|
HC LEAD STJ OPTISURE LDA220Q
|
Facility
|
OP
|
$7,363.00
|
|
|
Service Code
|
CPT C1895
|
| Hospital Charge Code |
906813780
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,472.60 |
| Max. Negotiated Rate |
$6,626.70 |
| Rate for Payer: Adventist Health Commercial |
$1,472.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,258.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,049.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,522.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,361.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,076.89
|
| Rate for Payer: Blue Shield of California Commercial |
$5,691.60
|
| Rate for Payer: Blue Shield of California EPN |
$3,710.95
|
| Rate for Payer: Cash Price |
$3,313.35
|
| Rate for Payer: Central Health Plan Commercial |
$5,890.40
|
| Rate for Payer: Cigna of CA HMO |
$5,154.10
|
| Rate for Payer: Cigna of CA PPO |
$5,154.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,258.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,258.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,258.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,945.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,945.20
|
| Rate for Payer: Galaxy Health WC |
$6,258.55
|
| Rate for Payer: Global Benefits Group Commercial |
$4,417.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,626.70
|
| Rate for Payer: InnovAge PACE Commercial |
$3,681.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,911.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,557.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,472.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,154.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,154.10
|
| Rate for Payer: Multiplan Commercial |
$5,522.25
|
| Rate for Payer: Networks By Design Commercial |
$3,681.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,258.55
|
| Rate for Payer: Riverside University Health System MISP |
$2,945.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,417.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,417.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,763.33
|
| Rate for Payer: United Healthcare All Other HMO |
$2,689.70
|
| Rate for Payer: United Healthcare HMO Rider |
$2,631.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,411.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,258.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,258.55
|
| Rate for Payer: Vantage Medical Group Senior |
$6,258.55
|
|
|
HC LEAD STJ QUARTET 1457Q
|
Facility
|
OP
|
$9,500.00
|
|
|
Service Code
|
CPT C1900
|
| Hospital Charge Code |
906813820
|
|
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 |
$4,275.00
|
| 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 STJ QUARTET 1457Q
|
Facility
|
IP
|
$9,500.00
|
|
|
Service Code
|
CPT C1900
|
| Hospital Charge Code |
906813820
|
|
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 |
$4,275.00
|
| 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 STJ QUARTET 1458Q-75
|
Facility
|
OP
|
$7,750.00
|
|
|
Service Code
|
CPT C1900
|
| Hospital Charge Code |
906813726
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,550.00 |
| Max. Negotiated Rate |
$6,975.00 |
| Rate for Payer: Adventist Health Commercial |
$1,550.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,587.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,262.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,812.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,538.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,291.18
|
| Rate for Payer: Blue Shield of California Commercial |
$5,990.75
|
| Rate for Payer: Blue Shield of California EPN |
$3,906.00
|
| Rate for Payer: Cash Price |
$3,487.50
|
| Rate for Payer: Central Health Plan Commercial |
$6,200.00
|
| Rate for Payer: Cigna of CA HMO |
$5,425.00
|
| Rate for Payer: Cigna of CA PPO |
$5,425.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,587.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,587.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,587.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,100.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,100.00
|
| Rate for Payer: Galaxy Health WC |
$6,587.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,650.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,975.00
|
| Rate for Payer: InnovAge PACE Commercial |
$3,875.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,169.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,952.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,797.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,550.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,425.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,425.00
|
| Rate for Payer: Multiplan Commercial |
$5,812.50
|
| Rate for Payer: Networks By Design Commercial |
$3,875.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,587.50
|
| Rate for Payer: Riverside University Health System MISP |
$3,100.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,650.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,650.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,908.57
|
| Rate for Payer: United Healthcare All Other HMO |
$2,831.07
|
| Rate for Payer: United Healthcare HMO Rider |
$2,769.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,538.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,587.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,587.50
|
| Rate for Payer: Vantage Medical Group Senior |
$6,587.50
|
|
|
HC LEAD STJ QUARTET 1458Q-75
|
Facility
|
IP
|
$7,750.00
|
|
|
Service Code
|
CPT C1900
|
| Hospital Charge Code |
906813726
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,550.00 |
| Max. Negotiated Rate |
$6,975.00 |
| Rate for Payer: Adventist Health Commercial |
