|
HC DFIB STJ CURRNT VR FR 1207-3
|
Facility
|
IP
|
$24,000.00
|
|
|
Service Code
|
CPT C1722
|
| Hospital Charge Code |
906813608
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,800.00 |
| Max. Negotiated Rate |
$20,400.00 |
| Rate for Payer: Adventist Health Commercial |
$4,800.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$10,800.00
|
| Rate for Payer: Cash Price |
$10,800.00
|
| Rate for Payer: Cigna of CA HMO |
$16,800.00
|
| Rate for Payer: Cigna of CA PPO |
$16,800.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,600.00
|
| Rate for Payer: EPIC Health Plan Senior |
$9,600.00
|
| Rate for Payer: Galaxy Health WC |
$20,400.00
|
| Rate for Payer: Global Benefits Group Commercial |
$14,400.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,008.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,144.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,856.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,760.00
|
| Rate for Payer: Multiplan Commercial |
$19,200.00
|
| Rate for Payer: Networks By Design Commercial |
$12,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$20,400.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,007.20
|
| Rate for Payer: United Healthcare All Other HMO |
$8,767.20
|
| Rate for Payer: United Healthcare HMO Rider |
$8,577.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,860.00
|
|
|
HC DFIB STJ CURRNT VR FR 1207-3
|
Facility
|
OP
|
$24,000.00
|
|
|
Service Code
|
CPT C1722
|
| Hospital Charge Code |
906813608
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,800.00 |
| Max. Negotiated Rate |
$20,400.00 |
| Rate for Payer: Adventist Health Commercial |
$4,800.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20,400.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13,200.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18,000.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,900.80
|
| Rate for Payer: Blue Shield of California Commercial |
$17,712.00
|
| Rate for Payer: Blue Shield of California EPN |
$11,664.00
|
| Rate for Payer: Cash Price |
$10,800.00
|
| Rate for Payer: Cigna of CA HMO |
$16,800.00
|
| Rate for Payer: Cigna of CA PPO |
$16,800.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20,400.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$20,400.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20,400.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,600.00
|
| Rate for Payer: EPIC Health Plan Senior |
$9,600.00
|
| Rate for Payer: Galaxy Health WC |
$20,400.00
|
| Rate for Payer: Global Benefits Group Commercial |
$14,400.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,008.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,856.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,760.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16,800.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16,800.00
|
| Rate for Payer: Multiplan Commercial |
$19,200.00
|
| Rate for Payer: Networks By Design Commercial |
$12,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$20,400.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14,400.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14,400.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,007.20
|
| Rate for Payer: United Healthcare All Other HMO |
$8,767.20
|
| Rate for Payer: United Healthcare HMO Rider |
$8,577.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,860.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20,400.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20,400.00
|
| Rate for Payer: Vantage Medical Group Senior |
$20,400.00
|
|
|
HC DFIB STJ ELLIPSE CD2411-36Q
|
Facility
|
OP
|
$19,915.00
|
|
|
Service Code
|
CPT C1721
|
| Hospital Charge Code |
906813761
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,983.00 |
| Max. Negotiated Rate |
$16,927.75 |
| Rate for Payer: Adventist Health Commercial |
$3,983.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16,927.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,953.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,936.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,534.77
|
| Rate for Payer: Blue Shield of California Commercial |
$14,697.27
|
| Rate for Payer: Blue Shield of California EPN |
$9,678.69
|
| Rate for Payer: Cash Price |
$8,961.75
|
| Rate for Payer: Cigna of CA HMO |
$13,940.50
|
| Rate for Payer: Cigna of CA PPO |
$13,940.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16,927.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$16,927.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16,927.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,966.00
|
| Rate for Payer: EPIC Health Plan Senior |
$7,966.00
|
| Rate for Payer: Galaxy Health WC |
$16,927.75
|
| Rate for Payer: Global Benefits Group Commercial |
$11,949.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,283.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,327.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,779.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13,940.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13,940.50
|
| Rate for Payer: Multiplan Commercial |
$15,932.00
|
| Rate for Payer: Networks By Design Commercial |
$9,957.50
|
| Rate for Payer: Prime Health Services Commercial |
$16,927.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11,949.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11,949.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,474.10
|
| Rate for Payer: United Healthcare All Other HMO |
$7,274.95
|
| Rate for Payer: United Healthcare HMO Rider |
