|
HC EO WADJTBL POSITION LOCK PREFAB
|
Facility
|
OP
|
$715.00
|
|
|
Service Code
|
CPT L3760
|
| Hospital Charge Code |
905353760
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$171.60 |
| Max. Negotiated Rate |
$607.75 |
| Rate for Payer: Adventist Health Commercial |
$293.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$607.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$393.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$536.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$414.13
|
| Rate for Payer: Blue Shield of California Commercial |
$527.67
|
| Rate for Payer: Blue Shield of California EPN |
$347.49
|
| Rate for Payer: Cash Price |
$393.25
|
| Rate for Payer: Cash Price |
$393.25
|
| Rate for Payer: Cigna of CA HMO |
$500.50
|
| Rate for Payer: Cigna of CA PPO |
$500.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$607.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$607.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$607.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$286.00
|
| Rate for Payer: EPIC Health Plan Senior |
$286.00
|
| Rate for Payer: Galaxy Health WC |
$607.75
|
| Rate for Payer: Global Benefits Group Commercial |
$429.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$480.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$476.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$543.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$442.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$171.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$500.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$500.50
|
| Rate for Payer: Multiplan Commercial |
$572.00
|
| Rate for Payer: Networks By Design Commercial |
$357.50
|
| Rate for Payer: Prime Health Services Commercial |
$607.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$429.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$429.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$268.34
|
| Rate for Payer: United Healthcare All Other HMO |
$261.19
|
| Rate for Payer: United Healthcare HMO Rider |
$255.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$234.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$607.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$607.75
|
| Rate for Payer: Vantage Medical Group Senior |
$607.75
|
|
|
HC EO WADJTBL POSITION LOCK PREFAB
|
Facility
|
IP
|
$715.00
|
|
|
Service Code
|
CPT L3760
|
| Hospital Charge Code |
905353760
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$143.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$143.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$393.25
|
| Rate for Payer: Cash Price |
$393.25
|
| Rate for Payer: Cigna of CA HMO |
$500.50
|
| Rate for Payer: Cigna of CA PPO |
$500.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$286.00
|
| Rate for Payer: EPIC Health Plan Senior |
$286.00
|
| Rate for Payer: Galaxy Health WC |
$607.75
|
| Rate for Payer: Global Benefits Group Commercial |
$429.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$476.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$272.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$442.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$171.60
|
| Rate for Payer: Multiplan Commercial |
$572.00
|
| Rate for Payer: Networks By Design Commercial |
$357.50
|
| Rate for Payer: Prime Health Services Commercial |
$607.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$268.34
|
| Rate for Payer: United Healthcare All Other HMO |
$261.19
|
| Rate for Payer: United Healthcare HMO Rider |
$255.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$234.16
|
|
|
HC EO WADJTBL POSITION LOCK PREFAB
|
Facility
|
OP
|
$715.00
|
|
|
Service Code
|
CPT L3760
|
| Hospital Charge Code |
915353760
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$171.60 |
| Max. Negotiated Rate |
$607.75 |
| Rate for Payer: Adventist Health Commercial |
$293.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$607.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$393.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$536.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$414.13
|
| Rate for Payer: Blue Shield of California Commercial |
$527.67
|
| Rate for Payer: Blue Shield of California EPN |
$347.49
|
| Rate for Payer: Cash Price |
$393.25
|
| Rate for Payer: Cash Price |
$393.25
|
| Rate for Payer: Cigna of CA HMO |
$500.50
|
| Rate for Payer: Cigna of CA PPO |
$500.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$607.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$607.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$607.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$286.00
|
| Rate for Payer: EPIC Health Plan Senior |
$286.00
|
| Rate for Payer: Galaxy Health WC |
$607.75
|
| Rate for Payer: Global Benefits Group Commercial |
$429.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$480.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$476.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$543.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$442.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$171.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$500.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$500.50
|
| Rate for Payer: Multiplan Commercial |
$572.00
|
| Rate for Payer: Networks By Design Commercial |
$357.50
|
| Rate for Payer: Prime Health Services Commercial |
$607.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$429.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$429.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$268.34
|
| Rate for Payer: United Healthcare All Other HMO |
$261.19
|
