|
HC L&D LEVEL I OBSERV - INIT 1 HR
|
Facility
|
IP
|
$189.00
|
|
| Hospital Charge Code |
902400380
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$37.80 |
| Max. Negotiated Rate |
$170.10 |
| Rate for Payer: Adventist Health Commercial |
$37.80
|
| Rate for Payer: Cash Price |
$103.95
|
| Rate for Payer: Central Health Plan Commercial |
$151.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$75.60
|
| Rate for Payer: EPIC Health Plan Senior |
$75.60
|
| Rate for Payer: Galaxy Health WC |
$160.65
|
| Rate for Payer: Global Benefits Group Commercial |
$113.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$170.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$126.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$116.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.80
|
| Rate for Payer: Multiplan Commercial |
$141.75
|
| Rate for Payer: Networks By Design Commercial |
$122.85
|
| Rate for Payer: Prime Health Services Commercial |
$160.65
|
|
|
HC L&D LEVEL IV - 1ST HR
|
Facility
|
OP
|
$7,263.00
|
|
| Hospital Charge Code |
902400056
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,452.60 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$1,452.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,173.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,994.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,447.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,516.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,265.56
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$3,994.65
|
| Rate for Payer: Cash Price |
$3,994.65
|
| Rate for Payer: Central Health Plan Commercial |
$5,810.40
|
| Rate for Payer: Cigna of CA HMO |
$4,648.32
|
| Rate for Payer: Cigna of CA PPO |
$5,374.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,173.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,173.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,173.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,905.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,905.20
|
| Rate for Payer: Galaxy Health WC |
$6,173.55
|
| Rate for Payer: Global Benefits Group Commercial |
$4,357.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,536.70
|
| Rate for Payer: InnovAge PACE Commercial |
$3,631.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,844.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,767.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,495.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,452.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,084.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,084.10
|
| Rate for Payer: Multiplan Commercial |
$5,447.25
|
| Rate for Payer: Networks By Design Commercial |
$4,720.95
|
| Rate for Payer: Prime Health Services Commercial |
$6,173.55
|
| Rate for Payer: Riverside University Health System MISP |
$2,905.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,357.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,631.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,631.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,631.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,631.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,173.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,173.55
|
| Rate for Payer: Vantage Medical Group Senior |
$6,173.55
|
|
|
HC L&D LEVEL IV - 1ST HR
|
Facility
|
IP
|
$7,263.00
|
|
| Hospital Charge Code |
902400056
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,452.60 |
| Max. Negotiated Rate |
$6,536.70 |
| Rate for Payer: Adventist Health Commercial |
$1,452.60
|
| Rate for Payer: Cash Price |
$3,994.65
|
| Rate for Payer: Central Health Plan Commercial |
$5,810.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,905.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,905.20
|
| Rate for Payer: Galaxy Health WC |
$6,173.55
|
| Rate for Payer: Global Benefits Group Commercial |
$4,357.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,536.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,844.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,767.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,495.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,452.60
|
| Rate for Payer: Multiplan Commercial |
$5,447.25
|
| Rate for Payer: Networks By Design Commercial |
$4,720.95
|
| Rate for Payer: Prime Health Services Commercial |
$6,173.55
|
|
|
HC L&D TREATMENT ROOM
|
Facility
|
OP
|
$391.00
|
|
| Hospital Charge Code |
902400418
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$78.20 |
| Max. Negotiated Rate |
$1,091.00 |
| Rate for Payer: Adventist Health Commercial |
$78.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$237.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$332.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$215.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$293.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$189.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$229.63
|
| Rate for Payer: Blue Shield of California Commercial |
$238.90
|
| Rate for Payer: Blue Shield of California EPN |
$156.01
|
| Rate for Payer: Cash Price |
$215.05
|
| Rate for Payer: Cash Price |
$215.05
|
| Rate for Payer: Central Health Plan Commercial |
$312.80
|
| Rate for Payer: Cigna of CA HMO |
$250.24
|
| Rate for Payer: Cigna of CA PPO |
$289.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$332.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$332.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$332.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$156.40
|
| Rate for Payer: EPIC Health Plan Senior |
$156.40
|
| Rate for Payer: Galaxy Health WC |
$332.35
|
| Rate for Payer: Global Benefits Group Commercial |
$234.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$351.90
|
| Rate for Payer: InnovAge PACE Commercial |
$195.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$260.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$148.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$242.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$273.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$273.70
