|
HC LEAD MED CAPSURE SP NOV 5592
|
Facility
|
IP
|
$2,262.00
|
|
|
Service Code
|
CPT C1898
|
| Hospital Charge Code |
906813255
|
|
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 5592
|
Facility
|
OP
|
$2,262.00
|
|
|
Service Code
|
CPT C1898
|
| Hospital Charge Code |
906813255
|
|
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 VDD 5038
|
Facility
|
OP
|
$2,126.00
|
|
|
Service Code
|
CPT C1779
|
| Hospital Charge Code |
906813341
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$425.20 |
| Max. Negotiated Rate |
$1,913.40 |
| Rate for Payer: Adventist Health Commercial |
$425.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,807.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,169.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,594.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,029.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,248.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,643.40
|
| Rate for Payer: Blue Shield of California EPN |
$1,071.50
|
| Rate for Payer: Cash Price |
$1,169.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,700.80
|
| Rate for Payer: Cigna of CA HMO |
$1,488.20
|
| Rate for Payer: Cigna of CA PPO |
$1,488.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,807.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,807.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,807.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$850.40
|
| Rate for Payer: EPIC Health Plan Senior |
$850.40
|
| Rate for Payer: Galaxy Health WC |
$1,807.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,275.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,913.40
|
| Rate for Payer: InnovAge PACE Commercial |
$1,063.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,418.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$810.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,315.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$425.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,488.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,488.20
|
| Rate for Payer: Multiplan Commercial |
$1,594.50
|
| Rate for Payer: Networks By Design Commercial |
$1,063.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,807.10
|
| Rate for Payer: Riverside University Health System MISP |
$850.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,275.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,275.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$797.89
|
| Rate for Payer: United Healthcare All Other HMO |
$776.63
|
| Rate for Payer: United Healthcare HMO Rider |
$759.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$696.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,807.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,807.10
|
| Rate for Payer: Vantage Medical Group Senior |
$1,807.10
|
|
|
HC LEAD MED CAPSURE VDD 5038
|
Facility
|
IP
|
$2,126.00
|
|
|
Service Code
|
CPT C1779
|
| Hospital Charge Code |
906813341
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$425.20 |
| Max. Negotiated Rate |
$1,913.40 |
| Rate for Payer: Adventist Health Commercial |
$425.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,643.40
|
| Rate for Payer: Blue Shield of California EPN |
$1,071.50
|
| Rate for Payer: Cash Price |
$1,169.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,700.80
|
| Rate for Payer: Cigna of CA HMO |
$1,488.20
|
| Rate for Payer: Cigna of CA PPO |
$1,488.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$850.40
|
| Rate for Payer: EPIC Health Plan Senior |
$850.40
|
| Rate for Payer: Galaxy Health WC |
$1,807.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,275.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,913.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,418.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$810.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,315.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$425.20
|
| Rate for Payer: Multiplan Commercial |
$1,594.50
|
| Rate for Payer: Networks By Design Commercial |
$1,063.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,807.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$797.89
|
| Rate for Payer: United Healthcare All Other HMO |
$776.63
|
| Rate for Payer: United Healthcare HMO Rider |
$759.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$696.26
|
|
|
HC LEAD MED SELECT SECURE 3830
|
Facility
|
IP
|
$2,126.00
|
|
|
Service Code
|
CPT C1898
|
| Hospital Charge Code |
906813631
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$425.20 |
| Max. Negotiated Rate |
$1,913.40 |
| Rate for Payer: Adventist Health Commercial |
$425.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,643.40
|
| Rate for Payer: Blue Shield of California EPN |
$1,071.50
|
| Rate for Payer: Cash Price |
$1,169.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,700.80
|
| Rate for Payer: Cigna of CA HMO |
$1,488.20
|
| Rate for Payer: Cigna of CA PPO |
$1,488.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$850.40
|
| Rate for Payer: EPIC Health Plan Senior |
$850.40
|
| Rate for Payer: Galaxy Health WC |
