|
HC LEAD B/S ACUITY X4 SPIRAL 4677
|
Facility
|
IP
|
$7,250.00
|
|
|
Service Code
|
CPT C1900
|
| Hospital Charge Code |
906813763
|
|
Hospital Revenue Code
|
275
|
| 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 X4 SPIRAL 4677
|
Facility
|
OP
|
$7,250.00
|
|
|
Service Code
|
CPT C1900
|
| Hospital Charge Code |
906813763
|
|
Hospital Revenue Code
|
275
|
| 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 |
$3,510.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,257.93
|
| 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 DEXTRUS 4135
|
Facility
|
OP
|
$2,300.00
|
|
|
Service Code
|
CPT C1898
|
| Hospital Charge Code |
906813630
|
|
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 B/S DEXTRUS 4135
|
Facility
|
IP
|
$2,300.00
|
|
|
Service Code
|
CPT C1898
|
| Hospital Charge Code |
906813630
|
|
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 DEXTRUS 4136
|
Facility
|
OP
|
$2,300.00
|
|
|
Service Code
|
CPT C1898
|
| Hospital Charge Code |
906813627
|
|
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 B/S DEXTRUS 4136
|
Facility
|
IP
|
$2,300.00
|
|
|
Service Code
|
CPT C1898
|
| Hospital Charge Code |
906813627
|
|
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 DEXTRUS 4137
|
Facility
|
IP
|
$2,300.00
|
|
|
Service Code
|
CPT C1898
|
| Hospital Charge Code |
906813593
|
|
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 DEXTRUS 4137
|
Facility
|
OP
|
$2,300.00
|
|
|
Service Code
|
CPT C1898
|
| Hospital Charge Code |
906813593
|
|
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 B/S EASYTRAK 2 4542
|
Facility
|
OP
|
$5,775.00
|
|
|
Service Code
|
CPT C1900
|
| Hospital Charge Code |
906813639
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,155.00 |
| Max. Negotiated Rate |
$5,197.50 |
| Rate for Payer: Adventist Health Commercial |
$1,155.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,908.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,176.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,331.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,636.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,197.62
|
| Rate for Payer: Blue Shield of California Commercial |
$4,464.07
|
| Rate for Payer: Blue Shield of California EPN |
$2,910.60
|
| Rate for Payer: Cash Price |
$3,176.25
|
| Rate for Payer: Central Health Plan Commercial |
$4,620.00
|
| Rate for Payer: Cigna of CA HMO |
$4,042.50
|
| Rate for Payer: Cigna of CA PPO |
$4,042.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,908.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,908.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,908.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,310.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,310.00
|
| Rate for Payer: Galaxy Health WC |
$4,908.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,465.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,197.50
|
| Rate for Payer: InnovAge PACE Commercial |
$2,887.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,851.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,200.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,574.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,155.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,042.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,042.50
|
| Rate for Payer: Multiplan Commercial |
$4,331.25
|
| Rate for Payer: Networks By Design Commercial |
$2,887.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,908.75
|
| Rate for Payer: Riverside University Health System MISP |
$2,310.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,465.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,465.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,167.36
|
| Rate for Payer: United Healthcare All Other HMO |
$2,109.61
|
| Rate for Payer: United Healthcare HMO Rider |
$2,063.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,891.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,908.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,908.75
|
| Rate for Payer: Vantage Medical Group Senior |
$4,908.75
|
|
|
HC LEAD B/S EASYTRAK 2 4542
|
Facility
|
IP
|
$5,775.00
|
|
|
Service Code
|
CPT C1900
|
| Hospital Charge Code |
906813639
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,155.00 |
| Max. Negotiated Rate |
$5,197.50 |
| Rate for Payer: Adventist Health Commercial |
$1,155.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,464.07
|
| Rate for Payer: Blue Shield of California EPN |
$2,910.60
|
| Rate for Payer: Cash Price |
$3,176.25
|
| Rate for Payer: Central Health Plan Commercial |
$4,620.00
|
| Rate for Payer: Cigna of CA HMO |
$4,042.50
|
| Rate for Payer: Cigna of CA PPO |
$4,042.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,310.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,310.00
|
| Rate for Payer: Galaxy Health WC |
$4,908.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,465.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,197.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,851.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,200.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,574.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,155.00
|
| Rate for Payer: Multiplan Commercial |
$4,331.25
|
| Rate for Payer: Networks By Design Commercial |
$2,887.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,908.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,167.36
|
| Rate for Payer: United Healthcare All Other HMO |
$2,109.61
|
| Rate for Payer: United Healthcare HMO Rider |
$2,063.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,891.31
|
|
|
HC LEAD B/S EASYTRAK 4543
|
Facility
|
IP
|
$5,775.00
|
|
|
Service Code
|
CPT C1900
|
| Hospital Charge Code |
906813562
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,155.00 |
| Max. Negotiated Rate |
$5,197.50 |
| Rate for Payer: Adventist Health Commercial |
$1,155.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,464.07
|
| Rate for Payer: Blue Shield of California EPN |
$2,910.60
|
| Rate for Payer: Cash Price |
$3,176.25
|
