|
HC DFIB B/S COGNIS 100-D N119
|
Facility
|
OP
|
$29,610.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813611
|
|
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 N119
|
Facility
|
IP
|
$29,610.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813611
|
|
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
|
|
|
HC DFIB B/S CONFIENT E030
|
Facility
|
IP
|
$25,000.00
|
|
|
Service Code
|
CPT C1721
|
| Hospital Charge Code |
906813596
|
|
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 CONFIENT E030
|
Facility
|
OP
|
$25,000.00
|
|
|
Service Code
|
CPT C1721
|
| Hospital Charge Code |
906813596
|
|
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 B/S DYNAGEN CRT-D G154
|
Facility
|
IP
|
$30,210.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813795
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,042.00 |
| Max. Negotiated Rate |
$25,678.50 |
| Rate for Payer: Adventist Health Commercial |
$6,042.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$16,615.50
|
| Rate for Payer: Cash Price |
$16,615.50
|
| Rate for Payer: Cigna of CA HMO |
$21,147.00
|
| Rate for Payer: Cigna of CA PPO |
$21,147.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,084.00
|
| Rate for Payer: EPIC Health Plan Senior |
$12,084.00
|
| Rate for Payer: Galaxy Health WC |
$25,678.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18,126.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20,150.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,510.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18,699.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,250.40
|
| Rate for Payer: Multiplan Commercial |
$24,168.00
|
| Rate for Payer: Networks By Design Commercial |
$15,105.00
|
| Rate for Payer: Prime Health Services Commercial |
$25,678.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,337.81
|
| Rate for Payer: United Healthcare All Other HMO |
$11,035.71
|
| Rate for Payer: United Healthcare HMO Rider |
$10,797.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,893.77
|
|
|
HC DFIB B/S DYNAGEN CRT-D G154
|
Facility
|
OP
|
$30,210.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813795
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,042.00 |
| Max. Negotiated Rate |
$25,678.50 |
| Rate for Payer: Adventist Health Commercial |
$6,042.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25,678.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16,615.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22,657.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17,497.63
|
| Rate for Payer: Blue Shield of California Commercial |
$22,294.98
|
| Rate for Payer: Blue Shield of California EPN |
$14,682.06
|
| Rate for Payer: Cash Price |
$16,615.50
|
| Rate for Payer: Cigna of CA HMO |
$21,147.00
|
| Rate for Payer: Cigna of CA PPO |
$21,147.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25,678.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,678.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25,678.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,084.00
|
| Rate for Payer: EPIC Health Plan Senior |
$12,084.00
|
| Rate for Payer: Galaxy Health WC |
$25,678.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18,126.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20,150.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18,699.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,250.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21,147.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21,147.00
|
| Rate for Payer: Multiplan Commercial |
$24,168.00
|
| Rate for Payer: Networks By Design Commercial |
$15,105.00
|
| Rate for Payer: Prime Health Services Commercial |
$25,678.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18,126.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18,126.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,337.81
|
| Rate for Payer: United Healthcare All Other HMO |
$11,035.71
|
| Rate for Payer: United Healthcare HMO Rider |
$10,797.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,893.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25,678.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,678.50
|
| Rate for Payer: Vantage Medical Group Senior |
$25,678.50
|
|
|
HC DFIB B/S DYNAGEN CRT G150
|
Facility
|
OP
|
$20,340.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813752
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,068.00 |
| Max. Negotiated Rate |
$17,289.00 |
| Rate for Payer: Adventist Health Commercial |
$4,068.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17,289.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11,187.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15,255.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,780.93
|
| Rate for Payer: Blue Shield of California Commercial |
$15,010.92
|
| Rate for Payer: Blue Shield of California EPN |
$9,885.24
|
| Rate for Payer: Cash Price |
$11,187.00
|
| Rate for Payer: Cigna of CA HMO |
$14,238.00
|
| Rate for Payer: Cigna of CA PPO |
$14,238.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17,289.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$17,289.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17,289.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,136.00
|
| Rate for Payer: EPIC Health Plan Senior |
$8,136.00
|
| Rate for Payer: Galaxy Health WC |
$17,289.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12,204.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,566.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,590.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,881.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14,238.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14,238.00
|
| Rate for Payer: Multiplan Commercial |
$16,272.00
|
| Rate for Payer: Networks By Design Commercial |
$10,170.00
|
| Rate for Payer: Prime Health Services Commercial |
