|
HC DFIB B/S EMBLEM A209
|
Facility
|
OP
|
$31,500.00
|
|
|
Service Code
|
CPT C1722
|
| Hospital Charge Code |
906813755
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,300.00 |
| Max. Negotiated Rate |
$28,350.00 |
| Rate for Payer: Adventist Health Commercial |
$6,300.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26,775.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17,325.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23,625.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$14,382.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17,441.55
|
| Rate for Payer: Blue Shield of California Commercial |
$24,349.50
|
| Rate for Payer: Blue Shield of California EPN |
$15,876.00
|
| Rate for Payer: Cash Price |
$17,325.00
|
| Rate for Payer: Central Health Plan Commercial |
$25,200.00
|
| Rate for Payer: Cigna of CA HMO |
$22,050.00
|
| Rate for Payer: Cigna of CA PPO |
$22,050.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26,775.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$26,775.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$26,775.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,600.00
|
| Rate for Payer: EPIC Health Plan Senior |
$12,600.00
|
| Rate for Payer: Galaxy Health WC |
$26,775.00
|
| Rate for Payer: Global Benefits Group Commercial |
$18,900.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$28,350.00
|
| Rate for Payer: InnovAge PACE Commercial |
$15,750.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21,010.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19,498.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,300.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22,050.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22,050.00
|
| Rate for Payer: Multiplan Commercial |
$23,625.00
|
| Rate for Payer: Networks By Design Commercial |
$15,750.00
|
| Rate for Payer: Prime Health Services Commercial |
$26,775.00
|
| Rate for Payer: Riverside University Health System MISP |
$12,600.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18,900.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18,900.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,821.95
|
| Rate for Payer: United Healthcare All Other HMO |
$11,506.95
|
| Rate for Payer: United Healthcare HMO Rider |
$11,258.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10,316.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26,775.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26,775.00
|
| Rate for Payer: Vantage Medical Group Senior |
$26,775.00
|
|
|
HC DFIB B/S EMBLEM A219
|
Facility
|
OP
|
$30,750.00
|
|
|
Service Code
|
CPT C1722
|
| Hospital Charge Code |
906813799
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,150.00 |
| Max. Negotiated Rate |
$27,675.00 |
| Rate for Payer: Adventist Health Commercial |
$6,150.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26,137.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16,912.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23,062.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$14,040.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17,026.28
|
| Rate for Payer: Blue Shield of California Commercial |
$23,769.75
|
| Rate for Payer: Blue Shield of California EPN |
$15,498.00
|
| Rate for Payer: Cash Price |
$16,912.50
|
| Rate for Payer: Central Health Plan Commercial |
$24,600.00
|
| Rate for Payer: Cigna of CA HMO |
$21,525.00
|
| Rate for Payer: Cigna of CA PPO |
$21,525.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26,137.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$26,137.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$26,137.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,300.00
|
| Rate for Payer: EPIC Health Plan Senior |
$12,300.00
|
| Rate for Payer: Galaxy Health WC |
$26,137.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18,450.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$27,675.00
|
| Rate for Payer: InnovAge PACE Commercial |
$15,375.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20,510.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19,034.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,150.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21,525.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21,525.00
|
| Rate for Payer: Multiplan Commercial |
$23,062.50
|
| Rate for Payer: Networks By Design Commercial |
$15,375.00
|
| Rate for Payer: Prime Health Services Commercial |
$26,137.50
|
| Rate for Payer: Riverside University Health System MISP |
$12,300.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18,450.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18,450.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,540.48
|
| Rate for Payer: United Healthcare All Other HMO |
$11,232.98
|
| Rate for Payer: United Healthcare HMO Rider |
$10,990.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10,070.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26,137.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26,137.50
|
| Rate for Payer: Vantage Medical Group Senior |
$26,137.50
|
|
|
HC DFIB B/S EMBLEM A219
|
Facility
|
IP
|
$30,750.00
|
|
|
Service Code
|
CPT C1722
|
| Hospital Charge Code |
906813799
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,150.00 |
| Max. Negotiated Rate |
$27,675.00 |
