|
HC DFIB MED PROTECTA XT D314TRG
|
Facility
|
IP
|
$26,445.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813652
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,289.00 |
| Max. Negotiated Rate |
$22,478.25 |
| Rate for Payer: Adventist Health Commercial |
$5,289.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$14,544.75
|
| Rate for Payer: Cash Price |
$14,544.75
|
| Rate for Payer: Cigna of CA HMO |
$18,511.50
|
| Rate for Payer: Cigna of CA PPO |
$18,511.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,578.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10,578.00
|
| Rate for Payer: Galaxy Health WC |
$22,478.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15,867.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17,638.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,075.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,369.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,346.80
|
| Rate for Payer: Multiplan Commercial |
$21,156.00
|
| Rate for Payer: Networks By Design Commercial |
$13,222.50
|
| Rate for Payer: Prime Health Services Commercial |
$22,478.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,924.81
|
| Rate for Payer: United Healthcare All Other HMO |
$9,660.36
|
| Rate for Payer: United Healthcare HMO Rider |
$9,451.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,660.74
|
|
|
HC DFIB MED PROTECTA XT D314TRG
|
Facility
|
OP
|
$26,445.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813652
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,289.00 |
| Max. Negotiated Rate |
$22,478.25 |
| Rate for Payer: Adventist Health Commercial |
$5,289.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22,478.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14,544.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19,833.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,316.94
|
| Rate for Payer: Blue Shield of California Commercial |
$19,516.41
|
| Rate for Payer: Blue Shield of California EPN |
$12,852.27
|
| Rate for Payer: Cash Price |
$14,544.75
|
| Rate for Payer: Cigna of CA HMO |
$18,511.50
|
| Rate for Payer: Cigna of CA PPO |
$18,511.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22,478.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$22,478.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22,478.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,578.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10,578.00
|
| Rate for Payer: Galaxy Health WC |
$22,478.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15,867.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17,638.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,369.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,346.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,511.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18,511.50
|
| Rate for Payer: Multiplan Commercial |
$21,156.00
|
| Rate for Payer: Networks By Design Commercial |
$13,222.50
|
| Rate for Payer: Prime Health Services Commercial |
$22,478.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15,867.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15,867.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,924.81
|
| Rate for Payer: United Healthcare All Other HMO |
$9,660.36
|
| Rate for Payer: United Healthcare HMO Rider |
$9,451.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,660.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22,478.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22,478.25
|
| Rate for Payer: Vantage Medical Group Senior |
$22,478.25
|
|
|
HC DFIB MED PROTECTA XT D314VRG
|
Facility
|
OP
|
$19,283.00
|
|
|
Service Code
|
CPT C1722
|
| Hospital Charge Code |
906813649
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,856.60 |
| Max. Negotiated Rate |
$16,390.55 |
| Rate for Payer: Adventist Health Commercial |
$3,856.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16,390.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,605.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,462.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,168.71
|
| Rate for Payer: Blue Shield of California Commercial |
$14,230.85
|
| Rate for Payer: Blue Shield of California EPN |
$9,371.54
|
| Rate for Payer: Cash Price |
$10,605.65
|
| Rate for Payer: Cigna of CA HMO |
$13,498.10
|
| Rate for Payer: Cigna of CA PPO |
$13,498.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16,390.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$16,390.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16,390.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,713.20
|
| Rate for Payer: EPIC Health Plan Senior |
$7,713.20
|
| Rate for Payer: Galaxy Health WC |
$16,390.55
|
| Rate for Payer: Global Benefits Group Commercial |
$11,569.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,861.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,936.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,627.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13,498.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13,498.10
|
| Rate for Payer: Multiplan Commercial |
$15,426.40
|
| Rate for Payer: Networks By Design Commercial |
$9,641.50
|
| Rate for Payer: Prime Health Services Commercial |