$7,117.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,522.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16,927.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16,927.75
|
| Rate for Payer: Vantage Medical Group Senior |
$16,927.75
|
|
|
HC DFIB STJ ELLIPSE CD2411-36Q
|
Facility
|
IP
|
$19,915.00
|
|
|
Service Code
|
CPT C1721
|
| Hospital Charge Code |
906813761
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,983.00 |
| Max. Negotiated Rate |
$16,927.75 |
| Rate for Payer: Adventist Health Commercial |
$3,983.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$8,961.75
|
| Rate for Payer: Cash Price |
$8,961.75
|
| Rate for Payer: Cigna of CA HMO |
$13,940.50
|
| Rate for Payer: Cigna of CA PPO |
$13,940.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,966.00
|
| Rate for Payer: EPIC Health Plan Senior |
$7,966.00
|
| Rate for Payer: Galaxy Health WC |
$16,927.75
|
| Rate for Payer: Global Benefits Group Commercial |
$11,949.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,283.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,587.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,327.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,779.60
|
| Rate for Payer: Multiplan Commercial |
$15,932.00
|
| Rate for Payer: Networks By Design Commercial |
$9,957.50
|
| Rate for Payer: Prime Health Services Commercial |
$16,927.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,474.10
|
| Rate for Payer: United Healthcare All Other HMO |
$7,274.95
|
| Rate for Payer: United Healthcare HMO Rider |
$7,117.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,522.16
|
|
|
HC DFIB STJ ELLIPSE VR CD1411 36Q
|
Facility
|
OP
|
$25,000.00
|
|
|
Service Code
|
CPT C1722
|
| Hospital Charge Code |
906813742
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,000.00 |
| Max. Negotiated Rate |
$21,250.00 |
| Rate for Payer: Adventist Health Commercial |
$5,000.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,250.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13,750.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18,750.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,480.00
|
| Rate for Payer: Blue Shield of California Commercial |
$18,450.00
|
| Rate for Payer: Blue Shield of California EPN |
$12,150.00
|
| Rate for Payer: Cash Price |
$11,250.00
|
| Rate for Payer: Cigna of CA HMO |
$17,500.00
|
| Rate for Payer: Cigna of CA PPO |
$17,500.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,250.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$21,250.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21,250.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10,000.00
|
| Rate for Payer: Galaxy Health WC |
$21,250.00
|
| Rate for Payer: Global Benefits Group Commercial |
$15,000.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,675.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,475.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,000.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,500.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17,500.00
|
| Rate for Payer: Multiplan Commercial |
$20,000.00
|
| Rate for Payer: Networks By Design Commercial |
$12,500.00
|
| Rate for Payer: Prime Health Services Commercial |
$21,250.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15,000.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15,000.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,382.50
|
| Rate for Payer: United Healthcare All Other HMO |
$9,132.50
|
| Rate for Payer: United Healthcare HMO Rider |
$8,935.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,187.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,250.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21,250.00
|
| Rate for Payer: Vantage Medical Group Senior |
$21,250.00
|
|
|
HC DFIB STJ ELLIPSE VR CD1411 36Q
|
Facility
|
IP
|
$25,000.00
|
|
|
Service Code
|
CPT C1722
|
| Hospital Charge Code |
906813742
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,000.00 |
| Max. Negotiated Rate |
$21,250.00 |
| Rate for Payer: Adventist Health Commercial |
$5,000.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$11,250.00
|
| Rate for Payer: Cash Price |
$11,250.00
|
| Rate for Payer: Cigna of CA HMO |
$17,500.00
|
| Rate for Payer: Cigna of CA PPO |
$17,500.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10,000.00
|
| Rate for Payer: Galaxy Health WC |
$21,250.00
|
| Rate for Payer: Global Benefits Group Commercial |
$15,000.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,675.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,525.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,475.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,000.00
|
| Rate for Payer: Multiplan Commercial |
$20,000.00
|
| Rate for Payer: Networks By Design Commercial |
$12,500.00
|
| Rate for Payer: Prime Health Services Commercial |
$21,250.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,382.50
|
| Rate for Payer: United Healthcare All Other HMO |
$9,132.50
|
| Rate for Payer: United Healthcare HMO Rider |
$8,935.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,187.50
|
|
|
HC DFIB STJ FORTIFY A CD135740C
|
Facility
|
OP
|
$25,000.00
|
|
|
Service Code
|
CPT C1722
|
| Hospital Charge Code |
906813750
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,000.00 |
| Max. Negotiated Rate |
$21,250.00 |
| Rate for Payer: Adventist Health Commercial |
$5,000.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,250.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13,750.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18,750.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,480.00
|
| Rate for Payer: Blue Shield of California Commercial |
$18,450.00
|