|
| Rate for Payer: Multiplan Commercial |
$293.25
|
| Rate for Payer: Networks By Design Commercial |
$254.15
|
| Rate for Payer: Prime Health Services Commercial |
$332.35
|
| Rate for Payer: Riverside University Health System MISP |
$156.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$234.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$234.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,091.00
|
| Rate for Payer: United Healthcare All Other HMO |
$839.00
|
| Rate for Payer: United Healthcare HMO Rider |
$635.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$581.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$332.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$332.35
|
| Rate for Payer: Vantage Medical Group Senior |
$332.35
|
|
|
HC L&D TREATMENT ROOM
|
Facility
|
IP
|
$391.00
|
|
| Hospital Charge Code |
902400418
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$78.20 |
| Max. Negotiated Rate |
$351.90 |
| Rate for Payer: Adventist Health Commercial |
$78.20
|
| Rate for Payer: Cash Price |
$215.05
|
| Rate for Payer: Central Health Plan Commercial |
$312.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$156.40
|
| Rate for Payer: EPIC Health Plan Senior |
$156.40
|
| Rate for Payer: Galaxy Health WC |
$332.35
|
| Rate for Payer: Global Benefits Group Commercial |
$234.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$351.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$260.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$148.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$242.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.20
|
| Rate for Payer: Multiplan Commercial |
$293.25
|
| Rate for Payer: Networks By Design Commercial |
$254.15
|
| Rate for Payer: Prime Health Services Commercial |
$332.35
|
|
|
HC LEAD BIOTRONIK LINOX SMART S
|
Facility
|
OP
|
$7,500.00
|
|
|
Service Code
|
CPT C1777
|
| Hospital Charge Code |
906813789
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,500.00 |
| Max. Negotiated Rate |
$6,750.00 |
| Rate for Payer: Adventist Health Commercial |
$1,500.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,375.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,125.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,625.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,631.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,404.75
|
| Rate for Payer: Blue Shield of California Commercial |
$5,797.50
|
| Rate for Payer: Blue Shield of California EPN |
$3,780.00
|
| Rate for Payer: Cash Price |
$4,125.00
|
| Rate for Payer: Central Health Plan Commercial |
$6,000.00
|
| Rate for Payer: Cigna of CA HMO |
$5,250.00
|
| Rate for Payer: Cigna of CA PPO |
$5,250.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,375.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,375.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,375.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,000.00
|
| Rate for Payer: Galaxy Health WC |
$6,375.00
|
| Rate for Payer: Global Benefits Group Commercial |
$4,500.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,750.00
|
| Rate for Payer: InnovAge PACE Commercial |
$3,750.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,002.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,642.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,500.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,250.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,250.00
|
| Rate for Payer: Multiplan Commercial |
$5,625.00
|
| Rate for Payer: Networks By Design Commercial |
$3,750.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,375.00
|
| Rate for Payer: Riverside University Health System MISP |
$3,000.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,500.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,500.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,814.75
|
| Rate for Payer: United Healthcare All Other HMO |
$2,739.75
|
| Rate for Payer: United Healthcare HMO Rider |
$2,680.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,456.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,375.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,375.00
|
| Rate for Payer: Vantage Medical Group Senior |
$6,375.00
|
|
|
HC LEAD BIOTRONIK LINOX SMART S
|
Facility
|
IP
|
$7,500.00
|
|
|
Service Code
|
CPT C1777
|
| Hospital Charge Code |
906813789
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,500.00 |
| Max. Negotiated Rate |
$6,750.00 |
| Rate for Payer: Adventist Health Commercial |
$1,500.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,797.50
|
| Rate for Payer: Blue Shield of California EPN |
$3,780.00
|
| Rate for Payer: Cash Price |
$4,125.00
|
| Rate for Payer: Central Health Plan Commercial |
$6,000.00
|
| Rate for Payer: Cigna of CA HMO |
$5,250.00
|
| Rate for Payer: Cigna of CA PPO |
$5,250.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,000.00
|
| Rate for Payer: Galaxy Health WC |
$6,375.00
|
| Rate for Payer: Global Benefits Group Commercial |
$4,500.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,750.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,002.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,857.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,642.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,500.00
|
| Rate for Payer: Multiplan Commercial |
$5,625.00
|
| Rate for Payer: Networks By Design Commercial |
$3,750.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,375.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,814.75
|
| Rate for Payer: United Healthcare All Other HMO |
$2,739.75
|
| Rate for Payer: United Healthcare HMO Rider |
$2,680.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,456.25
|
|
|
HC LEAD BIOTRONIK PLEXA 402266
|
Facility
|
OP
|
$8,000.00
|
|
|
Service Code
|
CPT C1777
|
| Hospital Charge Code |
906813806
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,600.00 |