| Rate for Payer: Central Health Plan Commercial |
$4,620.00
|
| Rate for Payer: Cigna of CA HMO |
$4,042.50
|
| Rate for Payer: Cigna of CA PPO |
$4,042.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,310.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,310.00
|
| Rate for Payer: Galaxy Health WC |
$4,908.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,465.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,197.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,851.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,200.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,574.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,155.00
|
| Rate for Payer: Multiplan Commercial |
$4,331.25
|
| Rate for Payer: Networks By Design Commercial |
$2,887.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,908.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,167.36
|
| Rate for Payer: United Healthcare All Other HMO |
$2,109.61
|
| Rate for Payer: United Healthcare HMO Rider |
$2,063.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,891.31
|
|
|
HC LEAD B/S EASYTRAK 4543
|
Facility
|
OP
|
$5,775.00
|
|
|
Service Code
|
CPT C1900
|
| Hospital Charge Code |
906813562
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,155.00 |
| Max. Negotiated Rate |
$5,197.50 |
| Rate for Payer: Adventist Health Commercial |
$1,155.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,908.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,176.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,331.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,796.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,391.66
|
| Rate for Payer: Blue Shield of California Commercial |
$4,464.07
|
| Rate for Payer: Blue Shield of California EPN |
$2,910.60
|
| Rate for Payer: Cash Price |
$3,176.25
|
| Rate for Payer: Central Health Plan Commercial |
$4,620.00
|
| Rate for Payer: Cigna of CA HMO |
$4,042.50
|
| Rate for Payer: Cigna of CA PPO |
$4,042.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,908.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,908.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,908.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,310.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,310.00
|
| Rate for Payer: Galaxy Health WC |
$4,908.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,465.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,197.50
|
| Rate for Payer: InnovAge PACE Commercial |
$2,887.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,851.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,200.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,574.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,155.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,042.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,042.50
|
| Rate for Payer: Multiplan Commercial |
$4,331.25
|
| Rate for Payer: Networks By Design Commercial |
$2,887.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,908.75
|
| Rate for Payer: Riverside University Health System MISP |
$2,310.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,465.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,465.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,167.36
|
| Rate for Payer: United Healthcare All Other HMO |
$2,109.61
|
| Rate for Payer: United Healthcare HMO Rider |
$2,063.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,891.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,908.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,908.75
|
| Rate for Payer: Vantage Medical Group Senior |
$4,908.75
|
|
|
HC LEAD B/S EASYTRAK 4549
|
Facility
|
IP
|
$5,775.00
|
|
|
Service Code
|
CPT C1900
|
| Hospital Charge Code |
906813563
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,155.00 |
| Max. Negotiated Rate |
$5,197.50 |
| Rate for Payer: Adventist Health Commercial |
$1,155.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,464.07
|
| Rate for Payer: Blue Shield of California EPN |
$2,910.60
|
| Rate for Payer: Cash Price |
$3,176.25
|
| Rate for Payer: Central Health Plan Commercial |
$4,620.00
|
| Rate for Payer: Cigna of CA HMO |
$4,042.50
|
| Rate for Payer: Cigna of CA PPO |
$4,042.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,310.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,310.00
|
| Rate for Payer: Galaxy Health WC |
$4,908.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,465.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,197.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,851.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,200.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,574.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,155.00
|
| Rate for Payer: Multiplan Commercial |
$4,331.25
|
| Rate for Payer: Networks By Design Commercial |
$2,887.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,908.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,167.36
|
| Rate for Payer: United Healthcare All Other HMO |
$2,109.61
|
| Rate for Payer: United Healthcare HMO Rider |
$2,063.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,891.31
|
|
|
HC LEAD B/S EASYTRAK 4549
|
Facility
|
OP
|
$5,775.00
|
|
|
Service Code
|
CPT C1900
|
| Hospital Charge Code |
906813563
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,155.00 |
| Max. Negotiated Rate |
$5,197.50 |
| Rate for Payer: Adventist Health Commercial |
$1,155.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,908.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,176.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,331.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,636.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,197.62
|
| Rate for Payer: Blue Shield of California Commercial |
$4,464.07
|
| Rate for Payer: Blue Shield of California EPN |
$2,910.60
|
| Rate for Payer: Cash Price |
$3,176.25
|
| Rate for Payer: Central Health Plan Commercial |
$4,620.00
|
| Rate for Payer: Cigna of CA HMO |
$4,042.50
|
| Rate for Payer: Cigna of CA PPO |
