|
HC DEVELOP TESTING W/INTERP & RPT ST
|
Facility
|
IP
|
$1,130.00
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
905601810
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$226.00 |
| Max. Negotiated Rate |
$960.50 |
| Rate for Payer: Adventist Health Commercial |
$226.00
|
| Rate for Payer: Cash Price |
$621.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$452.00
|
| Rate for Payer: EPIC Health Plan Senior |
$452.00
|
| Rate for Payer: Galaxy Health WC |
$960.50
|
| Rate for Payer: Global Benefits Group Commercial |
$678.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$753.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$430.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$699.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$271.20
|
| Rate for Payer: Multiplan Commercial |
$904.00
|
| Rate for Payer: Networks By Design Commercial |
$734.50
|
| Rate for Payer: Prime Health Services Commercial |
$960.50
|
|
|
HC DEVELOP TESTING W/INTERP & RPT ST MCAL
|
Facility
|
IP
|
$1,130.00
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
907000009
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$226.00 |
| Max. Negotiated Rate |
$960.50 |
| Rate for Payer: Adventist Health Commercial |
$226.00
|
| Rate for Payer: Cash Price |
$621.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$452.00
|
| Rate for Payer: EPIC Health Plan Senior |
$452.00
|
| Rate for Payer: Galaxy Health WC |
$960.50
|
| Rate for Payer: Global Benefits Group Commercial |
$678.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$753.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$430.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$699.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$271.20
|
| Rate for Payer: Multiplan Commercial |
$904.00
|
| Rate for Payer: Networks By Design Commercial |
$734.50
|
| Rate for Payer: Prime Health Services Commercial |
$960.50
|
|
|
HC DEVELOP TESTING W/INTERP & RPT ST MCAL
|
Facility
|
OP
|
$1,130.00
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
907000009
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$92.23 |
| Max. Negotiated Rate |
$960.50 |
| Rate for Payer: Adventist Health Commercial |
$463.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$741.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$960.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$621.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$847.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cash Price |
$621.50
|
| Rate for Payer: Cash Price |
$621.50
|
| Rate for Payer: Cash Price |
$621.50
|
| Rate for Payer: Cash Price |
$621.50
|
| Rate for Payer: Cigna of CA HMO |
$723.20
|
| Rate for Payer: Cigna of CA PPO |
$836.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$960.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$960.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$960.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$452.00
|
| Rate for Payer: EPIC Health Plan Senior |
$452.00
|
| Rate for Payer: Galaxy Health WC |
$960.50
|
| Rate for Payer: Global Benefits Group Commercial |
$678.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$92.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$753.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$699.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$271.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$791.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$791.00
|
| Rate for Payer: Multiplan Commercial |
$904.00
|
| Rate for Payer: Networks By Design Commercial |
$734.50
|
| Rate for Payer: Prime Health Services Commercial |
$960.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$678.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$678.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$960.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$960.50
|
| Rate for Payer: Vantage Medical Group Senior |
$960.50
|
|
|
HC DEVELOP TEST W INTERP & RPT MCAL
|
Facility
|
OP
|
$1,130.00
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
901300035
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$92.23 |
| Max. Negotiated Rate |
$960.50 |
| Rate for Payer: Adventist Health Commercial |
$463.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$741.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$960.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$621.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$847.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cash Price |
$621.50
|
| Rate for Payer: Cash Price |
$621.50
|
| Rate for Payer: Cash Price |
$621.50
|
| Rate for Payer: Cash Price |
$621.50
|
| Rate for Payer: Cigna of CA HMO |
$723.20
|
| Rate for Payer: Cigna of CA PPO |
$836.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$960.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$960.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$960.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$452.00
|
| Rate for Payer: EPIC Health Plan Senior |
$452.00
|
| Rate for Payer: Galaxy Health WC |
$960.50
|
| Rate for Payer: Global Benefits Group Commercial |
$678.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$92.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$753.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$699.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$271.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$791.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$791.00