| Rate for Payer: United Healthcare HMO Rider |
$255.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$234.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$607.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$607.75
|
| Rate for Payer: Vantage Medical Group Senior |
$607.75
|
|
|
HC EO WADJTBL POSITION LOCK PREFAB
|
Facility
|
IP
|
$715.00
|
|
|
Service Code
|
CPT L3760
|
| Hospital Charge Code |
915353760
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$143.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$143.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$393.25
|
| Rate for Payer: Cash Price |
$393.25
|
| Rate for Payer: Cigna of CA HMO |
$500.50
|
| Rate for Payer: Cigna of CA PPO |
$500.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$286.00
|
| Rate for Payer: EPIC Health Plan Senior |
$286.00
|
| Rate for Payer: Galaxy Health WC |
$607.75
|
| Rate for Payer: Global Benefits Group Commercial |
$429.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$476.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$272.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$442.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$171.60
|
| Rate for Payer: Multiplan Commercial |
$572.00
|
| Rate for Payer: Networks By Design Commercial |
$357.50
|
| Rate for Payer: Prime Health Services Commercial |
$607.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$268.34
|
| Rate for Payer: United Healthcare All Other HMO |
$261.19
|
| Rate for Payer: United Healthcare HMO Rider |
$255.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$234.16
|
|
|
HC EO W/O JOINTS CF
|
Facility
|
IP
|
$435.00
|
|
|
Service Code
|
CPT L3702
|
| Hospital Charge Code |
905353702
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$87.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$87.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$239.25
|
| Rate for Payer: Cash Price |
$239.25
|
| Rate for Payer: Cigna of CA HMO |
$304.50
|
| Rate for Payer: Cigna of CA PPO |
$304.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$174.00
|
| Rate for Payer: EPIC Health Plan Senior |
$174.00
|
| Rate for Payer: Galaxy Health WC |
$369.75
|
| Rate for Payer: Global Benefits Group Commercial |
$261.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$290.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$165.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$269.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$104.40
|
| Rate for Payer: Multiplan Commercial |
$348.00
|
| Rate for Payer: Networks By Design Commercial |
$217.50
|
| Rate for Payer: Prime Health Services Commercial |
$369.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$163.26
|
| Rate for Payer: United Healthcare All Other HMO |
$158.91
|
| Rate for Payer: United Healthcare HMO Rider |
$155.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$142.46
|
|
|
HC EO W/O JOINTS CF
|
Facility
|
IP
|
$435.00
|
|
|
Service Code
|
CPT L3702
|
| Hospital Charge Code |
915353702
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$87.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$87.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$239.25
|
| Rate for Payer: Cash Price |
$239.25
|
| Rate for Payer: Cigna of CA HMO |
$304.50
|
| Rate for Payer: Cigna of CA PPO |
$304.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$174.00
|
| Rate for Payer: EPIC Health Plan Senior |
$174.00
|
| Rate for Payer: Galaxy Health WC |
$369.75
|
| Rate for Payer: Global Benefits Group Commercial |
$261.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$290.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$165.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$269.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$104.40
|
| Rate for Payer: Multiplan Commercial |
$348.00
|
| Rate for Payer: Networks By Design Commercial |
$217.50
|
| Rate for Payer: Prime Health Services Commercial |
$369.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$163.26
|
| Rate for Payer: United Healthcare All Other HMO |
$158.91
|
| Rate for Payer: United Healthcare HMO Rider |
$155.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$142.46
|
|
|
HC EO W/O JOINTS CF
|
Facility
|
OP
|
$435.00
|
|
|
Service Code
|
CPT L3702
|
| Hospital Charge Code |
915353702
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$104.40 |
| Max. Negotiated Rate |
$369.75 |
| Rate for Payer: Adventist Health Commercial |
$178.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$369.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$239.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$326.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$251.95
|
| Rate for Payer: Blue Shield of California Commercial |
$321.03
|
| Rate for Payer: Blue Shield of California EPN |
$211.41
|
| Rate for Payer: Cash Price |
$239.25
|
| Rate for Payer: Cash Price |
$239.25
|
| Rate for Payer: Cigna of CA HMO |
$304.50
|
| Rate for Payer: Cigna of CA PPO |
$304.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$369.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$369.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$369.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$174.00
|
| Rate for Payer: EPIC Health Plan Senior |
$174.00
|
| Rate for Payer: Galaxy Health WC |
$369.75
|
| Rate for Payer: Global Benefits Group Commercial |
$261.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$277.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$290.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$313.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$269.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$104.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$304.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$304.50