$4,042.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,908.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,908.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,908.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,310.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,310.00
|
| Rate for Payer: Galaxy Health WC |
$4,908.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,465.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,197.50
|
| Rate for Payer: InnovAge PACE Commercial |
$2,887.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,851.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,200.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,574.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,155.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,042.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,042.50
|
| Rate for Payer: Multiplan Commercial |
$4,331.25
|
| Rate for Payer: Networks By Design Commercial |
$2,887.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,908.75
|
| Rate for Payer: Riverside University Health System MISP |
$2,310.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,465.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,465.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,167.36
|
| Rate for Payer: United Healthcare All Other HMO |
$2,109.61
|
| Rate for Payer: United Healthcare HMO Rider |
$2,063.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,891.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,908.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,908.75
|
| Rate for Payer: Vantage Medical Group Senior |
$4,908.75
|
|
|
HC LEAD B/S EMBLEM 3401
|
Facility
|
IP
|
$12,500.00
|
|
|
Service Code
|
CPT C1896
|
| Hospital Charge Code |
906813756
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,500.00 |
| Max. Negotiated Rate |
$11,250.00 |
| Rate for Payer: Adventist Health Commercial |
$2,500.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,662.50
|
| Rate for Payer: Blue Shield of California EPN |
$6,300.00
|
| Rate for Payer: Cash Price |
$6,875.00
|
| Rate for Payer: Central Health Plan Commercial |
$10,000.00
|
| Rate for Payer: Cigna of CA HMO |
$8,750.00
|
| Rate for Payer: Cigna of CA PPO |
$8,750.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,000.00
|
| Rate for Payer: Galaxy Health WC |
$10,625.00
|
| Rate for Payer: Global Benefits Group Commercial |
$7,500.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,250.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,337.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,762.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,737.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,500.00
|
| Rate for Payer: Multiplan Commercial |
$9,375.00
|
| Rate for Payer: Networks By Design Commercial |
$6,250.00
|
| Rate for Payer: Prime Health Services Commercial |
$10,625.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,691.25
|
| Rate for Payer: United Healthcare All Other HMO |
$4,566.25
|
| Rate for Payer: United Healthcare HMO Rider |
$4,467.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,093.75
|
|
|
HC LEAD B/S EMBLEM 3401
|
Facility
|
OP
|
$12,500.00
|
|
|
Service Code
|
CPT C1896
|
| Hospital Charge Code |
906813756
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,500.00 |
| Max. Negotiated Rate |
$11,250.00 |
| Rate for Payer: Adventist Health Commercial |
$2,500.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,625.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,875.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,375.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,052.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,341.25
|
| Rate for Payer: Blue Shield of California Commercial |
$9,662.50
|
| Rate for Payer: Blue Shield of California EPN |
$6,300.00
|
| Rate for Payer: Cash Price |
$6,875.00
|
| Rate for Payer: Central Health Plan Commercial |
$10,000.00
|
| Rate for Payer: Cigna of CA HMO |
$8,750.00
|
| Rate for Payer: Cigna of CA PPO |
$8,750.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,625.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,625.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,625.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,000.00
|
| Rate for Payer: Galaxy Health WC |
$10,625.00
|
| Rate for Payer: Global Benefits Group Commercial |
$7,500.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,250.00
|
| Rate for Payer: InnovAge PACE Commercial |
$6,250.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,337.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,737.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,500.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,750.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,750.00
|
| Rate for Payer: Multiplan Commercial |
$9,375.00
|
| Rate for Payer: Networks By Design Commercial |
$6,250.00
|
| Rate for Payer: Prime Health Services Commercial |
$10,625.00
|
| Rate for Payer: Riverside University Health System MISP |
$5,000.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,500.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,500.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,691.25
|
| Rate for Payer: United Healthcare All Other HMO |
$4,566.25
|
| Rate for Payer: United Healthcare HMO Rider |
$4,467.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,093.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,625.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,625.00
|
| Rate for Payer: Vantage Medical Group Senior |
$10,625.00
|
|
|
HC LEAD B/S ENDOTAK XP SQ 0085
|
Facility
|
IP
|
$6,250.00
|
|
|
Service Code
|
CPT C1896
|
| Hospital Charge Code |
906813601
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,250.00 |
| Max. Negotiated Rate |
$5,625.00 |
| Rate for Payer: Adventist Health Commercial |
$1,250.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,831.25
|
| Rate for Payer: Blue Shield of California EPN |
$3,150.00
|
| Rate for Payer: Cash Price |
$3,437.50
|
| Rate for Payer: Central Health Plan Commercial |
$5,000.00