$1,807.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,275.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,913.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,418.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$810.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,315.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$425.20
|
| Rate for Payer: Multiplan Commercial |
$1,594.50
|
| Rate for Payer: Networks By Design Commercial |
$1,063.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,807.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$797.89
|
| Rate for Payer: United Healthcare All Other HMO |
$776.63
|
| Rate for Payer: United Healthcare HMO Rider |
$759.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$696.26
|
|
|
HC LEAD MED SELECT SECURE 3830
|
Facility
|
OP
|
$2,126.00
|
|
|
Service Code
|
CPT C1898
|
| Hospital Charge Code |
906813631
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$425.20 |
| Max. Negotiated Rate |
$1,913.40 |
| Rate for Payer: Adventist Health Commercial |
$425.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,807.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,169.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,594.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,029.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,248.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,643.40
|
| Rate for Payer: Blue Shield of California EPN |
$1,071.50
|
| Rate for Payer: Cash Price |
$1,169.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,700.80
|
| Rate for Payer: Cigna of CA HMO |
$1,488.20
|
| Rate for Payer: Cigna of CA PPO |
$1,488.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,807.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,807.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,807.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$850.40
|
| Rate for Payer: EPIC Health Plan Senior |
$850.40
|
| Rate for Payer: Galaxy Health WC |
$1,807.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,275.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,913.40
|
| Rate for Payer: InnovAge PACE Commercial |
$1,063.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,418.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$810.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,315.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$425.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,488.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,488.20
|
| Rate for Payer: Multiplan Commercial |
$1,594.50
|
| Rate for Payer: Networks By Design Commercial |
$1,063.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,807.10
|
| Rate for Payer: Riverside University Health System MISP |
$850.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,275.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,275.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$797.89
|
| Rate for Payer: United Healthcare All Other HMO |
$776.63
|
| Rate for Payer: United Healthcare HMO Rider |
$759.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$696.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,807.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,807.10
|
| Rate for Payer: Vantage Medical Group Senior |
$1,807.10
|
|
|
HC LEAD MED SPRINT 6943
|
Facility
|
IP
|
$10,913.00
|
|
|
Service Code
|
CPT C1777
|
| Hospital Charge Code |
906813365
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,182.60 |
| Max. Negotiated Rate |
$9,821.70 |
| Rate for Payer: Adventist Health Commercial |
$2,182.60
|
| Rate for Payer: Blue Shield of California Commercial |
$8,435.75
|
| Rate for Payer: Blue Shield of California EPN |
$5,500.15
|
| Rate for Payer: Cash Price |
$6,002.15
|
| Rate for Payer: Central Health Plan Commercial |
$8,730.40
|
| Rate for Payer: Cigna of CA HMO |
$7,639.10
|
| Rate for Payer: Cigna of CA PPO |
$7,639.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,365.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,365.20
|
| Rate for Payer: Galaxy Health WC |
$9,276.05
|
| Rate for Payer: Global Benefits Group Commercial |
$6,547.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,821.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,278.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,157.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,755.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,182.60
|
| Rate for Payer: Multiplan Commercial |
$8,184.75
|
| Rate for Payer: Networks By Design Commercial |
$5,456.50
|
| Rate for Payer: Prime Health Services Commercial |
$9,276.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,095.65
|
| Rate for Payer: United Healthcare All Other HMO |
$3,986.52
|
| Rate for Payer: United Healthcare HMO Rider |
$3,900.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,574.01
|
|
|
HC LEAD MED SPRINT 6943
|
Facility
|
OP
|
$10,913.00
|
|
|
Service Code
|
CPT C1777
|
| Hospital Charge Code |
906813365
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,182.60 |
| Max. Negotiated Rate |
$9,821.70 |
| Rate for Payer: Adventist Health Commercial |
$2,182.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,276.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,002.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,184.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,982.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,042.53
