Multiplan WC |
$7,367.67
|
| Rate for Payer: Networks By Design Commercial |
$8,411.00
|
| Rate for Payer: Prime Health Services Commercial |
$10,999.00
|
| Rate for Payer: Prime Health Services WC |
$7,292.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,764.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,624.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,936.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,086.50
|
| Rate for Payer: Vantage Medical Group Senior |
$4,624.09
|
|
|
HC LEAD REPAIR DUAL A & V
|
Facility
|
OP
|
$12,576.00
|
|
|
Service Code
|
CPT 33220
|
| Hospital Charge Code |
906820118
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$495.99 |
| Max. Negotiated Rate |
$20,902.00 |
| Rate for Payer: Adventist Health Commercial |
$2,515.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,936.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,086.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,624.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$7,415.66
|
| Rate for Payer: Cash Price |
$6,916.80
|
| Rate for Payer: Cash Price |
$6,916.80
|
| Rate for Payer: Cash Price |
$6,916.80
|
| Rate for Payer: Cigna of CA HMO |
$8,048.64
|
| Rate for Payer: Cigna of CA PPO |
$9,306.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,936.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,086.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,624.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,242.52
|
| Rate for Payer: EPIC Health Plan Senior |
$4,624.09
|
| Rate for Payer: Galaxy Health WC |
$10,689.60
|
| Rate for Payer: Global Benefits Group Commercial |
$7,545.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,583.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$495.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,624.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,388.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$560.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,624.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,018.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,826.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,196.28
|
| Rate for Payer: Multiplan Commercial |
$10,060.80
|
| Rate for Payer: Multiplan WC |
$7,367.67
|
| Rate for Payer: Networks By Design Commercial |
$8,174.40
|
| Rate for Payer: Prime Health Services Commercial |
$10,689.60
|
| Rate for Payer: Prime Health Services WC |
$7,292.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,545.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,624.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,936.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,086.50
|
| Rate for Payer: Vantage Medical Group Senior |
$4,624.09
|
|
|
HC LEAD REPAIR SINGLE A OR V
|
Facility
|
IP
|
$12,576.00
|
|
|
Service Code
|
CPT 33218
|
| Hospital Charge Code |
906820113
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,515.20 |
| Max. Negotiated Rate |
$10,689.60 |
| Rate for Payer: Adventist Health Commercial |
$2,515.20
|
| Rate for Payer: Cash Price |
$6,916.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,030.40
|
| Rate for Payer: EPIC Health Plan Senior |
$5,030.40
|
| Rate for Payer: Galaxy Health WC |
$10,689.60
|
| Rate for Payer: Global Benefits Group Commercial |
$7,545.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,388.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,791.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,784.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,018.24
|
| Rate for Payer: Multiplan Commercial |
$10,060.80
|
| Rate for Payer: Networks By Design Commercial |
$8,174.40
|
| Rate for Payer: Prime Health Services Commercial |
$10,689.60
|
|
|
HC LEAD REPAIR SINGLE A OR V
|
Facility
|
IP
|
$12,940.00
|
|
|
Service Code
|
CPT 33218
|
| Hospital Charge Code |
906811355
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,588.00 |
| Max. Negotiated Rate |
$10,999.00 |
| Rate for Payer: Adventist Health Commercial |
$2,588.00
|
| Rate for Payer: Cash Price |
$7,117.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,176.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,176.00
|
| Rate for Payer: Galaxy Health WC |
$10,999.00
|
| Rate for Payer: Global Benefits Group Commercial |
$7,764.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,630.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,930.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,009.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,105.60
|
| Rate for Payer: Multiplan Commercial |
$10,352.00
|
| Rate for Payer: Networks By Design Commercial |
$8,411.00
|
| Rate for Payer: Prime Health Services Commercial |
$10,999.00
|
|
|
HC LEAD REPAIR SINGLE A OR V
|
Facility
|
OP
|
$12,940.00
|
|
|
Service Code
|
CPT 33218
|
| Hospital Charge Code |
906811355
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$354.01 |
| Max. Negotiated Rate |
$20,902.00 |
| Rate for Payer: Adventist Health Commercial |
$2,588.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,936.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,086.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,624.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$7,415.66
|
| Rate for Payer: Cash Price |
$7,117.00
|
| Rate for Payer: Cash Price |
$7,117.00
|
| Rate for Payer: Cash Price |
$7,117.00
|
| Rate for Payer: Cigna of CA HMO |
$8,281.60
|
| Rate for Payer: Cigna of CA PPO |
$9,575.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,936.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,086.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,624.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,242.52
|
| Rate for Payer: EPIC Health Plan Senior |
$4,624.09
|
| Rate for Payer: Galaxy Health WC |
$10,999.00
|
| Rate for Payer: Global Benefits Group Commercial |