$1,550.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,990.75
|
| Rate for Payer: Blue Shield of California EPN |
$3,906.00
|
| Rate for Payer: Cash Price |
$3,487.50
|
| Rate for Payer: Central Health Plan Commercial |
$6,200.00
|
| Rate for Payer: Cigna of CA HMO |
$5,425.00
|
| Rate for Payer: Cigna of CA PPO |
$5,425.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,100.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,100.00
|
| Rate for Payer: Galaxy Health WC |
$6,587.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,650.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,975.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,169.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,952.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,797.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,550.00
|
| Rate for Payer: Multiplan Commercial |
$5,812.50
|
| Rate for Payer: Networks By Design Commercial |
$3,875.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,587.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,908.57
|
| Rate for Payer: United Healthcare All Other HMO |
$2,831.07
|
| Rate for Payer: United Healthcare HMO Rider |
$2,769.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,538.12
|
|
|
HC LEAD STJ QUICKFLEX 1156T
|
Facility
|
OP
|
$9,375.00
|
|
|
Service Code
|
CPT C1900
|
| Hospital Charge Code |
906813605
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,875.00 |
| Max. Negotiated Rate |
$8,437.50 |
| Rate for Payer: Adventist Health Commercial |
$1,875.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,968.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,156.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,031.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,280.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,190.94
|
| Rate for Payer: Blue Shield of California Commercial |
$7,246.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,725.00
|
| Rate for Payer: Cash Price |
$4,218.75
|
| Rate for Payer: Central Health Plan Commercial |
$7,500.00
|
| Rate for Payer: Cigna of CA HMO |
$6,562.50
|
| Rate for Payer: Cigna of CA PPO |
$6,562.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,968.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,968.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,968.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,750.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,750.00
|
| Rate for Payer: Galaxy Health WC |
$7,968.75
|
| Rate for Payer: Global Benefits Group Commercial |
$5,625.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,437.50
|
| Rate for Payer: InnovAge PACE Commercial |
$4,687.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,253.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,571.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,803.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,875.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,562.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,562.50
|
| Rate for Payer: Multiplan Commercial |
$7,031.25
|
| Rate for Payer: Networks By Design Commercial |
$4,687.50
|
| Rate for Payer: Prime Health Services Commercial |
$7,968.75
|
| Rate for Payer: Riverside University Health System MISP |
$3,750.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,625.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,625.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,518.44
|
| Rate for Payer: United Healthcare All Other HMO |
$3,424.69
|
| Rate for Payer: United Healthcare HMO Rider |
$3,350.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,070.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,968.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,968.75
|
| Rate for Payer: Vantage Medical Group Senior |
$7,968.75
|
|
|
HC LEAD STJ QUICKFLEX 1156T
|
Facility
|
IP
|
$9,375.00
|
|
|
Service Code
|
CPT C1900
|
| Hospital Charge Code |
906813605
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,875.00 |
| Max. Negotiated Rate |
$8,437.50 |
| Rate for Payer: Adventist Health Commercial |
$1,875.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,246.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,725.00
|
| Rate for Payer: Cash Price |
$4,218.75
|
| Rate for Payer: Central Health Plan Commercial |
$7,500.00
|
| Rate for Payer: Cigna of CA HMO |
$6,562.50
|
| Rate for Payer: Cigna of CA PPO |
$6,562.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,750.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,750.00
|
| Rate for Payer: Galaxy Health WC |
$7,968.75
|
| Rate for Payer: Global Benefits Group Commercial |
$5,625.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,437.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,253.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,571.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,803.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,875.00
|
| Rate for Payer: Multiplan Commercial |
$7,031.25
|
| Rate for Payer: Networks By Design Commercial |
$4,687.50
|
| Rate for Payer: Prime Health Services Commercial |
$7,968.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,518.44
|
| Rate for Payer: United Healthcare All Other HMO |
$3,424.69
|
| Rate for Payer: United Healthcare HMO Rider |
$3,350.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,070.31
|
|
|
HC LEAD STJ QUICKFLEX 1258T
|
Facility
|
IP
|
$4,513.00
|
|
|
Service Code
|
CPT C1900
|
| Hospital Charge Code |
906813657
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$902.60 |
| Max. Negotiated Rate |
$4,061.70 |
| Rate for Payer: Adventist Health Commercial |
$902.60
|
| Rate for Payer: Blue Shield of California Commercial |
$3,488.55
|
| Rate for Payer: Blue Shield of California EPN |
$2,274.55
|
| Rate for Payer: Cash Price |
