|
HC LEAD B/S RELIANCE GORE DF4 283
|
Facility
|
IP
|
$10,750.00
|
|
|
Service Code
|
CPT C1777
|
| Hospital Charge Code |
906813680
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,150.00 |
| Max. Negotiated Rate |
$9,675.00 |
| Rate for Payer: Adventist Health Commercial |
$2,150.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,309.75
|
| Rate for Payer: Blue Shield of California EPN |
$5,418.00
|
| Rate for Payer: Cash Price |
$4,837.50
|
| Rate for Payer: Central Health Plan Commercial |
$8,600.00
|
| Rate for Payer: Cigna of CA HMO |
$7,525.00
|
| Rate for Payer: Cigna of CA PPO |
$7,525.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,300.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,300.00
|
| Rate for Payer: Galaxy Health WC |
$9,137.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6,450.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,675.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,170.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,095.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,654.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,150.00
|
| Rate for Payer: Multiplan Commercial |
$8,062.50
|
| Rate for Payer: Networks By Design Commercial |
$5,375.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,137.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,034.47
|
| Rate for Payer: United Healthcare All Other HMO |
$3,926.97
|
| Rate for Payer: United Healthcare HMO Rider |
$3,842.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,520.62
|
|
|
HC LEAD B/S RELIANCE GORE DF4 285
|
Facility
|
IP
|
$10,750.00
|
|
|
Service Code
|
CPT C1777
|
| Hospital Charge Code |
906813681
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,150.00 |
| Max. Negotiated Rate |
$9,675.00 |
| Rate for Payer: Adventist Health Commercial |
$2,150.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,309.75
|
| Rate for Payer: Blue Shield of California EPN |
$5,418.00
|
| Rate for Payer: Cash Price |
$4,837.50
|
| Rate for Payer: Central Health Plan Commercial |
$8,600.00
|
| Rate for Payer: Cigna of CA HMO |
$7,525.00
|
| Rate for Payer: Cigna of CA PPO |
$7,525.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,300.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,300.00
|
| Rate for Payer: Galaxy Health WC |
$9,137.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6,450.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,675.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,170.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,095.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,654.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,150.00
|
| Rate for Payer: Multiplan Commercial |
$8,062.50
|
| Rate for Payer: Networks By Design Commercial |
$5,375.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,137.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,034.47
|
| Rate for Payer: United Healthcare All Other HMO |
$3,926.97
|
| Rate for Payer: United Healthcare HMO Rider |
$3,842.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,520.62
|
|
|
HC LEAD B/S RELIANCE GORE DF4 285
|
Facility
|
OP
|
$10,750.00
|
|
|
Service Code
|
CPT C1777
|
| Hospital Charge Code |
906813681
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,150.00 |
| Max. Negotiated Rate |
$9,675.00 |
| Rate for Payer: Adventist Health Commercial |
$2,150.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,137.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,912.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,062.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,205.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,313.48
|
| Rate for Payer: Blue Shield of California Commercial |
$8,309.75
|
| Rate for Payer: Blue Shield of California EPN |
$5,418.00
|
| Rate for Payer: Cash Price |
$4,837.50
|
| Rate for Payer: Central Health Plan Commercial |
$8,600.00
|
| Rate for Payer: Cigna of CA HMO |
$7,525.00
|
| Rate for Payer: Cigna of CA PPO |
$7,525.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,137.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,137.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,137.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,300.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,300.00
|
| Rate for Payer: Galaxy Health WC |
$9,137.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6,450.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,675.00
|
| Rate for Payer: InnovAge PACE Commercial |
$5,375.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,170.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,654.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,150.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,525.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,525.00
|
| Rate for Payer: Multiplan Commercial |
$8,062.50
|
| Rate for Payer: Networks By Design Commercial |
$5,375.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,137.50
|
| Rate for Payer: Riverside University Health System MISP |
$4,300.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,450.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,450.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,034.47
|
| Rate for Payer: United Healthcare All Other HMO |
$3,926.97
|
| Rate for Payer: United Healthcare HMO Rider |
$3,842.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,520.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,137.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,137.50
|
| Rate for Payer: Vantage Medical Group Senior |
$9,137.50
|
|
|
HC LEAD B/S RELIANCE GORE DF4 286
|
Facility
|
OP
|
$10,750.00
|
|
|
Service Code
|
CPT C1777
|
| Hospital Charge Code |
906813682
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,150.00 |
| Max. Negotiated Rate |