$17,289.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12,204.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12,204.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,633.60
|
| Rate for Payer: United Healthcare All Other HMO |
$7,430.20
|
| Rate for Payer: United Healthcare HMO Rider |
$7,269.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,661.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17,289.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17,289.00
|
| Rate for Payer: Vantage Medical Group Senior |
$17,289.00
|
|
|
HC DFIB B/S DYNAGEN CRT G150
|
Facility
|
IP
|
$20,340.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813752
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,068.00 |
| Max. Negotiated Rate |
$17,289.00 |
| Rate for Payer: Adventist Health Commercial |
$4,068.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$11,187.00
|
| Rate for Payer: Cash Price |
$11,187.00
|
| Rate for Payer: Cigna of CA HMO |
$14,238.00
|
| Rate for Payer: Cigna of CA PPO |
$14,238.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,136.00
|
| Rate for Payer: EPIC Health Plan Senior |
$8,136.00
|
| Rate for Payer: Galaxy Health WC |
$17,289.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12,204.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,566.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,749.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,590.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,881.60
|
| Rate for Payer: Multiplan Commercial |
$16,272.00
|
| Rate for Payer: Networks By Design Commercial |
$10,170.00
|
| Rate for Payer: Prime Health Services Commercial |
$17,289.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,633.60
|
| Rate for Payer: United Healthcare All Other HMO |
$7,430.20
|
| Rate for Payer: United Healthcare HMO Rider |
$7,269.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,661.35
|
|
|
HC DFIB B/S DYNAGEN EL DR VR D151
|
Facility
|
IP
|
$25,000.00
|
|
|
Service Code
|
CPT C1722
|
| Hospital Charge Code |
906813751
|
|
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 DYNAGEN EL DR VR D151
|
Facility
|
OP
|
$25,000.00
|
|
|
Service Code
|
CPT C1722
|
| Hospital Charge Code |
906813751
|
|
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 B/S DYNAGEN X4CRT G156
|
Facility
|
OP
|
$30,510.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813818
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,102.00 |
| Max. Negotiated Rate |
$25,933.50 |
| Rate for Payer: Adventist Health Commercial |
$6,102.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25,933.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16,780.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22,882.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17,671.39
|
| Rate for Payer: Blue Shield of California Commercial |
$22,516.38
|
| Rate for Payer: Blue Shield of California EPN |
$14,827.86
|
| Rate for Payer: Cash Price |
$16,780.50
|
| Rate for Payer: Cigna of CA HMO |
$21,357.00
|
| Rate for Payer: Cigna of CA PPO |
$21,357.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25,933.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,933.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25,933.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,204.00
|
| Rate for Payer: EPIC Health Plan Senior |
$12,204.00
|
| Rate for Payer: Galaxy Health WC |
$25,933.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18,306.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20,350.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18,885.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,322.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21,357.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21,357.00
|
| Rate for Payer: Multiplan Commercial |
$24,408.00
|
| Rate for Payer: Networks By Design Commercial |
$15,255.00
|
| Rate for Payer: Prime Health Services Commercial |
$25,933.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18,306.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18,306.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,450.40
|
| Rate for Payer: United Healthcare All Other HMO |
$11,145.30
|
| Rate for Payer: United Healthcare HMO Rider |
$10,904.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,992.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25,933.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,933.50
|
| Rate for Payer: Vantage Medical Group Senior |
$25,933.50
|
|
|
HC DFIB B/S DYNAGEN X4CRT G156
|
Facility
|
IP
|
$30,510.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813818
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,102.00 |
| Max. Negotiated Rate |
$25,933.50 |
| Rate for Payer: Adventist Health Commercial |
$6,102.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$16,780.50
|
| Rate for Payer: Cash Price |
$16,780.50
|
| Rate for Payer: Cigna of CA HMO |
$21,357.00
|
| Rate for Payer: Cigna of CA PPO |
$21,357.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,204.00
|
| Rate for Payer: EPIC Health Plan Senior |
$12,204.00
|
| Rate for Payer: Galaxy Health WC |
$25,933.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18,306.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20,350.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,624.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18,885.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,322.40
|
| Rate for Payer: Multiplan Commercial |
$24,408.00
|
| Rate for Payer: Networks By Design Commercial |
$15,255.00
|
| Rate for Payer: Prime Health Services Commercial |
$25,933.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,450.40
|
| Rate for Payer: United Healthcare All Other HMO |
$11,145.30
|
| Rate for Payer: United Healthcare HMO Rider |
$10,904.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,992.02
|
|
|
HC DFIB B/S DYNAGEN X4 CRT G158
|
Facility
|
OP
|
$30,510.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813749