|
| Rate for Payer: Multiplan Commercial |
$348.00
|
| Rate for Payer: Networks By Design Commercial |
$217.50
|
| Rate for Payer: Prime Health Services Commercial |
$369.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$261.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$261.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$163.26
|
| Rate for Payer: United Healthcare All Other HMO |
$158.91
|
| Rate for Payer: United Healthcare HMO Rider |
$155.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$142.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$369.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$369.75
|
| Rate for Payer: Vantage Medical Group Senior |
$369.75
|
|
|
HC EO W/O JOINTS CF
|
Facility
|
OP
|
$435.00
|
|
|
Service Code
|
CPT L3702
|
| Hospital Charge Code |
905353702
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$104.40 |
| Max. Negotiated Rate |
$369.75 |
| Rate for Payer: Adventist Health Commercial |
$178.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$369.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$239.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$326.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$251.95
|
| Rate for Payer: Blue Shield of California Commercial |
$321.03
|
| Rate for Payer: Blue Shield of California EPN |
$211.41
|
| Rate for Payer: Cash Price |
$239.25
|
| Rate for Payer: Cash Price |
$239.25
|
| Rate for Payer: Cigna of CA HMO |
$304.50
|
| Rate for Payer: Cigna of CA PPO |
$304.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$369.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$369.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$369.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$174.00
|
| Rate for Payer: EPIC Health Plan Senior |
$174.00
|
| Rate for Payer: Galaxy Health WC |
$369.75
|
| Rate for Payer: Global Benefits Group Commercial |
$261.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$277.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$290.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$313.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$269.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$104.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$304.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$304.50
|
| Rate for Payer: Multiplan Commercial |
$348.00
|
| Rate for Payer: Networks By Design Commercial |
$217.50
|
| Rate for Payer: Prime Health Services Commercial |
$369.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$261.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$261.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$163.26
|
| Rate for Payer: United Healthcare All Other HMO |
$158.91
|
| Rate for Payer: United Healthcare HMO Rider |
$155.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$142.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$369.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$369.75
|
| Rate for Payer: Vantage Medical Group Senior |
$369.75
|
|
|
HC EP BARD TEMP PACING BAL-TIP
|
Facility
|
IP
|
$851.00
|
|
| Hospital Charge Code |
906812350
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$170.20 |
| Max. Negotiated Rate |
$723.35 |
| Rate for Payer: Adventist Health Commercial |
$170.20
|
| Rate for Payer: Cash Price |
$468.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.40
|
| Rate for Payer: EPIC Health Plan Senior |
$340.40
|
| Rate for Payer: Galaxy Health WC |
$723.35
|
| Rate for Payer: Global Benefits Group Commercial |
$510.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$567.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$324.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$526.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$204.24
|
| Rate for Payer: Multiplan Commercial |
$680.80
|
| Rate for Payer: Networks By Design Commercial |
$553.15
|
| Rate for Payer: Prime Health Services Commercial |
$723.35
|
|
|
HC EP BARD TEMP PACING BAL-TIP
|
Facility
|
OP
|
$851.00
|
|
| Hospital Charge Code |
906812350
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$170.20 |
| Max. Negotiated Rate |
$723.35 |
| Rate for Payer: Adventist Health Commercial |
$170.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$558.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$723.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$468.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$638.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$522.60
|
| Rate for Payer: Cash Price |
$468.05
|
| Rate for Payer: Cigna of CA HMO |
$544.64
|
| Rate for Payer: Cigna of CA PPO |
$629.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$723.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$723.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$723.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.40
|
| Rate for Payer: EPIC Health Plan Senior |
$340.40
|
| Rate for Payer: Galaxy Health WC |
$723.35
|
| Rate for Payer: Global Benefits Group Commercial |
$510.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$567.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$324.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$526.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$204.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$595.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$595.70
|
| Rate for Payer: Multiplan Commercial |
$680.80
|
| Rate for Payer: Networks By Design Commercial |
$553.15
|
| Rate for Payer: Prime Health Services Commercial |