$9,675.00 |
| Rate for Payer: Adventist Health Commercial |
$2,150.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,137.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,912.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,062.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,205.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,313.48
|
| Rate for Payer: Blue Shield of California Commercial |
$8,309.75
|
| Rate for Payer: Blue Shield of California EPN |
$5,418.00
|
| Rate for Payer: Cash Price |
$4,837.50
|
| Rate for Payer: Central Health Plan Commercial |
$8,600.00
|
| Rate for Payer: Cigna of CA HMO |
$7,525.00
|
| Rate for Payer: Cigna of CA PPO |
$7,525.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,137.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,137.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,137.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,300.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,300.00
|
| Rate for Payer: Galaxy Health WC |
$9,137.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6,450.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,675.00
|
| Rate for Payer: InnovAge PACE Commercial |
$5,375.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,170.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,654.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,150.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,525.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,525.00
|
| Rate for Payer: Multiplan Commercial |
$8,062.50
|
| Rate for Payer: Networks By Design Commercial |
$5,375.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,137.50
|
| Rate for Payer: Riverside University Health System MISP |
$4,300.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,450.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,450.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,034.47
|
| Rate for Payer: United Healthcare All Other HMO |
$3,926.97
|
| Rate for Payer: United Healthcare HMO Rider |
$3,842.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,520.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,137.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,137.50
|
| Rate for Payer: Vantage Medical Group Senior |
$9,137.50
|
|
|
HC LEAD B/S RELIANCE GORE DF4 286
|
Facility
|
IP
|
$10,750.00
|
|
|
Service Code
|
CPT C1777
|
| Hospital Charge Code |
906813682
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,150.00 |
| Max. Negotiated Rate |
$9,675.00 |
| Rate for Payer: Adventist Health Commercial |
$2,150.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,309.75
|
| Rate for Payer: Blue Shield of California EPN |
$5,418.00
|
| Rate for Payer: Cash Price |
$4,837.50
|
| Rate for Payer: Central Health Plan Commercial |
$8,600.00
|
| Rate for Payer: Cigna of CA HMO |
$7,525.00
|
| Rate for Payer: Cigna of CA PPO |
$7,525.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,300.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,300.00
|
| Rate for Payer: Galaxy Health WC |
$9,137.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6,450.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,675.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,170.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,095.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,654.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,150.00
|
| Rate for Payer: Multiplan Commercial |
$8,062.50
|
| Rate for Payer: Networks By Design Commercial |
$5,375.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,137.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,034.47
|
| Rate for Payer: United Healthcare All Other HMO |
$3,926.97
|
| Rate for Payer: United Healthcare HMO Rider |
$3,842.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,520.62
|
|
|
HC LEAD B/S RELIANCE GORE DF4 292
|
Facility
|
IP
|
$10,750.00
|
|
|
Service Code
|
CPT C1777
|
| Hospital Charge Code |
906813664
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,150.00 |
| Max. Negotiated Rate |
$9,675.00 |
| Rate for Payer: Adventist Health Commercial |
$2,150.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,309.75
|
| Rate for Payer: Blue Shield of California EPN |
$5,418.00
|
| Rate for Payer: Cash Price |
$4,837.50
|
| Rate for Payer: Central Health Plan Commercial |
$8,600.00
|
| Rate for Payer: Cigna of CA HMO |
$7,525.00
|
| Rate for Payer: Cigna of CA PPO |
$7,525.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,300.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,300.00
|
| Rate for Payer: Galaxy Health WC |
$9,137.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6,450.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,675.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,170.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,095.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,654.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,150.00
|
| Rate for Payer: Multiplan Commercial |
$8,062.50
|
| Rate for Payer: Networks By Design Commercial |
$5,375.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,137.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,034.47
|
| Rate for Payer: United Healthcare All Other HMO |
$3,926.97
|
| Rate for Payer: United Healthcare HMO Rider |
$3,842.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,520.62
|
|
|
HC LEAD B/S RELIANCE GORE DF4 292
|
Facility
|
OP
|
$10,750.00
|
|
|
Service Code
|
CPT C1777
|
| Hospital Charge Code |
906813664
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,150.00 |
| Max. Negotiated Rate |
$9,675.00 |
| Rate for Payer: Adventist Health Commercial |
$2,150.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,137.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,912.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,062.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,908.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,952.27