|
| Rate for Payer: Multiplan Commercial |
$904.00
|
| Rate for Payer: Networks By Design Commercial |
$734.50
|
| Rate for Payer: Prime Health Services Commercial |
$960.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$678.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$678.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$960.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$960.50
|
| Rate for Payer: Vantage Medical Group Senior |
$960.50
|
|
|
HC DEVELOP TEST W INTERP & RPT MCAL
|
Facility
|
IP
|
$1,130.00
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
901300035
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$226.00 |
| Max. Negotiated Rate |
$960.50 |
| Rate for Payer: Networks By Design Commercial |
$734.50
|
| Rate for Payer: Adventist Health Commercial |
$226.00
|
| Rate for Payer: Cash Price |
$621.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$452.00
|
| Rate for Payer: EPIC Health Plan Senior |
$452.00
|
| Rate for Payer: Galaxy Health WC |
$960.50
|
| Rate for Payer: Global Benefits Group Commercial |
$678.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$753.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$430.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$699.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$271.20
|
| Rate for Payer: Multiplan Commercial |
$904.00
|
| Rate for Payer: Prime Health Services Commercial |
$960.50
|
|
|
HC D EXT PWR MECH ELBW SWITCH CON
|
Facility
|
IP
|
$38,383.00
|
|
|
Service Code
|
CPT L6960
|
| Hospital Charge Code |
905356960
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$7,676.60 |
| Max. Negotiated Rate |
$32,625.55 |
| Rate for Payer: Adventist Health Commercial |
$7,676.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$21,110.65
|
| Rate for Payer: Cash Price |
$21,110.65
|
| Rate for Payer: Cigna of CA HMO |
$26,868.10
|
| Rate for Payer: Cigna of CA PPO |
$26,868.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,353.20
|
| Rate for Payer: EPIC Health Plan Senior |
$15,353.20
|
| Rate for Payer: Galaxy Health WC |
$32,625.55
|
| Rate for Payer: Global Benefits Group Commercial |
$23,029.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25,601.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,623.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23,759.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,211.92
|
| Rate for Payer: Multiplan Commercial |
$30,706.40
|
| Rate for Payer: Networks By Design Commercial |
$19,191.50
|
| Rate for Payer: Prime Health Services Commercial |
$32,625.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,405.14
|
| Rate for Payer: United Healthcare All Other HMO |
$14,021.31
|
| Rate for Payer: United Healthcare HMO Rider |
$13,718.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12,570.43
|
|
|
HC D EXT PWR MECH ELBW SWITCH CON
|
Facility
|
IP
|
$38,383.00
|
|
|
Service Code
|
CPT L6960
|
| Hospital Charge Code |
915356960
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$7,676.60 |
| Max. Negotiated Rate |
$32,625.55 |
| Rate for Payer: Adventist Health Commercial |
$7,676.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$21,110.65
|
| Rate for Payer: Cash Price |
$21,110.65
|
| Rate for Payer: Cigna of CA HMO |
$26,868.10
|
| Rate for Payer: Cigna of CA PPO |
$26,868.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,353.20
|
| Rate for Payer: EPIC Health Plan Senior |
$15,353.20
|
| Rate for Payer: Galaxy Health WC |
$32,625.55
|
| Rate for Payer: Global Benefits Group Commercial |
$23,029.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25,601.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,623.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23,759.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,211.92
|
| Rate for Payer: Multiplan Commercial |
$30,706.40
|
| Rate for Payer: Networks By Design Commercial |
$19,191.50
|
| Rate for Payer: Prime Health Services Commercial |
$32,625.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,405.14
|
| Rate for Payer: United Healthcare All Other HMO |
$14,021.31
|
| Rate for Payer: United Healthcare HMO Rider |
$13,718.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12,570.43
|
|
|
HC D EXT PWR MECH ELBW SWITCH CON
|
Facility
|
OP
|
$38,383.00
|
|
|
Service Code
|
CPT L6960
|
| Hospital Charge Code |
915356960
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$9,211.92 |
| Max. Negotiated Rate |
$32,625.55 |
| Rate for Payer: Adventist Health Commercial |
$15,737.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32,625.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21,110.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28,787.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22,231.43
|
| Rate for Payer: Blue Shield of California Commercial |
$28,326.65
|
| Rate for Payer: Blue Shield of California EPN |
$18,654.14
|
| Rate for Payer: Cash Price |
$21,110.65
|
| Rate for Payer: Cash Price |
$21,110.65
|
| Rate for Payer: Cigna of CA HMO |
$26,868.10
|
| Rate for Payer: Cigna of CA PPO |
$26,868.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32,625.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$32,625.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$32,625.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,353.20