$723.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$510.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$510.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$425.50
|
| Rate for Payer: United Healthcare All Other HMO |
$425.50
|
| Rate for Payer: United Healthcare HMO Rider |
$425.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$425.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$723.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$723.35
|
| Rate for Payer: Vantage Medical Group Senior |
$723.35
|
|
|
HC EP DF BARD CONFORMA 7F
|
Facility
|
OP
|
$3,803.00
|
|
|
Service Code
|
CPT C1731
|
| Hospital Charge Code |
906812374
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$760.60 |
| Max. Negotiated Rate |
$3,232.55 |
| Rate for Payer: Adventist Health Commercial |
$760.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,494.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,232.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,091.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,852.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,335.42
|
| Rate for Payer: Cash Price |
$2,091.65
|
| Rate for Payer: Cigna of CA HMO |
$2,433.92
|
| Rate for Payer: Cigna of CA PPO |
$2,814.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,232.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,232.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,232.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,521.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,521.20
|
| Rate for Payer: Galaxy Health WC |
$3,232.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,281.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,536.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,448.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,354.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$912.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,662.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,662.10
|
| Rate for Payer: Multiplan Commercial |
$3,042.40
|
| Rate for Payer: Networks By Design Commercial |
$2,471.95
|
| Rate for Payer: Prime Health Services Commercial |
$3,232.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,281.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,281.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,901.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,901.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,901.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,901.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,232.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,232.55
|
| Rate for Payer: Vantage Medical Group Senior |
$3,232.55
|
|
|
HC EP DF BARD CONFORMA 7F
|
Facility
|
IP
|
$3,803.00
|
|
|
Service Code
|
CPT C1731
|
| Hospital Charge Code |
906812374
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$760.60 |
| Max. Negotiated Rate |
$3,232.55 |
| Rate for Payer: Adventist Health Commercial |
$760.60
|
| Rate for Payer: Cash Price |
$2,091.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,521.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,521.20
|
| Rate for Payer: Galaxy Health WC |
$3,232.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,281.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,536.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,448.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,354.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$912.72
|
| Rate for Payer: Multiplan Commercial |
$3,042.40
|
| Rate for Payer: Networks By Design Commercial |
$2,471.95
|
| Rate for Payer: Prime Health Services Commercial |
$3,232.55
|
|
|
HC EP DF BIO WEB CS DECA
|
Facility
|
OP
|
$2,295.40
|
|
| Hospital Charge Code |
906812451
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$459.08 |
| Max. Negotiated Rate |
$1,951.09 |
| Rate for Payer: Adventist Health Commercial |
$459.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,505.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,951.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,262.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,721.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,409.61
|
| Rate for Payer: Cash Price |
$1,262.47
|
| Rate for Payer: Cigna of CA HMO |
$1,469.06
|
| Rate for Payer: Cigna of CA PPO |
$1,698.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,951.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,951.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,951.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$918.16
|
| Rate for Payer: EPIC Health Plan Senior |
$918.16
|
| Rate for Payer: Galaxy Health WC |
$1,951.09
|
| Rate for Payer: Global Benefits Group Commercial |
$1,377.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,531.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$874.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,420.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$550.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,606.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,606.78
|
| Rate for Payer: Multiplan Commercial |
$1,836.32
|
| Rate for Payer: Networks By Design Commercial |
$1,492.01
|
| Rate for Payer: Prime Health Services Commercial |
$1,951.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,377.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,377.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,147.70
|
| Rate for Payer: United Healthcare All Other HMO |
$1,147.70
|
| Rate for Payer: United Healthcare HMO Rider |
$1,147.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,147.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,951.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,951.09