|
| Rate for Payer: Blue Shield of California Commercial |
$8,309.75
|
| Rate for Payer: Blue Shield of California EPN |
$5,418.00
|
| Rate for Payer: Cash Price |
$4,837.50
|
| Rate for Payer: Central Health Plan Commercial |
$8,600.00
|
| Rate for Payer: Cigna of CA HMO |
$7,525.00
|
| Rate for Payer: Cigna of CA PPO |
$7,525.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,137.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,137.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,137.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,300.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,300.00
|
| Rate for Payer: Galaxy Health WC |
$9,137.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6,450.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,675.00
|
| Rate for Payer: InnovAge PACE Commercial |
$5,375.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,170.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,654.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,150.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,525.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,525.00
|
| Rate for Payer: Multiplan Commercial |
$8,062.50
|
| Rate for Payer: Networks By Design Commercial |
$5,375.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,137.50
|
| Rate for Payer: Riverside University Health System MISP |
$4,300.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,450.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,450.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,034.47
|
| Rate for Payer: United Healthcare All Other HMO |
$3,926.97
|
| Rate for Payer: United Healthcare HMO Rider |
$3,842.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,520.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,137.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,137.50
|
| Rate for Payer: Vantage Medical Group Senior |
$9,137.50
|
|
|
HC LEAD B/S RELIANCE GORE DF4 293
|
Facility
|
IP
|
$10,750.00
|
|
|
Service Code
|
CPT C1777
|
| Hospital Charge Code |
906813677
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,150.00 |
| Max. Negotiated Rate |
$9,675.00 |
| Rate for Payer: Adventist Health Commercial |
$2,150.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,309.75
|
| Rate for Payer: Blue Shield of California EPN |
$5,418.00
|
| Rate for Payer: Cash Price |
$4,837.50
|
| Rate for Payer: Central Health Plan Commercial |
$8,600.00
|
| Rate for Payer: Cigna of CA HMO |
$7,525.00
|
| Rate for Payer: Cigna of CA PPO |
$7,525.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,300.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,300.00
|
| Rate for Payer: Galaxy Health WC |
$9,137.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6,450.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,675.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,170.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,095.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,654.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,150.00
|
| Rate for Payer: Multiplan Commercial |
$8,062.50
|
| Rate for Payer: Networks By Design Commercial |
$5,375.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,137.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,034.47
|
| Rate for Payer: United Healthcare All Other HMO |
$3,926.97
|
| Rate for Payer: United Healthcare HMO Rider |
$3,842.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,520.62
|
|
|
HC LEAD B/S RELIANCE GORE DF4 293
|
Facility
|
OP
|
$10,750.00
|
|
|
Service Code
|
CPT C1777
|
| Hospital Charge Code |
906813677
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,150.00 |
| Max. Negotiated Rate |
$9,675.00 |
| Rate for Payer: Adventist Health Commercial |
$2,150.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,137.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,912.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,062.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,205.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,313.48
|
| Rate for Payer: Blue Shield of California Commercial |
$8,309.75
|
| Rate for Payer: Blue Shield of California EPN |
$5,418.00
|
| Rate for Payer: Cash Price |
$4,837.50
|
| Rate for Payer: Central Health Plan Commercial |
$8,600.00
|
| Rate for Payer: Cigna of CA HMO |
$7,525.00
|
| Rate for Payer: Cigna of CA PPO |
$7,525.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,137.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,137.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,137.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,300.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,300.00
|
| Rate for Payer: Galaxy Health WC |
$9,137.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6,450.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,675.00
|
| Rate for Payer: InnovAge PACE Commercial |
$5,375.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,170.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,654.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,150.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,525.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,525.00
|
| Rate for Payer: Multiplan Commercial |
$8,062.50
|
| Rate for Payer: Networks By Design Commercial |
$5,375.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,137.50
|
| Rate for Payer: Riverside University Health System MISP |
$4,300.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,450.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,450.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,034.47
|
| Rate for Payer: United Healthcare All Other HMO |
$3,926.97
|