|
| Rate for Payer: Blue Shield of California Commercial |
$8,435.75
|
| Rate for Payer: Blue Shield of California EPN |
$5,500.15
|
| Rate for Payer: Cash Price |
$6,002.15
|
| Rate for Payer: Central Health Plan Commercial |
$8,730.40
|
| Rate for Payer: Cigna of CA HMO |
$7,639.10
|
| Rate for Payer: Cigna of CA PPO |
$7,639.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,276.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,276.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,276.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,365.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,365.20
|
| Rate for Payer: Galaxy Health WC |
$9,276.05
|
| Rate for Payer: Global Benefits Group Commercial |
$6,547.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,821.70
|
| Rate for Payer: InnovAge PACE Commercial |
$5,456.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,278.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,755.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,182.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,639.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,639.10
|
| Rate for Payer: Multiplan Commercial |
$8,184.75
|
| Rate for Payer: Networks By Design Commercial |
$5,456.50
|
| Rate for Payer: Prime Health Services Commercial |
$9,276.05
|
| Rate for Payer: Riverside University Health System MISP |
$4,365.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,547.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,547.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,095.65
|
| Rate for Payer: United Healthcare All Other HMO |
$3,986.52
|
| Rate for Payer: United Healthcare HMO Rider |
$3,900.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,574.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,276.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,276.05
|
| Rate for Payer: Vantage Medical Group Senior |
$9,276.05
|
|
|
HC LEAD MED SPRINT QTO 6935
|
Facility
|
IP
|
$11,398.00
|
|
|
Service Code
|
CPT C1777
|
| Hospital Charge Code |
906813635
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,279.60 |
| Max. Negotiated Rate |
$10,258.20 |
| Rate for Payer: Adventist Health Commercial |
$2,279.60
|
| Rate for Payer: Blue Shield of California Commercial |
$8,810.65
|
| Rate for Payer: Blue Shield of California EPN |
$5,744.59
|
| Rate for Payer: Cash Price |
$6,268.90
|
| Rate for Payer: Central Health Plan Commercial |
$9,118.40
|
| Rate for Payer: Cigna of CA HMO |
$7,978.60
|
| Rate for Payer: Cigna of CA PPO |
$7,978.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,559.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,559.20
|
| Rate for Payer: Galaxy Health WC |
$9,688.30
|
| Rate for Payer: Global Benefits Group Commercial |
$6,838.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,258.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,602.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,342.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,055.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,279.60
|
| Rate for Payer: Multiplan Commercial |
$8,548.50
|
| Rate for Payer: Networks By Design Commercial |
$5,699.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,688.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,277.67
|
| Rate for Payer: United Healthcare All Other HMO |
$4,163.69
|
| Rate for Payer: United Healthcare HMO Rider |
$4,073.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,732.84
|
|
|
HC LEAD MED SPRINT QTO 6935
|
Facility
|
OP
|
$11,398.00
|
|
|
Service Code
|
CPT C1777
|
| Hospital Charge Code |
906813635
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,279.60 |
| Max. Negotiated Rate |
$10,258.20 |
| Rate for Payer: Adventist Health Commercial |
$2,279.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,688.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,268.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,548.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,204.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,311.07
|
| Rate for Payer: Blue Shield of California Commercial |
$8,810.65
|
| Rate for Payer: Blue Shield of California EPN |
$5,744.59
|
| Rate for Payer: Cash Price |
$6,268.90
|
| Rate for Payer: Central Health Plan Commercial |
$9,118.40
|
| Rate for Payer: Cigna of CA HMO |
$7,978.60
|
| Rate for Payer: Cigna of CA PPO |
$7,978.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,688.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,688.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,688.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,559.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,559.20
|
| Rate for Payer: Galaxy Health WC |
$9,688.30
|
| Rate for Payer: Global Benefits Group Commercial |
$6,838.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,258.20
|
| Rate for Payer: InnovAge PACE Commercial |
$5,699.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,602.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,055.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,279.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,978.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,978.60
|
| Rate for Payer: Multiplan Commercial |
$8,548.50
|