| Rate for Payer: Blue Shield of California EPN |
$12,150.00
|
| Rate for Payer: Cash Price |
$11,250.00
|
| Rate for Payer: Cigna of CA HMO |
$17,500.00
|
| Rate for Payer: Cigna of CA PPO |
$17,500.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,250.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$21,250.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21,250.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10,000.00
|
| Rate for Payer: Galaxy Health WC |
$21,250.00
|
| Rate for Payer: Global Benefits Group Commercial |
$15,000.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,675.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,475.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,000.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,500.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17,500.00
|
| Rate for Payer: Multiplan Commercial |
$20,000.00
|
| Rate for Payer: Networks By Design Commercial |
$12,500.00
|
| Rate for Payer: Prime Health Services Commercial |
$21,250.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15,000.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15,000.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,382.50
|
| Rate for Payer: United Healthcare All Other HMO |
$9,132.50
|
| Rate for Payer: United Healthcare HMO Rider |
$8,935.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,187.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,250.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21,250.00
|
| Rate for Payer: Vantage Medical Group Senior |
$21,250.00
|
|
|
HC DFIB STJ FORTIFY A CD135740C
|
Facility
|
IP
|
$25,000.00
|
|
|
Service Code
|
CPT C1722
|
| Hospital Charge Code |
906813750
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,000.00 |
| Max. Negotiated Rate |
$21,250.00 |
| Rate for Payer: Adventist Health Commercial |
$5,000.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$11,250.00
|
| Rate for Payer: Cash Price |
$11,250.00
|
| Rate for Payer: Cigna of CA HMO |
$17,500.00
|
| Rate for Payer: Cigna of CA PPO |
$17,500.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10,000.00
|
| Rate for Payer: Galaxy Health WC |
$21,250.00
|
| Rate for Payer: Global Benefits Group Commercial |
$15,000.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,675.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,525.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,475.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,000.00
|
| Rate for Payer: Multiplan Commercial |
$20,000.00
|
| Rate for Payer: Networks By Design Commercial |
$12,500.00
|
| Rate for Payer: Prime Health Services Commercial |
$21,250.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,382.50
|
| Rate for Payer: United Healthcare All Other HMO |
$9,132.50
|
| Rate for Payer: United Healthcare HMO Rider |
$8,935.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,187.50
|
|
|
HC DFIB STJ FORTIFY A CD2357-40C
|
Facility
|
OP
|
$19,808.00
|
|
|
Service Code
|
CPT C1721
|
| Hospital Charge Code |
906813757
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,961.60 |
| Max. Negotiated Rate |
$16,836.80 |
| Rate for Payer: Adventist Health Commercial |
$3,961.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16,836.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,894.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,856.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,472.79
|
| Rate for Payer: Blue Shield of California Commercial |
$14,618.30
|
| Rate for Payer: Blue Shield of California EPN |
$9,626.69
|
| Rate for Payer: Cash Price |
$8,913.60
|
| Rate for Payer: Cigna of CA HMO |
$13,865.60
|
| Rate for Payer: Cigna of CA PPO |
$13,865.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16,836.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$16,836.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16,836.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,923.20
|
| Rate for Payer: EPIC Health Plan Senior |
$7,923.20
|
| Rate for Payer: Galaxy Health WC |
$16,836.80
|
| Rate for Payer: Global Benefits Group Commercial |
$11,884.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,211.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,261.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,753.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13,865.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13,865.60
|
| Rate for Payer: Multiplan Commercial |
$15,846.40
|
| Rate for Payer: Networks By Design Commercial |
$9,904.00
|
| Rate for Payer: Prime Health Services Commercial |
$16,836.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11,884.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11,884.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,433.94
|
| Rate for Payer: United Healthcare All Other HMO |
$7,235.86
|
| Rate for Payer: United Healthcare HMO Rider |
$7,079.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,487.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16,836.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16,836.80
|
| Rate for Payer: Vantage Medical Group Senior |
$16,836.80
|
|
|
HC DFIB STJ FORTIFY A CD2357-40C
|
Facility
|
IP
|
$19,808.00
|
|
|
Service Code
|
CPT C1721
|
| Hospital Charge Code |
906813757
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,961.60 |
| Max. Negotiated Rate |
$16,836.80 |
| Rate for Payer: Adventist Health Commercial |
$3,961.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$8,913.60
|
| Rate for Payer: Cash Price |
$8,913.60
|
| Rate for Payer: Cigna of CA HMO |
$13,865.60
|
| Rate for Payer: Cigna of CA PPO |
$13,865.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,923.20