$16,390.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11,569.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11,569.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,236.91
|
| Rate for Payer: United Healthcare All Other HMO |
$7,044.08
|
| Rate for Payer: United Healthcare HMO Rider |
$6,891.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,315.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16,390.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16,390.55
|
| Rate for Payer: Vantage Medical Group Senior |
$16,390.55
|
|
|
HC DFIB MED PROTECTA XT D314VRG
|
Facility
|
IP
|
$19,283.00
|
|
|
Service Code
|
CPT C1722
|
| Hospital Charge Code |
906813649
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,856.60 |
| Max. Negotiated Rate |
$16,390.55 |
| Rate for Payer: Adventist Health Commercial |
$3,856.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$10,605.65
|
| Rate for Payer: Cash Price |
$10,605.65
|
| Rate for Payer: Cigna of CA HMO |
$13,498.10
|
| Rate for Payer: Cigna of CA PPO |
$13,498.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,713.20
|
| Rate for Payer: EPIC Health Plan Senior |
$7,713.20
|
| Rate for Payer: Galaxy Health WC |
$16,390.55
|
| Rate for Payer: Global Benefits Group Commercial |
$11,569.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,861.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,346.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,936.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,627.92
|
| Rate for Payer: Multiplan Commercial |
$15,426.40
|
| Rate for Payer: Networks By Design Commercial |
$9,641.50
|
| Rate for Payer: Prime Health Services Commercial |
$16,390.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,236.91
|
| Rate for Payer: United Healthcare All Other HMO |
$7,044.08
|
| Rate for Payer: United Healthcare HMO Rider |
$6,891.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,315.18
|
|
|
HC DFIB MED SECURA DR D 204DRM
|
Facility
|
OP
|
$27,742.50
|
|
|
Service Code
|
CPT C1721
|
| Hospital Charge Code |
906813671
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,548.50 |
| Max. Negotiated Rate |
$23,581.12 |
| Rate for Payer: Adventist Health Commercial |
$5,548.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23,581.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,258.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20,806.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16,068.46
|
| Rate for Payer: Blue Shield of California Commercial |
$20,473.97
|
| Rate for Payer: Blue Shield of California EPN |
$13,482.85
|
| Rate for Payer: Cash Price |
$15,258.38
|
| Rate for Payer: Cigna of CA HMO |
$19,419.75
|
| Rate for Payer: Cigna of CA PPO |
$19,419.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23,581.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$23,581.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23,581.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,097.00
|
| Rate for Payer: EPIC Health Plan Senior |
$11,097.00
|
| Rate for Payer: Galaxy Health WC |
$23,581.12
|
| Rate for Payer: Global Benefits Group Commercial |
$16,645.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18,504.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17,172.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,658.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19,419.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,419.75
|
| Rate for Payer: Multiplan Commercial |
$22,194.00
|
| Rate for Payer: Networks By Design Commercial |
$13,871.25
|
| Rate for Payer: Prime Health Services Commercial |
$23,581.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16,645.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16,645.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,411.76
|
| Rate for Payer: United Healthcare All Other HMO |
$10,134.34
|
| Rate for Payer: United Healthcare HMO Rider |
$9,915.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,085.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23,581.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23,581.12
|
| Rate for Payer: Vantage Medical Group Senior |
$23,581.12
|
|
|
HC DFIB MED SECURA DR D 204DRM
|
Facility
|
IP
|
$27,742.50
|
|
|
Service Code
|
CPT C1721
|
| Hospital Charge Code |
906813671
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,548.50 |
| Max. Negotiated Rate |
$23,581.12 |
| Rate for Payer: Adventist Health Commercial |
$5,548.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$15,258.38
|
| Rate for Payer: Cash Price |
$15,258.38
|
| Rate for Payer: Cigna of CA HMO |
$19,419.75
|
| Rate for Payer: Cigna of CA PPO |
$19,419.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,097.00
|
| Rate for Payer: EPIC Health Plan Senior |
$11,097.00
|
| Rate for Payer: Galaxy Health WC |
$23,581.12
|
| Rate for Payer: Global Benefits Group Commercial |
$16,645.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18,504.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,569.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17,172.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,658.20
|
| Rate for Payer: Multiplan Commercial |
$22,194.00
|
| Rate for Payer: Networks By Design Commercial |
$13,871.25
|