| Rate for Payer: Adventist Health Commercial |
$6,150.00
|
| Rate for Payer: Blue Shield of California Commercial |
$23,769.75
|
| Rate for Payer: Blue Shield of California EPN |
$15,498.00
|
| Rate for Payer: Cash Price |
$16,912.50
|
| Rate for Payer: Central Health Plan Commercial |
$24,600.00
|
| Rate for Payer: Cigna of CA HMO |
$21,525.00
|
| Rate for Payer: Cigna of CA PPO |
$21,525.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,300.00
|
| Rate for Payer: EPIC Health Plan Senior |
$12,300.00
|
| Rate for Payer: Galaxy Health WC |
$26,137.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18,450.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$27,675.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20,510.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,715.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19,034.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,150.00
|
| Rate for Payer: Multiplan Commercial |
$23,062.50
|
| Rate for Payer: Networks By Design Commercial |
$15,375.00
|
| Rate for Payer: Prime Health Services Commercial |
$26,137.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,540.48
|
| Rate for Payer: United Healthcare All Other HMO |
$11,232.98
|
| Rate for Payer: United Healthcare HMO Rider |
$10,990.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10,070.62
|
|
|
HC DFIB B/S ENERGEN DR DF4 E142
|
Facility
|
IP
|
$25,000.00
|
|
|
Service Code
|
CPT C1721
|
| Hospital Charge Code |
906813660
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,000.00 |
| Max. Negotiated Rate |
$22,500.00 |
| Rate for Payer: Adventist Health Commercial |
$5,000.00
|
| Rate for Payer: Blue Shield of California Commercial |
$19,325.00
|
| Rate for Payer: Blue Shield of California EPN |
$12,600.00
|
| Rate for Payer: Cash Price |
$13,750.00
|
| Rate for Payer: Central Health Plan Commercial |
$20,000.00
|
| Rate for Payer: Cigna of CA HMO |
$17,500.00
|
| Rate for Payer: Cigna of CA PPO |
$17,500.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10,000.00
|
| Rate for Payer: Galaxy Health WC |
$21,250.00
|
| Rate for Payer: Global Benefits Group Commercial |
$15,000.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22,500.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,675.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,525.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,475.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,000.00
|
| Rate for Payer: Multiplan Commercial |
$18,750.00
|
| Rate for Payer: Networks By Design Commercial |
$12,500.00
|
| Rate for Payer: Prime Health Services Commercial |
$21,250.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,382.50
|
| Rate for Payer: United Healthcare All Other HMO |
$9,132.50
|
| Rate for Payer: United Healthcare HMO Rider |
$8,935.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,187.50
|
|
|
HC DFIB B/S ENERGEN DR DF4 E142
|
Facility
|
OP
|
$25,000.00
|
|
|
Service Code
|
CPT C1721
|
| Hospital Charge Code |
906813660
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,000.00 |
| Max. Negotiated Rate |
$22,500.00 |
| Rate for Payer: Adventist Health Commercial |
$5,000.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,250.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13,750.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18,750.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,415.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,842.50
|
| Rate for Payer: Blue Shield of California Commercial |
$19,325.00
|
| Rate for Payer: Blue Shield of California EPN |
$12,600.00
|
| Rate for Payer: Cash Price |
$13,750.00
|
| Rate for Payer: Central Health Plan Commercial |
$20,000.00
|
| Rate for Payer: Cigna of CA HMO |
$17,500.00
|
| Rate for Payer: Cigna of CA PPO |
$17,500.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,250.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$21,250.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21,250.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10,000.00
|
| Rate for Payer: Galaxy Health WC |
$21,250.00
|
| Rate for Payer: Global Benefits Group Commercial |
$15,000.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22,500.00
|
| Rate for Payer: InnovAge PACE Commercial |
$12,500.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,675.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,475.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,000.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,500.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17,500.00
|
| Rate for Payer: Multiplan Commercial |
$18,750.00
|
| Rate for Payer: Networks By Design Commercial |
$12,500.00
|
| Rate for Payer: Prime Health Services Commercial |
$21,250.00
|
| Rate for Payer: Riverside University Health System MISP |
$10,000.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15,000.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15,000.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,382.50
|
| Rate for Payer: United Healthcare All Other HMO |
$9,132.50
|
| Rate for Payer: United Healthcare HMO Rider |
$8,935.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,187.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,250.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21,250.00
|
| Rate for Payer: Vantage Medical Group Senior |
$21,250.00
|
|
|
HC DFIB B/S ENERGEN DR E143
