|
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: 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 |
$2,351.25
|
| Rate for Payer: Cash Price |
$2,351.25
|
| Rate for Payer: Cash Price |
$2,351.25
|
| Rate for Payer: Cigna of CA HMO |
$3,344.00
|
| Rate for Payer: Cigna of CA PPO |
$3,866.50
|
| 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 |
$2,419.20
|
| 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 |
$2,351.25
|
| 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 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 |
$6,468.75
|
| 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 |
$6,468.75
|
| Rate for Payer: Cash Price |
$6,468.75
|
| 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
|
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 |
$885.60
|
| Rate for Payer: Cash Price |
$885.60
|
| 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 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 |
$885.60
|
| 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 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 |
$1,316.25
|
| 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
|
|
|
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 |
$1,316.25
|
| Rate for Payer: Cash Price |
$1,316.25
|
| 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 OPTISURE LDA210Q
|
Facility
|
OP
|
$7,363.00
|
|
|
Service Code
|
CPT C1777
|
| Hospital Charge Code |
906813730
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,472.60 |
| Max. Negotiated Rate |
$6,258.55 |
| Rate for Payer: Adventist Health Commercial |
$1,472.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,258.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,049.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,522.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,264.65
|
| Rate for Payer: Blue Shield of California Commercial |
$5,433.89
|
| Rate for Payer: Blue Shield of California EPN |
$3,578.42
|
| Rate for Payer: Cash Price |
$3,313.35
|
| Rate for Payer: Cigna of CA HMO |
$5,154.10
|
| Rate for Payer: Cigna of CA PPO |
$5,154.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,258.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,258.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,258.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,945.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,945.20
|
| Rate for Payer: Galaxy Health WC |
$6,258.55
|
| Rate for Payer: Global Benefits Group Commercial |
$4,417.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,911.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,557.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,767.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,154.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,154.10
|
| Rate for Payer: Multiplan Commercial |
$5,890.40
|
| Rate for Payer: Networks By Design Commercial |
$3,681.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,258.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,417.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,417.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,763.33
|
| Rate for Payer: United Healthcare All Other HMO |
$2,689.70
|
| Rate for Payer: United Healthcare HMO Rider |
$2,631.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,411.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,258.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,258.55
|
| Rate for Payer: Vantage Medical Group Senior |
$6,258.55
|
|
|
HC LEAD STJ OPTISURE LDA210Q
|
Facility
|
IP
|
$7,363.00
|
|
|
Service Code
|
CPT C1777
|
| Hospital Charge Code |
906813730
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,472.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Galaxy Health WC |
$6,258.55
|
| Rate for Payer: Adventist Health Commercial |
$1,472.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$3,313.35
|
| Rate for Payer: Cash Price |
$3,313.35
|
| Rate for Payer: Cigna of CA HMO |
$5,154.10
|
| Rate for Payer: Cigna of CA PPO |
$5,154.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,945.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,945.20
|
| Rate for Payer: Global Benefits Group Commercial |
$4,417.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,911.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,805.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,557.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,767.12
|
| Rate for Payer: Multiplan Commercial |
$5,890.40
|
| Rate for Payer: Networks By Design Commercial |
$3,681.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,258.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,763.33
|
| Rate for Payer: United Healthcare All Other HMO |
$2,689.70
|
| Rate for Payer: United Healthcare HMO Rider |
$2,631.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,411.38
|
|
|
HC LEAD STJ OPTISURE LDA220Q
|
Facility
|
IP
|
$7,363.00
|
|
|
Service Code
|
CPT C1895
|
| Hospital Charge Code |
906813780
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,472.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,472.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$3,313.35
|
| Rate for Payer: Cash Price |
$3,313.35
|
| Rate for Payer: Cigna of CA HMO |
$5,154.10
|
| Rate for Payer: Cigna of CA PPO |
$5,154.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,945.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,945.20
|
| Rate for Payer: Galaxy Health WC |
$6,258.55
|
| Rate for Payer: Global Benefits Group Commercial |
$4,417.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,911.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,805.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,557.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,767.12
|
| Rate for Payer: Multiplan Commercial |
$5,890.40
|
| Rate for Payer: Networks By Design Commercial |
$3,681.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,258.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,763.33
|
| Rate for Payer: United Healthcare All Other HMO |
$2,689.70
|
| Rate for Payer: United Healthcare HMO Rider |
$2,631.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,411.38
|
|
|
HC LEAD STJ OPTISURE LDA220Q
|
Facility
|
OP
|
$7,363.00
|
|
|
Service Code
|
CPT C1895
|
| Hospital Charge Code |
906813780
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,472.60 |
| Max. Negotiated Rate |
$6,258.55 |
| Rate for Payer: Adventist Health Commercial |
$1,472.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,258.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,049.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,522.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,264.65
