|
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 |
$14,148.75
|
| Rate for Payer: Cash Price |
$14,148.75
|
| 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 |
$14,148.75
|
| 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
|
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 |
$16,087.50
|
| 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 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 |
$16,087.50
|
| Rate for Payer: Cash Price |
$16,087.50
|
| 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 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 |
$16,087.50
|
| Rate for Payer: Cash Price |
$16,087.50
|
| 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 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 |
$16,087.50
|
| 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 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 |
$16,500.00
|
| 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
|
|
|
HC DFIB MED AMPLIA MRI DTMB1Q1
|
Facility
|
IP
|
$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: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$16,500.00
|
| Rate for Payer: Cash Price |
$16,500.00
|
| Rate for Payer: Cigna of CA HMO |
$21,000.00
|
| Rate for Payer: Cigna of CA PPO |
$21,000.00
|
| Rate for Payer: 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 Medi-Cal |
$11,430.00
|
| 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: 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: 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
|
|
|
HC DFIB MED AMPLIA MRI DTMC1QQ
|
Facility
|
IP
|
$29,250.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813772
|
|
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 |
$16,087.50
|
| Rate for Payer: Cash Price |
$16,087.50
|
| 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 DTMC1QQ
|
Facility
|
OP
|
$29,250.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813772
|
|
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 |
$16,087.50
|
| 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 CLARIA MRI QD DTMA1QQ
|
Facility
|
IP
|
$27,492.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813825
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,498.40 |
| Max. Negotiated Rate |
$23,368.20 |
| Rate for Payer: Adventist Health Commercial |
$5,498.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$15,120.60
|
| Rate for Payer: Cash Price |
$15,120.60
|
| Rate for Payer: Cigna of CA HMO |
$19,244.40
|
| Rate for Payer: Cigna of CA PPO |
$19,244.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,996.80
|
| Rate for Payer: EPIC Health Plan Senior |
$10,996.80
|
| Rate for Payer: Galaxy Health WC |
$23,368.20
|
| Rate for Payer: Global Benefits Group Commercial |
$16,495.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18,337.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,474.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17,017.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,598.08
|
| Rate for Payer: Multiplan Commercial |
$21,993.60
|
| Rate for Payer: Networks By Design Commercial |
$13,746.00
|
| Rate for Payer: Prime Health Services Commercial |
$23,368.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,317.75
|
| Rate for Payer: United Healthcare All Other HMO |
$10,042.83
|
| Rate for Payer: United Healthcare HMO Rider |
$9,825.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,003.63
|
|
|
HC DFIB MED CLARIA MRI QD DTMA1QQ
|
Facility
|
OP
|
$27,492.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813825
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,498.40 |
| Max. Negotiated Rate |
$23,368.20 |
| Rate for Payer: Adventist Health Commercial |
$5,498.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23,368.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,120.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20,619.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,923.37
|
| Rate for Payer: Blue Shield of California Commercial |
$20,289.10
|
| Rate for Payer: Blue Shield of California EPN |
$13,361.11
|
| Rate for Payer: Cash Price |
$15,120.60
|
| Rate for Payer: Cigna of CA HMO |
$19,244.40
|
| Rate for Payer: Cigna of CA PPO |
$19,244.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23,368.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$23,368.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23,368.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,996.80
|
| Rate for Payer: EPIC Health Plan Senior |
$10,996.80
|
| Rate for Payer: Galaxy Health WC |
$23,368.20
|
| Rate for Payer: Global Benefits Group Commercial |
$16,495.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18,337.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17,017.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,598.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19,244.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,244.40
|
| Rate for Payer: Multiplan Commercial |
$21,993.60
|
| Rate for Payer: Networks By Design Commercial |
$13,746.00
|
| Rate for Payer: Prime Health Services Commercial |
$23,368.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16,495.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16,495.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,317.75
|
| Rate for Payer: United Healthcare All Other HMO |
$10,042.83
|
| Rate for Payer: United Healthcare HMO Rider |
$9,825.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,003.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23,368.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23,368.20
|
| Rate for Payer: Vantage Medical Group Senior |