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,102.00 |
| Max. Negotiated Rate |
$25,933.50 |
| Rate for Payer: Adventist Health Commercial |
$6,102.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25,933.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16,780.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22,882.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17,671.39
|
| Rate for Payer: Blue Shield of California Commercial |
$22,516.38
|
| Rate for Payer: Blue Shield of California EPN |
$14,827.86
|
| Rate for Payer: Cash Price |
$16,780.50
|
| Rate for Payer: Cigna of CA HMO |
$21,357.00
|
| Rate for Payer: Cigna of CA PPO |
$21,357.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25,933.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,933.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25,933.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,204.00
|
| Rate for Payer: EPIC Health Plan Senior |
$12,204.00
|
| Rate for Payer: Galaxy Health WC |
$25,933.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18,306.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20,350.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18,885.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,322.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21,357.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21,357.00
|
| Rate for Payer: Multiplan Commercial |
$24,408.00
|
| Rate for Payer: Networks By Design Commercial |
$15,255.00
|
| Rate for Payer: Prime Health Services Commercial |
$25,933.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18,306.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18,306.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,450.40
|
| Rate for Payer: United Healthcare All Other HMO |
$11,145.30
|
| Rate for Payer: United Healthcare HMO Rider |
$10,904.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,992.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25,933.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,933.50
|
| Rate for Payer: Vantage Medical Group Senior |
$25,933.50
|
|
|
HC DFIB B/S DYNAGEN X4 CRT G158
|
Facility
|
IP
|
$30,510.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813749
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,102.00 |
| Max. Negotiated Rate |
$25,933.50 |
| Rate for Payer: Adventist Health Commercial |
$6,102.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$16,780.50
|
| Rate for Payer: Cash Price |
$16,780.50
|
| Rate for Payer: Cigna of CA HMO |
$21,357.00
|
| Rate for Payer: Cigna of CA PPO |
$21,357.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,204.00
|
| Rate for Payer: EPIC Health Plan Senior |
$12,204.00
|
| Rate for Payer: Galaxy Health WC |
$25,933.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18,306.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20,350.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,624.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18,885.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,322.40
|
| Rate for Payer: Multiplan Commercial |
$24,408.00
|
| Rate for Payer: Networks By Design Commercial |
$15,255.00
|
| Rate for Payer: Prime Health Services Commercial |
$25,933.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,450.40
|
| Rate for Payer: United Healthcare All Other HMO |
$11,145.30
|
| Rate for Payer: United Healthcare HMO Rider |
$10,904.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,992.02
|
|
|
HC DFIB B/S EMBLEM A209
|
Facility
|
IP
|
$31,500.00
|
|
|
Service Code
|
CPT C1722
|
| Hospital Charge Code |
906813755
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,300.00 |
| Max. Negotiated Rate |
$26,775.00 |
| Rate for Payer: Adventist Health Commercial |
$6,300.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$17,325.00
|
| Rate for Payer: Cash Price |
$17,325.00
|
| Rate for Payer: Cigna of CA HMO |
$22,050.00
|
| Rate for Payer: Cigna of CA PPO |
$22,050.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,600.00
|
| Rate for Payer: EPIC Health Plan Senior |
$12,600.00
|
| Rate for Payer: Galaxy Health WC |
$26,775.00
|
| Rate for Payer: Global Benefits Group Commercial |
$18,900.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21,010.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,001.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19,498.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,560.00
|
| Rate for Payer: Multiplan Commercial |
$25,200.00
|
| Rate for Payer: Networks By Design Commercial |
$15,750.00
|
| Rate for Payer: Prime Health Services Commercial |
$26,775.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,821.95
|
| Rate for Payer: United Healthcare All Other HMO |
$11,506.95
|
| Rate for Payer: United Healthcare HMO Rider |
$11,258.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10,316.25
|
|
|
HC DFIB B/S EMBLEM A209
|
Facility
|
OP
|
$31,500.00
|
|
|
Service Code
|
CPT C1722
|
| Hospital Charge Code |
906813755
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,300.00 |
| Max. Negotiated Rate |
$26,775.00 |
| Rate for Payer: Adventist Health Commercial |
$6,300.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26,775.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17,325.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23,625.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18,244.80
|
| Rate for Payer: Blue Shield of California Commercial |
$23,247.00
|
| Rate for Payer: Blue Shield of California EPN |
$15,309.00
|
| Rate for Payer: Cash Price |
$17,325.00
|
| Rate for Payer: Cigna of CA HMO |
$22,050.00
|
| Rate for Payer: Cigna of CA PPO |
$22,050.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26,775.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$26,775.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$26,775.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,600.00
|
| Rate for Payer: EPIC Health Plan Senior |
$12,600.00
|