| Rate for Payer: Networks By Design Commercial |
$5,699.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,688.30
|
| Rate for Payer: Riverside University Health System MISP |
$4,559.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,838.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,838.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,277.67
|
| Rate for Payer: United Healthcare All Other HMO |
$4,163.69
|
| Rate for Payer: United Healthcare HMO Rider |
$4,073.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,732.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,688.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,688.30
|
| Rate for Payer: Vantage Medical Group Senior |
$9,688.30
|
|
|
HC LEAD MED SPRINT QTO 6935M
|
Facility
|
IP
|
$11,398.00
|
|
|
Service Code
|
CPT C1777
|
| Hospital Charge Code |
906813690
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,279.60 |
| Max. Negotiated Rate |
$10,258.20 |
| Rate for Payer: Adventist Health Commercial |
$2,279.60
|
| Rate for Payer: Blue Shield of California Commercial |
$8,810.65
|
| Rate for Payer: Blue Shield of California EPN |
$5,744.59
|
| Rate for Payer: Cash Price |
$6,268.90
|
| Rate for Payer: Central Health Plan Commercial |
$9,118.40
|
| Rate for Payer: Cigna of CA HMO |
$7,978.60
|
| Rate for Payer: Cigna of CA PPO |
$7,978.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,559.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,559.20
|
| Rate for Payer: Galaxy Health WC |
$9,688.30
|
| Rate for Payer: Global Benefits Group Commercial |
$6,838.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,258.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,602.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,342.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,055.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,279.60
|
| Rate for Payer: Multiplan Commercial |
$8,548.50
|
| Rate for Payer: Networks By Design Commercial |
$5,699.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,688.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,277.67
|
| Rate for Payer: United Healthcare All Other HMO |
$4,163.69
|
| Rate for Payer: United Healthcare HMO Rider |
$4,073.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,732.84
|
|
|
HC LEAD MED SPRINT QTO 6935M
|
Facility
|
OP
|
$11,398.00
|
|
|
Service Code
|
CPT C1777
|
| Hospital Charge Code |
906813690
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,279.60 |
| Max. Negotiated Rate |
$10,258.20 |
| Rate for Payer: Adventist Health Commercial |
$2,279.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,688.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,268.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,548.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,204.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,311.07
|
| Rate for Payer: Blue Shield of California Commercial |
$8,810.65
|
| Rate for Payer: Blue Shield of California EPN |
$5,744.59
|
| Rate for Payer: Cash Price |
$6,268.90
|
| Rate for Payer: Central Health Plan Commercial |
$9,118.40
|
| Rate for Payer: Cigna of CA HMO |
$7,978.60
|
| Rate for Payer: Cigna of CA PPO |
$7,978.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,688.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,688.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,688.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,559.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,559.20
|
| Rate for Payer: Galaxy Health WC |
$9,688.30
|
| Rate for Payer: Global Benefits Group Commercial |
$6,838.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,258.20
|
| Rate for Payer: InnovAge PACE Commercial |
$5,699.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,602.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,055.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,279.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,978.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,978.60
|
| Rate for Payer: Multiplan Commercial |
$8,548.50
|
| Rate for Payer: Networks By Design Commercial |
$5,699.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,688.30
|
| Rate for Payer: Riverside University Health System MISP |
$4,559.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,838.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,838.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,277.67
|
| Rate for Payer: United Healthcare All Other HMO |
$4,163.69
|
| Rate for Payer: United Healthcare HMO Rider |
$4,073.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,732.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,688.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,688.30
|
| Rate for Payer: Vantage Medical Group Senior |
$9,688.30
|
|
|
HC LEAD MED SPRINT QTO SEC 6947M
|
Facility
|
IP
|
$12,125.00
|
|
|
Service Code
|
CPT C1895
|
| Hospital Charge Code |
906813676
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,425.00 |
| Max. Negotiated Rate |
$10,912.50 |
| Rate for Payer: Adventist Health Commercial |
$2,425.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,372.62
|
| Rate for Payer: Blue Shield of California EPN |
$6,111.00
|
| Rate for Payer: Cash Price |
$6,668.75
|
| Rate for Payer: Central Health Plan Commercial |