$7,764.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,583.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$354.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,624.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,630.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$400.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,624.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,105.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,826.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,196.28
|
| Rate for Payer: Multiplan Commercial |
$10,352.00
|
| Rate for Payer: Multiplan WC |
$7,367.67
|
| Rate for Payer: Networks By Design Commercial |
$8,411.00
|
| Rate for Payer: Prime Health Services Commercial |
$10,999.00
|
| Rate for Payer: Prime Health Services WC |
$7,292.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,764.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,624.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,936.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,086.50
|
| Rate for Payer: Vantage Medical Group Senior |
$4,624.09
|
|
|
HC LEAD REPAIR SINGLE A OR V
|
Facility
|
OP
|
$12,576.00
|
|
|
Service Code
|
CPT 33218
|
| Hospital Charge Code |
906820113
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$354.01 |
| Max. Negotiated Rate |
$20,902.00 |
| Rate for Payer: Adventist Health Commercial |
$2,515.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,936.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,086.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,624.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$7,415.66
|
| Rate for Payer: Cash Price |
$6,916.80
|
| Rate for Payer: Cash Price |
$6,916.80
|
| Rate for Payer: Cash Price |
$6,916.80
|
| Rate for Payer: Cigna of CA HMO |
$8,048.64
|
| Rate for Payer: Cigna of CA PPO |
$9,306.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,936.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,086.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,624.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,242.52
|
| Rate for Payer: EPIC Health Plan Senior |
$4,624.09
|
| Rate for Payer: Galaxy Health WC |
$10,689.60
|
| Rate for Payer: Global Benefits Group Commercial |
$7,545.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,583.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$354.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,624.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,388.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$400.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,624.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,018.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,826.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,196.28
|
| Rate for Payer: Multiplan Commercial |
$10,060.80
|
| Rate for Payer: Multiplan WC |
$7,367.67
|
| Rate for Payer: Networks By Design Commercial |
$8,174.40
|
| Rate for Payer: Prime Health Services Commercial |
$10,689.60
|
| Rate for Payer: Prime Health Services WC |
$7,292.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,545.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,624.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,936.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,086.50
|
| Rate for Payer: Vantage Medical Group Senior |
$4,624.09
|
|
|
HC LEAD REPOSITION A OR V
|
Facility
|
OP
|
$4,964.00
|
|
|
Service Code
|
CPT 33215
|
| Hospital Charge Code |
906820134
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$50.67 |
| Max. Negotiated Rate |
$20,902.00 |
| Rate for Payer: Adventist Health Commercial |
$992.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$7,415.66
|
| Rate for Payer: Cash Price |
$2,730.20
|
| Rate for Payer: Cash Price |
$2,730.20
|
| Rate for Payer: Cash Price |
$2,730.20
|
| Rate for Payer: Cigna of CA HMO |
$3,176.96
|
| Rate for Payer: Cigna of CA PPO |
$3,673.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,398.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3,999.21
|
| Rate for Payer: Galaxy Health WC |
$4,219.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2,978.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$50.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,310.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,191.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,039.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,358.94
|
| Rate for Payer: Multiplan Commercial |
$3,971.20
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: Networks By Design Commercial |
$3,226.60
|
| Rate for Payer: Prime Health Services Commercial |
$4,219.40
|
| Rate for Payer: Prime Health Services WC |
$6,307.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,978.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,999.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC LEAD REPOSITION A OR V
|
Facility
|
IP
|
$5,107.00
|
|
|
Service Code
|
CPT 33215
|
| Hospital Charge Code |
906812213
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,021.40 |
| Max. Negotiated Rate |
$4,340.95 |
| Rate for Payer: Adventist Health Commercial |
$1,021.40
|
| Rate for Payer: Cash Price |
$2,808.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,042.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,042.80
|
| Rate for Payer: Galaxy Health WC |
$4,340.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,064.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,406.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,945.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,161.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,225.68
|
| Rate for Payer: Multiplan Commercial |
$4,085.60
|
| Rate for Payer: Networks By Design Commercial |
$3,319.55
|
| Rate for Payer: Prime Health Services Commercial |
$4,340.95
|
|
|
HC LEAD REPOSITION A OR V
|
Facility
|
IP
|
$4,964.00
|
|
|
Service Code
|
CPT 33215
|
| Hospital Charge Code |
906820134
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$992.80 |
| Max. Negotiated Rate |
$4,219.40 |
| Rate for Payer: Adventist Health Commercial |
$992.80
|