| Max. Negotiated Rate |
$7,200.00 |
| Rate for Payer: Adventist Health Commercial |
$1,600.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,800.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,400.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,000.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,873.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,698.40
|
| Rate for Payer: Blue Shield of California Commercial |
$6,184.00
|
| Rate for Payer: Blue Shield of California EPN |
$4,032.00
|
| Rate for Payer: Cash Price |
$4,400.00
|
| Rate for Payer: Central Health Plan Commercial |
$6,400.00
|
| Rate for Payer: Cigna of CA HMO |
$5,600.00
|
| Rate for Payer: Cigna of CA PPO |
$5,600.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,800.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,800.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,800.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,200.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,200.00
|
| Rate for Payer: Galaxy Health WC |
$6,800.00
|
| Rate for Payer: Global Benefits Group Commercial |
$4,800.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,200.00
|
| Rate for Payer: InnovAge PACE Commercial |
$4,000.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,336.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,952.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,600.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,600.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,600.00
|
| Rate for Payer: Multiplan Commercial |
$6,000.00
|
| Rate for Payer: Networks By Design Commercial |
$4,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,800.00
|
| Rate for Payer: Riverside University Health System MISP |
$3,200.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,800.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,800.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,002.40
|
| Rate for Payer: United Healthcare All Other HMO |
$2,922.40
|
| Rate for Payer: United Healthcare HMO Rider |
$2,859.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,620.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,800.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,800.00
|
| Rate for Payer: Vantage Medical Group Senior |
$6,800.00
|
|
|
HC LEAD BIOTRONIK PLEXA 402266
|
Facility
|
IP
|
$8,000.00
|
|
|
Service Code
|
CPT C1777
|
| Hospital Charge Code |
906813806
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,600.00 |
| Max. Negotiated Rate |
$7,200.00 |
| Rate for Payer: Adventist Health Commercial |
$1,600.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,184.00
|
| Rate for Payer: Blue Shield of California EPN |
$4,032.00
|
| Rate for Payer: Cash Price |
$4,400.00
|
| Rate for Payer: Central Health Plan Commercial |
$6,400.00
|
| Rate for Payer: Cigna of CA HMO |
$5,600.00
|
| Rate for Payer: Cigna of CA PPO |
$5,600.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,200.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,200.00
|
| Rate for Payer: Galaxy Health WC |
$6,800.00
|
| Rate for Payer: Global Benefits Group Commercial |
$4,800.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,200.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,336.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,048.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,952.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,600.00
|
| Rate for Payer: Multiplan Commercial |
$6,000.00
|
| Rate for Payer: Networks By Design Commercial |
$4,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,800.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,002.40
|
| Rate for Payer: United Healthcare All Other HMO |
$2,922.40
|
| Rate for Payer: United Healthcare HMO Rider |
$2,859.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,620.00
|
|
|
HC LEAD BIOTRONIK PLEXA S 414005
|
Facility
|
IP
|
$8,000.00
|
|
|
Service Code
|
CPT C1777
|
| Hospital Charge Code |
906813798
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,600.00 |
| Max. Negotiated Rate |
$7,200.00 |
| Rate for Payer: Adventist Health Commercial |
$1,600.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,184.00
|
| Rate for Payer: Blue Shield of California EPN |
$4,032.00
|
| Rate for Payer: Cash Price |
$4,400.00
|
| Rate for Payer: Central Health Plan Commercial |
$6,400.00
|
| Rate for Payer: Cigna of CA HMO |
$5,600.00
|
| Rate for Payer: Cigna of CA PPO |
$5,600.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,200.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,200.00
|
| Rate for Payer: Galaxy Health WC |
$6,800.00
|
| Rate for Payer: Global Benefits Group Commercial |
$4,800.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,200.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,336.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,048.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,952.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,600.00
|
| Rate for Payer: Multiplan Commercial |
$6,000.00
|
| Rate for Payer: Networks By Design Commercial |
$4,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,800.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,002.40
|
| Rate for Payer: United Healthcare All Other HMO |
$2,922.40
|
| Rate for Payer: United Healthcare HMO Rider |
$2,859.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,620.00
|
|
|
HC LEAD BIOTRONIK PLEXA S 414005
|
Facility
|
OP
|
$8,000.00
|
|
|
Service Code
|
CPT C1777
|
| Hospital Charge Code |
906813798
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,600.00 |
| Max. Negotiated Rate |
$7,200.00 |
| Rate for Payer: Adventist Health Commercial |
$1,600.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,800.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,400.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,000.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,873.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,698.40
|
| Rate for Payer: Blue Shield of California Commercial |