|
| Rate for Payer: Vantage Medical Group Senior |
$1,951.09
|
|
|
HC EP DF BIO WEB CS DECA
|
Facility
|
IP
|
$2,295.40
|
|
| Hospital Charge Code |
906812451
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$459.08 |
| Max. Negotiated Rate |
$1,951.09 |
| Rate for Payer: Adventist Health Commercial |
$459.08
|
| Rate for Payer: Cash Price |
$1,262.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$918.16
|
| Rate for Payer: EPIC Health Plan Senior |
$918.16
|
| Rate for Payer: Galaxy Health WC |
$1,951.09
|
| Rate for Payer: Global Benefits Group Commercial |
$1,377.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,531.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$874.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,420.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$550.90
|
| Rate for Payer: Multiplan Commercial |
$1,836.32
|
| Rate for Payer: Networks By Design Commercial |
$1,492.01
|
| Rate for Payer: Prime Health Services Commercial |
$1,951.09
|
|
|
HC EP DF BIO/WEB ISMUS
|
Facility
|
IP
|
$3,654.00
|
|
|
Service Code
|
CPT C1731
|
| Hospital Charge Code |
906812369
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$730.80 |
| Max. Negotiated Rate |
$3,105.90 |
| Rate for Payer: Adventist Health Commercial |
$730.80
|
| Rate for Payer: Cash Price |
$2,009.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,461.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,461.60
|
| Rate for Payer: Galaxy Health WC |
$3,105.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,192.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,437.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,392.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,261.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$876.96
|
| Rate for Payer: Multiplan Commercial |
$2,923.20
|
| Rate for Payer: Networks By Design Commercial |
$2,375.10
|
| Rate for Payer: Prime Health Services Commercial |
$3,105.90
|
|
|
HC EP DF BIO/WEB ISMUS
|
Facility
|
OP
|
$3,654.00
|
|
|
Service Code
|
CPT C1731
|
| Hospital Charge Code |
906812369
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$730.80 |
| Max. Negotiated Rate |
$3,105.90 |
| Rate for Payer: Adventist Health Commercial |
$730.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,396.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,105.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,009.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,740.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,243.92
|
| Rate for Payer: Cash Price |
$2,009.70
|
| Rate for Payer: Cigna of CA HMO |
$2,338.56
|
| Rate for Payer: Cigna of CA PPO |
$2,703.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,105.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,105.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,105.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,461.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,461.60
|
| Rate for Payer: Galaxy Health WC |
$3,105.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,192.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,437.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,392.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,261.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$876.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,557.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,557.80
|
| Rate for Payer: Multiplan Commercial |
$2,923.20
|
| Rate for Payer: Networks By Design Commercial |
$2,375.10
|
| Rate for Payer: Prime Health Services Commercial |
$3,105.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,192.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,192.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,827.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,827.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,827.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,827.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,105.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,105.90
|
| Rate for Payer: Vantage Medical Group Senior |
$3,105.90
|
|
|
HC EP DF BIO/WEB LASSO 10 POLE
|
Facility
|
OP
|
$3,900.00
|
|
|
Service Code
|
CPT C1730
|
| Hospital Charge Code |
906812365
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,315.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,558.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,145.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,925.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,394.99
|
| Rate for Payer: Cash Price |
$2,145.00
|
| Rate for Payer: Cigna of CA HMO |
$2,496.00
|
| Rate for Payer: Cigna of CA PPO |
$2,886.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,315.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,315.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$936.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,730.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,730.00
|
| Rate for Payer: Multiplan Commercial |
$3,120.00
|
| Rate for Payer: Networks By Design Commercial |
$2,535.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,340.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,340.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,950.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,950.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,950.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,950.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,315.00
|
|
|
HC EP DF BIO/WEB LASSO 10 POLE
|
Facility
|
IP
|
$3,900.00
|
|
|
Service Code
|
CPT C1730
|
| Hospital Charge Code |
906812365