|
| Rate for Payer: EPIC Health Plan Senior |
$7,923.20
|
| Rate for Payer: Galaxy Health WC |
$16,836.80
|
| Rate for Payer: Global Benefits Group Commercial |
$11,884.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,211.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,546.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,261.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,753.92
|
| Rate for Payer: Multiplan Commercial |
$15,846.40
|
| Rate for Payer: Networks By Design Commercial |
$9,904.00
|
| Rate for Payer: Prime Health Services Commercial |
$16,836.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,433.94
|
| Rate for Payer: United Healthcare All Other HMO |
$7,235.86
|
| Rate for Payer: United Healthcare HMO Rider |
$7,079.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,487.12
|
|
|
HC DFIB STJ FORTIFY A CD2357 40Q
|
Facility
|
OP
|
$19,914.00
|
|
|
Service Code
|
CPT C1721
|
| Hospital Charge Code |
906813729
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,982.80 |
| Max. Negotiated Rate |
$16,926.90 |
| Rate for Payer: Adventist Health Commercial |
$3,982.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16,926.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,952.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,935.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,534.19
|
| Rate for Payer: Blue Shield of California Commercial |
$14,696.53
|
| Rate for Payer: Blue Shield of California EPN |
$9,678.20
|
| Rate for Payer: Cash Price |
$8,961.30
|
| Rate for Payer: Cigna of CA HMO |
$13,939.80
|
| Rate for Payer: Cigna of CA PPO |
$13,939.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16,926.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$16,926.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16,926.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,965.60
|
| Rate for Payer: EPIC Health Plan Senior |
$7,965.60
|
| Rate for Payer: Galaxy Health WC |
$16,926.90
|
| Rate for Payer: Global Benefits Group Commercial |
$11,948.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,282.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,326.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,779.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13,939.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13,939.80
|
| Rate for Payer: Multiplan Commercial |
$15,931.20
|
| Rate for Payer: Networks By Design Commercial |
$9,957.00
|
| Rate for Payer: Prime Health Services Commercial |
$16,926.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11,948.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11,948.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,473.72
|
| Rate for Payer: United Healthcare All Other HMO |
$7,274.58
|
| Rate for Payer: United Healthcare HMO Rider |
$7,117.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,521.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16,926.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16,926.90
|
| Rate for Payer: Vantage Medical Group Senior |
$16,926.90
|
|
|
HC DFIB STJ FORTIFY A CD2357 40Q
|
Facility
|
IP
|
$19,914.00
|
|
|
Service Code
|
CPT C1721
|
| Hospital Charge Code |
906813729
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,982.80 |
| Max. Negotiated Rate |
$16,926.90 |
| Rate for Payer: Adventist Health Commercial |
$3,982.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$8,961.30
|
| Rate for Payer: Cash Price |
$8,961.30
|
| Rate for Payer: Cigna of CA HMO |
$13,939.80
|
| Rate for Payer: Cigna of CA PPO |
$13,939.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,965.60
|
| Rate for Payer: EPIC Health Plan Senior |
$7,965.60
|
| Rate for Payer: Galaxy Health WC |
$16,926.90
|
| Rate for Payer: Global Benefits Group Commercial |
$11,948.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,282.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,587.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,326.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,779.36
|
| Rate for Payer: Multiplan Commercial |
$15,931.20
|
| Rate for Payer: Networks By Design Commercial |
$9,957.00
|
| Rate for Payer: Prime Health Services Commercial |
$16,926.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,473.72
|
| Rate for Payer: United Healthcare All Other HMO |
$7,274.58
|
| Rate for Payer: United Healthcare HMO Rider |
$7,117.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,521.84
|
|
|
HC DFIB STJ FORTIFY ASSURA CD1357 40Q
|
Facility
|
OP
|
$18,312.00
|
|
|
Service Code
|
CPT C1722
|
| Hospital Charge Code |
906813731
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,662.40 |
| Max. Negotiated Rate |
$15,565.20 |
| Rate for Payer: Adventist Health Commercial |
$3,662.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15,565.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,071.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,734.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,606.31
|
| Rate for Payer: Blue Shield of California Commercial |
$13,514.26
|
| Rate for Payer: Blue Shield of California EPN |
$8,899.63
|
| Rate for Payer: Cash Price |
$8,240.40
|
| Rate for Payer: Cigna of CA HMO |
$12,818.40
|
| Rate for Payer: Cigna of CA PPO |
$12,818.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15,565.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,565.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15,565.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,324.80
|
| Rate for Payer: EPIC Health Plan Senior |
$7,324.80
|
| Rate for Payer: Galaxy Health WC |
$15,565.20
|
| Rate for Payer: Global Benefits Group Commercial |
