|
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 |
$4,049.65
|
| Rate for Payer: Cigna of CA HMO |
$5,154.10
|
| Rate for Payer: Cigna of CA PPO |
$5,154.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,258.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,258.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,258.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,945.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,945.20
|
| Rate for Payer: Galaxy Health WC |
$6,258.55
|
| Rate for Payer: Global Benefits Group Commercial |
$4,417.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,911.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,557.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,767.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,154.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,154.10
|
| Rate for Payer: Multiplan Commercial |
$5,890.40
|
| Rate for Payer: Networks By Design Commercial |
$3,681.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,258.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,417.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,417.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,763.33
|
| Rate for Payer: United Healthcare All Other HMO |
$2,689.70
|
| Rate for Payer: United Healthcare HMO Rider |
$2,631.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,411.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,258.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,258.55
|
| Rate for Payer: Vantage Medical Group Senior |
$6,258.55
|
|
|
HC LEAD 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: Adventist Health Commercial |
$1,472.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$4,049.65
|
| Rate for Payer: Cash Price |
$4,049.65
|
| Rate for Payer: Cigna of CA HMO |
$5,154.10
|
| Rate for Payer: Cigna of CA PPO |
$5,154.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,945.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,945.20
|
| Rate for Payer: Galaxy Health WC |
$6,258.55
|
| Rate for Payer: Global Benefits Group Commercial |
$4,417.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,911.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,805.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,557.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,767.12
|
| Rate for Payer: Multiplan Commercial |
$5,890.40
|
| Rate for Payer: Networks By Design Commercial |
$3,681.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,258.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,763.33
|
| Rate for Payer: United Healthcare All Other HMO |
$2,689.70
|
| Rate for Payer: United Healthcare HMO Rider |
$2,631.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,411.38
|
|
|
HC LEAD 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 |
$4,049.65
|
| Rate for Payer: Cash Price |
$4,049.65
|
| Rate for Payer: Cigna of CA HMO |
$5,154.10
|
| Rate for Payer: Cigna of CA PPO |
$5,154.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,945.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,945.20
|
| Rate for Payer: Galaxy Health WC |
$6,258.55
|
| Rate for Payer: Global Benefits Group Commercial |
$4,417.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,911.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,805.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,557.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,767.12
|
| Rate for Payer: Multiplan Commercial |
$5,890.40
|
| Rate for Payer: Networks By Design Commercial |
$3,681.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,258.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,763.33
|
| Rate for Payer: United Healthcare All Other HMO |
$2,689.70
|
| Rate for Payer: United Healthcare HMO Rider |
$2,631.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,411.38
|
|
|
HC LEAD 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 |
$4,049.65
|
| Rate for Payer: Cigna of CA HMO |
$5,154.10
|
| Rate for Payer: Cigna of CA PPO |
$5,154.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,258.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,258.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,258.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,945.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,945.20
|
| Rate for Payer: Galaxy Health WC |
$6,258.55
|
| Rate for Payer: Global Benefits Group Commercial |
$4,417.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,911.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,557.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,767.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,154.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,154.10
|
| Rate for Payer: Multiplan Commercial |
$5,890.40
|
| Rate for Payer: Networks By Design Commercial |
$3,681.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,258.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,417.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,417.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,763.33
|
| Rate for Payer: United Healthcare All Other HMO |
$2,689.70
|
| Rate for Payer: United Healthcare HMO Rider |
$2,631.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,411.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,258.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,258.55
|
| Rate for Payer: Vantage Medical Group Senior |
$6,258.55
|
|
|
HC LEAD 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 |
$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 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 |
$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 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 |
$5,156.25
|
| Rate for Payer: Cash Price |
$5,156.25
|
| 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 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 |
$5,156.25
|
| 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 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 |
$2,482.15
|
| Rate for Payer: Cash Price |
$2,482.15
|
| 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 |
$2,482.15
|
| 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 |
$1,082.95
|
| Rate for Payer: Cash Price |
$1,082.95
|
| 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 |
$1,082.95
|
| 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
|
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 |
$1,082.95
|
| 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 |
$1,082.95
|
| Rate for Payer: Cash Price |
$1,082.95
|
| 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 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 |
$1,287.00
|
| Rate for Payer: Cash Price |
$1,287.00
|
| 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
|
|
|
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 |
$1,287.00
|
| 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 ST 1788TC
|
Facility
|
OP
|
$2,535.00
|
|
|
Service Code
|
CPT C1898
|
| Hospital Charge Code |
906813592
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$507.00 |
| Max. Negotiated Rate |
$2,154.75 |
