|
HC LEAD INSERT DUAL A & V
|
Facility
|
IP
|
$15,895.00
|
|
|
Service Code
|
CPT 33217
|
| Hospital Charge Code |
906820117
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,179.00 |
| Max. Negotiated Rate |
$14,305.50 |
| Rate for Payer: Adventist Health Commercial |
$3,179.00
|
| Rate for Payer: Cash Price |
$8,742.25
|
| Rate for Payer: Central Health Plan Commercial |
$12,716.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,358.00
|
| Rate for Payer: EPIC Health Plan Senior |
$6,358.00
|
| Rate for Payer: Galaxy Health WC |
$13,510.75
|
| Rate for Payer: Global Benefits Group Commercial |
$9,537.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,305.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,601.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,055.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,839.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,179.00
|
| Rate for Payer: Multiplan Commercial |
$11,921.25
|
| Rate for Payer: Networks By Design Commercial |
$10,331.75
|
| Rate for Payer: Prime Health Services Commercial |
$13,510.75
|
|
|
HC LEAD INSERT, SINGLE A OR V
|
Facility
|
IP
|
$15,895.00
|
|
|
Service Code
|
CPT 33216
|
| Hospital Charge Code |
906820112
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,179.00 |
| Max. Negotiated Rate |
$14,305.50 |
| Rate for Payer: Adventist Health Commercial |
$3,179.00
|
| Rate for Payer: Cash Price |
$8,742.25
|
| Rate for Payer: Central Health Plan Commercial |
$12,716.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,358.00
|
| Rate for Payer: EPIC Health Plan Senior |
$6,358.00
|
| Rate for Payer: Galaxy Health WC |
$13,510.75
|
| Rate for Payer: Global Benefits Group Commercial |
$9,537.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,305.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,601.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,055.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,839.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,179.00
|
| Rate for Payer: Multiplan Commercial |
$11,921.25
|
| Rate for Payer: Networks By Design Commercial |
$10,331.75
|
| Rate for Payer: Prime Health Services Commercial |
$13,510.75
|
|
|
HC LEAD INSERT, SINGLE A OR V
|
Facility
|
OP
|
$15,895.00
|
|
|
Service Code
|
CPT 33216
|
| Hospital Charge Code |
906820112
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$768.43 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$3,179.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$10,515.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15,773.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11,567.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,515.46
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10,526.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,070.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$16,754.51
|
| Rate for Payer: Blue Shield of California Commercial |
$12,745.22
|
| Rate for Payer: Blue Shield of California EPN |
$8,315.83
|
| Rate for Payer: Cash Price |
$8,742.25
|
| Rate for Payer: Cash Price |
$8,742.25
|
| Rate for Payer: Cash Price |
$8,742.25
|
| Rate for Payer: Central Health Plan Commercial |
$12,716.00
|
| Rate for Payer: Cigna of CA HMO |
$10,172.80
|
| Rate for Payer: Cigna of CA PPO |
$11,762.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15,773.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,567.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,515.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,195.87
|
| Rate for Payer: EPIC Health Plan Senior |
$10,515.46
|
| Rate for Payer: Galaxy Health WC |
$13,510.75
|
| Rate for Payer: Global Benefits Group Commercial |
$9,537.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,305.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$17,245.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$768.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10,515.46
|
| Rate for Payer: InnovAge PACE Commercial |
$15,773.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,601.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$848.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,515.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,179.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14,090.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14,090.72
|
| Rate for Payer: Multiplan Commercial |
$11,921.25
|
| Rate for Payer: Multiplan WC |
$16,754.51
|
| Rate for Payer: Networks By Design Commercial |
$10,331.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$10,515.46
|
| Rate for Payer: Preferred Health Network WC |
$17,096.44
|
| Rate for Payer: Prime Health Services Commercial |
$13,510.75
|
| Rate for Payer: Prime Health Services Medicare |
$11,146.39
|
| Rate for Payer: Prime Health Services WC |
$16,583.55
|
| Rate for Payer: Riverside University Health System MISP |
$11,567.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,537.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,712.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$10,515.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15,773.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,567.01
|
| Rate for Payer: Vantage Medical Group Senior |
$10,515.46
|
|
|
HC LEAD INSERT, SINGLE A OR V
|
Facility
|
OP
|
$13,511.00
|
|
|
Service Code
|
CPT 33216
|
| Hospital Charge Code |
906811354
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$768.43 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$2,702.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$10,515.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15,773.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11,567.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,515.46