$9,700.00
|
| Rate for Payer: Cigna of CA HMO |
$8,487.50
|
| Rate for Payer: Cigna of CA PPO |
$8,487.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,850.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,850.00
|
| Rate for Payer: Galaxy Health WC |
$10,306.25
|
| Rate for Payer: Global Benefits Group Commercial |
$7,275.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,912.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,087.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,619.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,505.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,425.00
|
| Rate for Payer: Multiplan Commercial |
$9,093.75
|
| Rate for Payer: Networks By Design Commercial |
$6,062.50
|
| Rate for Payer: Prime Health Services Commercial |
$10,306.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,550.51
|
| Rate for Payer: United Healthcare All Other HMO |
$4,429.26
|
| Rate for Payer: United Healthcare HMO Rider |
$4,333.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,970.94
|
|
|
HC LEAD MED SPRINT QTO SEC 6947M
|
Facility
|
OP
|
$12,125.00
|
|
|
Service Code
|
CPT C1895
|
| Hospital Charge Code |
906813676
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,425.00 |
| Max. Negotiated Rate |
$10,912.50 |
| Rate for Payer: Adventist Health Commercial |
$2,425.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,306.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,668.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,093.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,870.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,121.01
|
| Rate for Payer: Blue Shield of California Commercial |
$9,372.62
|
| Rate for Payer: Blue Shield of California EPN |
$6,111.00
|
| Rate for Payer: Cash Price |
$6,668.75
|
| Rate for Payer: Central Health Plan Commercial |
$9,700.00
|
| Rate for Payer: Cigna of CA HMO |
$8,487.50
|
| Rate for Payer: Cigna of CA PPO |
$8,487.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,306.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,306.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,306.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,850.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,850.00
|
| Rate for Payer: Galaxy Health WC |
$10,306.25
|
| Rate for Payer: Global Benefits Group Commercial |
$7,275.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,912.50
|
| Rate for Payer: InnovAge PACE Commercial |
$6,062.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,087.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,505.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,425.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,487.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,487.50
|
| Rate for Payer: Multiplan Commercial |
$9,093.75
|
| Rate for Payer: Networks By Design Commercial |
$6,062.50
|
| Rate for Payer: Prime Health Services Commercial |
$10,306.25
|
| Rate for Payer: Riverside University Health System MISP |
$4,850.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,275.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,275.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,550.51
|
| Rate for Payer: United Healthcare All Other HMO |
$4,429.26
|
| Rate for Payer: United Healthcare HMO Rider |
$4,333.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,970.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,306.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,306.25
|
| Rate for Payer: Vantage Medical Group Senior |
$10,306.25
|
|
|
HC LEAD MED STARFIX CS 4195
|
Facility
|
IP
|
$6,750.00
|
|
|
Service Code
|
CPT C1900
|
| Hospital Charge Code |
906813616
|
|
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 STARFIX CS 4195
|
Facility
|
OP
|
$6,750.00
|
|
|
Service Code
|
CPT C1900
|
| Hospital Charge Code |
906813616
|
|
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 SUBCUTANEOUS 6996SQ
|
Facility
|
IP
|
$6,250.00
|
|
|
Service Code
|
CPT C1896
|
| Hospital Charge Code |
906813727
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,250.00 |
| Max. Negotiated Rate |
$5,625.00 |
| Rate for Payer: Adventist Health Commercial |
$1,250.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,831.25
|
| Rate for Payer: Blue Shield of California EPN |
$3,150.00
|
| Rate for Payer: Cash Price |
$3,437.50
|
| Rate for Payer: Central Health Plan Commercial |
$5,000.00
|
| Rate for Payer: Cigna of CA HMO |
$4,375.00
|
| Rate for Payer: Cigna of CA PPO |
$4,375.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,500.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,500.00
|
| Rate for Payer: Galaxy Health WC |
$5,312.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,750.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,625.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,168.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,381.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,868.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,250.00
|
| Rate for Payer: Multiplan Commercial |
$4,687.50
|
| Rate for Payer: Networks By Design Commercial |
$3,125.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,312.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,345.62