$10,987.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,214.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,335.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,394.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12,818.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12,818.40
|
| Rate for Payer: Multiplan Commercial |
$14,649.60
|
| Rate for Payer: Networks By Design Commercial |
$9,156.00
|
| Rate for Payer: Prime Health Services Commercial |
$15,565.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,987.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10,987.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,872.49
|
| Rate for Payer: United Healthcare All Other HMO |
$6,689.37
|
| Rate for Payer: United Healthcare HMO Rider |
$6,544.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,997.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15,565.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,565.20
|
| Rate for Payer: Vantage Medical Group Senior |
$15,565.20
|
|
|
HC DFIB STJ FORTIFY ASSURA CD1357 40Q
|
Facility
|
IP
|
$18,312.00
|
|
|
Service Code
|
CPT C1722
|
| Hospital Charge Code |
906813731
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,662.40 |
| Max. Negotiated Rate |
$15,565.20 |
| Rate for Payer: Adventist Health Commercial |
$3,662.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$8,240.40
|
| Rate for Payer: Cash Price |
$8,240.40
|
| Rate for Payer: Cigna of CA HMO |
$12,818.40
|
| Rate for Payer: Cigna of CA PPO |
$12,818.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,324.80
|
| Rate for Payer: EPIC Health Plan Senior |
$7,324.80
|
| Rate for Payer: Galaxy Health WC |
$15,565.20
|
| Rate for Payer: Global Benefits Group Commercial |
$10,987.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,214.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,976.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,335.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,394.88
|
| Rate for Payer: Multiplan Commercial |
$14,649.60
|
| Rate for Payer: Networks By Design Commercial |
$9,156.00
|
| Rate for Payer: Prime Health Services Commercial |
$15,565.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,872.49
|
| Rate for Payer: United Healthcare All Other HMO |
$6,689.37
|
| Rate for Payer: United Healthcare HMO Rider |
$6,544.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,997.18
|
|
|
HC DFIB STJ FORTIFY ASSURA CD2257
|
Facility
|
OP
|
$27,000.00
|
|
|
Service Code
|
CPT C1721
|
| Hospital Charge Code |
906813703
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,400.00 |
| Max. Negotiated Rate |
$22,950.00 |
| Rate for Payer: Adventist Health Commercial |
$5,400.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22,950.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14,850.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20,250.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,638.40
|
| Rate for Payer: Blue Shield of California Commercial |
$19,926.00
|
| Rate for Payer: Blue Shield of California EPN |
$13,122.00
|
| Rate for Payer: Cash Price |
$12,150.00
|
| Rate for Payer: Cigna of CA HMO |
$18,900.00
|
| Rate for Payer: Cigna of CA PPO |
$18,900.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22,950.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$22,950.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22,950.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,800.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10,800.00
|
| Rate for Payer: Galaxy Health WC |
$22,950.00
|
| Rate for Payer: Global Benefits Group Commercial |
$16,200.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18,009.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,713.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,480.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,900.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18,900.00
|
| Rate for Payer: Multiplan Commercial |
$21,600.00
|
| Rate for Payer: Networks By Design Commercial |
$13,500.00
|
| Rate for Payer: Prime Health Services Commercial |
$22,950.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16,200.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16,200.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,133.10
|
| Rate for Payer: United Healthcare All Other HMO |
$9,863.10
|
| Rate for Payer: United Healthcare HMO Rider |
$9,649.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,842.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22,950.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22,950.00
|
| Rate for Payer: Vantage Medical Group Senior |
$22,950.00
|
|
|
HC DFIB STJ FORTIFY ASSURA CD2257
|
Facility
|
IP
|
$27,000.00
|
|
|
Service Code
|
CPT C1721
|
| Hospital Charge Code |
906813703
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,400.00 |
| Max. Negotiated Rate |
$22,950.00 |
| Rate for Payer: Adventist Health Commercial |
$5,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$12,150.00
|
| Rate for Payer: Cash Price |
$12,150.00
|
| Rate for Payer: Cigna of CA HMO |
$18,900.00
|
| Rate for Payer: Cigna of CA PPO |
$18,900.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,800.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10,800.00
|
| Rate for Payer: Galaxy Health WC |
$22,950.00
|
| Rate for Payer: Global Benefits Group Commercial |
$16,200.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18,009.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,287.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,713.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,480.00
|
| Rate for Payer: Multiplan Commercial |