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10,526.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,070.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$16,754.51
|
| Rate for Payer: Blue Shield of California Commercial |
$12,745.22
|
| Rate for Payer: Blue Shield of California EPN |
$8,315.83
|
| Rate for Payer: Cash Price |
$7,431.05
|
| Rate for Payer: Cash Price |
$7,431.05
|
| Rate for Payer: Cash Price |
$7,431.05
|
| Rate for Payer: Central Health Plan Commercial |
$10,808.80
|
| Rate for Payer: Cigna of CA HMO |
$8,647.04
|
| Rate for Payer: Cigna of CA PPO |
$9,998.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15,773.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,567.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,515.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,195.87
|
| Rate for Payer: EPIC Health Plan Senior |
$10,515.46
|
| Rate for Payer: Galaxy Health WC |
$11,484.35
|
| Rate for Payer: Global Benefits Group Commercial |
$8,106.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,159.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$17,245.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$768.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10,515.46
|
| Rate for Payer: InnovAge PACE Commercial |
$15,773.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,011.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$848.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,515.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,702.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14,090.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14,090.72
|
| Rate for Payer: Multiplan Commercial |
$10,133.25
|
| Rate for Payer: Multiplan WC |
$16,754.51
|
| Rate for Payer: Networks By Design Commercial |
$8,782.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$10,515.46
|
| Rate for Payer: Preferred Health Network WC |
$17,096.44
|
| Rate for Payer: Prime Health Services Commercial |
$11,484.35
|
| Rate for Payer: Prime Health Services Medicare |
$11,146.39
|
| Rate for Payer: Prime Health Services WC |
$16,583.55
|
| Rate for Payer: Riverside University Health System MISP |
$11,567.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,106.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,712.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$10,515.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15,773.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,567.01
|
| Rate for Payer: Vantage Medical Group Senior |
$10,515.46
|
|
|
HC LEAD INSERT, SINGLE A OR V
|
Facility
|
IP
|
$13,511.00
|
|
|
Service Code
|
CPT 33216
|
| Hospital Charge Code |
906811354
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,702.20 |
| Max. Negotiated Rate |
$12,159.90 |
| Rate for Payer: Adventist Health Commercial |
$2,702.20
|
| Rate for Payer: Cash Price |
$7,431.05
|
| Rate for Payer: Central Health Plan Commercial |
$10,808.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,404.40
|
| Rate for Payer: EPIC Health Plan Senior |
$5,404.40
|
| Rate for Payer: Galaxy Health WC |
$11,484.35
|
| Rate for Payer: Global Benefits Group Commercial |
$8,106.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,159.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,011.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,147.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,363.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,702.20
|
| Rate for Payer: Multiplan Commercial |
$10,133.25
|
| Rate for Payer: Networks By Design Commercial |
$8,782.15
|
| Rate for Payer: Prime Health Services Commercial |
$11,484.35
|
|
|
HC LEAD MED ATTAIN 4396
|
Facility
|
OP
|
$6,750.00
|
|
|
Service Code
|
CPT C1900
|
| Hospital Charge Code |
906813659
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,350.00 |
| Max. Negotiated Rate |
$6,075.00 |
| Rate for Payer: Adventist Health Commercial |
$1,350.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,737.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,712.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,062.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,268.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,964.28
|
| Rate for Payer: Blue Shield of California Commercial |
$5,217.75
|
| Rate for Payer: Blue Shield of California EPN |
$3,402.00
|
| Rate for Payer: Cash Price |
$3,712.50
|
| Rate for Payer: Central Health Plan Commercial |
$5,400.00
|
| Rate for Payer: Cigna of CA HMO |
$4,725.00
|
| Rate for Payer: Cigna of CA PPO |
$4,725.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,737.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,737.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,737.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,700.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,700.00
|
| Rate for Payer: Galaxy Health WC |
$5,737.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,050.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,075.00
|
| Rate for Payer: InnovAge PACE Commercial |
$3,375.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,502.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,571.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,178.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,350.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,725.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,725.00
|
| Rate for Payer: Multiplan Commercial |
$5,062.50
|
| Rate for Payer: Networks By Design Commercial |
$3,375.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,737.50
|
| Rate for Payer: Riverside University Health System MISP |
$2,700.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,050.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,050.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,533.28
|
| Rate for Payer: United Healthcare All Other HMO |