|
| Rate for Payer: EPIC Health Plan Senior |
$15,353.20
|
| Rate for Payer: Galaxy Health WC |
$32,625.55
|
| Rate for Payer: Global Benefits Group Commercial |
$23,029.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9,643.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25,601.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,906.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23,759.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,211.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26,868.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26,868.10
|
| Rate for Payer: Multiplan Commercial |
$30,706.40
|
| Rate for Payer: Networks By Design Commercial |
$19,191.50
|
| Rate for Payer: Prime Health Services Commercial |
$32,625.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23,029.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23,029.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,405.14
|
| Rate for Payer: United Healthcare All Other HMO |
$14,021.31
|
| Rate for Payer: United Healthcare HMO Rider |
$13,718.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12,570.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32,625.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32,625.55
|
| Rate for Payer: Vantage Medical Group Senior |
$32,625.55
|
|
|
HC D EXT PWR MECH ELBW SWITCH CON
|
Facility
|
OP
|
$38,383.00
|
|
|
Service Code
|
CPT L6960
|
| Hospital Charge Code |
905356960
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$9,211.92 |
| Max. Negotiated Rate |
$32,625.55 |
| Rate for Payer: Adventist Health Commercial |
$15,737.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32,625.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21,110.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28,787.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22,231.43
|
| Rate for Payer: Blue Shield of California Commercial |
$28,326.65
|
| Rate for Payer: Blue Shield of California EPN |
$18,654.14
|
| Rate for Payer: Cash Price |
$21,110.65
|
| Rate for Payer: Cash Price |
$21,110.65
|
| Rate for Payer: Cigna of CA HMO |
$26,868.10
|
| Rate for Payer: Cigna of CA PPO |
$26,868.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32,625.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$32,625.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$32,625.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,353.20
|
| Rate for Payer: EPIC Health Plan Senior |
$15,353.20
|
| Rate for Payer: Galaxy Health WC |
$32,625.55
|
| Rate for Payer: Global Benefits Group Commercial |
$23,029.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9,643.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25,601.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,906.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23,759.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,211.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26,868.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26,868.10
|
| Rate for Payer: Multiplan Commercial |
$30,706.40
|
| Rate for Payer: Networks By Design Commercial |
$19,191.50
|
| Rate for Payer: Prime Health Services Commercial |
$32,625.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23,029.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23,029.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,405.14
|
| Rate for Payer: United Healthcare All Other HMO |
$14,021.31
|
| Rate for Payer: United Healthcare HMO Rider |
$13,718.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12,570.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32,625.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32,625.55
|
| Rate for Payer: Vantage Medical Group Senior |
$32,625.55
|
|
|
HC DFIB BIOTRONIK ILIVIA 404623
|
Facility
|
IP
|
$25,000.00
|
|
|
Service Code
|
CPT C1721
|
| Hospital Charge Code |
906813807
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,000.00 |
| Max. Negotiated Rate |
$21,250.00 |
| Rate for Payer: Adventist Health Commercial |
$5,000.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$13,750.00
|
| Rate for Payer: Cash Price |
$13,750.00
|
| Rate for Payer: Cigna of CA HMO |
$17,500.00
|
| Rate for Payer: Cigna of CA PPO |
$17,500.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10,000.00
|
| Rate for Payer: Galaxy Health WC |
$21,250.00
|
| Rate for Payer: Global Benefits Group Commercial |
$15,000.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,675.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,525.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,475.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,000.00
|
| Rate for Payer: Multiplan Commercial |
$20,000.00
|
| Rate for Payer: Networks By Design Commercial |
$12,500.00
|
| Rate for Payer: Prime Health Services Commercial |
$21,250.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,382.50
|
| Rate for Payer: United Healthcare All Other HMO |
$9,132.50
|
| Rate for Payer: United Healthcare HMO Rider |
$8,935.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,187.50
|
|
|
HC DFIB BIOTRONIK ILIVIA 404623
|
Facility
|
OP
|
$25,000.00
|
|
|
Service Code
|
CPT C1721
|
| Hospital Charge Code |
906813807
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,000.00 |