| Rate for Payer: Prime Health Services Commercial |
$23,581.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,411.76
|
| Rate for Payer: United Healthcare All Other HMO |
$10,134.34
|
| Rate for Payer: United Healthcare HMO Rider |
$9,915.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,085.67
|
|
|
HC DFIB MED SECURA DR D224DRG
|
Facility
|
OP
|
$27,742.50
|
|
|
Service Code
|
CPT C1721
|
| Hospital Charge Code |
906813615
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,548.50 |
| Max. Negotiated Rate |
$23,581.12 |
| Rate for Payer: Adventist Health Commercial |
$5,548.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23,581.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,258.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20,806.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16,068.46
|
| Rate for Payer: Blue Shield of California Commercial |
$20,473.97
|
| Rate for Payer: Blue Shield of California EPN |
$13,482.85
|
| Rate for Payer: Cash Price |
$15,258.38
|
| Rate for Payer: Cigna of CA HMO |
$19,419.75
|
| Rate for Payer: Cigna of CA PPO |
$19,419.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23,581.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$23,581.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23,581.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,097.00
|
| Rate for Payer: EPIC Health Plan Senior |
$11,097.00
|
| Rate for Payer: Galaxy Health WC |
$23,581.12
|
| Rate for Payer: Global Benefits Group Commercial |
$16,645.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18,504.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17,172.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,658.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19,419.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,419.75
|
| Rate for Payer: Multiplan Commercial |
$22,194.00
|
| Rate for Payer: Networks By Design Commercial |
$13,871.25
|
| Rate for Payer: Prime Health Services Commercial |
$23,581.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16,645.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16,645.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,411.76
|
| Rate for Payer: United Healthcare All Other HMO |
$10,134.34
|
| Rate for Payer: United Healthcare HMO Rider |
$9,915.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,085.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23,581.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23,581.12
|
| Rate for Payer: Vantage Medical Group Senior |
$23,581.12
|
|
|
HC DFIB MED SECURA DR D224DRG
|
Facility
|
IP
|
$27,742.50
|
|
|
Service Code
|
CPT C1721
|
| Hospital Charge Code |
906813615
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,548.50 |
| Max. Negotiated Rate |
$23,581.12 |
| Rate for Payer: Adventist Health Commercial |
$5,548.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$15,258.38
|
| Rate for Payer: Cash Price |
$15,258.38
|
| Rate for Payer: Cigna of CA HMO |
$19,419.75
|
| Rate for Payer: Cigna of CA PPO |
$19,419.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,097.00
|
| Rate for Payer: EPIC Health Plan Senior |
$11,097.00
|
| Rate for Payer: Galaxy Health WC |
$23,581.12
|
| Rate for Payer: Global Benefits Group Commercial |
$16,645.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18,504.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,569.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17,172.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,658.20
|
| Rate for Payer: Multiplan Commercial |
$22,194.00
|
| Rate for Payer: Networks By Design Commercial |
$13,871.25
|
| Rate for Payer: Prime Health Services Commercial |
$23,581.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,411.76
|
| Rate for Payer: United Healthcare All Other HMO |
$10,134.34
|
| Rate for Payer: United Healthcare HMO Rider |
$9,915.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,085.67
|
|
|
HC DFIB MED SECURA VR D224VRC
|
Facility
|
OP
|
$25,000.00
|
|
|
Service Code
|
CPT C1722
|
| Hospital Charge Code |
906813613
|
|
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 SECURA VR D224VRC
|
Facility
|
IP
|
$25,000.00
|
|
|
Service Code
|
CPT C1722
|
| Hospital Charge Code |
906813613
|
|
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 VISIA AF MRI DVFB1D1
|
Facility
|
IP
|
$25,000.00
|
|
|
Service Code
|
CPT C1722
|
| Hospital Charge Code |
906813782
|
|
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 VISIA AF MRI DVFB1D1
|
Facility
|
OP
|
$25,000.00
|
|
|
Service Code
|
CPT C1722
|
| Hospital Charge Code |
906813782
|
|
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 VISIA AF VR DVAB1D4
|
Facility
|
OP
|
$25,000.00
|
|
|
Service Code
|
CPT C1722
|
| Hospital Charge Code |
906813776
|
|
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 VISIA AF VR DVAB1D4
|
Facility
|
IP
|
$25,000.00
|
|
|
Service Code
|
CPT C1722
|
| Hospital Charge Code |
906813776
|
|
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 VISIA MRI VR DVFB1D4
|
Facility
|
IP
|
$25,000.00
|
|
|
Service Code
|
CPT C1722
|
| Hospital Charge Code |
906813779
|
|
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 VISIA MRI VR DVFB1D4
|
Facility
|
OP
|
$25,000.00
|
|
|
Service Code
|
CPT C1722
|
| Hospital Charge Code |
906813779
|
|