$2,465.78
|
| Rate for Payer: United Healthcare HMO Rider |
$2,412.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,210.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,737.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,737.50
|
| Rate for Payer: Vantage Medical Group Senior |
$5,737.50
|
|
|
HC LEAD MED ATTAIN 4396
|
Facility
|
IP
|
$6,750.00
|
|
|
Service Code
|
CPT C1900
|
| Hospital Charge Code |
906813659
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,350.00 |
| Max. Negotiated Rate |
$6,075.00 |
| Rate for Payer: Adventist Health Commercial |
$1,350.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,217.75
|
| Rate for Payer: Blue Shield of California EPN |
$3,402.00
|
| Rate for Payer: Cash Price |
$3,712.50
|
| Rate for Payer: Central Health Plan Commercial |
$5,400.00
|
| Rate for Payer: Cigna of CA HMO |
$4,725.00
|
| Rate for Payer: Cigna of CA PPO |
$4,725.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,700.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,700.00
|
| Rate for Payer: Galaxy Health WC |
$5,737.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,050.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,075.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,502.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,571.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,178.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,350.00
|
| Rate for Payer: Multiplan Commercial |
$5,062.50
|
| Rate for Payer: Networks By Design Commercial |
$3,375.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,737.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,533.28
|
| Rate for Payer: United Healthcare All Other HMO |
$2,465.78
|
| Rate for Payer: United Healthcare HMO Rider |
$2,412.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,210.62
|
|
|
HC LEAD MED ATTAIN OTW 4194
|
Facility
|
OP
|
$4,875.00
|
|
|
Service Code
|
CPT C1900
|
| Hospital Charge Code |
906813552
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$975.00 |
| Max. Negotiated Rate |
$4,387.50 |
| Rate for Payer: Adventist Health Commercial |
$975.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,143.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,681.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,656.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,225.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,699.29
|
| Rate for Payer: Blue Shield of California Commercial |
$3,768.38
|
| Rate for Payer: Blue Shield of California EPN |
$2,457.00
|
| Rate for Payer: Cash Price |
$2,681.25
|
| Rate for Payer: Central Health Plan Commercial |
$3,900.00
|
| Rate for Payer: Cigna of CA HMO |
$3,412.50
|
| Rate for Payer: Cigna of CA PPO |
$3,412.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,143.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,143.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,143.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,950.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,950.00
|
| Rate for Payer: Galaxy Health WC |
$4,143.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,925.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,387.50
|
| Rate for Payer: InnovAge PACE Commercial |
$2,437.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,251.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,857.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,017.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$975.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,412.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,412.50
|
| Rate for Payer: Multiplan Commercial |
$3,656.25
|
| Rate for Payer: Networks By Design Commercial |
$2,437.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,143.75
|
| Rate for Payer: Riverside University Health System MISP |
$1,950.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,925.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,925.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,829.59
|
| Rate for Payer: United Healthcare All Other HMO |
$1,780.84
|
| Rate for Payer: United Healthcare HMO Rider |
$1,742.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,596.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,143.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,143.75
|
| Rate for Payer: Vantage Medical Group Senior |
$4,143.75
|
|
|
HC LEAD MED ATTAIN OTW 4194
|
Facility
|
IP
|
$4,875.00
|
|
|
Service Code
|
CPT C1900
|
| Hospital Charge Code |
906813552
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$975.00 |
| Max. Negotiated Rate |
$4,387.50 |
| Rate for Payer: Adventist Health Commercial |
$975.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,768.38
|
| Rate for Payer: Blue Shield of California EPN |
$2,457.00
|
| Rate for Payer: Cash Price |
$2,681.25
|
| Rate for Payer: Central Health Plan Commercial |
$3,900.00
|
| Rate for Payer: Cigna of CA HMO |
$3,412.50
|
| Rate for Payer: Cigna of CA PPO |
$3,412.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,950.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,950.00
|
| Rate for Payer: Galaxy Health WC |
$4,143.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,925.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,387.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,251.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,857.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,017.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$975.00
|
| Rate for Payer: Multiplan Commercial |
$3,656.25
|
| Rate for Payer: Networks By Design Commercial |
$2,437.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,143.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,829.59
|
| Rate for Payer: United Healthcare All Other HMO |
$1,780.84