| Max. Negotiated Rate |
$21,250.00 |
| Rate for Payer: Adventist Health Commercial |
$5,000.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,250.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13,750.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18,750.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,480.00
|
| Rate for Payer: Blue Shield of California Commercial |
$18,450.00
|
| Rate for Payer: Blue Shield of California EPN |
$12,150.00
|
| Rate for Payer: Cash Price |
$13,750.00
|
| Rate for Payer: Cigna of CA HMO |
$17,500.00
|
| Rate for Payer: Cigna of CA PPO |
$17,500.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,250.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$21,250.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21,250.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10,000.00
|
| Rate for Payer: Galaxy Health WC |
$21,250.00
|
| Rate for Payer: Global Benefits Group Commercial |
$15,000.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,675.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,475.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,000.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,500.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17,500.00
|
| Rate for Payer: Multiplan Commercial |
$20,000.00
|
| Rate for Payer: Networks By Design Commercial |
$12,500.00
|
| Rate for Payer: Prime Health Services Commercial |
$21,250.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15,000.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15,000.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,382.50
|
| Rate for Payer: United Healthcare All Other HMO |
$9,132.50
|
| Rate for Payer: United Healthcare HMO Rider |
$8,935.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,187.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,250.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21,250.00
|
| Rate for Payer: Vantage Medical Group Senior |
$21,250.00
|
|
|
HC DFIB BIOTRONIK ILIVIA 404626
|
Facility
|
OP
|
$25,000.00
|
|
|
Service Code
|
CPT C1722
|
| Hospital Charge Code |
906813810
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,000.00 |
| Max. Negotiated Rate |
$21,250.00 |
| Rate for Payer: Adventist Health Commercial |
$5,000.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,250.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13,750.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18,750.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,480.00
|
| Rate for Payer: Blue Shield of California Commercial |
$18,450.00
|
| Rate for Payer: Blue Shield of California EPN |
$12,150.00
|
| Rate for Payer: Cash Price |
$13,750.00
|
| Rate for Payer: Cigna of CA HMO |
$17,500.00
|
| Rate for Payer: Cigna of CA PPO |
$17,500.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,250.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$21,250.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21,250.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10,000.00
|
| Rate for Payer: Galaxy Health WC |
$21,250.00
|
| Rate for Payer: Global Benefits Group Commercial |
$15,000.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,675.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,475.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,000.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,500.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17,500.00
|
| Rate for Payer: Multiplan Commercial |
$20,000.00
|
| Rate for Payer: Networks By Design Commercial |
$12,500.00
|
| Rate for Payer: Prime Health Services Commercial |
$21,250.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15,000.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15,000.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,382.50
|
| Rate for Payer: United Healthcare All Other HMO |
$9,132.50
|
| Rate for Payer: United Healthcare HMO Rider |
$8,935.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,187.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,250.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21,250.00
|
| Rate for Payer: Vantage Medical Group Senior |
$21,250.00
|
|
|
HC DFIB BIOTRONIK ILIVIA 404626
|
Facility
|
IP
|
$25,000.00
|
|
|
Service Code
|
CPT C1722
|
| Hospital Charge Code |
906813810
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,000.00 |
| Max. Negotiated Rate |
$21,250.00 |
| Rate for Payer: Adventist Health Commercial |
$5,000.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$13,750.00
|
| Rate for Payer: Cash Price |
$13,750.00
|
| Rate for Payer: Cigna of CA HMO |
$17,500.00
|
| Rate for Payer: Cigna of CA PPO |
$17,500.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10,000.00
|
| Rate for Payer: Galaxy Health WC |
$21,250.00
|
| Rate for Payer: Global Benefits Group Commercial |
$15,000.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,675.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,525.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,475.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,000.00
|
| Rate for Payer: Multiplan Commercial |
$20,000.00
|
| Rate for Payer: Networks By Design Commercial |
$12,500.00
|
| Rate for Payer: Prime Health Services Commercial |
$21,250.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,382.50
|
| Rate for Payer: United Healthcare All Other HMO |