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 VIVA QUAD XT DTBA1Q1
|
Facility
|
IP
|
$27,933.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813753
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,586.60 |
| Max. Negotiated Rate |
$23,743.05 |
| Rate for Payer: Adventist Health Commercial |
$5,586.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$15,363.15
|
| Rate for Payer: Cash Price |
$15,363.15
|
| Rate for Payer: Cigna of CA HMO |
$19,553.10
|
| Rate for Payer: Cigna of CA PPO |
$19,553.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,173.20
|
| Rate for Payer: EPIC Health Plan Senior |
$11,173.20
|
| Rate for Payer: Galaxy Health WC |
$23,743.05
|
| Rate for Payer: Global Benefits Group Commercial |
$16,759.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18,631.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,642.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17,290.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,703.92
|
| Rate for Payer: Multiplan Commercial |
$22,346.40
|
| Rate for Payer: Networks By Design Commercial |
$13,966.50
|
| Rate for Payer: Prime Health Services Commercial |
$23,743.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,483.25
|
| Rate for Payer: United Healthcare All Other HMO |
$10,203.92
|
| Rate for Payer: United Healthcare HMO Rider |
$9,983.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,148.06
|
|
|
HC DFIB MED VIVA QUAD XT DTBA1Q1
|
Facility
|
OP
|
$27,933.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813753
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,586.60 |
| Max. Negotiated Rate |
$23,743.05 |
| Rate for Payer: Adventist Health Commercial |
$5,586.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23,743.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,363.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20,949.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16,178.79
|
| Rate for Payer: Blue Shield of California Commercial |
$20,614.55
|
| Rate for Payer: Blue Shield of California EPN |
$13,575.44
|
| Rate for Payer: Cash Price |
$15,363.15
|
| Rate for Payer: Cigna of CA HMO |
$19,553.10
|
| Rate for Payer: Cigna of CA PPO |
$19,553.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23,743.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$23,743.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23,743.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,173.20
|
| Rate for Payer: EPIC Health Plan Senior |
$11,173.20
|
| Rate for Payer: Galaxy Health WC |
$23,743.05
|
| Rate for Payer: Global Benefits Group Commercial |
$16,759.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18,631.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17,290.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,703.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19,553.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,553.10
|
| Rate for Payer: Multiplan Commercial |
$22,346.40
|
| Rate for Payer: Networks By Design Commercial |
$13,966.50
|
| Rate for Payer: Prime Health Services Commercial |
$23,743.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16,759.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16,759.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,483.25
|
| Rate for Payer: United Healthcare All Other HMO |
$10,203.92
|
| Rate for Payer: United Healthcare HMO Rider |
$9,983.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,148.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23,743.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23,743.05
|
| Rate for Payer: Vantage Medical Group Senior |
$23,743.05
|
|
|
HC DFIB MED VIVA QUAD XT DTBA1QQ
|
Facility
|
OP
|
$27,933.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813733
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,586.60 |
| Max. Negotiated Rate |
$23,743.05 |
| Rate for Payer: Adventist Health Commercial |
$5,586.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23,743.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,363.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20,949.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16,178.79
|
| Rate for Payer: Blue Shield of California Commercial |
$20,614.55
|
| Rate for Payer: Blue Shield of California EPN |
$13,575.44
|
| Rate for Payer: Cash Price |
$15,363.15
|
| Rate for Payer: Cigna of CA HMO |
$19,553.10
|
| Rate for Payer: Cigna of CA PPO |
$19,553.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23,743.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$23,743.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23,743.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,173.20
|
| Rate for Payer: EPIC Health Plan Senior |
$11,173.20
|
| Rate for Payer: Galaxy Health WC |
$23,743.05
|
| Rate for Payer: Global Benefits Group Commercial |
$16,759.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18,631.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17,290.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,703.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19,553.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,553.10
|
| Rate for Payer: Multiplan Commercial |
$22,346.40
|
| Rate for Payer: Networks By Design Commercial |
$13,966.50
|