| Rate for Payer: United Healthcare HMO Rider |
$3,842.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,520.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,137.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,137.50
|
| Rate for Payer: Vantage Medical Group Senior |
$9,137.50
|
|
|
HC LEAD B/S RELIANCE GORE DF4 295
|
Facility
|
OP
|
$10,750.00
|
|
|
Service Code
|
CPT C1777
|
| Hospital Charge Code |
906813678
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,150.00 |
| Max. Negotiated Rate |
$9,675.00 |
| Rate for Payer: Adventist Health Commercial |
$2,150.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,137.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,912.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,062.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,205.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,313.48
|
| Rate for Payer: Blue Shield of California Commercial |
$8,309.75
|
| Rate for Payer: Blue Shield of California EPN |
$5,418.00
|
| Rate for Payer: Cash Price |
$4,837.50
|
| Rate for Payer: Central Health Plan Commercial |
$8,600.00
|
| Rate for Payer: Cigna of CA HMO |
$7,525.00
|
| Rate for Payer: Cigna of CA PPO |
$7,525.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,137.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,137.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,137.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,300.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,300.00
|
| Rate for Payer: Galaxy Health WC |
$9,137.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6,450.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,675.00
|
| Rate for Payer: InnovAge PACE Commercial |
$5,375.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,170.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,654.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,150.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,525.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,525.00
|
| Rate for Payer: Multiplan Commercial |
$8,062.50
|
| Rate for Payer: Networks By Design Commercial |
$5,375.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,137.50
|
| Rate for Payer: Riverside University Health System MISP |
$4,300.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,450.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,450.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,034.47
|
| Rate for Payer: United Healthcare All Other HMO |
$3,926.97
|
| Rate for Payer: United Healthcare HMO Rider |
$3,842.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,520.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,137.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,137.50
|
| Rate for Payer: Vantage Medical Group Senior |
$9,137.50
|
|
|
HC LEAD B/S RELIANCE GORE DF4 295
|
Facility
|
IP
|
$10,750.00
|
|
|
Service Code
|
CPT C1777
|
| Hospital Charge Code |
906813678
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,150.00 |
| Max. Negotiated Rate |
$9,675.00 |
| Rate for Payer: Adventist Health Commercial |
$2,150.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,309.75
|
| Rate for Payer: Blue Shield of California EPN |
$5,418.00
|
| Rate for Payer: Cash Price |
$4,837.50
|
| Rate for Payer: Central Health Plan Commercial |
$8,600.00
|
| Rate for Payer: Cigna of CA HMO |
$7,525.00
|
| Rate for Payer: Cigna of CA PPO |
$7,525.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,300.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,300.00
|
| Rate for Payer: Galaxy Health WC |
$9,137.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6,450.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,675.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,170.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,095.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,654.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,150.00
|
| Rate for Payer: Multiplan Commercial |
$8,062.50
|
| Rate for Payer: Networks By Design Commercial |
$5,375.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,137.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,034.47
|
| Rate for Payer: United Healthcare All Other HMO |
$3,926.97
|
| Rate for Payer: United Healthcare HMO Rider |
$3,842.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,520.62
|
|
|
HC LEAD B/S RELIANCE GORE DF4 296
|
Facility
|
IP
|
$10,750.00
|
|
|
Service Code
|
CPT C1777
|
| Hospital Charge Code |
906813679
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,150.00 |
| Max. Negotiated Rate |
$9,675.00 |
| Rate for Payer: Adventist Health Commercial |
$2,150.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,309.75
|
| Rate for Payer: Blue Shield of California EPN |
$5,418.00
|
| Rate for Payer: Cash Price |
$4,837.50
|
| Rate for Payer: Central Health Plan Commercial |
$8,600.00
|
| Rate for Payer: Cigna of CA HMO |
$7,525.00
|
| Rate for Payer: Cigna of CA PPO |
$7,525.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,300.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,300.00
|
| Rate for Payer: Galaxy Health WC |
$9,137.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6,450.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,675.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,170.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,095.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,654.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,150.00
|
| Rate for Payer: Multiplan Commercial |
$8,062.50
|
| Rate for Payer: Networks By Design Commercial |
$5,375.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,137.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,034.47
|
| Rate for Payer: United Healthcare All Other HMO |
$3,926.97
|
| Rate for Payer: United Healthcare HMO Rider |