|
| Rate for Payer: Blue Shield of California Commercial |
$5,433.89
|
| Rate for Payer: Blue Shield of California EPN |
$3,578.42
|
| Rate for Payer: Cash Price |
$3,313.35
|
| Rate for Payer: Cigna of CA HMO |
$5,154.10
|
| Rate for Payer: Cigna of CA PPO |
$5,154.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,258.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,258.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,258.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,945.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,945.20
|
| Rate for Payer: Galaxy Health WC |
$6,258.55
|
| Rate for Payer: Global Benefits Group Commercial |
$4,417.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,911.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,557.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,767.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,154.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,154.10
|
| Rate for Payer: Multiplan Commercial |
$5,890.40
|
| Rate for Payer: Networks By Design Commercial |
$3,681.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,258.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,417.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,417.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,763.33
|
| Rate for Payer: United Healthcare All Other HMO |
$2,689.70
|
| Rate for Payer: United Healthcare HMO Rider |
$2,631.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,411.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,258.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,258.55
|
| Rate for Payer: Vantage Medical Group Senior |
$6,258.55
|
|
|
HC LEAD STJ QUARTET 1457Q
|
Facility
|
IP
|
$9,500.00
|
|
|
Service Code
|
CPT C1900
|
| Hospital Charge Code |
906813820
|
|
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 |
$4,275.00
|
| Rate for Payer: Cash Price |
$4,275.00
|
| 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 STJ QUARTET 1457Q
|
Facility
|
OP
|
$9,500.00
|
|
|
Service Code
|
CPT C1900
|
| Hospital Charge Code |
906813820
|
|
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 |
$4,275.00
|
| 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 STJ QUICKFLEX 1156T
|
Facility
|
OP
|
$9,375.00
|
|
|
Service Code
|
CPT C1900
|
| Hospital Charge Code |
906813605
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,875.00 |
| Max. Negotiated Rate |
$7,968.75 |
| Rate for Payer: Adventist Health Commercial |
$1,875.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,968.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,156.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,031.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,430.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,918.75
|
| Rate for Payer: Blue Shield of California EPN |
$4,556.25
|
| Rate for Payer: Cash Price |
$4,218.75
|
| Rate for Payer: Cigna of CA HMO |
$6,562.50
|
| Rate for Payer: Cigna of CA PPO |
$6,562.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,968.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,968.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,968.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,750.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,750.00
|
| Rate for Payer: Galaxy Health WC |
$7,968.75
|
| Rate for Payer: Global Benefits Group Commercial |
$5,625.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,253.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,571.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,803.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,250.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,562.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,562.50
|
| Rate for Payer: Multiplan Commercial |
$7,500.00
|
| Rate for Payer: Networks By Design Commercial |
$4,687.50
|
| Rate for Payer: Prime Health Services Commercial |
$7,968.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,625.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,625.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,518.44
|
| Rate for Payer: United Healthcare All Other HMO |
$3,424.69
|
| Rate for Payer: United Healthcare HMO Rider |
$3,350.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,070.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,968.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,968.75
|
| Rate for Payer: Vantage Medical Group Senior |
$7,968.75
|
|
|
HC LEAD STJ QUICKFLEX 1156T
|
Facility
|
IP
|
$9,375.00
|
|
|
Service Code
|
CPT C1900
|
| Hospital Charge Code |
906813605
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,875.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,875.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$4,218.75
|
| Rate for Payer: Cash Price |
$4,218.75
|
| Rate for Payer: Cigna of CA HMO |
$6,562.50
|
| Rate for Payer: Cigna of CA PPO |
$6,562.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,750.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,750.00
|
| Rate for Payer: Galaxy Health WC |
$7,968.75
|
| Rate for Payer: Global Benefits Group Commercial |
$5,625.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,253.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,571.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,803.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,250.00
|
| Rate for Payer: Multiplan Commercial |
$7,500.00
|
| Rate for Payer: Networks By Design Commercial |
$4,687.50
|
| Rate for Payer: Prime Health Services Commercial |
$7,968.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,518.44
|
| Rate for Payer: United Healthcare All Other HMO |
$3,424.69
|
| Rate for Payer: United Healthcare HMO Rider |
$3,350.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,070.31
|
|
|
HC LEAD STJ QUICKFLEX 1258T
|
Facility
|
IP
|
$4,513.00
|
|
|
Service Code
|
CPT C1900
|
| Hospital Charge Code |
906813657
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$902.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$902.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$2,030.85
|
| Rate for Payer: Cash Price |
$2,030.85
|
| Rate for Payer: Cigna of CA HMO |
$3,159.10
|
| Rate for Payer: Cigna of CA PPO |
$3,159.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,805.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,805.20
|
| Rate for Payer: Galaxy Health WC |
$3,836.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,707.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,010.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,719.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,793.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,083.12