|
| Rate for Payer: United Healthcare HMO Rider |
$1,742.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,596.56
|
|
|
HC LEAD MED ATTAIN OTW 4196
|
Facility
|
IP
|
$6,750.00
|
|
|
Service Code
|
CPT C1900
|
| Hospital Charge Code |
906813634
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,350.00 |
| Max. Negotiated Rate |
$6,075.00 |
| Rate for Payer: Adventist Health Commercial |
$1,350.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,217.75
|
| Rate for Payer: Blue Shield of California EPN |
$3,402.00
|
| Rate for Payer: Cash Price |
$3,712.50
|
| Rate for Payer: Central Health Plan Commercial |
$5,400.00
|
| Rate for Payer: Cigna of CA HMO |
$4,725.00
|
| Rate for Payer: Cigna of CA PPO |
$4,725.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,700.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,700.00
|
| Rate for Payer: Galaxy Health WC |
$5,737.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,050.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,075.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,502.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,571.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,178.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,350.00
|
| Rate for Payer: Multiplan Commercial |
$5,062.50
|
| Rate for Payer: Networks By Design Commercial |
$3,375.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,737.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,533.28
|
| Rate for Payer: United Healthcare All Other HMO |
$2,465.78
|
| Rate for Payer: United Healthcare HMO Rider |
$2,412.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,210.62
|
|
|
HC LEAD MED ATTAIN OTW 4196
|
Facility
|
OP
|
$6,750.00
|
|
|
Service Code
|
CPT C1900
|
| Hospital Charge Code |
906813634
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,350.00 |
| Max. Negotiated Rate |
$6,075.00 |
| Rate for Payer: Adventist Health Commercial |
$1,350.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,737.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,712.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,062.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,082.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,737.47
|
| Rate for Payer: Blue Shield of California Commercial |
$5,217.75
|
| Rate for Payer: Blue Shield of California EPN |
$3,402.00
|
| Rate for Payer: Cash Price |
$3,712.50
|
| Rate for Payer: Central Health Plan Commercial |
$5,400.00
|
| Rate for Payer: Cigna of CA HMO |
$4,725.00
|
| Rate for Payer: Cigna of CA PPO |
$4,725.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,737.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,737.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,737.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,700.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,700.00
|
| Rate for Payer: Galaxy Health WC |
$5,737.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,050.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,075.00
|
| Rate for Payer: InnovAge PACE Commercial |
$3,375.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,502.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,571.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,178.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,350.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,725.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,725.00
|
| Rate for Payer: Multiplan Commercial |
$5,062.50
|
| Rate for Payer: Networks By Design Commercial |
$3,375.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,737.50
|
| Rate for Payer: Riverside University Health System MISP |
$2,700.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,050.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,050.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,533.28
|
| Rate for Payer: United Healthcare All Other HMO |
$2,465.78
|
| Rate for Payer: United Healthcare HMO Rider |
$2,412.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,210.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,737.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,737.50
|
| Rate for Payer: Vantage Medical Group Senior |
$5,737.50
|
|
|
HC LEAD MED ATTAIN OTW 4296
|
Facility
|
IP
|
$6,750.00
|
|
|
Service Code
|
CPT C1900
|
| Hospital Charge Code |
906813655
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,350.00 |
| Max. Negotiated Rate |
$6,075.00 |
| Rate for Payer: Adventist Health Commercial |
$1,350.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,217.75
|
| Rate for Payer: Blue Shield of California EPN |
$3,402.00
|
| Rate for Payer: Cash Price |
$3,712.50
|
| Rate for Payer: Central Health Plan Commercial |
$5,400.00
|
| Rate for Payer: Cigna of CA HMO |
$4,725.00
|
| Rate for Payer: Cigna of CA PPO |
$4,725.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,700.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,700.00
|
| Rate for Payer: Galaxy Health WC |
$5,737.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,050.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,075.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,502.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,571.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,178.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,350.00
|
| Rate for Payer: Multiplan Commercial |
$5,062.50
|
| Rate for Payer: Networks By Design Commercial |
$3,375.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,737.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,533.28
|
| Rate for Payer: United Healthcare All Other HMO |
$2,465.78
|
| Rate for Payer: United Healthcare HMO Rider |
$2,412.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,210.62
|
|
|
HC LEAD MED ATTAIN OTW 4296
|
Facility
|
OP
|
$6,750.00
|
|
|