$3,842.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,520.62
|
|
|
HC LEAD B/S RELIANCE GORE DF4 296
|
Facility
|
OP
|
$10,750.00
|
|
|
Service Code
|
CPT C1777
|
| Hospital Charge Code |
906813679
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,150.00 |
| Max. Negotiated Rate |
$9,675.00 |
| Rate for Payer: Adventist Health Commercial |
$2,150.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,137.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,912.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,062.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,205.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,313.48
|
| Rate for Payer: Blue Shield of California Commercial |
$8,309.75
|
| Rate for Payer: Blue Shield of California EPN |
$5,418.00
|
| Rate for Payer: Cash Price |
$4,837.50
|
| Rate for Payer: Central Health Plan Commercial |
$8,600.00
|
| Rate for Payer: Cigna of CA HMO |
$7,525.00
|
| Rate for Payer: Cigna of CA PPO |
$7,525.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,137.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,137.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,137.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,300.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,300.00
|
| Rate for Payer: Galaxy Health WC |
$9,137.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6,450.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,675.00
|
| Rate for Payer: InnovAge PACE Commercial |
$5,375.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,170.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,654.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,150.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,525.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,525.00
|
| Rate for Payer: Multiplan Commercial |
$8,062.50
|
| Rate for Payer: Networks By Design Commercial |
$5,375.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,137.50
|
| Rate for Payer: Riverside University Health System MISP |
$4,300.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,450.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,450.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,034.47
|
| Rate for Payer: United Healthcare All Other HMO |
$3,926.97
|
| Rate for Payer: United Healthcare HMO Rider |
$3,842.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,520.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,137.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,137.50
|
| Rate for Payer: Vantage Medical Group Senior |
$9,137.50
|
|
|
HC LEAD B/S RELIANCE GORE DR4 266
|
Facility
|
IP
|
$10,000.00
|
|
|
Service Code
|
CPT C1895
|
| Hospital Charge Code |
906813684
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,000.00 |
| Max. Negotiated Rate |
$9,000.00 |
| Rate for Payer: Adventist Health Commercial |
$2,000.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,730.00
|
| Rate for Payer: Blue Shield of California EPN |
$5,040.00
|
| Rate for Payer: Cash Price |
$4,500.00
|
| Rate for Payer: Central Health Plan Commercial |
$8,000.00
|
| Rate for Payer: Cigna of CA HMO |
$7,000.00
|
| Rate for Payer: Cigna of CA PPO |
$7,000.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,000.00
|
| Rate for Payer: Galaxy Health WC |
$8,500.00
|
| Rate for Payer: Global Benefits Group Commercial |
$6,000.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,000.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,670.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,810.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,190.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,000.00
|
| Rate for Payer: Multiplan Commercial |
$7,500.00
|
| Rate for Payer: Networks By Design Commercial |
$5,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$8,500.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,753.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,653.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,574.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,275.00
|
|
|
HC LEAD B/S RELIANCE GORE DR4 266
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT C1895
|
| Hospital Charge Code |
906813684
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,000.00 |
| Max. Negotiated Rate |
$9,000.00 |
| Rate for Payer: Adventist Health Commercial |
$2,000.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,500.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,500.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,500.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,842.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,873.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,730.00
|
| Rate for Payer: Blue Shield of California EPN |
$5,040.00
|
| Rate for Payer: Cash Price |
$4,500.00
|
| Rate for Payer: Central Health Plan Commercial |
$8,000.00
|
| Rate for Payer: Cigna of CA HMO |
$7,000.00
|
| Rate for Payer: Cigna of CA PPO |
$7,000.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,500.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,500.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,500.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,000.00
|
| Rate for Payer: Galaxy Health WC |
$8,500.00
|
| Rate for Payer: Global Benefits Group Commercial |
$6,000.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,000.00
|
| Rate for Payer: InnovAge PACE Commercial |
$5,000.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,670.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,190.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,000.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,000.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,000.00
|
| Rate for Payer: Multiplan Commercial |
$7,500.00
|
| Rate for Payer: Networks By Design Commercial |