$9,132.50
|
| Rate for Payer: United Healthcare HMO Rider |
$8,935.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,187.50
|
|
|
HC DFIB BIOTRONIK INVENTRA 7VR 399436
|
Facility
|
OP
|
$25,000.00
|
|
|
Service Code
|
CPT C1722
|
| Hospital Charge Code |
906813792
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,000.00 |
| Max. Negotiated Rate |
$21,250.00 |
| Rate for Payer: Adventist Health Commercial |
$5,000.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,250.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13,750.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18,750.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,480.00
|
| Rate for Payer: Blue Shield of California Commercial |
$18,450.00
|
| Rate for Payer: Blue Shield of California EPN |
$12,150.00
|
| Rate for Payer: Cash Price |
$13,750.00
|
| Rate for Payer: Cigna of CA HMO |
$17,500.00
|
| Rate for Payer: Cigna of CA PPO |
$17,500.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,250.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$21,250.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21,250.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10,000.00
|
| Rate for Payer: Galaxy Health WC |
$21,250.00
|
| Rate for Payer: Global Benefits Group Commercial |
$15,000.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,675.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,475.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,000.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,500.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17,500.00
|
| Rate for Payer: Multiplan Commercial |
$20,000.00
|
| Rate for Payer: Networks By Design Commercial |
$12,500.00
|
| Rate for Payer: Prime Health Services Commercial |
$21,250.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15,000.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15,000.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,382.50
|
| Rate for Payer: United Healthcare All Other HMO |
$9,132.50
|
| Rate for Payer: United Healthcare HMO Rider |
$8,935.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,187.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,250.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21,250.00
|
| Rate for Payer: Vantage Medical Group Senior |
$21,250.00
|
|
|
HC DFIB BIOTRONIK INVENTRA 7VR 399436
|
Facility
|
IP
|
$25,000.00
|
|
|
Service Code
|
CPT C1722
|
| Hospital Charge Code |
906813792
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,000.00 |
| Max. Negotiated Rate |
$21,250.00 |
| Rate for Payer: Adventist Health Commercial |
$5,000.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$13,750.00
|
| Rate for Payer: Cash Price |
$13,750.00
|
| Rate for Payer: Cigna of CA HMO |
$17,500.00
|
| Rate for Payer: Cigna of CA PPO |
$17,500.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10,000.00
|
| Rate for Payer: Galaxy Health WC |
$21,250.00
|
| Rate for Payer: Global Benefits Group Commercial |
$15,000.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,675.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,525.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,475.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,000.00
|
| Rate for Payer: Multiplan Commercial |
$20,000.00
|
| Rate for Payer: Networks By Design Commercial |
$12,500.00
|
| Rate for Payer: Prime Health Services Commercial |
$21,250.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,382.50
|
| Rate for Payer: United Healthcare All Other HMO |
$9,132.50
|
| Rate for Payer: United Healthcare HMO Rider |
$8,935.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,187.50
|
|
|
HC DFIB BIOTRONIK IPERIA 7 DR-T 392423
|
Facility
|
OP
|
$25,000.00
|
|
|
Service Code
|
CPT C1721
|
| Hospital Charge Code |
906813784
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,000.00 |
| Max. Negotiated Rate |
$21,250.00 |
| Rate for Payer: Adventist Health Commercial |
$5,000.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,250.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13,750.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18,750.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,480.00
|
| Rate for Payer: Blue Shield of California Commercial |
$18,450.00
|
| Rate for Payer: Blue Shield of California EPN |
$12,150.00
|
| Rate for Payer: Cash Price |
$13,750.00
|
| Rate for Payer: Cigna of CA HMO |
$17,500.00
|
| Rate for Payer: Cigna of CA PPO |
$17,500.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,250.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$21,250.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21,250.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10,000.00
|
| Rate for Payer: Galaxy Health WC |
$21,250.00
|
| Rate for Payer: Global Benefits Group Commercial |
$15,000.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,675.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,475.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,000.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,500.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17,500.00
|
| Rate for Payer: Multiplan Commercial |
$20,000.00
|
| Rate for Payer: Networks By Design Commercial |
$12,500.00
|
| Rate for Payer: Prime Health Services Commercial |