|
| Rate for Payer: United Healthcare All Other HMO |
$2,283.12
|
| Rate for Payer: United Healthcare HMO Rider |
$2,233.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,046.88
|
|
|
HC LEAD MED SUBCUTANEOUS 6996SQ
|
Facility
|
OP
|
$6,250.00
|
|
|
Service Code
|
CPT C1896
|
| Hospital Charge Code |
906813727
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,250.00 |
| Max. Negotiated Rate |
$5,625.00 |
| Rate for Payer: Adventist Health Commercial |
$1,250.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,312.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,437.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,687.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,853.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,460.62
|
| Rate for Payer: Blue Shield of California Commercial |
$4,831.25
|
| Rate for Payer: Blue Shield of California EPN |
$3,150.00
|
| Rate for Payer: Cash Price |
$3,437.50
|
| Rate for Payer: Central Health Plan Commercial |
$5,000.00
|
| Rate for Payer: Cigna of CA HMO |
$4,375.00
|
| Rate for Payer: Cigna of CA PPO |
$4,375.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,312.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,312.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,312.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,500.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,500.00
|
| Rate for Payer: Galaxy Health WC |
$5,312.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,750.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,625.00
|
| Rate for Payer: InnovAge PACE Commercial |
$3,125.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,168.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,868.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,250.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,375.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,375.00
|
| Rate for Payer: Multiplan Commercial |
$4,687.50
|
| Rate for Payer: Networks By Design Commercial |
$3,125.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,312.50
|
| Rate for Payer: Riverside University Health System MISP |
$2,500.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,750.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,750.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,345.62
|
| Rate for Payer: United Healthcare All Other HMO |
$2,283.12
|
| Rate for Payer: United Healthcare HMO Rider |
$2,233.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,046.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,312.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,312.50
|
| Rate for Payer: Vantage Medical Group Senior |
$5,312.50
|
|
|
HC LEAD QUARTET 1456Q
|
Facility
|
OP
|
$9,500.00
|
|
|
Service Code
|
CPT C1900
|
| Hospital Charge Code |
906813821
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,900.00 |
| Max. Negotiated Rate |
$8,550.00 |
| Rate for Payer: Adventist Health Commercial |
$1,900.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,075.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,225.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,125.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,337.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,260.15
|
| Rate for Payer: Blue Shield of California Commercial |
$7,343.50
|
| Rate for Payer: Blue Shield of California EPN |
$4,788.00
|
| Rate for Payer: Cash Price |
$5,225.00
|
| Rate for Payer: Central Health Plan Commercial |
$7,600.00
|
| Rate for Payer: Cigna of CA HMO |
$6,650.00
|
| Rate for Payer: Cigna of CA PPO |
$6,650.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,075.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,075.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,075.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,800.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,800.00
|
| Rate for Payer: Galaxy Health WC |
$8,075.00
|
| Rate for Payer: Global Benefits Group Commercial |
$5,700.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,550.00
|
| Rate for Payer: InnovAge PACE Commercial |
$4,750.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,336.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,619.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,880.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,900.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,650.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,650.00
|
| Rate for Payer: Multiplan Commercial |
$7,125.00
|
| Rate for Payer: Networks By Design Commercial |
$4,750.00
|
| Rate for Payer: Prime Health Services Commercial |
$8,075.00
|
| Rate for Payer: Riverside University Health System MISP |
$3,800.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,700.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,700.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,565.35
|
| Rate for Payer: United Healthcare All Other HMO |
$3,470.35
|
| Rate for Payer: United Healthcare HMO Rider |
$3,395.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,111.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,075.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,075.00
|
| Rate for Payer: Vantage Medical Group Senior |
$8,075.00
|
|
|
HC LEAD QUARTET 1456Q
|