$5,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$8,500.00
|
| Rate for Payer: Riverside University Health System MISP |
$4,000.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,000.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,000.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,753.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,653.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,574.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,275.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,500.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,500.00
|
| Rate for Payer: Vantage Medical Group Senior |
$8,500.00
|
|
|
HC LEAD DELIVERY SYS B/S DSYS
|
Facility
|
OP
|
$2,535.00
|
|
| Hospital Charge Code |
906813545
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$507.00 |
| Max. Negotiated Rate |
$2,281.50 |
| Rate for Payer: Adventist Health Commercial |
$507.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,154.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,394.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,901.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,157.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,403.63
|
| Rate for Payer: Blue Shield of California Commercial |
$1,959.56
|
| Rate for Payer: Blue Shield of California EPN |
$1,277.64
|
| Rate for Payer: Cash Price |
$1,140.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,028.00
|
| Rate for Payer: Cigna of CA HMO |
$1,774.50
|
| Rate for Payer: Cigna of CA PPO |
$1,774.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,154.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,154.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,154.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,014.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,014.00
|
| Rate for Payer: Galaxy Health WC |
$2,154.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,521.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,281.50
|
| Rate for Payer: InnovAge PACE Commercial |
$1,267.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,690.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$965.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,569.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$507.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,774.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,774.50
|
| Rate for Payer: Multiplan Commercial |
$1,901.25
|
| Rate for Payer: Networks By Design Commercial |
$1,267.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,154.75
|
| Rate for Payer: Riverside University Health System MISP |
$1,014.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,521.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,521.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$951.39
|
| Rate for Payer: United Healthcare All Other HMO |
$926.04
|
| Rate for Payer: United Healthcare HMO Rider |
$906.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$830.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,154.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,154.75
|
| Rate for Payer: Vantage Medical Group Senior |
$2,154.75
|
|
|
HC LEAD DELIVERY SYS B/S DSYS
|
Facility
|
IP
|
$2,535.00
|
|
| Hospital Charge Code |
906813545
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$507.00 |
| Max. Negotiated Rate |
$2,281.50 |
| Rate for Payer: Adventist Health Commercial |
$507.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,959.56
|
| Rate for Payer: Blue Shield of California EPN |
$1,277.64
|
| Rate for Payer: Cash Price |
$1,140.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,028.00
|
| Rate for Payer: Cigna of CA HMO |
$1,774.50
|
| Rate for Payer: Cigna of CA PPO |
$1,774.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,014.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,014.00
|
| Rate for Payer: Galaxy Health WC |
$2,154.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,521.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,281.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,690.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$965.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,569.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$507.00
|
| Rate for Payer: Multiplan Commercial |
$1,901.25
|
| Rate for Payer: Networks By Design Commercial |
$1,267.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,154.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$951.39
|
| Rate for Payer: United Healthcare All Other HMO |
$926.04
|
| Rate for Payer: United Healthcare HMO Rider |
$906.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$830.21
|
|
|
HC LEAD INGEVITY 7741
|
Facility
|
IP
|
$2,300.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813773
|
|
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 |
$1,035.00
|
| 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 INGEVITY 7741
|
Facility
|
OP
|
$2,300.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813773
|
|
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 |
$1,035.00
|
| 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 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 INSERT CS, EXIST IMPL
|
Facility
|
OP
|
$44,282.00
|
|
|
Service Code
|
CPT 33224
|
| Hospital Charge Code |
906812214
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$480.91 |
| Max. Negotiated Rate |
$53,714.00 |
| Rate for Payer: Adventist Health Commercial |
$8,856.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$13,297.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19,945.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14,626.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,297.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$21,186.79
|