$21,250.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15,000.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15,000.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,382.50
|
| Rate for Payer: United Healthcare All Other HMO |
$9,132.50
|
| Rate for Payer: United Healthcare HMO Rider |
$8,935.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,187.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,250.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21,250.00
|
| Rate for Payer: Vantage Medical Group Senior |
$21,250.00
|
|
|
HC DFIB BIOTRONIK IPERIA 7 DR-T 392423
|
Facility
|
IP
|
$25,000.00
|
|
|
Service Code
|
CPT C1721
|
| Hospital Charge Code |
906813784
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,000.00 |
| Max. Negotiated Rate |
$21,250.00 |
| Rate for Payer: Adventist Health Commercial |
$5,000.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$13,750.00
|
| Rate for Payer: Cash Price |
$13,750.00
|
| Rate for Payer: Cigna of CA HMO |
$17,500.00
|
| Rate for Payer: Cigna of CA PPO |
$17,500.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10,000.00
|
| Rate for Payer: Galaxy Health WC |
$21,250.00
|
| Rate for Payer: Global Benefits Group Commercial |
$15,000.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,675.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,525.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,475.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,000.00
|
| Rate for Payer: Multiplan Commercial |
$20,000.00
|
| Rate for Payer: Networks By Design Commercial |
$12,500.00
|
| Rate for Payer: Prime Health Services Commercial |
$21,250.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,382.50
|
| Rate for Payer: United Healthcare All Other HMO |
$9,132.50
|
| Rate for Payer: United Healthcare HMO Rider |
$8,935.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,187.50
|
|
|
HC DFIB BIOTRONIK IPERIA VR 393032
|
Facility
|
OP
|
$25,000.00
|
|
|
Service Code
|
CPT C1722
|
| Hospital Charge Code |
906813788
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,000.00 |
| Max. Negotiated Rate |
$21,250.00 |
| Rate for Payer: Adventist Health Commercial |
$5,000.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,250.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13,750.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18,750.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,480.00
|
| Rate for Payer: Blue Shield of California Commercial |
$18,450.00
|
| Rate for Payer: Blue Shield of California EPN |
$12,150.00
|
| Rate for Payer: Cash Price |
$13,750.00
|
| Rate for Payer: Cigna of CA HMO |
$17,500.00
|
| Rate for Payer: Cigna of CA PPO |
$17,500.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,250.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$21,250.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21,250.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10,000.00
|
| Rate for Payer: Galaxy Health WC |
$21,250.00
|
| Rate for Payer: Global Benefits Group Commercial |
$15,000.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,675.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,475.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,000.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,500.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17,500.00
|
| Rate for Payer: Multiplan Commercial |
$20,000.00
|
| Rate for Payer: Networks By Design Commercial |
$12,500.00
|
| Rate for Payer: Prime Health Services Commercial |
$21,250.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15,000.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15,000.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,382.50
|
| Rate for Payer: United Healthcare All Other HMO |
$9,132.50
|
| Rate for Payer: United Healthcare HMO Rider |
$8,935.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,187.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,250.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21,250.00
|
| Rate for Payer: Vantage Medical Group Senior |
$21,250.00
|
|
|
HC DFIB BIOTRONIK IPERIA VR 393032
|
Facility
|
IP
|
$25,000.00
|
|
|
Service Code
|
CPT C1722
|
| Hospital Charge Code |
906813788
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,000.00 |
| Max. Negotiated Rate |
$21,250.00 |
| Rate for Payer: Adventist Health Commercial |
$5,000.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$13,750.00
|
| Rate for Payer: Cash Price |
$13,750.00
|
| Rate for Payer: Cigna of CA HMO |
$17,500.00
|
| Rate for Payer: Cigna of CA PPO |
$17,500.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10,000.00
|
| Rate for Payer: Galaxy Health WC |
$21,250.00
|
| Rate for Payer: Global Benefits Group Commercial |
$15,000.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,675.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,525.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,475.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,000.00
|
| Rate for Payer: Multiplan Commercial |
$20,000.00
|
| Rate for Payer: Networks By Design Commercial |
$12,500.00
|
| Rate for Payer: Prime Health Services Commercial |
$21,250.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,382.50
|
| Rate for Payer: United Healthcare All Other HMO |
$9,132.50
|
| Rate for Payer: United Healthcare HMO Rider |
$8,935.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,187.50
|
