|
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 |
$1,711.35
|
| 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 |
$1,711.35
|
| 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 |
$1,032.93
|
| 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 |
$1,032.93
|
| 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
|
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 |
$1,644.30
|
| 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 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 |
$1,644.30
|
| 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 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 |
$1,755.00
|
| 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 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 |
$1,755.00
|
| 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 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 |
$1,755.00
|
| 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 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 |
$1,755.00
|
| 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 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 |
$1,667.25
|
| Rate for Payer: Cash Price |
$1,667.25
|
| 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 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 |
$1,667.25
|
| 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 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 |
$1,500.75
|
| 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 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 |
$1,500.75
|
| Rate for Payer: Cash Price |
$1,500.75
|
| 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 ST J INQUIRY OPTIMA PLUS
|
Facility
|
IP
|
$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: Cash Price |
$1,800.00
|
| 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: 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
|
|
|
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 |
$1,800.00
|
| 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
|
|
|
HC EP FX CARDIMA PATHFINDER
|
Facility
|
OP
|
$3,900.00
|
|
|
Service Code
|
CPT C1730
|
| Hospital Charge Code |
906812404
|
|
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 |
$1,755.00
|
| 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 FX CARDIMA PATHFINDER
|
Facility
|
IP
|
$3,900.00
|
|
|
Service Code
|
CPT C1730
|
| Hospital Charge Code |
906812404
|
|
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 |
$1,755.00
|
| 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 EPHYS EVAL CCM DFIB LD INITIAL IMPL
|
Facility
|
IP
|
$3,315.00
|
|
|
Service Code
|
CPT 0930T
|
| Hospital Charge Code |
906811514
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$663.00 |
| Max. Negotiated Rate |
$2,817.75 |
| Rate for Payer: Adventist Health Commercial |
$663.00
|
| Rate for Payer: Cash Price |
$1,491.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,326.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,326.00
|
| Rate for Payer: Galaxy Health WC |
$2,817.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,989.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,211.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,263.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,051.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$795.60
|
| Rate for Payer: Multiplan Commercial |
$2,652.00
|
| Rate for Payer: Networks By Design Commercial |
$2,154.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,817.75
|
|
|
HC EPHYS EVAL CCM DFIB LD INITIAL IMPL
|
Facility
|
OP
|
$3,315.00
|
|
|
Service Code
|
CPT 0930T
|
| Hospital Charge Code |
906811514
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$663.00 |
| Max. Negotiated Rate |
$6,906.11 |
| Rate for Payer: Adventist Health Commercial |
$663.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,313.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,696.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,542.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,035.74
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$1,491.75
|
| Rate for Payer: Cash Price |
$1,491.75
|
| Rate for Payer: Cash Price |
$1,491.75
|
| Rate for Payer: Cigna of CA HMO |
$2,121.60
|
| Rate for Payer: Cigna of CA PPO |
$2,453.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,313.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,696.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,542.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,082.38
|
| Rate for Payer: EPIC Health Plan Senior |
$1,542.50
|
| Rate for Payer: Galaxy Health WC |
$2,817.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,989.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,529.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,542.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,211.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,263.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,542.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$795.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,943.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,066.95
|
| Rate for Payer: Multiplan Commercial |
$2,652.00
|
| Rate for Payer: Networks By Design Commercial |
$2,154.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,817.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,989.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,989.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,542.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,313.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,696.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1,542.50
|
|
|
HC EPHYS EVAL CCM DFIB LD SEPARATE
|
Facility
|
OP
|
$3,315.00
|
|
|
Service Code
|
CPT 0931T
|
| Hospital Charge Code |
906811515
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$663.00 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$663.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,313.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,696.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,542.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,035.74
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$1,491.75
|
| Rate for Payer: Cash Price |
$1,491.75
|
| Rate for Payer: Cash Price |
$1,491.75
|
| Rate for Payer: Cigna of CA HMO |
$2,121.60
|
| Rate for Payer: Cigna of CA PPO |
$2,453.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,313.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,696.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,542.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,082.38
|
| Rate for Payer: EPIC Health Plan Senior |
$1,542.50
|
| Rate for Payer: Galaxy Health WC |
$2,817.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,989.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,529.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,542.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,211.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,263.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,542.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$795.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,943.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,066.95