|
| Rate for Payer: Multiplan Commercial |
$3,610.40
|
| Rate for Payer: Networks By Design Commercial |
$2,256.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,836.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,693.73
|
| Rate for Payer: United Healthcare All Other HMO |
$1,648.60
|
| Rate for Payer: United Healthcare HMO Rider |
$1,612.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,478.01
|
|
|
HC LEAD STJ QUICKFLEX 1258T
|
Facility
|
OP
|
$4,513.00
|
|
|
Service Code
|
CPT C1900
|
| Hospital Charge Code |
906813657
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$902.60 |
| Max. Negotiated Rate |
$3,836.05 |
| Rate for Payer: Adventist Health Commercial |
$902.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,836.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,482.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,384.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,613.93
|
| Rate for Payer: Blue Shield of California Commercial |
$3,330.59
|
| Rate for Payer: Blue Shield of California EPN |
$2,193.32
|
| Rate for Payer: Cash Price |
$2,030.85
|
| Rate for Payer: Cigna of CA HMO |
$3,159.10
|
| Rate for Payer: Cigna of CA PPO |
$3,159.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,836.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,836.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,836.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,805.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,805.20
|
| Rate for Payer: Galaxy Health WC |
$3,836.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,707.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,010.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,719.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,793.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,083.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,159.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,159.10
|
| Rate for Payer: Multiplan Commercial |
$3,610.40
|
| Rate for Payer: Networks By Design Commercial |
$2,256.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,836.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,707.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,707.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,693.73
|
| Rate for Payer: United Healthcare All Other HMO |
$1,648.60
|
| Rate for Payer: United Healthcare HMO Rider |
$1,612.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,478.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,836.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,836.05
|
| Rate for Payer: Vantage Medical Group Senior |
$3,836.05
|
|
|
HC LEAD STJ TENDRIL 1882TC
|
Facility
|
IP
|
$1,969.00
|
|
|
Service Code
|
CPT C1898
|
| Hospital Charge Code |
906813732
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$393.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$393.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$886.05
|
| Rate for Payer: Cash Price |
$886.05
|
| Rate for Payer: Cigna of CA HMO |
$1,378.30
|
| Rate for Payer: Cigna of CA PPO |
$1,378.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$787.60
|
| Rate for Payer: EPIC Health Plan Senior |
$787.60
|
| Rate for Payer: Galaxy Health WC |
$1,673.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,181.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,313.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$750.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,218.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$472.56
|
| Rate for Payer: Multiplan Commercial |
$1,575.20
|
| Rate for Payer: Networks By Design Commercial |
$984.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,673.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$738.97
|
| Rate for Payer: United Healthcare All Other HMO |
$719.28
|
| Rate for Payer: United Healthcare HMO Rider |
$703.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$644.85
|
|
|
HC LEAD STJ TENDRIL 1882TC
|
Facility
|
OP
|
$1,969.00
|
|
|
Service Code
|
CPT C1898
|
| Hospital Charge Code |
906813732
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$393.80 |
| Max. Negotiated Rate |
$1,673.65 |
| Rate for Payer: Adventist Health Commercial |
$393.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,673.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,082.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,476.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,140.44
|
| Rate for Payer: Blue Shield of California Commercial |
$1,453.12
|
| Rate for Payer: Blue Shield of California EPN |
$956.93
|
| Rate for Payer: Cash Price |
$886.05
|
| Rate for Payer: Cigna of CA HMO |
$1,378.30
|
| Rate for Payer: Cigna of CA PPO |
$1,378.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,673.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,673.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,673.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$787.60
|
| Rate for Payer: EPIC Health Plan Senior |
$787.60
|
| Rate for Payer: Galaxy Health WC |
$1,673.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,181.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,313.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$750.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,218.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$472.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,378.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,378.30
|
| Rate for Payer: Multiplan Commercial |
$1,575.20
|
| Rate for Payer: Networks By Design Commercial |
$984.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,673.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,181.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,181.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$738.97
|
| Rate for Payer: United Healthcare All Other HMO |
$719.28
|
| Rate for Payer: United Healthcare HMO Rider |
$703.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$644.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,673.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,673.65
|
| Rate for Payer: Vantage Medical Group Senior |
$1,673.65
|
|
|
HC LEAD STJ TENDRIL LPA1200M
|
Facility
|
IP
|
$1,969.00
|
|
|
Service Code
|
CPT C1898
|
| Hospital Charge Code |
906813812
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$393.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$393.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$886.05
|
| Rate for Payer: Cash Price |
$886.05
|
| Rate for Payer: Cigna of CA HMO |
$1,378.30
|
| Rate for Payer: Cigna of CA PPO |
