|
HC DFIB BS INCEPTA DF4 N160
|
Facility
|
OP
|
$29,910.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813701
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,982.00 |
| Max. Negotiated Rate |
$25,423.50 |
| Rate for Payer: Adventist Health Commercial |
$5,982.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25,423.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16,450.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22,432.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17,323.87
|
| Rate for Payer: Blue Shield of California Commercial |
$22,073.58
|
| Rate for Payer: Blue Shield of California EPN |
$14,536.26
|
| Rate for Payer: Cash Price |
$13,459.50
|
| Rate for Payer: Cigna of CA HMO |
$20,937.00
|
| Rate for Payer: Cigna of CA PPO |
$20,937.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25,423.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,423.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25,423.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,964.00
|
| Rate for Payer: EPIC Health Plan Senior |
$11,964.00
|
| Rate for Payer: Galaxy Health WC |
$25,423.50
|
| Rate for Payer: Global Benefits Group Commercial |
$17,946.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19,949.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18,514.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,178.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20,937.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20,937.00
|
| Rate for Payer: Multiplan Commercial |
$23,928.00
|
| Rate for Payer: Networks By Design Commercial |
$14,955.00
|
| Rate for Payer: Prime Health Services Commercial |
$25,423.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17,946.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17,946.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,225.22
|
| Rate for Payer: United Healthcare All Other HMO |
$10,926.12
|
| Rate for Payer: United Healthcare HMO Rider |
$10,689.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,795.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25,423.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,423.50
|
| Rate for Payer: Vantage Medical Group Senior |
$25,423.50
|
|
|
HC DFIB BS INCEPTA DF4 N160
|
Facility
|
IP
|
$29,910.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813701
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,982.00 |
| Max. Negotiated Rate |
$25,423.50 |
| Rate for Payer: Adventist Health Commercial |
$5,982.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$13,459.50
|
| Rate for Payer: Cash Price |
$13,459.50
|
| Rate for Payer: Cigna of CA HMO |
$20,937.00
|
| Rate for Payer: Cigna of CA PPO |
$20,937.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,964.00
|
| Rate for Payer: EPIC Health Plan Senior |
$11,964.00
|
| Rate for Payer: Galaxy Health WC |
$25,423.50
|
| Rate for Payer: Global Benefits Group Commercial |
$17,946.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19,949.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,395.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18,514.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,178.40
|
| Rate for Payer: Multiplan Commercial |
$23,928.00
|
| Rate for Payer: Networks By Design Commercial |
$14,955.00
|
| Rate for Payer: Prime Health Services Commercial |
$25,423.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,225.22
|
| Rate for Payer: United Healthcare All Other HMO |
$10,926.12
|
| Rate for Payer: United Healthcare HMO Rider |
$10,689.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,795.52
|
|
|
HC DFIB BS INCEPTA DR DF4 E162
|
Facility
|
IP
|
$25,000.00
|
|
|
Service Code
|
CPT C1721
|
| Hospital Charge Code |
906813697
|
|
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 |
$11,250.00
|
| Rate for Payer: Cash Price |
$11,250.00
|
| 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 BS INCEPTA DR DF4 E162
|
Facility
|
OP
|
$25,000.00
|
|
|
Service Code
|
CPT C1721
|
| Hospital Charge Code |
906813697
|
|
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 |
$11,250.00
|
| 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 BS INCEPTA DR E163
|
Facility
|
OP
|
$25,000.00
|
|
|
Service Code
|
CPT C1721
|
| Hospital Charge Code |
906813698
|
|
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 |
$11,250.00
|
| 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 BS INCEPTA DR E163
|
Facility
|
IP
|
$25,000.00
|
|
|
Service Code
|
CPT C1721
|
| Hospital Charge Code |
906813698
|
|
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 |
$11,250.00
|
| Rate for Payer: Cash Price |
$11,250.00
|
| 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 BS INCEPTA N161
|
Facility
|
OP
|
$29,910.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813702
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,982.00 |
| Max. Negotiated Rate |
$25,423.50 |
| Rate for Payer: Adventist Health Commercial |
$5,982.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25,423.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16,450.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22,432.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17,323.87
|
| Rate for Payer: Blue Shield of California Commercial |
$22,073.58
|
| Rate for Payer: Blue Shield of California EPN |
$14,536.26
|
| Rate for Payer: Cash Price |
$13,459.50
|
| Rate for Payer: Cigna of CA HMO |
$20,937.00
|
| Rate for Payer: Cigna of CA PPO |