| Rate for Payer: Prime Health Services Commercial |
$23,743.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16,759.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16,759.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,483.25
|
| Rate for Payer: United Healthcare All Other HMO |
$10,203.92
|
| Rate for Payer: United Healthcare HMO Rider |
$9,983.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,148.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23,743.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23,743.05
|
| Rate for Payer: Vantage Medical Group Senior |
$23,743.05
|
|
|
HC DFIB MED VIVA QUAD XT DTBA1QQ
|
Facility
|
IP
|
$27,933.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813733
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,586.60 |
| Max. Negotiated Rate |
$23,743.05 |
| Rate for Payer: Adventist Health Commercial |
$5,586.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$15,363.15
|
| Rate for Payer: Cash Price |
$15,363.15
|
| Rate for Payer: Cigna of CA HMO |
$19,553.10
|
| Rate for Payer: Cigna of CA PPO |
$19,553.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,173.20
|
| Rate for Payer: EPIC Health Plan Senior |
$11,173.20
|
| Rate for Payer: Galaxy Health WC |
$23,743.05
|
| Rate for Payer: Global Benefits Group Commercial |
$16,759.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18,631.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,642.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17,290.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,703.92
|
| Rate for Payer: Multiplan Commercial |
$22,346.40
|
| Rate for Payer: Networks By Design Commercial |
$13,966.50
|
| Rate for Payer: Prime Health Services Commercial |
$23,743.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,483.25
|
| Rate for Payer: United Healthcare All Other HMO |
$10,203.92
|
| Rate for Payer: United Healthcare HMO Rider |
$9,983.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,148.06
|
|
|
HC DFIB MED VIVA S CRT DTBB1D1
|
Facility
|
OP
|
$25,500.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813715
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,100.00 |
| Max. Negotiated Rate |
$21,675.00 |
| Rate for Payer: Adventist Health Commercial |
$5,100.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,675.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14,025.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19,125.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,769.60
|
| Rate for Payer: Blue Shield of California Commercial |
$18,819.00
|
| Rate for Payer: Blue Shield of California EPN |
$12,393.00
|
| Rate for Payer: Cash Price |
$14,025.00
|
| Rate for Payer: Cigna of CA HMO |
$17,850.00
|
| Rate for Payer: Cigna of CA PPO |
$17,850.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,675.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$21,675.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21,675.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,200.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10,200.00
|
| Rate for Payer: Galaxy Health WC |
$21,675.00
|
| Rate for Payer: Global Benefits Group Commercial |
$15,300.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17,008.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,784.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,120.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,850.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17,850.00
|
| Rate for Payer: Multiplan Commercial |
$20,400.00
|
| Rate for Payer: Networks By Design Commercial |
$12,750.00
|
| Rate for Payer: Prime Health Services Commercial |
$21,675.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15,300.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15,300.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,570.15
|
| Rate for Payer: United Healthcare All Other HMO |
$9,315.15
|
| Rate for Payer: United Healthcare HMO Rider |
$9,113.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,351.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,675.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21,675.00
|
| Rate for Payer: Vantage Medical Group Senior |
$21,675.00
|
|
|
HC DFIB MED VIVA S CRT DTBB1D1
|
Facility
|
IP
|
$25,500.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813715
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,100.00 |
| Max. Negotiated Rate |
$21,675.00 |
| Rate for Payer: Adventist Health Commercial |
$5,100.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$14,025.00
|
| Rate for Payer: Cash Price |
$14,025.00
|
| Rate for Payer: Cigna of CA HMO |
$17,850.00
|
| Rate for Payer: Cigna of CA PPO |
$17,850.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,200.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10,200.00
|
| Rate for Payer: Galaxy Health WC |
$21,675.00
|
| Rate for Payer: Global Benefits Group Commercial |
$15,300.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17,008.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,715.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,784.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,120.00
|
| Rate for Payer: Multiplan Commercial |
$20,400.00
|
| Rate for Payer: Networks By Design Commercial |
$12,750.00
|