| Rate for Payer: Adventist Health Commercial |
$507.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,154.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,394.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,901.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,556.74
|
| Rate for Payer: Blue Shield of California Commercial |
$1,870.83
|
| Rate for Payer: Blue Shield of California EPN |
$1,232.01
|
| Rate for Payer: Cash Price |
$1,394.25
|
| Rate for Payer: Cigna of CA HMO |
$1,774.50
|
| Rate for Payer: Cigna of CA PPO |
$1,774.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,154.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,154.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,154.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,014.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,014.00
|
| Rate for Payer: Galaxy Health WC |
$2,154.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,521.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,690.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$965.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,569.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$608.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,774.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,774.50
|
| Rate for Payer: Multiplan Commercial |
$2,028.00
|
| Rate for Payer: Networks By Design Commercial |
$1,267.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,154.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,521.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,521.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$951.39
|
| Rate for Payer: United Healthcare All Other HMO |
$926.04
|
| Rate for Payer: United Healthcare HMO Rider |
$906.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$830.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,154.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,154.75
|
| Rate for Payer: Vantage Medical Group Senior |
$2,154.75
|
|
|
HC LEAD STJ TENDRIL ST 1788TC
|
Facility
|
IP
|
$2,535.00
|
|
|
Service Code
|
CPT C1898
|
| Hospital Charge Code |
906813592
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$507.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Galaxy Health WC |
$2,154.75
|
| Rate for Payer: Adventist Health Commercial |
$507.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,394.25
|
| Rate for Payer: Cash Price |
$1,394.25
|
| Rate for Payer: Cigna of CA HMO |
$1,774.50
|
| Rate for Payer: Cigna of CA PPO |
$1,774.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,014.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,014.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,521.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,690.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$965.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,569.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$608.40
|
| Rate for Payer: Multiplan Commercial |
$2,028.00
|
| Rate for Payer: Networks By Design Commercial |
$1,267.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,154.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$951.39
|
| Rate for Payer: United Healthcare All Other HMO |
$926.04
|
| Rate for Payer: United Healthcare HMO Rider |
$906.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$830.21
|
|
|
HC LEATHER KAFO-AFO PORX
|
Facility
|
IP
|
$249.00
|
|
|
Service Code
|
CPT L4100
|
| Hospital Charge Code |
905354100
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$49.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$49.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$136.95
|
| Rate for Payer: Cash Price |
$136.95
|
| Rate for Payer: Cigna of CA HMO |
$174.30
|
| Rate for Payer: Cigna of CA PPO |
$174.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.60
|
| Rate for Payer: EPIC Health Plan Senior |
$99.60
|
| Rate for Payer: Galaxy Health WC |
$211.65
|
| Rate for Payer: Global Benefits Group Commercial |
$149.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$166.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$94.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$154.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.76
|
| Rate for Payer: Multiplan Commercial |
$199.20
|
| Rate for Payer: Networks By Design Commercial |
$124.50
|
| Rate for Payer: Prime Health Services Commercial |
$211.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$93.45
|
| Rate for Payer: United Healthcare All Other HMO |
$90.96
|
| Rate for Payer: United Healthcare HMO Rider |
$88.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$81.55
|
|
|
HC LEATHER KAFO-AFO PORX
|
Facility
|
OP
|
$249.00
|
|
|
Service Code
|
CPT L4100
|
| Hospital Charge Code |
905354100
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$59.76 |
| Max. Negotiated Rate |
$211.65 |
| Rate for Payer: Adventist Health Commercial |
$102.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$211.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$136.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$186.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$144.22
|
| Rate for Payer: Blue Shield of California Commercial |
$183.76
|
| Rate for Payer: Blue Shield of California EPN |
$121.01
|
| Rate for Payer: Cash Price |
$136.95
|
| Rate for Payer: Cash Price |
$136.95
|
| Rate for Payer: Cigna of CA HMO |
$174.30
|
| Rate for Payer: Cigna of CA PPO |
$174.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$211.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$211.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$211.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.60
|
| Rate for Payer: EPIC Health Plan Senior |
$99.60
|
| Rate for Payer: Galaxy Health WC |
$211.65
|
| Rate for Payer: Global Benefits Group Commercial |
$149.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$97.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$166.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$110.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$154.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$174.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$174.30
|
| Rate for Payer: Multiplan Commercial |
$199.20
|
| Rate for Payer: Networks By Design Commercial |
$124.50
|
| Rate for Payer: Prime Health Services Commercial |
$211.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$149.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$149.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$93.45
|
| Rate for Payer: United Healthcare All Other HMO |
$90.96
|
| Rate for Payer: United Healthcare HMO Rider |
$88.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$81.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$211.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$211.65
|
| Rate for Payer: Vantage Medical Group Senior |
$211.65
|
|
|
HC LEATHER KAFO-AFO PORX
|
Facility
|
OP
|
$249.00
|
|
|
Service Code
|
CPT L4100
|
| Hospital Charge Code |
915354100
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$59.76 |
| Max. Negotiated Rate |
$211.65 |
| Rate for Payer: Adventist Health Commercial |