$2,030.85
|
| Rate for Payer: Central Health Plan Commercial |
$3,610.40
|
| Rate for Payer: Cigna of CA HMO |
$3,159.10
|
| Rate for Payer: Cigna of CA PPO |
$3,159.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,805.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,805.20
|
| Rate for Payer: Galaxy Health WC |
$3,836.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,707.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,061.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,010.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,719.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,793.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$902.60
|
| Rate for Payer: Multiplan Commercial |
$3,384.75
|
| Rate for Payer: Networks By Design Commercial |
$2,256.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,836.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,693.73
|
| Rate for Payer: United Healthcare All Other HMO |
$1,648.60
|
| Rate for Payer: United Healthcare HMO Rider |
$1,612.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,478.01
|
|
|
HC LEAD STJ QUICKFLEX 1258T
|
Facility
|
OP
|
$4,513.00
|
|
|
Service Code
|
CPT C1900
|
| Hospital Charge Code |
906813657
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$902.60 |
| Max. Negotiated Rate |
$4,061.70 |
| Rate for Payer: Adventist Health Commercial |
$902.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,836.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,482.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,384.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,060.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,498.85
|
| Rate for Payer: Blue Shield of California Commercial |
$3,488.55
|
| Rate for Payer: Blue Shield of California EPN |
$2,274.55
|
| Rate for Payer: Cash Price |
$2,030.85
|
| Rate for Payer: Central Health Plan Commercial |
$3,610.40
|
| Rate for Payer: Cigna of CA HMO |
$3,159.10
|
| Rate for Payer: Cigna of CA PPO |
$3,159.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,836.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,836.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,836.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,805.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,805.20
|
| Rate for Payer: Galaxy Health WC |
$3,836.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,707.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,061.70
|
| Rate for Payer: InnovAge PACE Commercial |
$2,256.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,010.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,719.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,793.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$902.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,159.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,159.10
|
| Rate for Payer: Multiplan Commercial |
$3,384.75
|
| Rate for Payer: Networks By Design Commercial |
$2,256.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,836.05
|
| Rate for Payer: Riverside University Health System MISP |
$1,805.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,707.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,707.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,693.73
|
| Rate for Payer: United Healthcare All Other HMO |
$1,648.60
|
| Rate for Payer: United Healthcare HMO Rider |
$1,612.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,478.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,836.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,836.05
|
| Rate for Payer: Vantage Medical Group Senior |
$3,836.05
|
|
|
HC LEAD STJ TENDRIL 1882TC
|
Facility
|
OP
|
$1,969.00
|
|
|
Service Code
|
CPT C1898
|
| Hospital Charge Code |
906813732
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$393.80 |
| Max. Negotiated Rate |
$1,772.10 |
| Rate for Payer: Adventist Health Commercial |
$393.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,673.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,082.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,476.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$899.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,090.24
|
| Rate for Payer: Blue Shield of California Commercial |
$1,522.04
|
| Rate for Payer: Blue Shield of California EPN |
$992.38
|
| Rate for Payer: Cash Price |
$886.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,575.20
|
| Rate for Payer: Cigna of CA HMO |
$1,378.30
|
| Rate for Payer: Cigna of CA PPO |
$1,378.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,673.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,673.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,673.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$787.60
|
| Rate for Payer: EPIC Health Plan Senior |
$787.60
|
| Rate for Payer: Galaxy Health WC |
$1,673.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,181.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,772.10
|
| Rate for Payer: InnovAge PACE Commercial |
$984.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,313.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$750.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,218.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$393.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,378.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,378.30
|
| Rate for Payer: Multiplan Commercial |
$1,476.75
|
| Rate for Payer: Networks By Design Commercial |
$984.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,673.65
|
| Rate for Payer: Riverside University Health System MISP |
$787.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,181.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,181.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$738.97
|