$20,937.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25,423.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,423.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25,423.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,964.00
|
| Rate for Payer: EPIC Health Plan Senior |
$11,964.00
|
| Rate for Payer: Galaxy Health WC |
$25,423.50
|
| Rate for Payer: Global Benefits Group Commercial |
$17,946.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19,949.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18,514.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,178.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20,937.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20,937.00
|
| Rate for Payer: Multiplan Commercial |
$23,928.00
|
| Rate for Payer: Networks By Design Commercial |
$14,955.00
|
| Rate for Payer: Prime Health Services Commercial |
$25,423.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17,946.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17,946.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,225.22
|
| Rate for Payer: United Healthcare All Other HMO |
$10,926.12
|
| Rate for Payer: United Healthcare HMO Rider |
$10,689.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,795.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25,423.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,423.50
|
| Rate for Payer: Vantage Medical Group Senior |
$25,423.50
|
|
|
HC DFIB BS INCEPTA N161
|
Facility
|
IP
|
$29,910.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813702
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,982.00 |
| Max. Negotiated Rate |
$25,423.50 |
| Rate for Payer: Adventist Health Commercial |
$5,982.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$13,459.50
|
| Rate for Payer: Cash Price |
$13,459.50
|
| Rate for Payer: Cigna of CA HMO |
$20,937.00
|
| Rate for Payer: Cigna of CA PPO |
$20,937.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,964.00
|
| Rate for Payer: EPIC Health Plan Senior |
$11,964.00
|
| Rate for Payer: Galaxy Health WC |
$25,423.50
|
| Rate for Payer: Global Benefits Group Commercial |
$17,946.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19,949.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,395.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18,514.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,178.40
|
| Rate for Payer: Multiplan Commercial |
$23,928.00
|
| Rate for Payer: Networks By Design Commercial |
$14,955.00
|
| Rate for Payer: Prime Health Services Commercial |
$25,423.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,225.22
|
| Rate for Payer: United Healthcare All Other HMO |
$10,926.12
|
| Rate for Payer: United Healthcare HMO Rider |
$10,689.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,795.52
|
|
|
HC DFIB BS INCEPTA VR DF4 E160
|
Facility
|
IP
|
$25,000.00
|
|
|
Service Code
|
CPT C1722
|
| Hospital Charge Code |
906813699
|
|
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 |
$11,250.00
|
| Rate for Payer: Cash Price |
$11,250.00
|
| 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 BS INCEPTA VR DF4 E160
|
Facility
|
OP
|
$25,000.00
|
|
|
Service Code
|
CPT C1722
|
| Hospital Charge Code |
906813699
|
|
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 |
$11,250.00
|
| 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 BS INCEPTA VR E161
|
Facility
|
IP
|
$25,000.00
|
|
|
Service Code
|
CPT C1722
|
| Hospital Charge Code |
906813700
|
|
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 |
$11,250.00
|
| Rate for Payer: Cash Price |
$11,250.00
|
| 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 BS INCEPTA VR E161
|
Facility
|
OP
|
$25,000.00
|
|
|
Service Code
|
CPT C1722
|
| Hospital Charge Code |
906813700
|
|
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 |
$11,250.00
|
| 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 BS SQ RX PULSE 1010
|
Facility
|
OP
|
$31,500.00
|
|
|
Service Code
|
CPT C1722
|
| Hospital Charge Code |
906813706
|
|
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 |
$14,175.00
|
| 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 BS SQ RX PULSE 1010
|
Facility
|
IP
|
$31,500.00
|
|
|
Service Code
|
CPT C1722
|
| Hospital Charge Code |
906813706
|
|
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 |
$14,175.00
|
| Rate for Payer: Cash Price |
$14,175.00
|
| 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 TELIGEN 100 E110
|
Facility
|
OP
|
$21,735.00
|
|
|
Service Code
|
CPT C1721
|
| Hospital Charge Code |
906813610
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,347.00 |
| Max. Negotiated Rate |
$18,474.75 |
| Rate for Payer: Adventist Health Commercial |
$4,347.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18,474.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11,954.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16,301.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,588.91
|
| Rate for Payer: Blue Shield of California Commercial |
$16,040.43
|
| Rate for Payer: Blue Shield of California EPN |
$10,563.21
|
| Rate for Payer: Cash Price |
$9,780.75
|
| Rate for Payer: Cigna of CA HMO |
$15,214.50
|
| Rate for Payer: Cigna of CA PPO |
$15,214.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18,474.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$18,474.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18,474.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,694.00