$21,600.00
|
| Rate for Payer: Networks By Design Commercial |
$13,500.00
|
| Rate for Payer: Prime Health Services Commercial |
$22,950.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,133.10
|
| Rate for Payer: United Healthcare All Other HMO |
$9,863.10
|
| Rate for Payer: United Healthcare HMO Rider |
$9,649.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,842.50
|
|
|
HC DFIB STJ FORTIFY DR CD2231
|
Facility
|
IP
|
$36,052.50
|
|
|
Service Code
|
CPT C1721
|
| Hospital Charge Code |
906813685
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,210.50 |
| Max. Negotiated Rate |
$30,644.62 |
| Rate for Payer: Adventist Health Commercial |
$7,210.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$16,223.62
|
| Rate for Payer: Cash Price |
$16,223.62
|
| Rate for Payer: Cigna of CA HMO |
$25,236.75
|
| Rate for Payer: Cigna of CA PPO |
$25,236.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,421.00
|
| Rate for Payer: EPIC Health Plan Senior |
$14,421.00
|
| Rate for Payer: Galaxy Health WC |
$30,644.62
|
| Rate for Payer: Global Benefits Group Commercial |
$21,631.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24,047.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,736.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,316.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,652.60
|
| Rate for Payer: Multiplan Commercial |
$28,842.00
|
| Rate for Payer: Networks By Design Commercial |
$18,026.25
|
| Rate for Payer: Prime Health Services Commercial |
$30,644.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,530.50
|
| Rate for Payer: United Healthcare All Other HMO |
$13,169.98
|
| Rate for Payer: United Healthcare HMO Rider |
$12,885.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,807.19
|
|
|
HC DFIB STJ FORTIFY DR CD2231
|
Facility
|
OP
|
$36,052.50
|
|
|
Service Code
|
CPT C1721
|
| Hospital Charge Code |
906813685
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,210.50 |
| Max. Negotiated Rate |
$30,644.62 |
| Rate for Payer: Adventist Health Commercial |
$7,210.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30,644.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19,828.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27,039.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20,881.61
|
| Rate for Payer: Blue Shield of California Commercial |
$26,606.74
|
| Rate for Payer: Blue Shield of California EPN |
$17,521.51
|
| Rate for Payer: Cash Price |
$16,223.62
|
| Rate for Payer: Cigna of CA HMO |
$25,236.75
|
| Rate for Payer: Cigna of CA PPO |
$25,236.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30,644.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$30,644.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$30,644.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,421.00
|
| Rate for Payer: EPIC Health Plan Senior |
$14,421.00
|
| Rate for Payer: Galaxy Health WC |
$30,644.62
|
| Rate for Payer: Global Benefits Group Commercial |
$21,631.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24,047.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,316.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,652.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25,236.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25,236.75
|
| Rate for Payer: Multiplan Commercial |
$28,842.00
|
| Rate for Payer: Networks By Design Commercial |
$18,026.25
|
| Rate for Payer: Prime Health Services Commercial |
$30,644.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21,631.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21,631.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,530.50
|
| Rate for Payer: United Healthcare All Other HMO |
$13,169.98
|
| Rate for Payer: United Healthcare HMO Rider |
$12,885.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,807.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30,644.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30,644.62
|
| Rate for Payer: Vantage Medical Group Senior |
$30,644.62
|
|
|
HC DFIB STJ PROMOTE RF 3207-36
|
Facility
|
IP
|
$36,000.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813594
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,200.00 |
| Max. Negotiated Rate |
$30,600.00 |
| Rate for Payer: Adventist Health Commercial |
$7,200.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$16,200.00
|
| Rate for Payer: Cash Price |
$16,200.00
|
| Rate for Payer: Cigna of CA HMO |
$25,200.00
|
| Rate for Payer: Cigna of CA PPO |
$25,200.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,400.00
|
| Rate for Payer: EPIC Health Plan Senior |
$14,400.00
|
| Rate for Payer: Galaxy Health WC |
$30,600.00
|
| Rate for Payer: Global Benefits Group Commercial |
$21,600.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24,012.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,716.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,284.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,640.00
|
| Rate for Payer: Multiplan Commercial |
$28,800.00
|
| Rate for Payer: Networks By Design Commercial |
$18,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$30,600.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,510.80
|
| Rate for Payer: United Healthcare All Other HMO |
$13,150.80
|
| Rate for Payer: United Healthcare HMO Rider |
$12,866.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,790.00
|
|
|
HC DFIB STJ PROMOTE RF 3207-36
|
Facility
|
OP
|
$36,000.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813594
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,200.00 |
| Max. Negotiated Rate |
$30,600.00 |
| Rate for Payer: Adventist Health Commercial |