| Rate for Payer: United Healthcare All Other HMO |
$719.28
|
| Rate for Payer: United Healthcare HMO Rider |
$703.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$644.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,673.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,673.65
|
| Rate for Payer: Vantage Medical Group Senior |
$1,673.65
|
|
|
HC LEAD STJ TENDRIL 1882TC
|
Facility
|
IP
|
$1,969.00
|
|
|
Service Code
|
CPT C1898
|
| Hospital Charge Code |
906813732
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$393.80 |
| Max. Negotiated Rate |
$1,772.10 |
| Rate for Payer: Adventist Health Commercial |
$393.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,522.04
|
| Rate for Payer: Blue Shield of California EPN |
$992.38
|
| Rate for Payer: Cash Price |
$886.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,575.20
|
| Rate for Payer: Cigna of CA HMO |
$1,378.30
|
| Rate for Payer: Cigna of CA PPO |
$1,378.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$787.60
|
| Rate for Payer: EPIC Health Plan Senior |
$787.60
|
| Rate for Payer: Galaxy Health WC |
$1,673.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,181.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,772.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,313.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$750.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,218.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$393.80
|
| Rate for Payer: Multiplan Commercial |
$1,476.75
|
| Rate for Payer: Networks By Design Commercial |
$984.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,673.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$738.97
|
| Rate for Payer: United Healthcare All Other HMO |
$719.28
|
| Rate for Payer: United Healthcare HMO Rider |
$703.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$644.85
|
|
|
HC LEAD STJ TENDRIL LPA1200M
|
Facility
|
OP
|
$1,969.00
|
|
|
Service Code
|
CPT C1898
|
| Hospital Charge Code |
906813812
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$393.80 |
| Max. Negotiated Rate |
$1,772.10 |
| Rate for Payer: Adventist Health Commercial |
$393.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,673.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,082.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,476.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$953.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,156.39
|
| Rate for Payer: Blue Shield of California Commercial |
$1,522.04
|
| Rate for Payer: Blue Shield of California EPN |
$992.38
|
| Rate for Payer: Cash Price |
$886.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,575.20
|
| Rate for Payer: Cigna of CA HMO |
$1,378.30
|
| Rate for Payer: Cigna of CA PPO |
$1,378.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,673.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,673.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,673.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$787.60
|
| Rate for Payer: EPIC Health Plan Senior |
$787.60
|
| Rate for Payer: Galaxy Health WC |
$1,673.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,181.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,772.10
|
| Rate for Payer: InnovAge PACE Commercial |
$984.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,313.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$750.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,218.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$393.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,378.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,378.30
|
| Rate for Payer: Multiplan Commercial |
$1,476.75
|
| Rate for Payer: Networks By Design Commercial |
$984.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,673.65
|
| Rate for Payer: Riverside University Health System MISP |
$787.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,181.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,181.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$738.97
|
| Rate for Payer: United Healthcare All Other HMO |
$719.28
|
| Rate for Payer: United Healthcare HMO Rider |
$703.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$644.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,673.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,673.65
|
| Rate for Payer: Vantage Medical Group Senior |
$1,673.65
|
|
|
HC LEAD STJ TENDRIL LPA1200M
|
Facility
|
IP
|
$1,969.00
|
|
|
Service Code
|
CPT C1898
|
| Hospital Charge Code |
906813812
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$393.80 |
| Max. Negotiated Rate |
$1,772.10 |
| Rate for Payer: Adventist Health Commercial |
$393.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,522.04
|
| Rate for Payer: Blue Shield of California EPN |
$992.38
|
| Rate for Payer: Cash Price |
$886.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,575.20
|
| Rate for Payer: Cigna of CA HMO |
$1,378.30
|
| Rate for Payer: Cigna of CA PPO |
$1,378.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$787.60
|
| Rate for Payer: EPIC Health Plan Senior |
$787.60
|
| Rate for Payer: Galaxy Health WC |
$1,673.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,181.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,772.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,313.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$750.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,218.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$393.80
|
| Rate for Payer: Multiplan Commercial |
$1,476.75
|
| Rate for Payer: Networks By Design Commercial |
$984.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,673.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$738.97
|
| Rate for Payer: United Healthcare All Other HMO |
$719.28
|
| Rate for Payer: United Healthcare HMO Rider |