Service Code
|
CPT C1900
|
| Hospital Charge Code |
906813655
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,350.00 |
| Max. Negotiated Rate |
$6,075.00 |
| Rate for Payer: Adventist Health Commercial |
$1,350.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,737.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,712.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,062.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,268.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,964.28
|
| Rate for Payer: Blue Shield of California Commercial |
$5,217.75
|
| Rate for Payer: Blue Shield of California EPN |
$3,402.00
|
| Rate for Payer: Cash Price |
$3,712.50
|
| Rate for Payer: Central Health Plan Commercial |
$5,400.00
|
| Rate for Payer: Cigna of CA HMO |
$4,725.00
|
| Rate for Payer: Cigna of CA PPO |
$4,725.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,737.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,737.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,737.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,700.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,700.00
|
| Rate for Payer: Galaxy Health WC |
$5,737.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,050.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,075.00
|
| Rate for Payer: InnovAge PACE Commercial |
$3,375.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,502.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,571.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,178.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,350.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,725.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,725.00
|
| Rate for Payer: Multiplan Commercial |
$5,062.50
|
| Rate for Payer: Networks By Design Commercial |
$3,375.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,737.50
|
| Rate for Payer: Riverside University Health System MISP |
$2,700.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,050.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,050.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,533.28
|
| Rate for Payer: United Healthcare All Other HMO |
$2,465.78
|
| Rate for Payer: United Healthcare HMO Rider |
$2,412.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,210.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,737.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,737.50
|
| Rate for Payer: Vantage Medical Group Senior |
$5,737.50
|
|
|
HC LEAD MED ATTAIN PERFORMA 4298
|
Facility
|
IP
|
$8,750.00
|
|
|
Service Code
|
CPT C1900
|
| Hospital Charge Code |
906813734
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,750.00 |
| Max. Negotiated Rate |
$7,875.00 |
| Rate for Payer: Adventist Health Commercial |
$1,750.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,763.75
|
| Rate for Payer: Blue Shield of California EPN |
$4,410.00
|
| Rate for Payer: Cash Price |
$4,812.50
|
| Rate for Payer: Central Health Plan Commercial |
$7,000.00
|
| Rate for Payer: Cigna of CA HMO |
$6,125.00
|
| Rate for Payer: Cigna of CA PPO |
$6,125.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,500.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,500.00
|
| Rate for Payer: Galaxy Health WC |
$7,437.50
|
| Rate for Payer: Global Benefits Group Commercial |
$5,250.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,875.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,836.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,333.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,416.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,750.00
|
| Rate for Payer: Multiplan Commercial |
$6,562.50
|
| Rate for Payer: Networks By Design Commercial |
$4,375.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,437.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,283.88
|
| Rate for Payer: United Healthcare All Other HMO |
$3,196.38
|
| Rate for Payer: United Healthcare HMO Rider |
$3,127.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,865.62
|
|
|
HC LEAD MED ATTAIN PERFORMA 4298
|
Facility
|
OP
|
$8,750.00
|
|
|
Service Code
|
CPT C1900
|
| Hospital Charge Code |
906813734
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,750.00 |
| Max. Negotiated Rate |
$7,875.00 |
| Rate for Payer: Adventist Health Commercial |
$1,750.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,437.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,812.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,562.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,236.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,138.88
|
| Rate for Payer: Blue Shield of California Commercial |
$6,763.75
|
| Rate for Payer: Blue Shield of California EPN |
$4,410.00
|
| Rate for Payer: Cash Price |
$4,812.50
|
| Rate for Payer: Central Health Plan Commercial |
$7,000.00
|
| Rate for Payer: Cigna of CA HMO |
$6,125.00
|
| Rate for Payer: Cigna of CA PPO |
$6,125.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,437.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,437.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,437.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,500.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,500.00
|
| Rate for Payer: Galaxy Health WC |
$7,437.50
|
| Rate for Payer: Global Benefits Group Commercial |
$5,250.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,875.00
|
| Rate for Payer: InnovAge PACE Commercial |
$4,375.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,836.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,333.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,416.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,750.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,125.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,125.00
|