$7,200.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30,600.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19,800.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27,000.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20,851.20
|
| Rate for Payer: Blue Shield of California Commercial |
$26,568.00
|
| Rate for Payer: Blue Shield of California EPN |
$17,496.00
|
| Rate for Payer: Cash Price |
$16,200.00
|
| Rate for Payer: Cigna of CA HMO |
$25,200.00
|
| Rate for Payer: Cigna of CA PPO |
$25,200.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30,600.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$30,600.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$30,600.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,400.00
|
| Rate for Payer: EPIC Health Plan Senior |
$14,400.00
|
| Rate for Payer: Galaxy Health WC |
$30,600.00
|
| Rate for Payer: Global Benefits Group Commercial |
$21,600.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24,012.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,284.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,640.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25,200.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25,200.00
|
| Rate for Payer: Multiplan Commercial |
$28,800.00
|
| Rate for Payer: Networks By Design Commercial |
$18,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$30,600.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21,600.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21,600.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,510.80
|
| Rate for Payer: United Healthcare All Other HMO |
$13,150.80
|
| Rate for Payer: United Healthcare HMO Rider |
$12,866.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,790.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30,600.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30,600.00
|
| Rate for Payer: Vantage Medical Group Senior |
$30,600.00
|
|
|
HC DFIB STJ QUADRA A CD3365-40C
|
Facility
|
IP
|
$25,080.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813762
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,016.00 |
| Max. Negotiated Rate |
$21,318.00 |
| Rate for Payer: Adventist Health Commercial |
$5,016.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$11,286.00
|
| Rate for Payer: Cash Price |
$11,286.00
|
| Rate for Payer: Cigna of CA HMO |
$17,556.00
|
| Rate for Payer: Cigna of CA PPO |
$17,556.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,032.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10,032.00
|
| Rate for Payer: Galaxy Health WC |
$21,318.00
|
| Rate for Payer: Global Benefits Group Commercial |
$15,048.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,728.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,555.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,524.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,019.20
|
| Rate for Payer: Multiplan Commercial |
$20,064.00
|
| Rate for Payer: Networks By Design Commercial |
$12,540.00
|
| Rate for Payer: Prime Health Services Commercial |
$21,318.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,412.52
|
| Rate for Payer: United Healthcare All Other HMO |
$9,161.72
|
| Rate for Payer: United Healthcare HMO Rider |
$8,963.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,213.70
|
|
|
HC DFIB STJ QUADRA A CD3365-40C
|
Facility
|
OP
|
$25,080.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813762
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,016.00 |
| Max. Negotiated Rate |
$21,318.00 |
| Rate for Payer: Adventist Health Commercial |
$5,016.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,318.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13,794.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18,810.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,526.34
|
| Rate for Payer: Blue Shield of California Commercial |
$18,509.04
|
| Rate for Payer: Blue Shield of California EPN |
$12,188.88
|
| Rate for Payer: Cash Price |
$11,286.00
|
| Rate for Payer: Cigna of CA HMO |
$17,556.00
|
| Rate for Payer: Cigna of CA PPO |
$17,556.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,318.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$21,318.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21,318.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,032.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10,032.00
|
| Rate for Payer: Galaxy Health WC |
$21,318.00
|
| Rate for Payer: Global Benefits Group Commercial |
$15,048.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,728.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,524.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,019.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,556.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17,556.00
|
| Rate for Payer: Multiplan Commercial |
$20,064.00
|
| Rate for Payer: Networks By Design Commercial |
$12,540.00
|
| Rate for Payer: Prime Health Services Commercial |
$21,318.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15,048.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15,048.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,412.52
|
| Rate for Payer: United Healthcare All Other HMO |
$9,161.72
|
| Rate for Payer: United Healthcare HMO Rider |
$8,963.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,213.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,318.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21,318.00
|
| Rate for Payer: Vantage Medical Group Senior |
$21,318.00
|
|
|
HC DFIB STJ QUADRA A CD3369-40Q
|
Facility
|
OP
|
$25,080.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813819