$703.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$644.85
|
|
|
HC LEAD STJ TENDRIL SDX 1688TC
|
Facility
|
OP
|
$2,340.00
|
|
|
Service Code
|
CPT C1898
|
| Hospital Charge Code |
906813572
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$468.00 |
| Max. Negotiated Rate |
$2,106.00 |
| Rate for Payer: Adventist Health Commercial |
$468.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,989.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,287.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,755.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,133.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,374.28
|
| Rate for Payer: Blue Shield of California Commercial |
$1,808.82
|
| Rate for Payer: Blue Shield of California EPN |
$1,179.36
|
| Rate for Payer: Cash Price |
$1,053.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,872.00
|
| Rate for Payer: Cigna of CA HMO |
$1,638.00
|
| Rate for Payer: Cigna of CA PPO |
$1,638.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,989.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,989.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,989.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$936.00
|
| Rate for Payer: EPIC Health Plan Senior |
$936.00
|
| Rate for Payer: Galaxy Health WC |
$1,989.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,404.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,106.00
|
| Rate for Payer: InnovAge PACE Commercial |
$1,170.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,560.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$891.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,448.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$468.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,638.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,638.00
|
| Rate for Payer: Multiplan Commercial |
$1,755.00
|
| Rate for Payer: Networks By Design Commercial |
$1,170.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,989.00
|
| Rate for Payer: Riverside University Health System MISP |
$936.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,404.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,404.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$878.20
|
| Rate for Payer: United Healthcare All Other HMO |
$854.80
|
| Rate for Payer: United Healthcare HMO Rider |
$836.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$766.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,989.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,989.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,989.00
|
|
|
HC LEAD STJ TENDRIL SDX 1688TC
|
Facility
|
IP
|
$2,340.00
|
|
|
Service Code
|
CPT C1898
|
| Hospital Charge Code |
906813572
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$468.00 |
| Max. Negotiated Rate |
$2,106.00 |
| Rate for Payer: Adventist Health Commercial |
$468.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,808.82
|
| Rate for Payer: Blue Shield of California EPN |
$1,179.36
|
| Rate for Payer: Cash Price |
$1,053.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,872.00
|
| Rate for Payer: Cigna of CA HMO |
$1,638.00
|
| Rate for Payer: Cigna of CA PPO |
$1,638.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$936.00
|
| Rate for Payer: EPIC Health Plan Senior |
$936.00
|
| Rate for Payer: Galaxy Health WC |
$1,989.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,404.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,106.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,560.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$891.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,448.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$468.00
|
| Rate for Payer: Multiplan Commercial |
$1,755.00
|
| Rate for Payer: Networks By Design Commercial |
$1,170.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,989.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$878.20
|
| Rate for Payer: United Healthcare All Other HMO |
$854.80
|
| Rate for Payer: United Healthcare HMO Rider |
$836.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$766.35
|
|
|
HC LEAD STJ TENDRIL ST 1788TC
|
Facility
|
OP
|
$2,535.00
|
|
|
Service Code
|
CPT C1898
|
| Hospital Charge Code |
906813592
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$507.00 |
| Max. Negotiated Rate |
$2,281.50 |
| Rate for Payer: Adventist Health Commercial |
$507.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,154.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,394.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,901.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,227.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,488.81
|
| Rate for Payer: Blue Shield of California Commercial |
$1,959.56
|
| Rate for Payer: Blue Shield of California EPN |
$1,277.64
|
| Rate for Payer: Cash Price |
$1,140.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,028.00
|
| Rate for Payer: Cigna of CA HMO |
$1,774.50
|
| Rate for Payer: Cigna of CA PPO |
$1,774.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,154.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,154.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,154.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,014.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,014.00
|
| Rate for Payer: Galaxy Health WC |
$2,154.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,521.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,281.50
|
| Rate for Payer: InnovAge PACE Commercial |
$1,267.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,690.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$965.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,569.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$507.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,774.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,774.50