$6,184.00
|
| Rate for Payer: Blue Shield of California EPN |
$4,032.00
|
| Rate for Payer: Cash Price |
$4,400.00
|
| Rate for Payer: Central Health Plan Commercial |
$6,400.00
|
| Rate for Payer: Cigna of CA HMO |
$5,600.00
|
| Rate for Payer: Cigna of CA PPO |
$5,600.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,800.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,800.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,800.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,200.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,200.00
|
| Rate for Payer: Galaxy Health WC |
$6,800.00
|
| Rate for Payer: Global Benefits Group Commercial |
$4,800.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,200.00
|
| Rate for Payer: InnovAge PACE Commercial |
$4,000.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,336.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,952.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,600.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,600.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,600.00
|
| Rate for Payer: Multiplan Commercial |
$6,000.00
|
| Rate for Payer: Networks By Design Commercial |
$4,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,800.00
|
| Rate for Payer: Riverside University Health System MISP |
$3,200.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,800.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,800.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,002.40
|
| Rate for Payer: United Healthcare All Other HMO |
$2,922.40
|
| Rate for Payer: United Healthcare HMO Rider |
$2,859.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,620.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,800.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,800.00
|
| Rate for Payer: Vantage Medical Group Senior |
$6,800.00
|
|
|
HC LEAD BIOTRONIK PROTEGO S
|
Facility
|
OP
|
$7,500.00
|
|
|
Service Code
|
CPT C1777
|
| Hospital Charge Code |
906813785
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,500.00 |
| Max. Negotiated Rate |
$6,750.00 |
| Rate for Payer: Adventist Health Commercial |
$1,500.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,375.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,125.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,625.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,631.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,404.75
|
| Rate for Payer: Blue Shield of California Commercial |
$5,797.50
|
| Rate for Payer: Blue Shield of California EPN |
$3,780.00
|
| Rate for Payer: Cash Price |
$4,125.00
|
| Rate for Payer: Central Health Plan Commercial |
$6,000.00
|
| Rate for Payer: Cigna of CA HMO |
$5,250.00
|
| Rate for Payer: Cigna of CA PPO |
$5,250.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,375.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,375.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,375.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,000.00
|
| Rate for Payer: Galaxy Health WC |
$6,375.00
|
| Rate for Payer: Global Benefits Group Commercial |
$4,500.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,750.00
|
| Rate for Payer: InnovAge PACE Commercial |
$3,750.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,002.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,642.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,500.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,250.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,250.00
|
| Rate for Payer: Multiplan Commercial |
$5,625.00
|
| Rate for Payer: Networks By Design Commercial |
$3,750.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,375.00
|
| Rate for Payer: Riverside University Health System MISP |
$3,000.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,500.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,500.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,814.75
|
| Rate for Payer: United Healthcare All Other HMO |
$2,739.75
|
| Rate for Payer: United Healthcare HMO Rider |
$2,680.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,456.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,375.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,375.00
|
| Rate for Payer: Vantage Medical Group Senior |
$6,375.00
|
|
|
HC LEAD BIOTRONIK PROTEGO S
|
Facility
|
IP
|
$7,500.00
|
|
|
Service Code
|
CPT C1777
|
| Hospital Charge Code |
906813785
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,500.00 |
| Max. Negotiated Rate |
$6,750.00 |
| Rate for Payer: Adventist Health Commercial |
$1,500.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,797.50
|
| Rate for Payer: Blue Shield of California EPN |
$3,780.00
|
| Rate for Payer: Cash Price |
$4,125.00
|
| Rate for Payer: Central Health Plan Commercial |
$6,000.00
|
| Rate for Payer: Cigna of CA HMO |
$5,250.00
|
| Rate for Payer: Cigna of CA PPO |
$5,250.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,000.00
|
| Rate for Payer: Galaxy Health WC |
$6,375.00
|
| Rate for Payer: Global Benefits Group Commercial |
$4,500.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,750.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,002.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,857.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,642.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,500.00
|
| Rate for Payer: Multiplan Commercial |
$5,625.00
|
| Rate for Payer: Networks By Design Commercial |
$3,750.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,375.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,814.75
|
| Rate for Payer: United Healthcare All Other HMO |
$2,739.75
|
| Rate for Payer: United Healthcare HMO Rider |
$2,680.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,456.25
|
|
|
HC LEAD BIOTRONIK SETROX S
|
Facility
|
OP
|
$2,300.00
|
|
|
Service Code
|
CPT C1898
|
| Hospital Charge Code |
906813720
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$460.00 |
| Max. Negotiated Rate |
$2,070.00 |