|
| Rate for Payer: EPIC Health Plan Senior |
$8,694.00
|
| Rate for Payer: Galaxy Health WC |
$18,474.75
|
| Rate for Payer: Global Benefits Group Commercial |
$13,041.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,497.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,453.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,216.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15,214.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15,214.50
|
| Rate for Payer: Multiplan Commercial |
$17,388.00
|
| Rate for Payer: Networks By Design Commercial |
$10,867.50
|
| Rate for Payer: Prime Health Services Commercial |
$18,474.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13,041.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13,041.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,157.15
|
| Rate for Payer: United Healthcare All Other HMO |
$7,939.80
|
| Rate for Payer: United Healthcare HMO Rider |
$7,768.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,118.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18,474.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18,474.75
|
| Rate for Payer: Vantage Medical Group Senior |
$18,474.75
|
|
|
HC DFIB B/S TELIGEN 100 E110
|
Facility
|
IP
|
$21,735.00
|
|
|
Service Code
|
CPT C1721
|
| Hospital Charge Code |
906813610
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,347.00 |
| Max. Negotiated Rate |
$18,474.75 |
| Rate for Payer: Adventist Health Commercial |
$4,347.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$9,780.75
|
| Rate for Payer: Cash Price |
$9,780.75
|
| Rate for Payer: Cigna of CA HMO |
$15,214.50
|
| Rate for Payer: Cigna of CA PPO |
$15,214.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,694.00
|
| Rate for Payer: EPIC Health Plan Senior |
$8,694.00
|
| Rate for Payer: Galaxy Health WC |
$18,474.75
|
| Rate for Payer: Global Benefits Group Commercial |
$13,041.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,497.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,281.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,453.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,216.40
|
| Rate for Payer: Multiplan Commercial |
$17,388.00
|
| Rate for Payer: Networks By Design Commercial |
$10,867.50
|
| Rate for Payer: Prime Health Services Commercial |
$18,474.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,157.15
|
| Rate for Payer: United Healthcare All Other HMO |
$7,939.80
|
| Rate for Payer: United Healthcare HMO Rider |
$7,768.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,118.21
|
|
|
HC DFIB B/S TELIGEN VR E102
|
Facility
|
IP
|
$25,000.00
|
|
|
Service Code
|
CPT C1722
|
| Hospital Charge Code |
906813626
|
|
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 |
$11,250.00
|
| Rate for Payer: Cash Price |
$11,250.00
|
| 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 TELIGEN VR E102
|
Facility
|
OP
|
$25,000.00
|
|
|
Service Code
|
CPT C1722
|
| Hospital Charge Code |
906813626
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,000.00 |
| Max. Negotiated Rate |
$21,250.00 |
| Rate for Payer: Multiplan Commercial |
$20,000.00
|
| 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 |
$11,250.00
|
| 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: 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 IPERIA 7 HF-T 393009
|
Facility
|
IP
|
$25,725.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813817
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,145.00 |
| Max. Negotiated Rate |
$21,866.25 |
| Rate for Payer: Adventist Health Commercial |
$5,145.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$11,576.25
|
| Rate for Payer: Cash Price |
$11,576.25
|
| Rate for Payer: Cigna of CA HMO |
$18,007.50
|
| Rate for Payer: Cigna of CA PPO |
$18,007.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,290.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10,290.00
|
| Rate for Payer: Galaxy Health WC |
$21,866.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15,435.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17,158.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,801.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,923.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,174.00
|
| Rate for Payer: Multiplan Commercial |
$20,580.00
|
| Rate for Payer: Networks By Design Commercial |
$12,862.50
|
| Rate for Payer: Prime Health Services Commercial |
$21,866.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,654.59
|
| Rate for Payer: United Healthcare All Other HMO |
$9,397.34
|
| Rate for Payer: United Healthcare HMO Rider |
$9,194.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,424.94
|
|
|
HC DFIB IPERIA 7 HF-T 393009
|
Facility
|
OP
|
$25,725.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813817
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,145.00 |
| Max. Negotiated Rate |
$21,866.25 |
| Rate for Payer: Adventist Health Commercial |
$5,145.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,866.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14,148.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19,293.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,899.92
|
| Rate for Payer: Blue Shield of California Commercial |
$18,985.05
|
| Rate for Payer: Blue Shield of California EPN |
$12,502.35
|
| Rate for Payer: Cash Price |
$11,576.25
|
| Rate for Payer: Cigna of CA HMO |