| Rate for Payer: Prime Health Services Commercial |
$21,675.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,570.15
|
| Rate for Payer: United Healthcare All Other HMO |
$9,315.15
|
| Rate for Payer: United Healthcare HMO Rider |
$9,113.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,351.25
|
|
|
HC DFIB MED VIVA S CRT DTBB1D4
|
Facility
|
IP
|
$25,500.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813716
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,100.00 |
| Max. Negotiated Rate |
$21,675.00 |
| Rate for Payer: Adventist Health Commercial |
$5,100.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$14,025.00
|
| Rate for Payer: Cash Price |
$14,025.00
|
| Rate for Payer: Cigna of CA HMO |
$17,850.00
|
| Rate for Payer: Cigna of CA PPO |
$17,850.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,200.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10,200.00
|
| Rate for Payer: Galaxy Health WC |
$21,675.00
|
| Rate for Payer: Global Benefits Group Commercial |
$15,300.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17,008.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,715.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,784.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,120.00
|
| Rate for Payer: Multiplan Commercial |
$20,400.00
|
| Rate for Payer: Networks By Design Commercial |
$12,750.00
|
| Rate for Payer: Prime Health Services Commercial |
$21,675.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,570.15
|
| Rate for Payer: United Healthcare All Other HMO |
$9,315.15
|
| Rate for Payer: United Healthcare HMO Rider |
$9,113.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,351.25
|
|
|
HC DFIB MED VIVA S CRT DTBB1D4
|
Facility
|
OP
|
$25,500.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813716
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,100.00 |
| Max. Negotiated Rate |
$21,675.00 |
| Rate for Payer: Adventist Health Commercial |
$5,100.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,675.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14,025.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19,125.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,769.60
|
| Rate for Payer: Blue Shield of California Commercial |
$18,819.00
|
| Rate for Payer: Blue Shield of California EPN |
$12,393.00
|
| Rate for Payer: Cash Price |
$14,025.00
|
| Rate for Payer: Cigna of CA HMO |
$17,850.00
|
| Rate for Payer: Cigna of CA PPO |
$17,850.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,675.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$21,675.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21,675.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,200.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10,200.00
|
| Rate for Payer: Galaxy Health WC |
$21,675.00
|
| Rate for Payer: Global Benefits Group Commercial |
$15,300.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17,008.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,784.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,120.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,850.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17,850.00
|
| Rate for Payer: Multiplan Commercial |
$20,400.00
|
| Rate for Payer: Networks By Design Commercial |
$12,750.00
|
| Rate for Payer: Prime Health Services Commercial |
$21,675.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15,300.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15,300.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,570.15
|
| Rate for Payer: United Healthcare All Other HMO |
$9,315.15
|
| Rate for Payer: United Healthcare HMO Rider |
$9,113.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,351.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,675.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21,675.00
|
| Rate for Payer: Vantage Medical Group Senior |
$21,675.00
|
|
|
HC DFIB MED VIVA XT CRT DTBA1D1
|
Facility
|
IP
|
$27,453.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813704
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,490.60 |
| Max. Negotiated Rate |
$23,335.05 |
| Rate for Payer: Adventist Health Commercial |
$5,490.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$15,099.15
|
| Rate for Payer: Cash Price |
$15,099.15
|
| Rate for Payer: Cigna of CA HMO |
$19,217.10
|
| Rate for Payer: Cigna of CA PPO |
$19,217.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,981.20
|
| Rate for Payer: EPIC Health Plan Senior |
$10,981.20
|
| Rate for Payer: Galaxy Health WC |
$23,335.05
|
| Rate for Payer: Global Benefits Group Commercial |
$16,471.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18,311.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,459.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,993.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,588.72
|
| Rate for Payer: Multiplan Commercial |
$21,962.40
|
| Rate for Payer: Networks By Design Commercial |
$13,726.50
|
| Rate for Payer: Prime Health Services Commercial |
$23,335.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,303.11
|
| Rate for Payer: United Healthcare All Other HMO |
$10,028.58
|
| Rate for Payer: United Healthcare HMO Rider |
$9,811.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,990.86
|
|