| Rate for Payer: Adventist Health Commercial |
$460.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,955.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,265.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,725.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,113.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,350.79
|
| Rate for Payer: Blue Shield of California Commercial |
$1,777.90
|
| Rate for Payer: Blue Shield of California EPN |
$1,159.20
|
| Rate for Payer: Cash Price |
$1,265.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,840.00
|
| Rate for Payer: Cigna of CA HMO |
$1,610.00
|
| Rate for Payer: Cigna of CA PPO |
$1,610.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,955.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,955.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,955.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$920.00
|
| Rate for Payer: EPIC Health Plan Senior |
$920.00
|
| Rate for Payer: Galaxy Health WC |
$1,955.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,380.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,070.00
|
| Rate for Payer: InnovAge PACE Commercial |
$1,150.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,534.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$876.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,423.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$460.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,610.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,610.00
|
| Rate for Payer: Multiplan Commercial |
$1,725.00
|
| Rate for Payer: Networks By Design Commercial |
$1,150.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,955.00
|
| Rate for Payer: Riverside University Health System MISP |
$920.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,380.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,380.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$863.19
|
| Rate for Payer: United Healthcare All Other HMO |
$840.19
|
| Rate for Payer: United Healthcare HMO Rider |
$822.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$753.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,955.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,955.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,955.00
|
|
|
HC LEAD BIOTRONIK SETROX S
|
Facility
|
IP
|
$2,300.00
|
|
|
Service Code
|
CPT C1898
|
| Hospital Charge Code |
906813720
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$460.00 |
| Max. Negotiated Rate |
$2,070.00 |
| Rate for Payer: Adventist Health Commercial |
$460.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,777.90
|
| Rate for Payer: Blue Shield of California EPN |
$1,159.20
|
| Rate for Payer: Cash Price |
$1,265.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,840.00
|
| Rate for Payer: Cigna of CA HMO |
$1,610.00
|
| Rate for Payer: Cigna of CA PPO |
$1,610.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$920.00
|
| Rate for Payer: EPIC Health Plan Senior |
$920.00
|
| Rate for Payer: Galaxy Health WC |
$1,955.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,380.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,070.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,534.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$876.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,423.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$460.00
|
| Rate for Payer: Multiplan Commercial |
$1,725.00
|
| Rate for Payer: Networks By Design Commercial |
$1,150.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,955.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$863.19
|
| Rate for Payer: United Healthcare All Other HMO |
$840.19
|
| Rate for Payer: United Healthcare HMO Rider |
$822.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$753.25
|
|
|
HC LEAD BIOTRONIK SOLIA S
|
Facility
|
OP
|
$2,300.00
|
|
|
Service Code
|
CPT C1898
|
| Hospital Charge Code |
906813786
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$460.00 |
| Max. Negotiated Rate |
$2,070.00 |
| Rate for Payer: Adventist Health Commercial |
$460.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,955.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,265.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,725.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,113.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,350.79
|
| Rate for Payer: Blue Shield of California Commercial |
$1,777.90
|
| Rate for Payer: Blue Shield of California EPN |
$1,159.20
|
| Rate for Payer: Cash Price |
$1,265.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,840.00
|
| Rate for Payer: Cigna of CA HMO |
$1,610.00
|
| Rate for Payer: Cigna of CA PPO |
$1,610.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,955.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,955.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,955.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$920.00
|
| Rate for Payer: EPIC Health Plan Senior |
$920.00
|
| Rate for Payer: Galaxy Health WC |
$1,955.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,380.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,070.00
|
| Rate for Payer: InnovAge PACE Commercial |
$1,150.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,534.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$876.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,423.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$460.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,610.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,610.00
|
| Rate for Payer: Multiplan Commercial |
$1,725.00
|
| Rate for Payer: Networks By Design Commercial |
$1,150.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,955.00
|
| Rate for Payer: Riverside University Health System MISP |
$920.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,380.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,380.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$863.19
|
| Rate for Payer: United Healthcare All Other HMO |