|
| Rate for Payer: Multiplan Commercial |
$1,901.25
|
| Rate for Payer: Networks By Design Commercial |
$1,267.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,154.75
|
| Rate for Payer: Riverside University Health System MISP |
$1,014.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,521.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,521.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$951.39
|
| Rate for Payer: United Healthcare All Other HMO |
$926.04
|
| Rate for Payer: United Healthcare HMO Rider |
$906.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$830.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,154.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,154.75
|
| Rate for Payer: Vantage Medical Group Senior |
$2,154.75
|
|
|
HC LEAD STJ TENDRIL ST 1788TC
|
Facility
|
IP
|
$2,535.00
|
|
|
Service Code
|
CPT C1898
|
| Hospital Charge Code |
906813592
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$507.00 |
| Max. Negotiated Rate |
$2,281.50 |
| Rate for Payer: Adventist Health Commercial |
$507.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,959.56
|
| Rate for Payer: Blue Shield of California EPN |
$1,277.64
|
| Rate for Payer: Cash Price |
$1,140.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,028.00
|
| Rate for Payer: Cigna of CA HMO |
$1,774.50
|
| Rate for Payer: Cigna of CA PPO |
$1,774.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,014.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,014.00
|
| Rate for Payer: Galaxy Health WC |
$2,154.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,521.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,281.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,690.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$965.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,569.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$507.00
|
| Rate for Payer: Multiplan Commercial |
$1,901.25
|
| Rate for Payer: Networks By Design Commercial |
$1,267.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,154.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$951.39
|
| Rate for Payer: United Healthcare All Other HMO |
$926.04
|
| Rate for Payer: United Healthcare HMO Rider |
$906.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$830.21
|
|
|
HC LEATHER KAFO-AFO PORX
|
Facility
|
IP
|
$249.00
|
|
|
Service Code
|
CPT L4100
|
| Hospital Charge Code |
905354100
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$49.80 |
| Max. Negotiated Rate |
$224.10 |
| Rate for Payer: Adventist Health Commercial |
$49.80
|
| Rate for Payer: Blue Shield of California Commercial |
$192.48
|
| Rate for Payer: Blue Shield of California EPN |
$125.50
|
| Rate for Payer: Cash Price |
$112.05
|
| Rate for Payer: Central Health Plan Commercial |
$199.20
|
| Rate for Payer: Cigna of CA HMO |
$174.30
|
| Rate for Payer: Cigna of CA PPO |
$174.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.60
|
| Rate for Payer: EPIC Health Plan Senior |
$99.60
|
| Rate for Payer: Galaxy Health WC |
$211.65
|
| Rate for Payer: Global Benefits Group Commercial |
$149.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$224.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$166.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$94.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$154.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.80
|
| Rate for Payer: Multiplan Commercial |
$186.75
|
| Rate for Payer: Networks By Design Commercial |
$161.85
|
| Rate for Payer: Prime Health Services Commercial |
$211.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$93.45
|
| Rate for Payer: United Healthcare All Other HMO |
$90.96
|
| Rate for Payer: United Healthcare HMO Rider |
$88.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$81.55
|
|
|
HC LEATHER KAFO-AFO PORX
|
Facility
|
OP
|
$249.00
|
|
|
Service Code
|
CPT L4100
|
| Hospital Charge Code |
905354100
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$81.55 |
| Max. Negotiated Rate |
$224.10 |
| Rate for Payer: Adventist Health Commercial |
$102.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$211.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$136.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$186.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$146.24
|
| Rate for Payer: Blue Shield of California Commercial |
$192.48
|
| Rate for Payer: Blue Shield of California EPN |
$125.50
|
| Rate for Payer: Cash Price |
$112.05
|
| Rate for Payer: Cash Price |
$112.05
|
| Rate for Payer: Central Health Plan Commercial |
$199.20
|
| Rate for Payer: Cigna of CA HMO |
$174.30
|
| Rate for Payer: Cigna of CA PPO |
$174.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$211.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$211.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$211.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.60
|
| Rate for Payer: EPIC Health Plan Senior |
$99.60
|
| Rate for Payer: Galaxy Health WC |
$211.65
|
| Rate for Payer: Global Benefits Group Commercial |
$149.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$224.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$99.79
|
| Rate for Payer: InnovAge PACE Commercial |
$124.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$166.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$110.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$154.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$174.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$174.30
|
| Rate for Payer: Multiplan Commercial |
$186.75
|
| Rate for Payer: Networks By Design Commercial |
$124.50
|
| Rate for Payer: Prime Health Services Commercial |
$211.65
|