| Rate for Payer: Cash Price |
$2,730.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,985.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,985.60
|
| Rate for Payer: Galaxy Health WC |
$4,219.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2,978.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,310.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,891.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,072.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,191.36
|
| Rate for Payer: Multiplan Commercial |
$3,971.20
|
| Rate for Payer: Networks By Design Commercial |
$3,226.60
|
| Rate for Payer: Prime Health Services Commercial |
$4,219.40
|
|
|
HC LEAD REPOSITION A OR V
|
Facility
|
OP
|
$5,107.00
|
|
|
Service Code
|
CPT 33215
|
| Hospital Charge Code |
906812213
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$50.67 |
| Max. Negotiated Rate |
$20,902.00 |
| Rate for Payer: Adventist Health Commercial |
$1,021.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$7,415.66
|
| Rate for Payer: Cash Price |
$2,808.85
|
| Rate for Payer: Cash Price |
$2,808.85
|
| Rate for Payer: Cash Price |
$2,808.85
|
| Rate for Payer: Cigna of CA HMO |
$3,268.48
|
| Rate for Payer: Cigna of CA PPO |
$3,779.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,398.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3,999.21
|
| Rate for Payer: Galaxy Health WC |
$4,340.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,064.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$50.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,406.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,225.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,039.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,358.94
|
| Rate for Payer: Multiplan Commercial |
$4,085.60
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: Networks By Design Commercial |
$3,319.55
|
| Rate for Payer: Prime Health Services Commercial |
$4,340.95
|
| Rate for Payer: Prime Health Services WC |
$6,307.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,064.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,999.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC LEAD REPOSITION CS
|
Facility
|
OP
|
$5,225.00
|
|
|
Service Code
|
CPT 33226
|
| Hospital Charge Code |
906820137
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$451.58 |
| Max. Negotiated Rate |
$20,902.00 |
| Rate for Payer: Cigna of CA PPO |
$3,866.50
|
| Rate for Payer: Adventist Health Commercial |
$1,045.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,712.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,822.94
|
| Rate for Payer: Cash Price |
$2,873.75
|
| Rate for Payer: Cash Price |
$2,873.75
|
| Rate for Payer: Cash Price |
$2,873.75
|
| Rate for Payer: Cigna of CA HMO |
$3,344.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,398.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3,999.21
|
| Rate for Payer: Galaxy Health WC |
$4,441.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,135.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$451.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,485.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$510.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,254.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,039.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,358.94
|
| Rate for Payer: Multiplan Commercial |
$4,180.00
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: Networks By Design Commercial |
$3,396.25
|
| Rate for Payer: Prime Health Services Commercial |
$4,441.25
|
| Rate for Payer: Prime Health Services WC |
$6,307.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,135.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,999.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC LEAD REPOSITION CS
|
Facility
|
IP
|
$5,376.00
|
|
|
Service Code
|
CPT 33226
|
| Hospital Charge Code |
906812216
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,075.20 |
| Max. Negotiated Rate |
$4,569.60 |
| Rate for Payer: Adventist Health Commercial |
$1,075.20
|
| Rate for Payer: Cash Price |
$2,956.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,150.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,150.40
|
| Rate for Payer: Galaxy Health WC |
$4,569.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,225.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,585.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,048.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,327.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,290.24
|
| Rate for Payer: Multiplan Commercial |
$4,300.80
|
| Rate for Payer: Networks By Design Commercial |
$3,494.40
|
| Rate for Payer: Prime Health Services Commercial |
$4,569.60
|
|
|
HC LEAD REPOSITION CS
|
Facility
|
IP
|
$5,225.00
|
|
|
Service Code
|
CPT 33226
|
| Hospital Charge Code |
906820137
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,045.00 |
| Max. Negotiated Rate |
$4,441.25 |
| Rate for Payer: Adventist Health Commercial |
$1,045.00
|
| Rate for Payer: Cash Price |
$2,873.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,090.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,090.00
|
| Rate for Payer: Galaxy Health WC |
$4,441.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,135.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,485.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,990.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,234.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,254.00
|
| Rate for Payer: Multiplan Commercial |
$4,180.00
|
| Rate for Payer: Networks By Design Commercial |
$3,396.25
|
| Rate for Payer: Prime Health Services Commercial |
$4,441.25
|
|
|
HC LEAD REPOSITION CS
|
Facility
|
OP
|
$5,376.00
|
|
|
Service Code
|
CPT 33226
|
| Hospital Charge Code |
906812216
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$451.58 |
| Max. Negotiated Rate |
$20,902.00 |
| Rate for Payer: Adventist Health Commercial |