|
| Rate for Payer: Multiplan Commercial |
$2,652.00
|
| Rate for Payer: Networks By Design Commercial |
$2,154.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,817.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,989.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,989.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,542.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,313.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,696.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1,542.50
|
|
|
HC EPHYS EVAL CCM DFIB LD SEPARATE
|
Facility
|
IP
|
$3,315.00
|
|
|
Service Code
|
CPT 0931T
|
| Hospital Charge Code |
906811515
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$663.00 |
| Max. Negotiated Rate |
$2,817.75 |
| Rate for Payer: Adventist Health Commercial |
$663.00
|
| Rate for Payer: Cash Price |
$1,491.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,326.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,326.00
|
| Rate for Payer: Galaxy Health WC |
$2,817.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,989.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,211.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,263.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,051.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$795.60
|
| Rate for Payer: Multiplan Commercial |
$2,652.00
|
| Rate for Payer: Networks By Design Commercial |
$2,154.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,817.75
|
|
|
HC EPIDRM AGRFT TRNK ARM LEG LT 100
|
Facility
|
OP
|
$3,168.00
|
|
|
Service Code
|
CPT 15110
|
| Hospital Charge Code |
900501779
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$633.60 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$633.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,556.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,324.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Cash Price |
$1,425.60
|
| Rate for Payer: Cash Price |
$1,425.60
|
| Rate for Payer: Cash Price |
$1,425.60
|
| Rate for Payer: Cigna of CA HMO |
$2,027.52
|
| Rate for Payer: Cigna of CA PPO |
$2,344.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,556.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,324.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,137.70
|
| Rate for Payer: EPIC Health Plan Senior |
$2,324.22
|
| Rate for Payer: Galaxy Health WC |
$2,692.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,900.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,811.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,324.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,113.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,266.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,324.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$760.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,928.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,114.45
|
| Rate for Payer: Multiplan Commercial |
$2,534.40
|
| Rate for Payer: Multiplan WC |
$3,703.23
|
| Rate for Payer: Networks By Design Commercial |
$2,059.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,692.80
|
| Rate for Payer: Prime Health Services WC |
$3,665.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,900.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,584.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,584.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,584.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,584.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,324.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,556.64
|
| Rate for Payer: Vantage Medical Group Senior |
$2,324.22
|
|
|
HC EPIDRM AGRFT TRNK ARM LEG LT 100
|
Facility
|
IP
|
$3,168.00
|
|
|
Service Code
|
CPT 15110
|
| Hospital Charge Code |
900501779
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$633.60 |
| Max. Negotiated Rate |
$2,692.80 |
| Rate for Payer: Adventist Health Commercial |
$633.60
|
| Rate for Payer: Cash Price |
$1,425.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,267.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,267.20
|
| Rate for Payer: Galaxy Health WC |
$2,692.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,900.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,113.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,207.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,960.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$760.32
|
| Rate for Payer: Multiplan Commercial |
$2,534.40
|
| Rate for Payer: Networks By Design Commercial |
$2,059.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,692.80
|
|
|
HC EPIDURAL INJECT BLOOD PATCH
|
Facility
|
OP
|
$2,639.00
|
|
|
Service Code
|
CPT 62273
|
| Hospital Charge Code |
902400135
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$144.31 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$527.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$967.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$879.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$1,187.55
|
| Rate for Payer: Cash Price |
$1,187.55
|
| Rate for Payer: Cash Price |
$1,187.55
|
| Rate for Payer: Cigna of CA HMO |
$1,688.96
|
| Rate for Payer: Cigna of CA PPO |
$1,952.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$967.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$879.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,187.89
|
| Rate for Payer: EPIC Health Plan Senior |
$879.92
|
| Rate for Payer: Galaxy Health WC |
$2,243.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,583.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,443.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$879.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,760.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$144.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$879.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$633.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,108.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,179.09
|
| Rate for Payer: Multiplan Commercial |
$2,111.20
|
| Rate for Payer: Multiplan WC |
$1,402.00
|
| Rate for Payer: Networks By Design Commercial |
$1,715.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,243.15
|
| Rate for Payer: Prime Health Services WC |
$1,387.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,583.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,319.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,319.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,319.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,319.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$879.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$967.91
|
| Rate for Payer: Vantage Medical Group Senior |
$879.92
|
|