| Rate for Payer: Blue Shield of California Commercial |
$4,245.30
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$19,926.90
|
| Rate for Payer: Cash Price |
$19,926.90
|
| Rate for Payer: Cash Price |
$19,926.90
|
| Rate for Payer: Central Health Plan Commercial |
$35,425.60
|
| Rate for Payer: Cigna of CA HMO |
$28,340.48
|
| Rate for Payer: Cigna of CA PPO |
$32,768.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19,945.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$14,626.98
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13,297.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$17,951.29
|
| Rate for Payer: EPIC Health Plan Senior |
$13,297.25
|
| Rate for Payer: Galaxy Health WC |
$37,639.70
|
| Rate for Payer: Global Benefits Group Commercial |
$26,569.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$39,853.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21,807.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$480.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13,297.25
|
| Rate for Payer: InnovAge PACE Commercial |
$19,945.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29,536.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$531.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,297.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,856.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,818.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17,818.31
|
| Rate for Payer: Multiplan Commercial |
$33,211.50
|
| Rate for Payer: Multiplan WC |
$21,186.79
|
| Rate for Payer: Networks By Design Commercial |
$28,783.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13,297.25
|
| Rate for Payer: Preferred Health Network WC |
$21,619.17
|
| Rate for Payer: Prime Health Services Commercial |
$37,639.70
|
| Rate for Payer: Prime Health Services Medicare |
$14,095.08
|
| Rate for Payer: Prime Health Services WC |
$20,970.59
|
| Rate for Payer: Riverside University Health System MISP |
$14,626.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26,569.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$43,822.00
|
| Rate for Payer: United Healthcare All Other HMO |
$53,714.00
|
| Rate for Payer: United Healthcare HMO Rider |
$37,572.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34,424.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$13,297.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19,945.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14,626.98
|
| Rate for Payer: Vantage Medical Group Senior |
$13,297.25
|
|
|
HC LEAD INSERT CS, EXIST IMPL
|
Facility
|
IP
|
$52,096.00
|
|
|
Service Code
|
CPT 33224
|
| Hospital Charge Code |
906820135
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$10,419.20 |
| Max. Negotiated Rate |
$46,886.40 |
| Rate for Payer: Adventist Health Commercial |
$10,419.20
|
| Rate for Payer: Cash Price |
$23,443.20
|
| Rate for Payer: Central Health Plan Commercial |
$41,676.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$20,838.40
|
| Rate for Payer: EPIC Health Plan Senior |
$20,838.40
|
| Rate for Payer: Galaxy Health WC |
$44,281.60
|
| Rate for Payer: Global Benefits Group Commercial |
$31,257.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$46,886.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34,748.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19,848.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$32,247.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10,419.20
|
| Rate for Payer: Multiplan Commercial |
$39,072.00
|
| Rate for Payer: Networks By Design Commercial |
$33,862.40
|
| Rate for Payer: Prime Health Services Commercial |
$44,281.60
|
|
|
HC LEAD INSERT CS, EXIST IMPL
|
Facility
|
IP
|
$44,282.00
|
|
|
Service Code
|
CPT 33224
|
| Hospital Charge Code |
906812214
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$8,856.40 |
| Max. Negotiated Rate |
$39,853.80 |
| Rate for Payer: Adventist Health Commercial |
$8,856.40
|
| Rate for Payer: Cash Price |
$19,926.90
|
| Rate for Payer: Central Health Plan Commercial |
$35,425.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$17,712.80
|
| Rate for Payer: EPIC Health Plan Senior |
$17,712.80
|
| Rate for Payer: Galaxy Health WC |
$37,639.70
|
| Rate for Payer: Global Benefits Group Commercial |
$26,569.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$39,853.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29,536.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16,871.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27,410.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,856.40
|
| Rate for Payer: Multiplan Commercial |
$33,211.50
|
| Rate for Payer: Networks By Design Commercial |
$28,783.30
|
| Rate for Payer: Prime Health Services Commercial |
$37,639.70
|
|
|
HC LEAD INSERT CS, EXIST IMPL
|
Facility
|
OP
|
$52,096.00
|
|
|
Service Code
|
CPT 33224
|
| Hospital Charge Code |
906820135
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$480.91 |
| Max. Negotiated Rate |
$53,714.00 |
| Rate for Payer: Adventist Health Commercial |
$10,419.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$13,297.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19,945.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14,626.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,297.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$21,186.79
|
| Rate for Payer: Blue Shield of California Commercial |
$4,245.30
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$23,443.20
|
| Rate for Payer: Cash Price |
$23,443.20
|
| Rate for Payer: Cash Price |
$23,443.20
|
| Rate for Payer: Central Health Plan Commercial |
$41,676.80
|
| Rate for Payer: Cigna of CA HMO |
$33,341.44
|
| Rate for Payer: Cigna of CA PPO |
$38,551.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19,945.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$14,626.98