$840.19
|
| Rate for Payer: United Healthcare HMO Rider |
$822.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$753.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,955.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,955.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,955.00
|
|
|
HC LEAD BIOTRONIK SOLIA S
|
Facility
|
IP
|
$2,300.00
|
|
|
Service Code
|
CPT C1898
|
| Hospital Charge Code |
906813786
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$460.00 |
| Max. Negotiated Rate |
$2,070.00 |
| Rate for Payer: Adventist Health Commercial |
$460.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,777.90
|
| Rate for Payer: Blue Shield of California EPN |
$1,159.20
|
| Rate for Payer: Cash Price |
$1,265.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,840.00
|
| Rate for Payer: Cigna of CA HMO |
$1,610.00
|
| Rate for Payer: Cigna of CA PPO |
$1,610.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$920.00
|
| Rate for Payer: EPIC Health Plan Senior |
$920.00
|
| Rate for Payer: Galaxy Health WC |
$1,955.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,380.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,070.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,534.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$876.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,423.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$460.00
|
| Rate for Payer: Multiplan Commercial |
$1,725.00
|
| Rate for Payer: Networks By Design Commercial |
$1,150.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,955.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$863.19
|
| Rate for Payer: United Healthcare All Other HMO |
$840.19
|
| Rate for Payer: United Healthcare HMO Rider |
$822.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$753.25
|
|
|
HC LEAD B/S ACUITY 4554
|
Facility
|
IP
|
$6,725.00
|
|
|
Service Code
|
CPT C1900
|
| Hospital Charge Code |
906813591
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,345.00 |
| Max. Negotiated Rate |
$6,052.50 |
| Rate for Payer: Adventist Health Commercial |
$1,345.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,198.43
|
| Rate for Payer: Blue Shield of California EPN |
$3,389.40
|
| Rate for Payer: Cash Price |
$3,698.75
|
| Rate for Payer: Central Health Plan Commercial |
$5,380.00
|
| Rate for Payer: Cigna of CA HMO |
$4,707.50
|
| Rate for Payer: Cigna of CA PPO |
$4,707.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,690.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,690.00
|
| Rate for Payer: Galaxy Health WC |
$5,716.25
|
| Rate for Payer: Global Benefits Group Commercial |
$4,035.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,052.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,485.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,562.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,162.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,345.00
|
| Rate for Payer: Multiplan Commercial |
$5,043.75
|
| Rate for Payer: Networks By Design Commercial |
$3,362.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,716.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,523.89
|
| Rate for Payer: United Healthcare All Other HMO |
$2,456.64
|
| Rate for Payer: United Healthcare HMO Rider |
$2,403.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,202.44
|
|
|
HC LEAD B/S ACUITY 4554
|
Facility
|
OP
|
$6,725.00
|
|
|
Service Code
|
CPT C1900
|
| Hospital Charge Code |
906813591
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,345.00 |
| Max. Negotiated Rate |
$6,052.50 |
| Rate for Payer: Adventist Health Commercial |
$1,345.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,716.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,698.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,043.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,070.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,723.63
|
| Rate for Payer: Blue Shield of California Commercial |
$5,198.43
|
| Rate for Payer: Blue Shield of California EPN |
$3,389.40
|
| Rate for Payer: Cash Price |
$3,698.75
|
| Rate for Payer: Central Health Plan Commercial |
$5,380.00
|
| Rate for Payer: Cigna of CA HMO |
$4,707.50
|
| Rate for Payer: Cigna of CA PPO |
$4,707.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,716.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,716.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,716.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,690.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,690.00
|
| Rate for Payer: Galaxy Health WC |
$5,716.25
|
| Rate for Payer: Global Benefits Group Commercial |
$4,035.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,052.50
|
| Rate for Payer: InnovAge PACE Commercial |
$3,362.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,485.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,562.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,162.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,345.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,707.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,707.50
|
| Rate for Payer: Multiplan Commercial |
$5,043.75
|
| Rate for Payer: Networks By Design Commercial |
$3,362.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,716.25
|
| Rate for Payer: Riverside University Health System MISP |
$2,690.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,035.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,035.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,523.89
|
| Rate for Payer: United Healthcare All Other HMO |
$2,456.64
|
| Rate for Payer: United Healthcare HMO Rider |
$2,403.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,202.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,716.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,716.25
|
| Rate for Payer: Vantage Medical Group Senior |
$5,716.25
|
|
|
HC LEAD B/S ACUITY 4555
|
Facility
|
OP
|
$6,725.00
|
|
|
Service Code
|
CPT C1900
|
| Hospital Charge Code |