Facility
|
IP
|
$9,500.00
|
|
|
Service Code
|
CPT C1900
|
| Hospital Charge Code |
906813821
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,900.00 |
| Max. Negotiated Rate |
$8,550.00 |
| Rate for Payer: Adventist Health Commercial |
$1,900.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,343.50
|
| Rate for Payer: Blue Shield of California EPN |
$4,788.00
|
| Rate for Payer: Cash Price |
$5,225.00
|
| Rate for Payer: Central Health Plan Commercial |
$7,600.00
|
| Rate for Payer: Cigna of CA HMO |
$6,650.00
|
| Rate for Payer: Cigna of CA PPO |
$6,650.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,800.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,800.00
|
| Rate for Payer: Galaxy Health WC |
$8,075.00
|
| Rate for Payer: Global Benefits Group Commercial |
$5,700.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,550.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,336.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,619.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,880.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,900.00
|
| Rate for Payer: Multiplan Commercial |
$7,125.00
|
| Rate for Payer: Networks By Design Commercial |
$4,750.00
|
| Rate for Payer: Prime Health Services Commercial |
$8,075.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,565.35
|
| Rate for Payer: United Healthcare All Other HMO |
$3,470.35
|
| Rate for Payer: United Healthcare HMO Rider |
$3,395.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,111.25
|
|
|
HC LEAD REPAIR DUAL A & V
|
Facility
|
OP
|
$10,690.00
|
|
|
Service Code
|
CPT 33220
|
| Hospital Charge Code |
906811361
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$507.80 |
| Max. Negotiated Rate |
$20,902.00 |
| Rate for Payer: Adventist Health Commercial |
$2,138.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,624.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,936.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,086.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,624.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,461.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,320.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$7,367.67
|
| 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 |
$5,879.50
|
| Rate for Payer: Cash Price |
$5,879.50
|
| Rate for Payer: Cash Price |
$5,879.50
|
| Rate for Payer: Central Health Plan Commercial |
$8,552.00
|
| Rate for Payer: Cigna of CA HMO |
$6,841.60
|
| Rate for Payer: Cigna of CA PPO |
$7,910.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,936.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,086.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,624.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,242.52
|
| Rate for Payer: EPIC Health Plan Senior |
$4,624.09
|
| Rate for Payer: Galaxy Health WC |
$9,086.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6,414.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,621.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,583.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$507.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,624.09
|
| Rate for Payer: InnovAge PACE Commercial |
$6,936.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,130.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$560.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,624.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,138.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,196.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,196.28
|
| Rate for Payer: Multiplan Commercial |
$8,017.50
|
| Rate for Payer: Multiplan WC |
$7,367.67
|
| Rate for Payer: Networks By Design Commercial |
$6,948.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,624.09
|
| Rate for Payer: Preferred Health Network WC |
$7,518.03
|
| Rate for Payer: Prime Health Services Commercial |
$9,086.50
|
| Rate for Payer: Prime Health Services Medicare |
$4,901.54
|
| Rate for Payer: Prime Health Services WC |
$7,292.49
|
| Rate for Payer: Riverside University Health System MISP |
$5,086.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,414.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,624.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,936.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,086.50
|
| Rate for Payer: Vantage Medical Group Senior |
$4,624.09
|
|
|
HC LEAD REPAIR DUAL A & V
|
Facility
|
IP
|
$10,690.00
|
|
|
Service Code
|
CPT 33220
|
| Hospital Charge Code |
906811361
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,138.00 |
| Max. Negotiated Rate |
$9,621.00 |
| Rate for Payer: Adventist Health Commercial |
$2,138.00
|
| Rate for Payer: Cash Price |
$5,879.50
|
| Rate for Payer: Central Health Plan Commercial |
$8,552.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,276.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,276.00
|
| Rate for Payer: Galaxy Health WC |
$9,086.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6,414.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,621.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,130.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,072.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,617.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,138.00