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,315.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Cash Price |
$2,145.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$936.00
|
| Rate for Payer: Multiplan Commercial |
$3,120.00
|
| Rate for Payer: Networks By Design Commercial |
$2,535.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
|
|
HC EP DF BIO/WEB LASSO NAV 20MM
|
Facility
|
IP
|
$3,900.00
|
|
|
Service Code
|
CPT C1730
|
| Hospital Charge Code |
906812411
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,315.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Cash Price |
$2,145.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$936.00
|
| Rate for Payer: Multiplan Commercial |
$3,120.00
|
| Rate for Payer: Networks By Design Commercial |
$2,535.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
|
|
HC EP DF BIO/WEB LASSO NAV 20MM
|
Facility
|
OP
|
$3,900.00
|
|
|
Service Code
|
CPT C1730
|
| Hospital Charge Code |
906812411
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,315.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,558.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,145.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,925.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,394.99
|
| Rate for Payer: Cash Price |
$2,145.00
|
| Rate for Payer: Cigna of CA HMO |
$2,496.00
|
| Rate for Payer: Cigna of CA PPO |
$2,886.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,315.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,315.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$936.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,730.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,730.00
|
| Rate for Payer: Multiplan Commercial |
$3,120.00
|
| Rate for Payer: Networks By Design Commercial |
$2,535.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,340.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,340.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,950.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,950.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,950.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,950.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,315.00
|
|
|
HC EP DF MED ACHIEVE
|
Facility
|
OP
|
$3,705.00
|
|
|
Service Code
|
CPT C1730
|
| Hospital Charge Code |
906812544
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$741.00 |
| Max. Negotiated Rate |
$3,149.25 |
| Rate for Payer: Adventist Health Commercial |
$741.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,149.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,037.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,778.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,145.94
|
| Rate for Payer: Blue Shield of California Commercial |
$2,734.29
|
| Rate for Payer: Blue Shield of California EPN |
$1,800.63
|
| Rate for Payer: Cash Price |
$2,037.75
|
| Rate for Payer: Cigna of CA HMO |
$2,593.50
|
| Rate for Payer: Cigna of CA PPO |
$2,593.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,149.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,149.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,149.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,482.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,482.00
|
| Rate for Payer: Galaxy Health WC |
$3,149.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,223.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,471.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,411.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,293.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$889.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,593.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,593.50
|
| Rate for Payer: Multiplan Commercial |
$2,964.00
|
| Rate for Payer: Networks By Design Commercial |
$1,852.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,149.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,223.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,223.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,390.49
|
| Rate for Payer: United Healthcare All Other HMO |
$1,353.44
|
| Rate for Payer: United Healthcare HMO Rider |
$1,324.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,213.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,149.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,149.25
|
| Rate for Payer: Vantage Medical Group Senior |
$3,149.25
|
|
|
HC EP DF MED ACHIEVE
|
Facility
|
IP
|
$3,705.00
|
|
|
Service Code
|
CPT C1730
|
| Hospital Charge Code |
906812544
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$741.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$741.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$2,037.75
|
| Rate for Payer: Cash Price |
$2,037.75
|
| Rate for Payer: Cigna of CA HMO |
$2,593.50
|
| Rate for Payer: Cigna of CA PPO |
$2,593.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,482.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,482.00
|
| Rate for Payer: Galaxy Health WC |
$3,149.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,223.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,471.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,411.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,293.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$889.20
|
| Rate for Payer: Multiplan Commercial |
$2,964.00
|
| Rate for Payer: Networks By Design Commercial |
$1,852.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,149.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,390.49
|
| Rate for Payer: United Healthcare All Other HMO |
$1,353.44
|
| Rate for Payer: United Healthcare HMO Rider |
$1,324.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,213.39