|
|
HC DFIB BIOTRONIK ITREVIA 392412
|
Facility
|
OP
|
$25,000.00
|
|
|
Service Code
|
CPT C1721
|
| Hospital Charge Code |
906813796
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,000.00 |
| Max. Negotiated Rate |
$21,250.00 |
| Rate for Payer: Adventist Health Commercial |
$5,000.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,250.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13,750.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18,750.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,480.00
|
| Rate for Payer: Blue Shield of California Commercial |
$18,450.00
|
| Rate for Payer: Blue Shield of California EPN |
$12,150.00
|
| Rate for Payer: Cash Price |
$13,750.00
|
| Rate for Payer: Cigna of CA HMO |
$17,500.00
|
| Rate for Payer: Cigna of CA PPO |
$17,500.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,250.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$21,250.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21,250.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10,000.00
|
| Rate for Payer: Galaxy Health WC |
$21,250.00
|
| Rate for Payer: Global Benefits Group Commercial |
$15,000.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,675.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,475.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,000.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,500.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17,500.00
|
| Rate for Payer: Multiplan Commercial |
$20,000.00
|
| Rate for Payer: Networks By Design Commercial |
$12,500.00
|
| Rate for Payer: Prime Health Services Commercial |
$21,250.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15,000.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15,000.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,382.50
|
| Rate for Payer: United Healthcare All Other HMO |
$9,132.50
|
| Rate for Payer: United Healthcare HMO Rider |
$8,935.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,187.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,250.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21,250.00
|
| Rate for Payer: Vantage Medical Group Senior |
$21,250.00
|
|
|
HC DFIB BIOTRONIK ITREVIA 392412
|
Facility
|
IP
|
$25,000.00
|
|
|
Service Code
|
CPT C1721
|
| Hospital Charge Code |
906813796
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,000.00 |
| Max. Negotiated Rate |
$21,250.00 |
| Rate for Payer: Adventist Health Commercial |
$5,000.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$13,750.00
|
| Rate for Payer: Cash Price |
$13,750.00
|
| Rate for Payer: Cigna of CA HMO |
$17,500.00
|
| Rate for Payer: Cigna of CA PPO |
$17,500.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10,000.00
|
| Rate for Payer: Galaxy Health WC |
$21,250.00
|
| Rate for Payer: Global Benefits Group Commercial |
$15,000.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,675.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,525.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,475.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,000.00
|
| Rate for Payer: Multiplan Commercial |
$20,000.00
|
| Rate for Payer: Networks By Design Commercial |
$12,500.00
|
| Rate for Payer: Prime Health Services Commercial |
$21,250.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,382.50
|
| Rate for Payer: United Healthcare All Other HMO |
$9,132.50
|
| Rate for Payer: United Healthcare HMO Rider |
$8,935.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,187.50
|
|
|
HC DFIB B/S ASSURA MP 3369
|
Facility
|
OP
|
$25,088.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813809
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,017.60 |
| Max. Negotiated Rate |
$21,324.80 |
| Rate for Payer: Adventist Health Commercial |
$5,017.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,324.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13,798.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18,816.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,530.97
|
| Rate for Payer: Blue Shield of California Commercial |
$18,514.94
|
| Rate for Payer: Blue Shield of California EPN |
$12,192.77
|
| Rate for Payer: Cash Price |
$13,798.40
|
| Rate for Payer: Cigna of CA HMO |
$17,561.60
|
| Rate for Payer: Cigna of CA PPO |
$17,561.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,324.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$21,324.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21,324.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,035.20
|
| Rate for Payer: EPIC Health Plan Senior |
$10,035.20
|
| Rate for Payer: Galaxy Health WC |
$21,324.80
|
| Rate for Payer: Global Benefits Group Commercial |
$15,052.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,733.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,529.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,021.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,561.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17,561.60
|
| Rate for Payer: Multiplan Commercial |
$20,070.40
|
| Rate for Payer: Networks By Design Commercial |
$12,544.00
|
| Rate for Payer: Prime Health Services Commercial |
$21,324.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15,052.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15,052.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,415.53