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13,297.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$17,951.29
|
| Rate for Payer: EPIC Health Plan Senior |
$13,297.25
|
| Rate for Payer: Galaxy Health WC |
$44,281.60
|
| Rate for Payer: Global Benefits Group Commercial |
$31,257.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$46,886.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21,807.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$480.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13,297.25
|
| Rate for Payer: InnovAge PACE Commercial |
$19,945.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34,748.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$531.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,297.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10,419.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,818.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17,818.31
|
| Rate for Payer: Multiplan Commercial |
$39,072.00
|
| Rate for Payer: Multiplan WC |
$21,186.79
|
| Rate for Payer: Networks By Design Commercial |
$33,862.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13,297.25
|
| Rate for Payer: Preferred Health Network WC |
$21,619.17
|
| Rate for Payer: Prime Health Services Commercial |
$44,281.60
|
| Rate for Payer: Prime Health Services Medicare |
$14,095.08
|
| Rate for Payer: Prime Health Services WC |
$20,970.59
|
| Rate for Payer: Riverside University Health System MISP |
$14,626.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$31,257.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$43,822.00
|
| Rate for Payer: United Healthcare All Other HMO |
$53,714.00
|
| Rate for Payer: United Healthcare HMO Rider |
$37,572.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34,424.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$13,297.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19,945.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14,626.98
|
| Rate for Payer: Vantage Medical Group Senior |
$13,297.25
|
|
|
HC LEAD INSERT CS INITIAL IMPL
|
Facility
|
OP
|
$39,913.00
|
|
|
Service Code
|
CPT 33225
|
| Hospital Charge Code |
906812215
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$444.41 |
| Max. Negotiated Rate |
$53,714.00 |
| Rate for Payer: Adventist Health Commercial |
$7,982.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33,926.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21,952.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29,934.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,764.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,851.77
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$17,960.85
|
| Rate for Payer: Cash Price |
$17,960.85
|
| Rate for Payer: Cash Price |
$17,960.85
|
| Rate for Payer: Central Health Plan Commercial |
$31,930.40
|
| Rate for Payer: Cigna of CA HMO |
$25,544.32
|
| Rate for Payer: Cigna of CA PPO |
$29,535.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33,926.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$33,926.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$33,926.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,965.20
|
| Rate for Payer: EPIC Health Plan Senior |
$15,965.20
|
| Rate for Payer: Galaxy Health WC |
$33,926.05
|
| Rate for Payer: Global Benefits Group Commercial |
$23,947.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$35,921.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$444.41
|
| Rate for Payer: InnovAge PACE Commercial |
$19,956.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26,621.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$490.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24,706.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,982.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27,939.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27,939.10
|
| Rate for Payer: Multiplan Commercial |
$29,934.75
|
| Rate for Payer: Networks By Design Commercial |
$25,943.45
|
| Rate for Payer: Prime Health Services Commercial |
$33,926.05
|
| Rate for Payer: Riverside University Health System MISP |
$15,965.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23,947.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$43,822.00
|
| Rate for Payer: United Healthcare All Other HMO |
$53,714.00
|
| Rate for Payer: United Healthcare HMO Rider |
$37,572.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34,424.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33,926.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$33,926.05
|
| Rate for Payer: Vantage Medical Group Senior |
$33,926.05
|
|
|
HC LEAD INSERT CS INITIAL IMPL
|
Facility
|
IP
|
$46,956.00
|
|
|
Service Code
|
CPT 33225
|
| Hospital Charge Code |
906820136
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$9,391.20 |
| Max. Negotiated Rate |
$42,260.40 |
| Rate for Payer: Adventist Health Commercial |
$9,391.20
|
| Rate for Payer: Cash Price |
$21,130.20
|
| Rate for Payer: Central Health Plan Commercial |
$37,564.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,782.40
|
| Rate for Payer: EPIC Health Plan Senior |
$18,782.40
|
| Rate for Payer: Galaxy Health WC |
$39,912.60
|
| Rate for Payer: Global Benefits Group Commercial |
$28,173.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$42,260.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31,319.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17,890.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29,065.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,391.20
|
| Rate for Payer: Multiplan Commercial |
$35,217.00
|
| Rate for Payer: Networks By Design Commercial |
$30,521.40
|
| Rate for Payer: Prime Health Services Commercial |
$39,912.60
|
|