$102.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$211.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$136.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$186.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$144.22
|
| Rate for Payer: Blue Shield of California Commercial |
$183.76
|
| Rate for Payer: Blue Shield of California EPN |
$121.01
|
| Rate for Payer: Cash Price |
$136.95
|
| Rate for Payer: Cash Price |
$136.95
|
| Rate for Payer: Cigna of CA HMO |
$174.30
|
| Rate for Payer: Cigna of CA PPO |
$174.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$211.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$211.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$211.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.60
|
| Rate for Payer: EPIC Health Plan Senior |
$99.60
|
| Rate for Payer: Galaxy Health WC |
$211.65
|
| Rate for Payer: Global Benefits Group Commercial |
$149.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$97.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$166.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$110.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$154.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$174.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$174.30
|
| Rate for Payer: Multiplan Commercial |
$199.20
|
| Rate for Payer: Networks By Design Commercial |
$124.50
|
| Rate for Payer: Prime Health Services Commercial |
$211.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$149.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$149.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$93.45
|
| Rate for Payer: United Healthcare All Other HMO |
$90.96
|
| Rate for Payer: United Healthcare HMO Rider |
$88.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$81.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$211.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$211.65
|
| Rate for Payer: Vantage Medical Group Senior |
$211.65
|
|
|
HC LEATHER KAFO-AFO PORX
|
Facility
|
IP
|
$249.00
|
|
|
Service Code
|
CPT L4100
|
| Hospital Charge Code |
915354100
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$49.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$49.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$136.95
|
| Rate for Payer: Cash Price |
$136.95
|
| Rate for Payer: Cigna of CA HMO |
$174.30
|
| Rate for Payer: Cigna of CA PPO |
$174.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.60
|
| Rate for Payer: EPIC Health Plan Senior |
$99.60
|
| Rate for Payer: Galaxy Health WC |
$211.65
|
| Rate for Payer: Global Benefits Group Commercial |
$149.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$166.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$94.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$154.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.76
|
| Rate for Payer: Multiplan Commercial |
$199.20
|
| Rate for Payer: Networks By Design Commercial |
$124.50
|
| Rate for Payer: Prime Health Services Commercial |
$211.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$93.45
|
| Rate for Payer: United Healthcare All Other HMO |
$90.96
|
| Rate for Payer: United Healthcare HMO Rider |
$88.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$81.55
|
|
|
HC LEECHES - WOUND THERAPY, EA
|
Facility
|
OP
|
$137.94
|
|
| Hospital Charge Code |
901605575
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$27.59 |
| Max. Negotiated Rate |
$117.25 |
| Rate for Payer: Adventist Health Commercial |
$27.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$90.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$117.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$75.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$103.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$84.71
|
| Rate for Payer: Cash Price |
$75.87
|
| Rate for Payer: Cigna of CA HMO |
$88.28
|
| Rate for Payer: Cigna of CA PPO |
$102.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$117.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$117.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$117.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.18
|
| Rate for Payer: EPIC Health Plan Senior |
$55.18
|
| Rate for Payer: Galaxy Health WC |
$117.25
|
| Rate for Payer: Global Benefits Group Commercial |
$82.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$92.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$85.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$96.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$96.56
|
| Rate for Payer: Multiplan Commercial |
$110.35
|
| Rate for Payer: Networks By Design Commercial |
$89.66
|
| Rate for Payer: Prime Health Services Commercial |
$117.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$82.76
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$82.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$68.97
|
| Rate for Payer: United Healthcare All Other HMO |
$68.97
|
| Rate for Payer: United Healthcare HMO Rider |
$68.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$68.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$117.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$117.25
|
| Rate for Payer: Vantage Medical Group Senior |
$117.25
|
|
|
HC LEECHES - WOUND THERAPY, EA
|
Facility
|
IP
|
$137.94
|
|
| Hospital Charge Code |
901605575
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$27.59 |
| Max. Negotiated Rate |
$117.25 |
| Rate for Payer: Adventist Health Commercial |
$27.59
|
| Rate for Payer: Cash Price |
$75.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.18
|
| Rate for Payer: EPIC Health Plan Senior |
$55.18
|
| Rate for Payer: Galaxy Health WC |
$117.25
|
| Rate for Payer: Global Benefits Group Commercial |
$82.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$92.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$85.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.11
|
| Rate for Payer: Multiplan Commercial |
$110.35
|
| Rate for Payer: Networks By Design Commercial |
$89.66
|
| Rate for Payer: Prime Health Services Commercial |
$117.25
|
|
|
HC LEFT ATRIAL APPENDAGE CLOSURE
|
Facility
|
IP
|
$80,419.00
|
|
|
Service Code
|
CPT 33340
|
| Hospital Charge Code |
906811496
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$16,083.80 |
| Max. Negotiated Rate |
$68,356.15 |
| Rate for Payer: Adventist Health Commercial |
$16,083.80
|
| Rate for Payer: Cash Price |
$44,230.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$32,167.60
|
| Rate for Payer: EPIC Health Plan Senior |
$32,167.60
|
| Rate for Payer: Galaxy Health WC |
$68,356.15
|
| Rate for Payer: Global Benefits Group Commercial |
$48,251.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$53,639.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30,639.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$49,779.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19,300.56
|
| Rate for Payer: Multiplan Commercial |
$64,335.20
|
| Rate for Payer: Networks By Design Commercial |
$52,272.35
|
| Rate for Payer: Prime Health Services Commercial |
$68,356.15
|
|