|
Facility
|
IP
|
$25,000.00
|
|
|
Service Code
|
CPT C1721
|
| Hospital Charge Code |
906813661
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,000.00 |
| Max. Negotiated Rate |
$22,500.00 |
| Rate for Payer: Adventist Health Commercial |
$5,000.00
|
| Rate for Payer: Blue Shield of California Commercial |
$19,325.00
|
| Rate for Payer: Blue Shield of California EPN |
$12,600.00
|
| Rate for Payer: Cash Price |
$13,750.00
|
| Rate for Payer: Central Health Plan Commercial |
$20,000.00
|
| Rate for Payer: Cigna of CA HMO |
$17,500.00
|
| Rate for Payer: Cigna of CA PPO |
$17,500.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10,000.00
|
| Rate for Payer: Galaxy Health WC |
$21,250.00
|
| Rate for Payer: Global Benefits Group Commercial |
$15,000.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22,500.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,675.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,525.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,475.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,000.00
|
| Rate for Payer: Multiplan Commercial |
$18,750.00
|
| Rate for Payer: Networks By Design Commercial |
$12,500.00
|
| Rate for Payer: Prime Health Services Commercial |
$21,250.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,382.50
|
| Rate for Payer: United Healthcare All Other HMO |
$9,132.50
|
| Rate for Payer: United Healthcare HMO Rider |
$8,935.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,187.50
|
|
|
HC DFIB B/S ENERGEN DR E143
|
Facility
|
OP
|
$25,000.00
|
|
|
Service Code
|
CPT C1721
|
| Hospital Charge Code |
906813661
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,000.00 |
| Max. Negotiated Rate |
$22,500.00 |
| Rate for Payer: Adventist Health Commercial |
$5,000.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,250.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13,750.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18,750.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,415.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,842.50
|
| Rate for Payer: Blue Shield of California Commercial |
$19,325.00
|
| Rate for Payer: Blue Shield of California EPN |
$12,600.00
|
| Rate for Payer: Cash Price |
$13,750.00
|
| Rate for Payer: Central Health Plan Commercial |
$20,000.00
|
| Rate for Payer: Cigna of CA HMO |
$17,500.00
|
| Rate for Payer: Cigna of CA PPO |
$17,500.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,250.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$21,250.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21,250.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10,000.00
|
| Rate for Payer: Galaxy Health WC |
$21,250.00
|
| Rate for Payer: Global Benefits Group Commercial |
$15,000.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22,500.00
|
| Rate for Payer: InnovAge PACE Commercial |
$12,500.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,675.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,475.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,000.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,500.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17,500.00
|
| Rate for Payer: Multiplan Commercial |
$18,750.00
|
| Rate for Payer: Networks By Design Commercial |
$12,500.00
|
| Rate for Payer: Prime Health Services Commercial |
$21,250.00
|
| Rate for Payer: Riverside University Health System MISP |
$10,000.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15,000.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15,000.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,382.50
|
| Rate for Payer: United Healthcare All Other HMO |
$9,132.50
|
| Rate for Payer: United Healthcare HMO Rider |
$8,935.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,187.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,250.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21,250.00
|
| Rate for Payer: Vantage Medical Group Senior |
$21,250.00
|
|
|
HC DFIB B/S ENERGEN RF DF4 N140
|
Facility
|
IP
|
$29,610.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813668
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,922.00 |
| Max. Negotiated Rate |
$26,649.00 |
| Rate for Payer: Adventist Health Commercial |
$5,922.00
|
| Rate for Payer: Blue Shield of California Commercial |
$22,888.53
|
| Rate for Payer: Blue Shield of California EPN |
$14,923.44
|
| Rate for Payer: Cash Price |
$16,285.50
|
| Rate for Payer: Central Health Plan Commercial |
$23,688.00
|
| Rate for Payer: Cigna of CA HMO |
$20,727.00
|
| Rate for Payer: Cigna of CA PPO |
$20,727.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,844.00
|
| Rate for Payer: EPIC Health Plan Senior |
$11,844.00
|
| Rate for Payer: Galaxy Health WC |
$25,168.50
|
| Rate for Payer: Global Benefits Group Commercial |
$17,766.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$26,649.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19,749.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,281.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18,328.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,922.00
|
| Rate for Payer: Multiplan Commercial |
$22,207.50
|
| Rate for Payer: Networks By Design Commercial |
$14,805.00
|
| Rate for Payer: Prime Health Services Commercial |
$25,168.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,112.63