$1,075.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,712.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,822.94
|
| Rate for Payer: Cash Price |
$2,956.80
|
| Rate for Payer: Cash Price |
$2,956.80
|
| Rate for Payer: Cash Price |
$2,956.80
|
| Rate for Payer: Cigna of CA HMO |
$3,440.64
|
| Rate for Payer: Cigna of CA PPO |
$3,978.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,398.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3,999.21
|
| Rate for Payer: Galaxy Health WC |
$4,569.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,225.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$451.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,585.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$510.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,290.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,039.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,358.94
|
| Rate for Payer: Multiplan Commercial |
$4,300.80
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: Networks By Design Commercial |
$3,494.40
|
| Rate for Payer: Prime Health Services Commercial |
$4,569.60
|
| Rate for Payer: Prime Health Services WC |
$6,307.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,225.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,999.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC LEAD STJ DURATA 7120
|
Facility
|
OP
|
$14,375.00
|
|
|
Service Code
|
CPT C1895
|
| Hospital Charge Code |
906813604
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,875.00 |
| Max. Negotiated Rate |
$12,218.75 |
| Rate for Payer: Adventist Health Commercial |
$2,875.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,218.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,906.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,781.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,326.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,608.75
|
| Rate for Payer: Blue Shield of California EPN |
$6,986.25
|
| Rate for Payer: Cash Price |
$7,906.25
|
| Rate for Payer: Cigna of CA HMO |
$10,062.50
|
| Rate for Payer: Cigna of CA PPO |
$10,062.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,218.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$12,218.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12,218.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,750.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,750.00
|
| Rate for Payer: Galaxy Health WC |
$12,218.75
|
| Rate for Payer: Global Benefits Group Commercial |
$8,625.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,588.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,898.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,450.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,062.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,062.50
|
| Rate for Payer: Multiplan Commercial |
$11,500.00
|
| Rate for Payer: Networks By Design Commercial |
$7,187.50
|
| Rate for Payer: Prime Health Services Commercial |
$12,218.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,625.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8,625.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,394.94
|
| Rate for Payer: United Healthcare All Other HMO |
$5,251.19
|
| Rate for Payer: United Healthcare HMO Rider |
$5,137.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,707.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,218.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12,218.75
|
| Rate for Payer: Vantage Medical Group Senior |
$12,218.75
|
|
|
HC LEAD STJ DURATA 7120
|
Facility
|
IP
|
$14,375.00
|
|
|
Service Code
|
CPT C1895
|
| Hospital Charge Code |
906813604
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,875.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$2,875.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$7,906.25
|
| Rate for Payer: Cash Price |
$7,906.25
|
| Rate for Payer: Cigna of CA HMO |
$10,062.50
|
| Rate for Payer: Cigna of CA PPO |
$10,062.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,750.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,750.00
|
| Rate for Payer: Galaxy Health WC |
$12,218.75
|
| Rate for Payer: Global Benefits Group Commercial |
$8,625.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,588.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,476.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,898.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,450.00
|
| Rate for Payer: Multiplan Commercial |
$11,500.00
|
| Rate for Payer: Networks By Design Commercial |
$7,187.50
|
| Rate for Payer: Prime Health Services Commercial |
$12,218.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,394.94
|
| Rate for Payer: United Healthcare All Other HMO |
$5,251.19
|
| Rate for Payer: United Healthcare HMO Rider |
$5,137.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,707.81
|
|
|
HC LEAD STJ GREATBATCH 511212
|
Facility
|
OP
|
$1,968.00
|
|
|
Service Code
|
CPT C1883
|
| Hospital Charge Code |
906813764
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$393.60 |
| Max. Negotiated Rate |
$1,672.80 |
| Rate for Payer: Adventist Health Commercial |
$393.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,672.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,082.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,476.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,139.87
|
| Rate for Payer: Blue Shield of California Commercial |
$1,452.38
|
| Rate for Payer: Blue Shield of California EPN |
$956.45
|
| Rate for Payer: Cash Price |
$1,082.40
|
| Rate for Payer: Cigna of CA HMO |
$1,377.60
|
| Rate for Payer: Cigna of CA PPO |
$1,377.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,672.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,672.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,672.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$787.20
|
| Rate for Payer: EPIC Health Plan Senior |
$787.20
|