| Rate for Payer: Riverside University Health System MISP |
$99.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$149.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$149.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$93.45
|
| Rate for Payer: United Healthcare All Other HMO |
$90.96
|
| Rate for Payer: United Healthcare HMO Rider |
$88.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$81.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$211.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$211.65
|
| Rate for Payer: Vantage Medical Group Senior |
$211.65
|
|
|
HC LEATHER KAFO-AFO PORX
|
Facility
|
OP
|
$249.00
|
|
|
Service Code
|
CPT L4100
|
| Hospital Charge Code |
915354100
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$81.55 |
| Max. Negotiated Rate |
$224.10 |
| Rate for Payer: Adventist Health Commercial |
$102.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$211.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$136.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$186.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$146.24
|
| Rate for Payer: Blue Shield of California Commercial |
$192.48
|
| Rate for Payer: Blue Shield of California EPN |
$125.50
|
| Rate for Payer: Cash Price |
$112.05
|
| Rate for Payer: Cash Price |
$112.05
|
| Rate for Payer: Central Health Plan Commercial |
$199.20
|
| Rate for Payer: Cigna of CA HMO |
$174.30
|
| Rate for Payer: Cigna of CA PPO |
$174.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$211.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$211.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$211.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.60
|
| Rate for Payer: EPIC Health Plan Senior |
$99.60
|
| Rate for Payer: Galaxy Health WC |
$211.65
|
| Rate for Payer: Global Benefits Group Commercial |
$149.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$224.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$99.79
|
| Rate for Payer: InnovAge PACE Commercial |
$124.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$166.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$110.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$154.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$174.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$174.30
|
| Rate for Payer: Multiplan Commercial |
$186.75
|
| Rate for Payer: Networks By Design Commercial |
$124.50
|
| Rate for Payer: Prime Health Services Commercial |
$211.65
|
| Rate for Payer: Riverside University Health System MISP |
$99.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$149.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$149.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$93.45
|
| Rate for Payer: United Healthcare All Other HMO |
$90.96
|
| Rate for Payer: United Healthcare HMO Rider |
$88.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$81.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$211.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$211.65
|
| Rate for Payer: Vantage Medical Group Senior |
$211.65
|
|
|
HC LEATHER KAFO-AFO PORX
|
Facility
|
IP
|
$249.00
|
|
|
Service Code
|
CPT L4100
|
| Hospital Charge Code |
915354100
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$49.80 |
| Max. Negotiated Rate |
$224.10 |
| Rate for Payer: Adventist Health Commercial |
$49.80
|
| Rate for Payer: Blue Shield of California Commercial |
$192.48
|
| Rate for Payer: Blue Shield of California EPN |
$125.50
|
| Rate for Payer: Cash Price |
$112.05
|
| Rate for Payer: Central Health Plan Commercial |
$199.20
|
| Rate for Payer: Cigna of CA HMO |
$174.30
|
| Rate for Payer: Cigna of CA PPO |
$174.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.60
|
| Rate for Payer: EPIC Health Plan Senior |
$99.60
|
| Rate for Payer: Galaxy Health WC |
$211.65
|
| Rate for Payer: Global Benefits Group Commercial |
$149.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$224.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$166.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$94.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$154.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.80
|
| Rate for Payer: Multiplan Commercial |
$186.75
|
| Rate for Payer: Networks By Design Commercial |
$161.85
|
| Rate for Payer: Prime Health Services Commercial |
$211.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$93.45
|
| Rate for Payer: United Healthcare All Other HMO |
$90.96
|
| Rate for Payer: United Healthcare HMO Rider |
$88.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$81.55
|
|
|
HC LEECHES - WOUND THERAPY, EA
|
Facility
|
OP
|
$137.94
|
|
| Hospital Charge Code |
901605575
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$27.59 |
| Max. Negotiated Rate |
$124.15 |
| Rate for Payer: Adventist Health Commercial |
$27.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$83.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$117.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$75.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$103.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$66.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$81.01
|
| Rate for Payer: Blue Shield of California Commercial |
$84.28
|
| Rate for Payer: Blue Shield of California EPN |
$55.04
|
| Rate for Payer: Cash Price |
$62.07
|
| Rate for Payer: Central Health Plan Commercial |
$110.35
|
| Rate for Payer: Cigna of CA HMO |
$88.28
|
| Rate for Payer: Cigna of CA PPO |
$102.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$117.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$117.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$117.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.18
|
| Rate for Payer: EPIC Health Plan Senior |
$55.18
|
| Rate for Payer: Galaxy Health WC |