|
| Rate for Payer: United Healthcare All Other HMO |
$10,816.53
|
| Rate for Payer: United Healthcare HMO Rider |
$10,582.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,697.27
|
|
|
HC DFIB B/S ENERGEN RF DF4 N140
|
Facility
|
OP
|
$29,610.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813668
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,922.00 |
| Max. Negotiated Rate |
$26,649.00 |
| Rate for Payer: Adventist Health Commercial |
$5,922.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25,168.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16,285.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22,207.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$13,519.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16,395.06
|
| Rate for Payer: Blue Shield of California Commercial |
$22,888.53
|
| Rate for Payer: Blue Shield of California EPN |
$14,923.44
|
| Rate for Payer: Cash Price |
$16,285.50
|
| Rate for Payer: Central Health Plan Commercial |
$23,688.00
|
| Rate for Payer: Cigna of CA HMO |
$20,727.00
|
| Rate for Payer: Cigna of CA PPO |
$20,727.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25,168.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,168.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25,168.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,844.00
|
| Rate for Payer: EPIC Health Plan Senior |
$11,844.00
|
| Rate for Payer: Galaxy Health WC |
$25,168.50
|
| Rate for Payer: Global Benefits Group Commercial |
$17,766.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$26,649.00
|
| Rate for Payer: InnovAge PACE Commercial |
$14,805.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19,749.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18,328.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,922.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20,727.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20,727.00
|
| Rate for Payer: Multiplan Commercial |
$22,207.50
|
| Rate for Payer: Networks By Design Commercial |
$14,805.00
|
| Rate for Payer: Prime Health Services Commercial |
$25,168.50
|
| Rate for Payer: Riverside University Health System MISP |
$11,844.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17,766.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17,766.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,112.63
|
| Rate for Payer: United Healthcare All Other HMO |
$10,816.53
|
| Rate for Payer: United Healthcare HMO Rider |
$10,582.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,697.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25,168.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,168.50
|
| Rate for Payer: Vantage Medical Group Senior |
$25,168.50
|
|
|
HC DFIB B/S ENERGEN RF N141
|
Facility
|
IP
|
$29,610.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813669
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,922.00 |
| Max. Negotiated Rate |
$26,649.00 |
| Rate for Payer: Adventist Health Commercial |
$5,922.00
|
| Rate for Payer: Blue Shield of California Commercial |
$22,888.53
|
| Rate for Payer: Blue Shield of California EPN |
$14,923.44
|
| Rate for Payer: Cash Price |
$16,285.50
|
| Rate for Payer: Central Health Plan Commercial |
$23,688.00
|
| Rate for Payer: Cigna of CA HMO |
$20,727.00
|
| Rate for Payer: Cigna of CA PPO |
$20,727.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,844.00
|
| Rate for Payer: EPIC Health Plan Senior |
$11,844.00
|
| Rate for Payer: Galaxy Health WC |
$25,168.50
|
| Rate for Payer: Global Benefits Group Commercial |
$17,766.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$26,649.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19,749.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,281.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18,328.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,922.00
|
| Rate for Payer: Multiplan Commercial |
$22,207.50
|
| Rate for Payer: Networks By Design Commercial |
$14,805.00
|
| Rate for Payer: Prime Health Services Commercial |
$25,168.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,112.63
|
| Rate for Payer: United Healthcare All Other HMO |
$10,816.53
|
| Rate for Payer: United Healthcare HMO Rider |
$10,582.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,697.27
|
|
|
HC DFIB B/S ENERGEN RF N141
|
Facility
|
OP
|
$29,610.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813669
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,922.00 |
| Max. Negotiated Rate |
$26,649.00 |
| Rate for Payer: Adventist Health Commercial |
$5,922.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25,168.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16,285.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22,207.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$13,519.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16,395.06
|
| Rate for Payer: Blue Shield of California Commercial |
$22,888.53
|
| Rate for Payer: Blue Shield of California EPN |
$14,923.44
|
| Rate for Payer: Cash Price |
$16,285.50
|
| Rate for Payer: Central Health Plan Commercial |
$23,688.00
|
| Rate for Payer: Cigna of CA HMO |
$20,727.00
|
| Rate for Payer: Cigna of CA PPO |
$20,727.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25,168.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,168.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25,168.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,844.00