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,016.00 |
| Max. Negotiated Rate |
$21,318.00 |
| Rate for Payer: Adventist Health Commercial |
$5,016.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,318.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13,794.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18,810.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,526.34
|
| Rate for Payer: Blue Shield of California Commercial |
$18,509.04
|
| Rate for Payer: Blue Shield of California EPN |
$12,188.88
|
| Rate for Payer: Cash Price |
$11,286.00
|
| Rate for Payer: Cigna of CA HMO |
$17,556.00
|
| Rate for Payer: Cigna of CA PPO |
$17,556.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,318.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$21,318.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21,318.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,032.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10,032.00
|
| Rate for Payer: Galaxy Health WC |
$21,318.00
|
| Rate for Payer: Global Benefits Group Commercial |
$15,048.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,728.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,524.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,019.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,556.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17,556.00
|
| Rate for Payer: Multiplan Commercial |
$20,064.00
|
| Rate for Payer: Networks By Design Commercial |
$12,540.00
|
| Rate for Payer: Prime Health Services Commercial |
$21,318.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15,048.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15,048.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,412.52
|
| Rate for Payer: United Healthcare All Other HMO |
$9,161.72
|
| Rate for Payer: United Healthcare HMO Rider |
$8,963.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,213.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,318.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21,318.00
|
| Rate for Payer: Vantage Medical Group Senior |
$21,318.00
|
|
|
HC DFIB STJ QUADRA A CD3369-40Q
|
Facility
|
IP
|
$25,080.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813819
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,016.00 |
| Max. Negotiated Rate |
$21,318.00 |
| Rate for Payer: Adventist Health Commercial |
$5,016.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$11,286.00
|
| Rate for Payer: Cash Price |
$11,286.00
|
| Rate for Payer: Cigna of CA HMO |
$17,556.00
|
| Rate for Payer: Cigna of CA PPO |
$17,556.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,032.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10,032.00
|
| Rate for Payer: Galaxy Health WC |
$21,318.00
|
| Rate for Payer: Global Benefits Group Commercial |
$15,048.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,728.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,555.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,524.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,019.20
|
| Rate for Payer: Multiplan Commercial |
$20,064.00
|
| Rate for Payer: Networks By Design Commercial |
$12,540.00
|
| Rate for Payer: Prime Health Services Commercial |
$21,318.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,412.52
|
| Rate for Payer: United Healthcare All Other HMO |
$9,161.72
|
| Rate for Payer: United Healthcare HMO Rider |
$8,963.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,213.70
|
|
|
HC DFIB STJ UNIFY A CD335740Q
|
Facility
|
OP
|
$25,000.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813748
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,000.00 |
| Max. Negotiated Rate |
$21,250.00 |
| Rate for Payer: Adventist Health Commercial |
$5,000.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,250.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13,750.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18,750.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,480.00
|
| Rate for Payer: Blue Shield of California Commercial |
$18,450.00
|
| Rate for Payer: Blue Shield of California EPN |
$12,150.00
|
| Rate for Payer: Cash Price |
$11,250.00
|
| Rate for Payer: Cigna of CA HMO |
$17,500.00
|
| Rate for Payer: Cigna of CA PPO |
$17,500.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,250.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$21,250.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21,250.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10,000.00
|
| Rate for Payer: Galaxy Health WC |
$21,250.00
|
| Rate for Payer: Global Benefits Group Commercial |
$15,000.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,675.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,475.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,000.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,500.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17,500.00
|
| Rate for Payer: Multiplan Commercial |
$20,000.00
|
| Rate for Payer: Networks By Design Commercial |
$12,500.00
|
| Rate for Payer: Prime Health Services Commercial |
$21,250.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15,000.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15,000.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,382.50
|
| Rate for Payer: United Healthcare All Other HMO |
$9,132.50
|
| Rate for Payer: United Healthcare HMO Rider |
$8,935.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,187.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,250.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21,250.00
|
| Rate for Payer: Vantage Medical Group Senior |
$21,250.00
|
|