$23,368.20
|
|
|
HC DFIB MED CONSULTA D204TRM
|
Facility
|
OP
|
$34,492.50
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813674
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,898.50 |
| Max. Negotiated Rate |
$29,318.62 |
| Rate for Payer: Adventist Health Commercial |
$6,898.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29,318.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18,970.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25,869.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19,978.06
|
| Rate for Payer: Blue Shield of California Commercial |
$25,455.47
|
| Rate for Payer: Blue Shield of California EPN |
$16,763.35
|
| Rate for Payer: Cash Price |
$18,970.88
|
| Rate for Payer: Cigna of CA HMO |
$24,144.75
|
| Rate for Payer: Cigna of CA PPO |
$24,144.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29,318.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$29,318.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$29,318.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,797.00
|
| Rate for Payer: EPIC Health Plan Senior |
$13,797.00
|
| Rate for Payer: Galaxy Health WC |
$29,318.62
|
| Rate for Payer: Global Benefits Group Commercial |
$20,695.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23,006.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21,350.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,278.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24,144.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24,144.75
|
| Rate for Payer: Multiplan Commercial |
$27,594.00
|
| Rate for Payer: Networks By Design Commercial |
$17,246.25
|
| Rate for Payer: Prime Health Services Commercial |
$29,318.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20,695.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20,695.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,945.04
|
| Rate for Payer: United Healthcare All Other HMO |
$12,600.11
|
| Rate for Payer: United Healthcare HMO Rider |
$12,327.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,296.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29,318.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29,318.62
|
| Rate for Payer: Vantage Medical Group Senior |
$29,318.62
|
|
|
HC DFIB MED CONSULTA D204TRM
|
Facility
|
IP
|
$34,492.50
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813674
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,898.50 |
| Max. Negotiated Rate |
$29,318.62 |
| Rate for Payer: Adventist Health Commercial |
$6,898.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$18,970.88
|
| Rate for Payer: Cash Price |
$18,970.88
|
| Rate for Payer: Cigna of CA HMO |
$24,144.75
|
| Rate for Payer: Cigna of CA PPO |
$24,144.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,797.00
|
| Rate for Payer: EPIC Health Plan Senior |
$13,797.00
|
| Rate for Payer: Galaxy Health WC |
$29,318.62
|
| Rate for Payer: Global Benefits Group Commercial |
$20,695.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23,006.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,141.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21,350.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,278.20
|
| Rate for Payer: Multiplan Commercial |
$27,594.00
|
| Rate for Payer: Networks By Design Commercial |
$17,246.25
|
| Rate for Payer: Prime Health Services Commercial |
$29,318.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,945.04
|
| Rate for Payer: United Healthcare All Other HMO |
$12,600.11
|
| Rate for Payer: United Healthcare HMO Rider |
$12,327.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,296.29
|
|
|
HC DFIB MED EVERA MRI XT DDMB1D1
|
Facility
|
IP
|
$25,000.00
|
|
|
Service Code
|
CPT C1721
|
| Hospital Charge Code |
906813781
|
|
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 MED EVERA MRI XT DDMB1D1
|
Facility
|
OP
|
$25,000.00
|
|
|
Service Code
|
CPT C1721
|
| Hospital Charge Code |
906813781
|
|
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 MED EVERA S DR DDBC3D1
|
Facility
|
OP
|
$25,000.00
|
|
|
Service Code
|
CPT C1721
|
| Hospital Charge Code |
906813709
|
|
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 MED EVERA S DR DDBC3D1
|
Facility
|
IP
|
$25,000.00
|
|
|
Service Code
|
CPT C1721
|
| Hospital Charge Code |
906813709
|
|
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 MED EVERA S DR DDBC3D4
|
Facility
|
OP
|
$25,000.00
|
|
|
Service Code
|
CPT C1721
|
| Hospital Charge Code |
906813710
|
|
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 MED EVERA S DR DDBC3D4
|
Facility
|
IP
|
$25,000.00
|
|
|
Service Code
|
CPT C1721
|
| Hospital Charge Code |
906813710
|
|
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 MED EVERA S VR DVBC3D1
|
Facility
|
IP
|
$25,000.00
|
|
|
Service Code
|
CPT C1722
|
| Hospital Charge Code |
906813712
|
|
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 MED EVERA S VR DVBC3D1
|
Facility
|
OP
|
$25,000.00
|
|
|
Service Code
|
CPT C1722
|
| Hospital Charge Code |
906813712
|
|
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 MED EVERA S VR DVBC3D4
|
Facility
|
OP
|
$25,000.00
|
|
|
Service Code
|
CPT C1722
|
| Hospital Charge Code |
906813713
|
|
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 MED EVERA S VR DVBC3D4
|
Facility
|
IP
|
$25,000.00
|
|
|
Service Code
|
CPT C1722
|
| Hospital Charge Code |
906813713
|
|
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 MED EVERA XT DR DDBB1D1
|
Facility
|
OP
|
$25,000.00
|
|
|
Service Code
|
CPT C1721
|
| Hospital Charge Code |
906813707
|
|
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
|
|