|
| Rate for Payer: EPIC Health Plan Senior |
$11,844.00
|
| Rate for Payer: Galaxy Health WC |
$25,168.50
|
| Rate for Payer: Global Benefits Group Commercial |
$17,766.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$26,649.00
|
| Rate for Payer: InnovAge PACE Commercial |
$14,805.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19,749.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18,328.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,922.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20,727.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20,727.00
|
| Rate for Payer: Multiplan Commercial |
$22,207.50
|
| Rate for Payer: Networks By Design Commercial |
$14,805.00
|
| Rate for Payer: Prime Health Services Commercial |
$25,168.50
|
| Rate for Payer: Riverside University Health System MISP |
$11,844.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17,766.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17,766.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,112.63
|
| Rate for Payer: United Healthcare All Other HMO |
$10,816.53
|
| Rate for Payer: United Healthcare HMO Rider |
$10,582.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,697.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25,168.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,168.50
|
| Rate for Payer: Vantage Medical Group Senior |
$25,168.50
|
|
|
HC DFIB B/S ENERGEN VR DF4 E140
|
Facility
|
IP
|
$25,000.00
|
|
|
Service Code
|
CPT C1722
|
| Hospital Charge Code |
906813662
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,000.00 |
| Max. Negotiated Rate |
$22,500.00 |
| Rate for Payer: Adventist Health Commercial |
$5,000.00
|
| Rate for Payer: Blue Shield of California Commercial |
$19,325.00
|
| Rate for Payer: Blue Shield of California EPN |
$12,600.00
|
| Rate for Payer: Cash Price |
$13,750.00
|
| Rate for Payer: Central Health Plan Commercial |
$20,000.00
|
| Rate for Payer: Cigna of CA HMO |
$17,500.00
|
| Rate for Payer: Cigna of CA PPO |
$17,500.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10,000.00
|
| Rate for Payer: Galaxy Health WC |
$21,250.00
|
| Rate for Payer: Global Benefits Group Commercial |
$15,000.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22,500.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,675.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,525.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,475.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,000.00
|
| Rate for Payer: Multiplan Commercial |
$18,750.00
|
| Rate for Payer: Networks By Design Commercial |
$12,500.00
|
| Rate for Payer: Prime Health Services Commercial |
$21,250.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,382.50
|
| Rate for Payer: United Healthcare All Other HMO |
$9,132.50
|
| Rate for Payer: United Healthcare HMO Rider |
$8,935.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,187.50
|
|
|
HC DFIB B/S ENERGEN VR DF4 E140
|
Facility
|
OP
|
$25,000.00
|
|
|
Service Code
|
CPT C1722
|
| Hospital Charge Code |
906813662
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,000.00 |
| Max. Negotiated Rate |
$22,500.00 |
| Rate for Payer: Adventist Health Commercial |
$5,000.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,250.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13,750.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18,750.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,415.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,842.50
|
| Rate for Payer: Blue Shield of California Commercial |
$19,325.00
|
| Rate for Payer: Blue Shield of California EPN |
$12,600.00
|
| Rate for Payer: Cash Price |
$13,750.00
|
| Rate for Payer: Central Health Plan Commercial |
$20,000.00
|
| Rate for Payer: Cigna of CA HMO |
$17,500.00
|
| Rate for Payer: Cigna of CA PPO |
$17,500.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,250.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$21,250.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21,250.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10,000.00
|
| Rate for Payer: Galaxy Health WC |
$21,250.00
|
| Rate for Payer: Global Benefits Group Commercial |
$15,000.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22,500.00
|
| Rate for Payer: InnovAge PACE Commercial |
$12,500.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,675.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,475.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,000.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,500.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17,500.00
|
| Rate for Payer: Multiplan Commercial |
$18,750.00
|
| Rate for Payer: Networks By Design Commercial |
$12,500.00
|
| Rate for Payer: Prime Health Services Commercial |
$21,250.00
|
| Rate for Payer: Riverside University Health System MISP |
$10,000.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15,000.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15,000.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,382.50
|
| Rate for Payer: United Healthcare All Other HMO |
$9,132.50
|
| Rate for Payer: United Healthcare HMO Rider |