906813628
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,345.00 |
| Max. Negotiated Rate |
$6,052.50 |
| Rate for Payer: Adventist Health Commercial |
$1,345.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,716.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,698.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,043.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,256.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,949.59
|
| Rate for Payer: Blue Shield of California Commercial |
$5,198.43
|
| Rate for Payer: Blue Shield of California EPN |
$3,389.40
|
| Rate for Payer: Cash Price |
$3,698.75
|
| Rate for Payer: Central Health Plan Commercial |
$5,380.00
|
| Rate for Payer: Cigna of CA HMO |
$4,707.50
|
| Rate for Payer: Cigna of CA PPO |
$4,707.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,716.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,716.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,716.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,690.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,690.00
|
| Rate for Payer: Galaxy Health WC |
$5,716.25
|
| Rate for Payer: Global Benefits Group Commercial |
$4,035.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,052.50
|
| Rate for Payer: InnovAge PACE Commercial |
$3,362.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,485.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,562.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,162.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,345.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,707.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,707.50
|
| Rate for Payer: Multiplan Commercial |
$5,043.75
|
| Rate for Payer: Networks By Design Commercial |
$3,362.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,716.25
|
| Rate for Payer: Riverside University Health System MISP |
$2,690.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,035.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,035.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,523.89
|
| Rate for Payer: United Healthcare All Other HMO |
$2,456.64
|
| Rate for Payer: United Healthcare HMO Rider |
$2,403.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,202.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,716.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,716.25
|
| Rate for Payer: Vantage Medical Group Senior |
$5,716.25
|
|
|
HC LEAD B/S ACUITY 4555
|
Facility
|
IP
|
$6,725.00
|
|
|
Service Code
|
CPT C1900
|
| Hospital Charge Code |
906813628
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,345.00 |
| Max. Negotiated Rate |
$6,052.50 |
| Rate for Payer: Adventist Health Commercial |
$1,345.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,198.43
|
| Rate for Payer: Blue Shield of California EPN |
$3,389.40
|
| Rate for Payer: Cash Price |
$3,698.75
|
| Rate for Payer: Central Health Plan Commercial |
$5,380.00
|
| Rate for Payer: Cigna of CA HMO |
$4,707.50
|
| Rate for Payer: Cigna of CA PPO |
$4,707.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,690.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,690.00
|
| Rate for Payer: Galaxy Health WC |
$5,716.25
|
| Rate for Payer: Global Benefits Group Commercial |
$4,035.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,052.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,485.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,562.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,162.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,345.00
|
| Rate for Payer: Multiplan Commercial |
$5,043.75
|
| Rate for Payer: Networks By Design Commercial |
$3,362.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,716.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,523.89
|
| Rate for Payer: United Healthcare All Other HMO |
$2,456.64
|
| Rate for Payer: United Healthcare HMO Rider |
$2,403.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,202.44
|
|
|
HC LEAD B/S ACUITY 4674
|
Facility
|
OP
|
$7,250.00
|
|
|
Service Code
|
CPT C1900
|
| Hospital Charge Code |
906813803
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,450.00 |
| Max. Negotiated Rate |
$6,525.00 |
| Rate for Payer: Adventist Health Commercial |
$1,450.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,162.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,987.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,437.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,310.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,014.32
|
| Rate for Payer: Blue Shield of California Commercial |
$5,604.25
|
| Rate for Payer: Blue Shield of California EPN |
$3,654.00
|
| Rate for Payer: Cash Price |
$3,987.50
|
| Rate for Payer: Central Health Plan Commercial |
$5,800.00
|
| Rate for Payer: Cigna of CA HMO |
$5,075.00
|
| Rate for Payer: Cigna of CA PPO |
$5,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,162.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,162.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,162.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,900.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,900.00
|
| Rate for Payer: Galaxy Health WC |
$6,162.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,350.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,525.00
|
| Rate for Payer: InnovAge PACE Commercial |
$3,625.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,835.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,762.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,487.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,450.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,075.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,075.00
|
| Rate for Payer: Multiplan Commercial |
$5,437.50
|
| Rate for Payer: Networks By Design Commercial |
$3,625.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,162.50
|
| Rate for Payer: Riverside University Health System MISP |