$18,007.50
|
| Rate for Payer: Cigna of CA PPO |
$18,007.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,866.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$21,866.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21,866.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,290.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10,290.00
|
| Rate for Payer: Galaxy Health WC |
$21,866.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15,435.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17,158.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,923.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,174.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,007.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18,007.50
|
| Rate for Payer: Multiplan Commercial |
$20,580.00
|
| Rate for Payer: Networks By Design Commercial |
$12,862.50
|
| Rate for Payer: Prime Health Services Commercial |
$21,866.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15,435.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15,435.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,654.59
|
| Rate for Payer: United Healthcare All Other HMO |
$9,397.34
|
| Rate for Payer: United Healthcare HMO Rider |
$9,194.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,424.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,866.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21,866.25
|
| Rate for Payer: Vantage Medical Group Senior |
$21,866.25
|
|
|
HC DFIB MED AMPLIA MRI DTMB1D1
|
Facility
|
IP
|
$29,250.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813787
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,850.00 |
| Max. Negotiated Rate |
$24,862.50 |
| Rate for Payer: Adventist Health Commercial |
$5,850.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$13,162.50
|
| Rate for Payer: Cash Price |
$13,162.50
|
| Rate for Payer: Cigna of CA HMO |
$20,475.00
|
| Rate for Payer: Cigna of CA PPO |
$20,475.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,700.00
|
| Rate for Payer: EPIC Health Plan Senior |
$11,700.00
|
| Rate for Payer: Galaxy Health WC |
$24,862.50
|
| Rate for Payer: Global Benefits Group Commercial |
$17,550.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19,509.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,144.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18,105.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,020.00
|
| Rate for Payer: Multiplan Commercial |
$23,400.00
|
| Rate for Payer: Networks By Design Commercial |
$14,625.00
|
| Rate for Payer: Prime Health Services Commercial |
$24,862.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,977.52
|
| Rate for Payer: United Healthcare All Other HMO |
$10,685.02
|
| Rate for Payer: United Healthcare HMO Rider |
$10,453.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,579.38
|
|
|
HC DFIB MED AMPLIA MRI DTMB1D1
|
Facility
|
OP
|
$29,250.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813787
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,850.00 |
| Max. Negotiated Rate |
$24,862.50 |
| Rate for Payer: Adventist Health Commercial |
$5,850.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24,862.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16,087.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21,937.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16,941.60
|
| Rate for Payer: Blue Shield of California Commercial |
$21,586.50
|
| Rate for Payer: Blue Shield of California EPN |
$14,215.50
|
| Rate for Payer: Cash Price |
$13,162.50
|
| Rate for Payer: Cigna of CA HMO |
$20,475.00
|
| Rate for Payer: Cigna of CA PPO |
$20,475.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24,862.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$24,862.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24,862.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,700.00
|
| Rate for Payer: EPIC Health Plan Senior |
$11,700.00
|
| Rate for Payer: Galaxy Health WC |
$24,862.50
|
| Rate for Payer: Global Benefits Group Commercial |
$17,550.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19,509.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18,105.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,020.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20,475.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20,475.00
|
| Rate for Payer: Multiplan Commercial |
$23,400.00
|
| Rate for Payer: Networks By Design Commercial |
$14,625.00
|
| Rate for Payer: Prime Health Services Commercial |
$24,862.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17,550.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17,550.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,977.52
|
| Rate for Payer: United Healthcare All Other HMO |
$10,685.02
|
| Rate for Payer: United Healthcare HMO Rider |
$10,453.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,579.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24,862.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24,862.50
|
| Rate for Payer: Vantage Medical Group Senior |
$24,862.50
|
|
|
HC DFIB MED AMPLIA MRI DTMB1D4
|
Facility
|
OP
|
$29,250.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813771
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,850.00 |
| Max. Negotiated Rate |
$24,862.50 |
| Rate for Payer: Adventist Health Commercial |