| Rate for Payer: Multiplan Commercial |
$6,562.50
|
| Rate for Payer: Networks By Design Commercial |
$4,375.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,437.50
|
| Rate for Payer: Riverside University Health System MISP |
$3,500.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,250.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,250.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,283.88
|
| Rate for Payer: United Healthcare All Other HMO |
$3,196.38
|
| Rate for Payer: United Healthcare HMO Rider |
$3,127.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,865.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,437.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,437.50
|
| Rate for Payer: Vantage Medical Group Senior |
$7,437.50
|
|
|
HC LEAD MED ATTAIN PERFORMA 4598
|
Facility
|
OP
|
$8,750.00
|
|
|
Service Code
|
CPT C1900
|
| Hospital Charge Code |
906813778
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,750.00 |
| Max. Negotiated Rate |
$7,875.00 |
| Rate for Payer: Adventist Health Commercial |
$1,750.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,437.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,812.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,562.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,995.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,844.88
|
| Rate for Payer: Blue Shield of California Commercial |
$6,763.75
|
| Rate for Payer: Blue Shield of California EPN |
$4,410.00
|
| Rate for Payer: Cash Price |
$4,812.50
|
| Rate for Payer: Central Health Plan Commercial |
$7,000.00
|
| Rate for Payer: Cigna of CA HMO |
$6,125.00
|
| Rate for Payer: Cigna of CA PPO |
$6,125.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,437.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,437.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,437.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,500.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,500.00
|
| Rate for Payer: Galaxy Health WC |
$7,437.50
|
| Rate for Payer: Global Benefits Group Commercial |
$5,250.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,875.00
|
| Rate for Payer: InnovAge PACE Commercial |
$4,375.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,836.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,333.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,416.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,750.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,125.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,125.00
|
| Rate for Payer: Multiplan Commercial |
$6,562.50
|
| Rate for Payer: Networks By Design Commercial |
$4,375.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,437.50
|
| Rate for Payer: Riverside University Health System MISP |
$3,500.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,250.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,250.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,283.88
|
| Rate for Payer: United Healthcare All Other HMO |
$3,196.38
|
| Rate for Payer: United Healthcare HMO Rider |
$3,127.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,865.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,437.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,437.50
|
| Rate for Payer: Vantage Medical Group Senior |
$7,437.50
|
|
|
HC LEAD MED ATTAIN PERFORMA 4598
|
Facility
|
IP
|
$8,750.00
|
|
|
Service Code
|
CPT C1900
|
| Hospital Charge Code |
906813778
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,750.00 |
| Max. Negotiated Rate |
$7,875.00 |
| Rate for Payer: Adventist Health Commercial |
$1,750.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,763.75
|
| Rate for Payer: Blue Shield of California EPN |
$4,410.00
|
| Rate for Payer: Cash Price |
$4,812.50
|
| Rate for Payer: Central Health Plan Commercial |
$7,000.00
|
| Rate for Payer: Cigna of CA HMO |
$6,125.00
|
| Rate for Payer: Cigna of CA PPO |
$6,125.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,500.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,500.00
|
| Rate for Payer: Galaxy Health WC |
$7,437.50
|
| Rate for Payer: Global Benefits Group Commercial |
$5,250.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,875.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,836.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,333.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,416.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,750.00
|
| Rate for Payer: Multiplan Commercial |
$6,562.50
|
| Rate for Payer: Networks By Design Commercial |
$4,375.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,437.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,283.88
|
| Rate for Payer: United Healthcare All Other HMO |
$3,196.38
|
| Rate for Payer: United Healthcare HMO Rider |
$3,127.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,865.62
|
|
|
HC LEAD MED CAPSURE FIX 5568
|
Facility
|
IP
|
$2,262.00
|
|
|
Service Code
|
CPT C1898
|
| Hospital Charge Code |
906813303
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$452.40 |
| Max. Negotiated Rate |
$2,035.80 |
| Rate for Payer: Adventist Health Commercial |
$452.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,748.53
|
| Rate for Payer: Blue Shield of California EPN |
$1,140.05
|
| Rate for Payer: Cash Price |
$1,244.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,809.60
|
| Rate for Payer: Cigna of CA HMO |
$1,583.40
|
| Rate for Payer: Cigna of CA PPO |
$1,583.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$904.80
|
| Rate for Payer: EPIC Health Plan Senior |
$904.80
|
| Rate for Payer: Galaxy Health WC |
$1,922.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,357.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,035.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,508.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$861.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,400.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$452.40