| Rate for Payer: Galaxy Health WC |
$26,775.00
|
| Rate for Payer: Global Benefits Group Commercial |
$18,900.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21,010.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19,498.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,560.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22,050.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22,050.00
|
| Rate for Payer: Multiplan Commercial |
$25,200.00
|
| Rate for Payer: Networks By Design Commercial |
$15,750.00
|
| Rate for Payer: Prime Health Services Commercial |
$26,775.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18,900.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18,900.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,821.95
|
| Rate for Payer: United Healthcare All Other HMO |
$11,506.95
|
| Rate for Payer: United Healthcare HMO Rider |
$11,258.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10,316.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26,775.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26,775.00
|
| Rate for Payer: Vantage Medical Group Senior |
$26,775.00
|
|
|
HC DFIB B/S EMBLEM A219
|
Facility
|
IP
|
$30,750.00
|
|
|
Service Code
|
CPT C1722
|
| Hospital Charge Code |
906813799
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,150.00 |
| Max. Negotiated Rate |
$26,137.50 |
| Rate for Payer: Adventist Health Commercial |
$6,150.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$16,912.50
|
| Rate for Payer: Cash Price |
$16,912.50
|
| Rate for Payer: Cigna of CA HMO |
$21,525.00
|
| Rate for Payer: Cigna of CA PPO |
$21,525.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,300.00
|
| Rate for Payer: EPIC Health Plan Senior |
$12,300.00
|
| Rate for Payer: Galaxy Health WC |
$26,137.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18,450.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20,510.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,715.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19,034.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,380.00
|
| Rate for Payer: Multiplan Commercial |
$24,600.00
|
| Rate for Payer: Networks By Design Commercial |
$15,375.00
|
| Rate for Payer: Prime Health Services Commercial |
$26,137.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,540.48
|
| Rate for Payer: United Healthcare All Other HMO |
$11,232.98
|
| Rate for Payer: United Healthcare HMO Rider |
$10,990.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10,070.62
|
|
|
HC DFIB B/S EMBLEM A219
|
Facility
|
OP
|
$30,750.00
|
|
|
Service Code
|
CPT C1722
|
| Hospital Charge Code |
906813799
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,150.00 |
| Max. Negotiated Rate |
$26,137.50 |
| Rate for Payer: Adventist Health Commercial |
$6,150.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26,137.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16,912.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23,062.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17,810.40
|
| Rate for Payer: Blue Shield of California Commercial |
$22,693.50
|
| Rate for Payer: Blue Shield of California EPN |
$14,944.50
|
| Rate for Payer: Cash Price |
$16,912.50
|
| Rate for Payer: Cigna of CA HMO |
$21,525.00
|
| Rate for Payer: Cigna of CA PPO |
$21,525.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26,137.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$26,137.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$26,137.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,300.00
|
| Rate for Payer: EPIC Health Plan Senior |
$12,300.00
|
| Rate for Payer: Galaxy Health WC |
$26,137.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18,450.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20,510.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19,034.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,380.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21,525.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21,525.00
|
| Rate for Payer: Multiplan Commercial |
$24,600.00
|
| Rate for Payer: Networks By Design Commercial |
$15,375.00
|
| Rate for Payer: Prime Health Services Commercial |
$26,137.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18,450.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18,450.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,540.48
|
| Rate for Payer: United Healthcare All Other HMO |
$11,232.98
|
| Rate for Payer: United Healthcare HMO Rider |
$10,990.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10,070.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26,137.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26,137.50
|
| Rate for Payer: Vantage Medical Group Senior |
$26,137.50
|
|
|
HC DFIB B/S ENERGEN DR DF4 E142
|
Facility
|
OP
|
$25,000.00
|
|
|
Service Code
|
CPT C1721
|
| Hospital Charge Code |
906813660
|
|
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 B/S ENERGEN DR DF4 E142
|
Facility
|
IP
|
$25,000.00
|
|
|
Service Code
|
CPT C1721
|
| Hospital Charge Code |
906813660
|
|
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 ENERGEN DR E143
|
Facility
|
OP
|
$25,000.00
|
|
|
Service Code
|
CPT C1721
|
| Hospital Charge Code |
906813661
|
|
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 B/S ENERGEN DR E143
|
Facility
|
IP
|
$25,000.00
|
|
|
Service Code
|
CPT C1721
|
| Hospital Charge Code |
906813661
|
|
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 ENERGEN RF DF4 N140
|
Facility
|
OP
|
$29,610.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813668
|
|
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 ENERGEN RF DF4 N140
|
Facility
|
IP
|
$29,610.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813668
|
|
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
|
|
|
HC DFIB B/S ENERGEN RF N141
|
Facility
|
IP
|
$29,610.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813669
|
|
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
|
|