$5,850.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24,862.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16,087.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21,937.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16,941.60
|
| Rate for Payer: Blue Shield of California Commercial |
$21,586.50
|
| Rate for Payer: Blue Shield of California EPN |
$14,215.50
|
| Rate for Payer: Cash Price |
$13,162.50
|
| Rate for Payer: Cigna of CA HMO |
$20,475.00
|
| Rate for Payer: Cigna of CA PPO |
$20,475.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24,862.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$24,862.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24,862.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,700.00
|
| Rate for Payer: EPIC Health Plan Senior |
$11,700.00
|
| Rate for Payer: Galaxy Health WC |
$24,862.50
|
| Rate for Payer: Global Benefits Group Commercial |
$17,550.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19,509.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18,105.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,020.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20,475.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20,475.00
|
| Rate for Payer: Multiplan Commercial |
$23,400.00
|
| Rate for Payer: Networks By Design Commercial |
$14,625.00
|
| Rate for Payer: Prime Health Services Commercial |
$24,862.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17,550.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17,550.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,977.52
|
| Rate for Payer: United Healthcare All Other HMO |
$10,685.02
|
| Rate for Payer: United Healthcare HMO Rider |
$10,453.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,579.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24,862.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24,862.50
|
| Rate for Payer: Vantage Medical Group Senior |
$24,862.50
|
|
|
HC DFIB MED AMPLIA MRI DTMB1D4
|
Facility
|
IP
|
$29,250.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813771
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,850.00 |
| Max. Negotiated Rate |
$24,862.50 |
| Rate for Payer: Adventist Health Commercial |
$5,850.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$13,162.50
|
| Rate for Payer: Cash Price |
$13,162.50
|
| Rate for Payer: Cigna of CA HMO |
$20,475.00
|
| Rate for Payer: Cigna of CA PPO |
$20,475.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,700.00
|
| Rate for Payer: EPIC Health Plan Senior |
$11,700.00
|
| Rate for Payer: Galaxy Health WC |
$24,862.50
|
| Rate for Payer: Global Benefits Group Commercial |
$17,550.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19,509.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,144.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18,105.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,020.00
|
| Rate for Payer: Multiplan Commercial |
$23,400.00
|
| Rate for Payer: Networks By Design Commercial |
$14,625.00
|
| Rate for Payer: Prime Health Services Commercial |
$24,862.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,977.52
|
| Rate for Payer: United Healthcare All Other HMO |
$10,685.02
|
| Rate for Payer: United Healthcare HMO Rider |
$10,453.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,579.38
|
|
|
HC DFIB MED AMPLIA MRI DTMB1Q1
|
Facility
|
OP
|
$30,000.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813793
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,000.00 |
| Max. Negotiated Rate |
$25,500.00 |
| Rate for Payer: Adventist Health Commercial |
$6,000.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25,500.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16,500.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22,500.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17,376.00
|
| Rate for Payer: Blue Shield of California Commercial |
$22,140.00
|
| Rate for Payer: Blue Shield of California EPN |
$14,580.00
|
| Rate for Payer: Cash Price |
$13,500.00
|
| Rate for Payer: Cigna of CA HMO |
$21,000.00
|
| Rate for Payer: Cigna of CA PPO |
$21,000.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25,500.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,500.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25,500.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$12,000.00
|
| Rate for Payer: Galaxy Health WC |
$25,500.00
|
| Rate for Payer: Global Benefits Group Commercial |
$18,000.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20,010.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18,570.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,200.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21,000.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21,000.00
|
| Rate for Payer: Multiplan Commercial |
$24,000.00
|
| Rate for Payer: Networks By Design Commercial |
$15,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$25,500.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18,000.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18,000.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,259.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,959.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,722.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,825.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25,500.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,500.00
|
| Rate for Payer: Vantage Medical Group Senior |
$25,500.00
|
|