|
| Rate for Payer: Multiplan Commercial |
$1,696.50
|
| Rate for Payer: Networks By Design Commercial |
$1,131.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,922.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$848.93
|
| Rate for Payer: United Healthcare All Other HMO |
$826.31
|
| Rate for Payer: United Healthcare HMO Rider |
$808.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$740.80
|
|
|
HC LEAD MED CAPSURE FIX 5568
|
Facility
|
OP
|
$2,262.00
|
|
|
Service Code
|
CPT C1898
|
| Hospital Charge Code |
906813303
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$452.40 |
| Max. Negotiated Rate |
$2,035.80 |
| Rate for Payer: Adventist Health Commercial |
$452.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,922.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,244.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,696.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,095.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,328.47
|
| Rate for Payer: Blue Shield of California Commercial |
$1,748.53
|
| Rate for Payer: Blue Shield of California EPN |
$1,140.05
|
| Rate for Payer: Cash Price |
$1,244.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,809.60
|
| Rate for Payer: Cigna of CA HMO |
$1,583.40
|
| Rate for Payer: Cigna of CA PPO |
$1,583.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,922.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,922.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,922.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$904.80
|
| Rate for Payer: EPIC Health Plan Senior |
$904.80
|
| Rate for Payer: Galaxy Health WC |
$1,922.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,357.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,035.80
|
| Rate for Payer: InnovAge PACE Commercial |
$1,131.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,508.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$861.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,400.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$452.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,583.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,583.40
|
| Rate for Payer: Multiplan Commercial |
$1,696.50
|
| Rate for Payer: Networks By Design Commercial |
$1,131.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,922.70
|
| Rate for Payer: Riverside University Health System MISP |
$904.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,357.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,357.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$848.93
|
| Rate for Payer: United Healthcare All Other HMO |
$826.31
|
| Rate for Payer: United Healthcare HMO Rider |
$808.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$740.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,922.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,922.70
|
| Rate for Payer: Vantage Medical Group Senior |
$1,922.70
|
|
|
HC LEAD MED CAPSURE FIX MRI 5086
|
Facility
|
OP
|
$3,299.00
|
|
|
Service Code
|
CPT C1898
|
| Hospital Charge Code |
906813645
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$659.80 |
| Max. Negotiated Rate |
$2,969.10 |
| Rate for Payer: Adventist Health Commercial |
$659.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,804.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,814.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,474.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,506.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,826.66
|
| Rate for Payer: Blue Shield of California Commercial |
$2,550.13
|
| Rate for Payer: Blue Shield of California EPN |
$1,662.70
|
| Rate for Payer: Cash Price |
$1,814.45
|
| Rate for Payer: Central Health Plan Commercial |
$2,639.20
|
| Rate for Payer: Cigna of CA HMO |
$2,309.30
|
| Rate for Payer: Cigna of CA PPO |
$2,309.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,804.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,804.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,804.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,319.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,319.60
|
| Rate for Payer: Galaxy Health WC |
$2,804.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,979.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,969.10
|
| Rate for Payer: InnovAge PACE Commercial |
$1,649.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,200.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,256.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,042.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$659.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,309.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,309.30
|
| Rate for Payer: Multiplan Commercial |
$2,474.25
|
| Rate for Payer: Networks By Design Commercial |
$1,649.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,804.15
|
| Rate for Payer: Riverside University Health System MISP |
$1,319.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,979.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,979.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,238.11
|
| Rate for Payer: United Healthcare All Other HMO |
$1,205.12
|
| Rate for Payer: United Healthcare HMO Rider |
$1,179.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,080.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,804.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,804.15
|
| Rate for Payer: Vantage Medical Group Senior |
$2,804.15
|
|
|
HC LEAD MED CAPSURE FIX MRI 5086
|
Facility
|
IP
|
$3,299.00
|
|
|
Service Code
|
CPT C1898
|
| Hospital Charge Code |
906813645