$1,378.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$787.60
|
| Rate for Payer: EPIC Health Plan Senior |
$787.60
|
| Rate for Payer: Galaxy Health WC |
$1,673.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,181.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,313.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$750.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,218.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$472.56
|
| Rate for Payer: Multiplan Commercial |
$1,575.20
|
| Rate for Payer: Networks By Design Commercial |
$984.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,673.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$738.97
|
| Rate for Payer: United Healthcare All Other HMO |
$719.28
|
| Rate for Payer: United Healthcare HMO Rider |
$703.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$644.85
|
|
|
HC LEAD STJ TENDRIL LPA1200M
|
Facility
|
OP
|
$1,969.00
|
|
|
Service Code
|
CPT C1898
|
| Hospital Charge Code |
906813812
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$393.80 |
| Max. Negotiated Rate |
$1,673.65 |
| Rate for Payer: Adventist Health Commercial |
$393.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,673.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,082.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,476.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,209.16
|
| Rate for Payer: Blue Shield of California Commercial |
$1,453.12
|
| Rate for Payer: Blue Shield of California EPN |
$956.93
|
| Rate for Payer: Cash Price |
$886.05
|
| Rate for Payer: Cigna of CA HMO |
$1,378.30
|
| Rate for Payer: Cigna of CA PPO |
$1,378.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,673.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,673.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,673.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$787.60
|
| Rate for Payer: EPIC Health Plan Senior |
$787.60
|
| Rate for Payer: Galaxy Health WC |
$1,673.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,181.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,313.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$750.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,218.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$472.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,378.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,378.30
|
| Rate for Payer: Multiplan Commercial |
$1,575.20
|
| Rate for Payer: Networks By Design Commercial |
$984.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,673.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,181.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,181.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$738.97
|
| Rate for Payer: United Healthcare All Other HMO |
$719.28
|
| Rate for Payer: United Healthcare HMO Rider |
$703.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$644.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,673.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,673.65
|
| Rate for Payer: Vantage Medical Group Senior |
$1,673.65
|
|
|
HC LEAD STJ TENDRIL SDX 1688TC
|
Facility
|
OP
|
$2,340.00
|
|
|
Service Code
|
CPT C1898
|
| Hospital Charge Code |
906813572
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$468.00 |
| Max. Negotiated Rate |
$1,989.00 |
| Rate for Payer: Adventist Health Commercial |
$468.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,989.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,287.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,755.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,436.99
|
| Rate for Payer: Blue Shield of California Commercial |
$1,726.92
|
| Rate for Payer: Blue Shield of California EPN |
$1,137.24
|
| Rate for Payer: Cash Price |
$1,053.00
|
| Rate for Payer: Cigna of CA HMO |
$1,638.00
|
| Rate for Payer: Cigna of CA PPO |
$1,638.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,989.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,989.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,989.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$936.00
|
| Rate for Payer: EPIC Health Plan Senior |
$936.00
|
| Rate for Payer: Galaxy Health WC |
$1,989.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,404.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,560.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$891.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,448.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$561.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,638.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,638.00
|
| Rate for Payer: Multiplan Commercial |
$1,872.00
|
| Rate for Payer: Networks By Design Commercial |
$1,170.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,989.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,404.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,404.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$878.20
|
| Rate for Payer: United Healthcare All Other HMO |
$854.80
|
| Rate for Payer: United Healthcare HMO Rider |
$836.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$766.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,989.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,989.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,989.00
|
|
|
HC LEAD STJ TENDRIL SDX 1688TC
|
Facility
|
IP
|
$2,340.00
|
|
|
Service Code
|
CPT C1898
|
| Hospital Charge Code |
906813572
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$468.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$468.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,053.00
|
| Rate for Payer: Cash Price |
$1,053.00
|
| Rate for Payer: Cigna of CA HMO |
$1,638.00
|
| Rate for Payer: Cigna of CA PPO |
$1,638.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$936.00
|
| Rate for Payer: EPIC Health Plan Senior |
$936.00
|
| Rate for Payer: Galaxy Health WC |
$1,989.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,404.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,560.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$891.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,448.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$561.60
|
| Rate for Payer: Multiplan Commercial |
$1,872.00
|
| Rate for Payer: Networks By Design Commercial |
$1,170.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,989.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$878.20
|
| Rate for Payer: United Healthcare All Other HMO |
$854.80
|
| Rate for Payer: United Healthcare HMO Rider |
$836.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$766.35
|
|