|
| Rate for Payer: Multiplan Commercial |
$8,017.50
|
| Rate for Payer: Networks By Design Commercial |
$6,948.50
|
| Rate for Payer: Prime Health Services Commercial |
$9,086.50
|
|
|
HC LEAD REPAIR DUAL A & V
|
Facility
|
IP
|
$12,576.00
|
|
|
Service Code
|
CPT 33220
|
| Hospital Charge Code |
906820118
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,515.20 |
| Max. Negotiated Rate |
$11,318.40 |
| Rate for Payer: Adventist Health Commercial |
$2,515.20
|
| Rate for Payer: Cash Price |
$6,916.80
|
| Rate for Payer: Central Health Plan Commercial |
$10,060.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,030.40
|
| Rate for Payer: EPIC Health Plan Senior |
$5,030.40
|
| Rate for Payer: Galaxy Health WC |
$10,689.60
|
| Rate for Payer: Global Benefits Group Commercial |
$7,545.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,318.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,388.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,791.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,784.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,515.20
|
| Rate for Payer: Multiplan Commercial |
$9,432.00
|
| Rate for Payer: Networks By Design Commercial |
$8,174.40
|
| Rate for Payer: Prime Health Services Commercial |
$10,689.60
|
|
|
HC LEAD REPAIR DUAL A & V
|
Facility
|
OP
|
$12,576.00
|
|
|
Service Code
|
CPT 33220
|
| Hospital Charge Code |
906820118
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$507.80 |
| Max. Negotiated Rate |
$20,902.00 |
| Rate for Payer: Adventist Health Commercial |
$2,515.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,624.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,936.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,086.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,624.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,461.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,320.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$7,367.67
|
| 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 |
$6,916.80
|
| Rate for Payer: Cash Price |
$6,916.80
|
| Rate for Payer: Cash Price |
$6,916.80
|
| Rate for Payer: Central Health Plan Commercial |
$10,060.80
|
| Rate for Payer: Cigna of CA HMO |
$8,048.64
|
| Rate for Payer: Cigna of CA PPO |
$9,306.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,936.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,086.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,624.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,242.52
|
| Rate for Payer: EPIC Health Plan Senior |
$4,624.09
|
| Rate for Payer: Galaxy Health WC |
$10,689.60
|
| Rate for Payer: Global Benefits Group Commercial |
$7,545.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,318.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,583.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$507.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,624.09
|
| Rate for Payer: InnovAge PACE Commercial |
$6,936.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,388.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$560.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,624.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,515.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,196.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,196.28
|
| Rate for Payer: Multiplan Commercial |
$9,432.00
|
| Rate for Payer: Multiplan WC |
$7,367.67
|
| Rate for Payer: Networks By Design Commercial |
$8,174.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,624.09
|
| Rate for Payer: Preferred Health Network WC |
$7,518.03
|
| Rate for Payer: Prime Health Services Commercial |
$10,689.60
|
| Rate for Payer: Prime Health Services Medicare |
$4,901.54
|
| Rate for Payer: Prime Health Services WC |
$7,292.49
|
| Rate for Payer: Riverside University Health System MISP |
$5,086.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,545.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,624.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,936.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,086.50
|
| Rate for Payer: Vantage Medical Group Senior |
$4,624.09
|
|
|
HC LEAD REPAIR SINGLE A OR V
|
Facility
|
IP
|
$10,690.00
|
|
|
Service Code
|
CPT 33218
|
| Hospital Charge Code |
906811355
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,138.00 |
| Max. Negotiated Rate |
$9,621.00 |
| Rate for Payer: Adventist Health Commercial |
$2,138.00
|
| Rate for Payer: Cash Price |
$5,879.50
|
| Rate for Payer: Central Health Plan Commercial |
$8,552.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,276.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,276.00
|
| Rate for Payer: Galaxy Health WC |
$9,086.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6,414.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,621.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,130.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,072.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,617.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,138.00
|
| Rate for Payer: Multiplan Commercial |
$8,017.50
|
| Rate for Payer: Networks By Design Commercial |
$6,948.50
|
| Rate for Payer: Prime Health Services Commercial |
$9,086.50
|
|