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$659.80 |
| Max. Negotiated Rate |
$2,969.10 |
| Rate for Payer: Adventist Health Commercial |
$659.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2,550.13
|
| Rate for Payer: Blue Shield of California EPN |
$1,662.70
|
| Rate for Payer: Cash Price |
$1,814.45
|
| Rate for Payer: Central Health Plan Commercial |
$2,639.20
|
| Rate for Payer: Cigna of CA HMO |
$2,309.30
|
| Rate for Payer: Cigna of CA PPO |
$2,309.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,319.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,319.60
|
| Rate for Payer: Galaxy Health WC |
$2,804.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,979.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,969.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,200.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,256.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,042.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$659.80
|
| Rate for Payer: Multiplan Commercial |
$2,474.25
|
| Rate for Payer: Networks By Design Commercial |
$1,649.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,804.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,238.11
|
| Rate for Payer: United Healthcare All Other HMO |
$1,205.12
|
| Rate for Payer: United Healthcare HMO Rider |
$1,179.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,080.42
|
|
|
HC LEAD MED CAPSURE SENSE 4574
|
Facility
|
IP
|
$2,300.00
|
|
|
Service Code
|
CPT C1898
|
| Hospital Charge Code |
906813827
|
|
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 MED CAPSURE SENSE 4574
|
Facility
|
OP
|
$2,300.00
|
|
|
Service Code
|
CPT C1898
|
| Hospital Charge Code |
906813827
|
|
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 MED CAPSURE SP NOV 5092
|
Facility
|
IP
|
$2,262.00
|
|
|
Service Code
|
CPT C1898
|
| Hospital Charge Code |
906813251
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$452.40 |
| Max. Negotiated Rate |
$2,035.80 |
| Rate for Payer: Adventist Health Commercial |
$452.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,748.53
|
| Rate for Payer: Blue Shield of California EPN |
$1,140.05
|
| Rate for Payer: Cash Price |
$1,244.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,809.60
|
| Rate for Payer: Cigna of CA HMO |
$1,583.40
|
| Rate for Payer: Cigna of CA PPO |
$1,583.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$904.80
|
| Rate for Payer: EPIC Health Plan Senior |
$904.80
|
| Rate for Payer: Galaxy Health WC |
$1,922.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,357.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,035.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,508.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$861.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,400.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$452.40
|
| Rate for Payer: Multiplan Commercial |
$1,696.50
|
| Rate for Payer: Networks By Design Commercial |
$1,131.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,922.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$848.93
|
| Rate for Payer: United Healthcare All Other HMO |
$826.31
|
| Rate for Payer: United Healthcare HMO Rider |
$808.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$740.80
|
|
|
HC LEAD MED CAPSURE SP NOV 5092
|
Facility
|
OP
|
$2,262.00
|
|
|
Service Code
|
CPT C1898
|
| Hospital Charge Code |
906813251
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$452.40 |
| Max. Negotiated Rate |
$2,035.80 |
| Rate for Payer: Adventist Health Commercial |
$452.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,922.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,244.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,696.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,095.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,328.47
|
| Rate for Payer: Blue Shield of California Commercial |
$1,748.53
|
| Rate for Payer: Blue Shield of California EPN |
$1,140.05
|
| Rate for Payer: Cash Price |
$1,244.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,809.60
|
| Rate for Payer: Cigna of CA HMO |
$1,583.40
|
| Rate for Payer: Cigna of CA PPO |
$1,583.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,922.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,922.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,922.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$904.80
|
| Rate for Payer: EPIC Health Plan Senior |
$904.80
|
| Rate for Payer: Galaxy Health WC |
$1,922.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,357.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,035.80
|
| Rate for Payer: InnovAge PACE Commercial |
$1,131.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,508.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$861.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,400.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$452.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,583.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,583.40
|
| Rate for Payer: Multiplan Commercial |
$1,696.50
|
| Rate for Payer: Networks By Design Commercial |
$1,131.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,922.70
|
| Rate for Payer: Riverside University Health System MISP |
$904.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,357.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,357.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$848.93
|
| Rate for Payer: United Healthcare All Other HMO |
$826.31
|
| Rate for Payer: United Healthcare HMO Rider |
$808.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$740.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,922.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,922.70
|
| Rate for Payer: Vantage Medical Group Senior |
$1,922.70
|
|