|
|
|
HC EP DF STJ AFOCUS II
|
Facility
|
IP
|
$3,335.00
|
|
|
Service Code
|
CPT C1732
|
| Hospital Charge Code |
906812583
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$667.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$667.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,834.25
|
| Rate for Payer: Cash Price |
$1,834.25
|
| Rate for Payer: Cigna of CA HMO |
$2,334.50
|
| Rate for Payer: Cigna of CA PPO |
$2,334.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,334.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,334.00
|
| Rate for Payer: Galaxy Health WC |
$2,834.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,001.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,224.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,270.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,064.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$800.40
|
| Rate for Payer: Multiplan Commercial |
$2,668.00
|
| Rate for Payer: Networks By Design Commercial |
$1,667.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,834.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,251.63
|
| Rate for Payer: United Healthcare All Other HMO |
$1,218.28
|
| Rate for Payer: United Healthcare HMO Rider |
$1,191.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,092.21
|
|
|
HC EP DF STJ AFOCUS II
|
Facility
|
OP
|
$3,335.00
|
|
|
Service Code
|
CPT C1732
|
| Hospital Charge Code |
906812583
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$667.00 |
| Max. Negotiated Rate |
$2,834.75 |
| Rate for Payer: Adventist Health Commercial |
$667.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,834.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,834.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,501.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,931.63
|
| Rate for Payer: Blue Shield of California Commercial |
$2,461.23
|
| Rate for Payer: Blue Shield of California EPN |
$1,620.81
|
| Rate for Payer: Cash Price |
$1,834.25
|
| Rate for Payer: Cigna of CA HMO |
$2,334.50
|
| Rate for Payer: Cigna of CA PPO |
$2,334.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,834.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,834.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,834.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,334.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,334.00
|
| Rate for Payer: Galaxy Health WC |
$2,834.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,001.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,224.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,270.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,064.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$800.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,334.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,334.50
|
| Rate for Payer: Multiplan Commercial |
$2,668.00
|
| Rate for Payer: Networks By Design Commercial |
$1,667.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,834.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,001.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,001.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,251.63
|
| Rate for Payer: United Healthcare All Other HMO |
$1,218.28
|
| Rate for Payer: United Healthcare HMO Rider |
$1,191.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,092.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,834.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,834.75
|
| Rate for Payer: Vantage Medical Group Senior |
$2,834.75
|
|
|
HC EP DF ST J INQUIRY OPTIMA PLUS
|
Facility
|
OP
|
$4,000.00
|
|
|
Service Code
|
CPT C1730
|
| Hospital Charge Code |
906812410
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$800.00 |
| Max. Negotiated Rate |
$3,400.00 |
| Rate for Payer: Adventist Health Commercial |
$800.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,623.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,400.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,200.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,000.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,456.40
|
| Rate for Payer: Cash Price |
$2,200.00
|
| Rate for Payer: Cigna of CA HMO |
$2,560.00
|
| Rate for Payer: Cigna of CA PPO |
$2,960.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,400.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,400.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,400.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,600.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,600.00
|
| Rate for Payer: Galaxy Health WC |
$3,400.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,400.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,668.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,524.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,476.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$960.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,800.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,800.00
|
| Rate for Payer: Multiplan Commercial |
$3,200.00
|
| Rate for Payer: Networks By Design Commercial |
$2,600.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,400.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,400.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,400.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,000.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,000.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,000.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,400.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,400.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,400.00
|
|