| Rate for Payer: Galaxy Health WC |
$1,672.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,180.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,312.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$749.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,218.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$472.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,377.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,377.60
|
| Rate for Payer: Multiplan Commercial |
$1,574.40
|
| Rate for Payer: Networks By Design Commercial |
$984.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,672.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,180.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,180.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$738.59
|
| Rate for Payer: United Healthcare All Other HMO |
$718.91
|
| Rate for Payer: United Healthcare HMO Rider |
$703.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$644.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,672.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,672.80
|
| Rate for Payer: Vantage Medical Group Senior |
$1,672.80
|
|
|
HC LEAD STJ GREATBATCH 511212
|
Facility
|
IP
|
$1,968.00
|
|
|
Service Code
|
CPT C1883
|
| Hospital Charge Code |
906813764
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$393.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$393.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,082.40
|
| Rate for Payer: Cash Price |
$1,082.40
|
| Rate for Payer: Cigna of CA HMO |
$1,377.60
|
| Rate for Payer: Cigna of CA PPO |
$1,377.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$787.20
|
| Rate for Payer: EPIC Health Plan Senior |
$787.20
|
| Rate for Payer: Galaxy Health WC |
$1,672.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,180.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,312.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$749.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,218.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$472.32
|
| Rate for Payer: Multiplan Commercial |
$1,574.40
|
| Rate for Payer: Networks By Design Commercial |
$984.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,672.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$738.59
|
| Rate for Payer: United Healthcare All Other HMO |
$718.91
|
| Rate for Payer: United Healthcare HMO Rider |
$703.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$644.52
|
|
|
HC LEAD STJ OPTISENSE 1699TC
|
Facility
|
IP
|
$2,925.00
|
|
|
Service Code
|
CPT C1898
|
| Hospital Charge Code |
906813595
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$585.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$585.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,608.75
|
| Rate for Payer: Cash Price |
$1,608.75
|
| Rate for Payer: Cigna of CA HMO |
$2,047.50
|
| Rate for Payer: Cigna of CA PPO |
$2,047.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,170.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,170.00
|
| Rate for Payer: Galaxy Health WC |
$2,486.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,755.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,950.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,114.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,810.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$702.00
|
| Rate for Payer: Multiplan Commercial |
$2,340.00
|
| Rate for Payer: Networks By Design Commercial |
$1,462.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,486.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,097.75
|
| Rate for Payer: United Healthcare All Other HMO |
$1,068.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,045.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$957.94
|
|
|
HC LEAD STJ OPTISENSE 1699TC
|
Facility
|
OP
|
$2,925.00
|
|
|
Service Code
|
CPT C1898
|
| Hospital Charge Code |
906813595
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$585.00 |
| Max. Negotiated Rate |
$2,486.25 |
| Rate for Payer: Adventist Health Commercial |
$585.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,486.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,608.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,193.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,796.24
|
| Rate for Payer: Blue Shield of California Commercial |
$2,158.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,421.55
|
| Rate for Payer: Cash Price |
$1,608.75
|
| Rate for Payer: Cigna of CA HMO |
$2,047.50
|
| Rate for Payer: Cigna of CA PPO |
$2,047.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,486.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,486.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,486.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,170.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,170.00
|
| Rate for Payer: Galaxy Health WC |
$2,486.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,755.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,950.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,114.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,810.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$702.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,047.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,047.50
|
| Rate for Payer: Multiplan Commercial |
$2,340.00
|
| Rate for Payer: Networks By Design Commercial |
$1,462.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,486.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,755.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,755.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,097.75
|
| Rate for Payer: United Healthcare All Other HMO |
$1,068.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,045.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$957.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,486.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,486.25
|
| Rate for Payer: Vantage Medical Group Senior |
$2,486.25
|
|