$2,900.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,350.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,350.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,720.93
|
| Rate for Payer: United Healthcare All Other HMO |
$2,648.43
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,162.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,162.50
|
| Rate for Payer: Vantage Medical Group Senior |
$6,162.50
|
|
|
HC LEAD B/S ACUITY 4674
|
Facility
|
IP
|
$7,250.00
|
|
|
Service Code
|
CPT C1900
|
| Hospital Charge Code |
906813803
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,450.00 |
| Max. Negotiated Rate |
$6,525.00 |
| Rate for Payer: Adventist Health Commercial |
$1,450.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,604.25
|
| Rate for Payer: Blue Shield of California EPN |
$3,654.00
|
| Rate for Payer: Cash Price |
$3,987.50
|
| Rate for Payer: Central Health Plan Commercial |
$5,800.00
|
| Rate for Payer: Cigna of CA HMO |
$5,075.00
|
| Rate for Payer: Cigna of CA PPO |
$5,075.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,900.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,900.00
|
| Rate for Payer: Galaxy Health WC |
$6,162.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,350.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,525.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,835.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,762.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,487.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,450.00
|
| Rate for Payer: Multiplan Commercial |
$5,437.50
|
| Rate for Payer: Networks By Design Commercial |
$3,625.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,162.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,720.93
|
| Rate for Payer: United Healthcare All Other HMO |
$2,648.43
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.38
|
|
|
HC LEAD B/S ACUITY SPIRAL 4592
|
Facility
|
OP
|
$21,735.00
|
|
|
Service Code
|
CPT C1900
|
| Hospital Charge Code |
906813609
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,347.00 |
| Max. Negotiated Rate |
$19,561.50 |
| Rate for Payer: Adventist Health Commercial |
$4,347.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18,474.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11,954.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16,301.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9,924.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,034.67
|
| Rate for Payer: Blue Shield of California Commercial |
$16,801.15
|
| Rate for Payer: Blue Shield of California EPN |
$10,954.44
|
| Rate for Payer: Cash Price |
$11,954.25
|
| Rate for Payer: Central Health Plan Commercial |
$17,388.00
|
| Rate for Payer: Cigna of CA HMO |
$15,214.50
|
| Rate for Payer: Cigna of CA PPO |
$15,214.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18,474.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$18,474.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18,474.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,694.00
|
| Rate for Payer: EPIC Health Plan Senior |
$8,694.00
|
| Rate for Payer: Galaxy Health WC |
$18,474.75
|
| Rate for Payer: Global Benefits Group Commercial |
$13,041.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$19,561.50
|
| Rate for Payer: InnovAge PACE Commercial |
$10,867.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,497.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,281.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,453.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,347.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15,214.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15,214.50
|
| Rate for Payer: Multiplan Commercial |
$16,301.25
|
| Rate for Payer: Networks By Design Commercial |
$10,867.50
|
| Rate for Payer: Prime Health Services Commercial |
$18,474.75
|
| Rate for Payer: Riverside University Health System MISP |
$8,694.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13,041.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13,041.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,157.15
|
| Rate for Payer: United Healthcare All Other HMO |
$7,939.80
|
| Rate for Payer: United Healthcare HMO Rider |
$7,768.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,118.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18,474.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18,474.75
|
| Rate for Payer: Vantage Medical Group Senior |
$18,474.75
|
|
|
HC LEAD B/S ACUITY SPIRAL 4592
|
Facility
|
IP
|
$21,735.00
|
|
|
Service Code
|
CPT C1900
|
| Hospital Charge Code |
906813609
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,347.00 |
| Max. Negotiated Rate |
$19,561.50 |
| Rate for Payer: Adventist Health Commercial |
$4,347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$16,801.15
|
| Rate for Payer: Blue Shield of California EPN |
$10,954.44
|
| Rate for Payer: Cash Price |
$11,954.25
|
| Rate for Payer: Central Health Plan Commercial |
$17,388.00
|
| Rate for Payer: Cigna of CA HMO |
$15,214.50
|
| Rate for Payer: Cigna of CA PPO |
$15,214.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,694.00
|
| Rate for Payer: EPIC Health Plan Senior |
$8,694.00
|
| Rate for Payer: Galaxy Health WC |
$18,474.75
|
| Rate for Payer: Global Benefits Group Commercial |
$13,041.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$19,561.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,497.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,281.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,453.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,347.00
|
| Rate for Payer: Multiplan Commercial |
$16,301.25
|
| Rate for Payer: Networks By Design Commercial |
$10,867.50
|
| Rate for Payer: Prime Health Services Commercial |
$18,474.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,157.15
|
| Rate for Payer: United Healthcare All Other HMO |
$7,939.80
|
| Rate for Payer: United Healthcare HMO Rider |
$7,768.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,118.21
|
|