$117.25
|
| Rate for Payer: Global Benefits Group Commercial |
$82.76
|
| Rate for Payer: Health Management Network EPO/PPO |
$124.15
|
| Rate for Payer: InnovAge PACE Commercial |
$68.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$92.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$85.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$96.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$96.56
|
| Rate for Payer: Multiplan Commercial |
$103.45
|
| Rate for Payer: Networks By Design Commercial |
$89.66
|
| Rate for Payer: Prime Health Services Commercial |
$117.25
|
| Rate for Payer: Riverside University Health System MISP |
$55.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$82.76
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$82.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$68.97
|
| Rate for Payer: United Healthcare All Other HMO |
$68.97
|
| Rate for Payer: United Healthcare HMO Rider |
$68.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$68.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$117.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$117.25
|
| Rate for Payer: Vantage Medical Group Senior |
$117.25
|
|
|
HC LEECHES - WOUND THERAPY, EA
|
Facility
|
IP
|
$137.94
|
|
| Hospital Charge Code |
901605575
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$27.59 |
| Max. Negotiated Rate |
$124.15 |
| Rate for Payer: Adventist Health Commercial |
$27.59
|
| Rate for Payer: Cash Price |
$62.07
|
| Rate for Payer: Central Health Plan Commercial |
$110.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.18
|
| Rate for Payer: EPIC Health Plan Senior |
$55.18
|
| Rate for Payer: Galaxy Health WC |
$117.25
|
| Rate for Payer: Global Benefits Group Commercial |
$82.76
|
| Rate for Payer: Health Management Network EPO/PPO |
$124.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$92.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$85.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.59
|
| Rate for Payer: Multiplan Commercial |
$103.45
|
| Rate for Payer: Networks By Design Commercial |
$89.66
|
| Rate for Payer: Prime Health Services Commercial |
$117.25
|
|
|
HC LEECH THERAPY
|
Facility
|
OP
|
$2,160.00
|
|
|
Service Code
|
CPT 17999
|
| Hospital Charge Code |
906500660
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$252.47 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$432.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$252.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,045.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,268.57
|
| Rate for Payer: Blue Shield of California Commercial |
$1,319.76
|
| Rate for Payer: Blue Shield of California EPN |
$861.84
|
| Rate for Payer: Cash Price |
$972.00
|
| Rate for Payer: Cash Price |
$972.00
|
| Rate for Payer: Cash Price |
$972.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,728.00
|
| Rate for Payer: Cigna of CA HMO |
$1,382.40
|
| Rate for Payer: Cigna of CA PPO |
$1,598.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$378.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$277.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$252.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.83
|
| Rate for Payer: EPIC Health Plan Senior |
$252.47
|
| Rate for Payer: Galaxy Health WC |
$1,836.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,296.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,944.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$414.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$252.47
|
| Rate for Payer: InnovAge PACE Commercial |
$378.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,440.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$252.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$432.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$338.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$338.31
|
| Rate for Payer: Multiplan Commercial |
$1,620.00
|
| Rate for Payer: Networks By Design Commercial |
$1,404.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$252.47
|
| Rate for Payer: Prime Health Services Commercial |
$1,836.00
|
| Rate for Payer: Prime Health Services Medicare |
$267.62
|
| Rate for Payer: Riverside University Health System MISP |
$277.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,296.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,296.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$803.00
|
| Rate for Payer: United Healthcare All Other HMO |
$541.00
|
| Rate for Payer: United Healthcare HMO Rider |
$328.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$300.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$252.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Vantage Medical Group Senior |
$252.47
|
|
|
HC LEECH THERAPY
|
Facility
|
IP
|
$2,160.00
|
|
|
Service Code
|
CPT 17999
|
| Hospital Charge Code |
906500660
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$432.00 |
| Max. Negotiated Rate |
$1,944.00 |
| Rate for Payer: Adventist Health Commercial |
$432.00
|
| Rate for Payer: Cash Price |
$972.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,728.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$864.00
|
| Rate for Payer: EPIC Health Plan Senior |
$864.00
|
| Rate for Payer: Galaxy Health WC |
$1,836.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,296.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,944.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,440.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$822.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,337.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$432.00
|
| Rate for Payer: Multiplan Commercial |
$1,620.00
|
| Rate for Payer: Networks By Design Commercial |
$1,404.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,836.00
|
|