|
| Rate for Payer: Cigna of CA HMO |
$4,375.00
|
| Rate for Payer: Cigna of CA PPO |
$4,375.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,500.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,500.00
|
| Rate for Payer: Galaxy Health WC |
$5,312.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,750.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,625.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,168.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,381.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,868.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,250.00
|
| Rate for Payer: Multiplan Commercial |
$4,687.50
|
| Rate for Payer: Networks By Design Commercial |
$3,125.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,312.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,345.62
|
| Rate for Payer: United Healthcare All Other HMO |
$2,283.12
|
| Rate for Payer: United Healthcare HMO Rider |
$2,233.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,046.88
|
|
|
HC LEAD B/S ENDOTAK XP SQ 0085
|
Facility
|
OP
|
$6,250.00
|
|
|
Service Code
|
CPT C1896
|
| Hospital Charge Code |
906813601
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,250.00 |
| Max. Negotiated Rate |
$5,625.00 |
| Rate for Payer: Adventist Health Commercial |
$1,250.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,312.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,437.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,687.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,853.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,460.62
|
| Rate for Payer: Blue Shield of California Commercial |
$4,831.25
|
| Rate for Payer: Blue Shield of California EPN |
$3,150.00
|
| Rate for Payer: Cash Price |
$3,437.50
|
| Rate for Payer: Central Health Plan Commercial |
$5,000.00
|
| Rate for Payer: Cigna of CA HMO |
$4,375.00
|
| Rate for Payer: Cigna of CA PPO |
$4,375.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,312.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,312.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,312.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,500.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,500.00
|
| Rate for Payer: Galaxy Health WC |
$5,312.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,750.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,625.00
|
| Rate for Payer: InnovAge PACE Commercial |
$3,125.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,168.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,868.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,250.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,375.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,375.00
|
| Rate for Payer: Multiplan Commercial |
$4,687.50
|
| Rate for Payer: Networks By Design Commercial |
$3,125.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,312.50
|
| Rate for Payer: Riverside University Health System MISP |
$2,500.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,750.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,750.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,345.62
|
| Rate for Payer: United Healthcare All Other HMO |
$2,283.12
|
| Rate for Payer: United Healthcare HMO Rider |
$2,233.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,046.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,312.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,312.50
|
| Rate for Payer: Vantage Medical Group Senior |
$5,312.50
|
|
|
HC LEAD BS GREATBATCH 4046
|
Facility
|
OP
|
$2,300.00
|
|
|
Service Code
|
CPT C1898
|
| Hospital Charge Code |
906813723
|
|
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 BS GREATBATCH 4046
|
Facility
|
IP
|
$2,300.00
|
|
|
Service Code
|
CPT C1898
|
| Hospital Charge Code |
906813723
|
|
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 INGEVITY 7735
|
Facility
|
OP
|
$2,300.00
|
|
|
Service Code
|
CPT C1898
|
| Hospital Charge Code |
906813829
|
|
Hospital Revenue Code
|
278
|
| 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 |
$1,050.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,273.51
|
| 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 B/S INGEVITY 7735
|
Facility
|
IP
|
$2,300.00
|
|
|
Service Code
|
CPT C1898
|
| Hospital Charge Code |
906813829
|
|
Hospital Revenue Code
|
278
|
| 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 INGEVITY 7742
|
Facility
|
OP
|
$2,300.00
|
|
|
Service Code
|
CPT C1898
|
| Hospital Charge Code |
906813777
|
|
Hospital Revenue Code
|
278
|
| 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 |
$1,050.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,273.51
|
| 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 B/S INGEVITY 7742
|
Facility
|
IP
|
$2,300.00
|
|
|
Service Code
|
CPT C1898
|
| Hospital Charge Code |
906813777
|
|
Hospital Revenue Code
|
278
|
| 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 OPTISURE 210Q
|
Facility
|
OP
|
$7,363.00
|
|
|
Service Code
|
CPT C1777
|
| Hospital Charge Code |
906813808
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,472.60 |
| Max. Negotiated Rate |
$6,626.70 |
| 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 Exchange |
$3,361.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,076.89
|
| Rate for Payer: Blue Shield of California Commercial |
$5,691.60
|
| Rate for Payer: Blue Shield of California EPN |
$3,710.95
|
| Rate for Payer: Cash Price |
$4,049.65
|
| Rate for Payer: Central Health Plan Commercial |
$5,890.40
|
| 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: Health Management Network EPO/PPO |
$6,626.70
|
| Rate for Payer: InnovAge PACE Commercial |
$3,681.50
|
| 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 |
$1,472.60
|
| 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 |
$5,522.25
|
| Rate for Payer: Networks By Design Commercial |
$3,681.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,258.55
|
| Rate for Payer: Riverside University Health System MISP |
$2,945.20
|
| 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
|
|