|
| Rate for Payer: United Healthcare All Other HMO |
$9,164.65
|
| Rate for Payer: United Healthcare HMO Rider |
$8,966.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,216.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,324.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21,324.80
|
| Rate for Payer: Vantage Medical Group Senior |
$21,324.80
|
|
|
HC DFIB B/S ASSURA MP 3369
|
Facility
|
IP
|
$25,088.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813809
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,017.60 |
| Max. Negotiated Rate |
$21,324.80 |
| Rate for Payer: Adventist Health Commercial |
$5,017.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$13,798.40
|
| Rate for Payer: Cash Price |
$13,798.40
|
| Rate for Payer: Cigna of CA HMO |
$17,561.60
|
| Rate for Payer: Cigna of CA PPO |
$17,561.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,035.20
|
| Rate for Payer: EPIC Health Plan Senior |
$10,035.20
|
| Rate for Payer: Galaxy Health WC |
$21,324.80
|
| Rate for Payer: Global Benefits Group Commercial |
$15,052.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,733.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,558.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,529.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,021.12
|
| Rate for Payer: Multiplan Commercial |
$20,070.40
|
| Rate for Payer: Networks By Design Commercial |
$12,544.00
|
| Rate for Payer: Prime Health Services Commercial |
$21,324.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,415.53
|
| Rate for Payer: United Healthcare All Other HMO |
$9,164.65
|
| Rate for Payer: United Healthcare HMO Rider |
$8,966.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,216.32
|
|
|
HC DFIB B/S COGNIS 100-D N118
|
Facility
|
OP
|
$29,610.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813633
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,922.00 |
| Max. Negotiated Rate |
$25,168.50 |
| Rate for Payer: Adventist Health Commercial |
$5,922.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25,168.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16,285.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22,207.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17,150.11
|
| Rate for Payer: Blue Shield of California Commercial |
$21,852.18
|
| Rate for Payer: Blue Shield of California EPN |
$14,390.46
|
| Rate for Payer: Cash Price |
$16,285.50
|
| Rate for Payer: Cigna of CA HMO |
$20,727.00
|
| Rate for Payer: Cigna of CA PPO |
$20,727.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25,168.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,168.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25,168.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,844.00
|
| Rate for Payer: EPIC Health Plan Senior |
$11,844.00
|
| Rate for Payer: Galaxy Health WC |
$25,168.50
|
| Rate for Payer: Global Benefits Group Commercial |
$17,766.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19,749.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18,328.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,106.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20,727.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20,727.00
|
| Rate for Payer: Multiplan Commercial |
$23,688.00
|
| Rate for Payer: Networks By Design Commercial |
$14,805.00
|
| Rate for Payer: Prime Health Services Commercial |
$25,168.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17,766.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17,766.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,112.63
|
| Rate for Payer: United Healthcare All Other HMO |
$10,816.53
|
| Rate for Payer: United Healthcare HMO Rider |
$10,582.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,697.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25,168.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,168.50
|
| Rate for Payer: Vantage Medical Group Senior |
$25,168.50
|
|
|
HC DFIB B/S COGNIS 100-D N118
|
Facility
|
IP
|
$29,610.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813633
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,922.00 |
| Max. Negotiated Rate |
$25,168.50 |
| Rate for Payer: Adventist Health Commercial |
$5,922.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$16,285.50
|
| Rate for Payer: Cash Price |
$16,285.50
|
| Rate for Payer: Cigna of CA HMO |
$20,727.00
|
| Rate for Payer: Cigna of CA PPO |
$20,727.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,844.00
|
| Rate for Payer: EPIC Health Plan Senior |
$11,844.00
|
| Rate for Payer: Galaxy Health WC |
$25,168.50
|
| Rate for Payer: Global Benefits Group Commercial |
$17,766.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19,749.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,281.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18,328.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,106.40
|
| Rate for Payer: Multiplan Commercial |
$23,688.00
|
| Rate for Payer: Networks By Design Commercial |
$14,805.00
|
| Rate for Payer: Prime Health Services Commercial |
$25,168.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,112.63
|
| Rate for Payer: United Healthcare All Other HMO |
$10,816.53
|
| Rate for Payer: United Healthcare HMO Rider |
$10,582.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,697.27
|
|