$8,935.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,187.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,250.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21,250.00
|
| Rate for Payer: Vantage Medical Group Senior |
$21,250.00
|
|
|
HC DFIB B/S ENERGEN VR E141
|
Facility
|
IP
|
$25,000.00
|
|
|
Service Code
|
CPT C1722
|
| Hospital Charge Code |
906813663
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,000.00 |
| Max. Negotiated Rate |
$22,500.00 |
| Rate for Payer: Adventist Health Commercial |
$5,000.00
|
| Rate for Payer: Blue Shield of California Commercial |
$19,325.00
|
| Rate for Payer: Blue Shield of California EPN |
$12,600.00
|
| Rate for Payer: Cash Price |
$13,750.00
|
| Rate for Payer: Central Health Plan Commercial |
$20,000.00
|
| Rate for Payer: Cigna of CA HMO |
$17,500.00
|
| Rate for Payer: Cigna of CA PPO |
$17,500.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10,000.00
|
| Rate for Payer: Galaxy Health WC |
$21,250.00
|
| Rate for Payer: Global Benefits Group Commercial |
$15,000.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22,500.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,675.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,525.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,475.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,000.00
|
| Rate for Payer: Multiplan Commercial |
$18,750.00
|
| Rate for Payer: Networks By Design Commercial |
$12,500.00
|
| Rate for Payer: Prime Health Services Commercial |
$21,250.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,382.50
|
| Rate for Payer: United Healthcare All Other HMO |
$9,132.50
|
| Rate for Payer: United Healthcare HMO Rider |
$8,935.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,187.50
|
|
|
HC DFIB B/S ENERGEN VR E141
|
Facility
|
OP
|
$25,000.00
|
|
|
Service Code
|
CPT C1722
|
| Hospital Charge Code |
906813663
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,000.00 |
| Max. Negotiated Rate |
$22,500.00 |
| Rate for Payer: Adventist Health Commercial |
$5,000.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,250.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13,750.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18,750.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,415.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,842.50
|
| Rate for Payer: Blue Shield of California Commercial |
$19,325.00
|
| Rate for Payer: Blue Shield of California EPN |
$12,600.00
|
| Rate for Payer: Cash Price |
$13,750.00
|
| Rate for Payer: Central Health Plan Commercial |
$20,000.00
|
| Rate for Payer: Cigna of CA HMO |
$17,500.00
|
| Rate for Payer: Cigna of CA PPO |
$17,500.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,250.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$21,250.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21,250.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10,000.00
|
| Rate for Payer: Galaxy Health WC |
$21,250.00
|
| Rate for Payer: Global Benefits Group Commercial |
$15,000.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22,500.00
|
| Rate for Payer: InnovAge PACE Commercial |
$12,500.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,675.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,475.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,000.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,500.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17,500.00
|
| Rate for Payer: Multiplan Commercial |
$18,750.00
|
| Rate for Payer: Networks By Design Commercial |
$12,500.00
|
| Rate for Payer: Prime Health Services Commercial |
$21,250.00
|
| Rate for Payer: Riverside University Health System MISP |
$10,000.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15,000.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15,000.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,382.50
|
| Rate for Payer: United Healthcare All Other HMO |
$9,132.50
|
| Rate for Payer: United Healthcare HMO Rider |
$8,935.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,187.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,250.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21,250.00
|
| Rate for Payer: Vantage Medical Group Senior |
$21,250.00
|
|
|
HC DFIB BS INCEPTA CRT-D N164
|
Facility
|
IP
|
$29,610.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813687
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,922.00 |
| Max. Negotiated Rate |
$26,649.00 |
| Rate for Payer: Adventist Health Commercial |
$5,922.00
|
| Rate for Payer: Blue Shield of California Commercial |
$22,888.53
|
| Rate for Payer: Blue Shield of California EPN |
$14,923.44
|
| Rate for Payer: Cash Price |
$16,285.50
|
| Rate for Payer: Central Health Plan Commercial |
$23,688.00
|
| Rate for Payer: Cigna of CA HMO |
$20,727.00
|
| Rate for Payer: Cigna of CA PPO |
$20,727.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,844.00
|
| Rate for Payer: EPIC Health Plan Senior |
$11,844.00
|
| Rate for Payer: Galaxy Health WC |
$25,168.50
|
| Rate for Payer: Global Benefits Group Commercial |
$17,766.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$26,649.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19,749.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,281.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18,328.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,922.00
|
| Rate for Payer: Multiplan Commercial |
$22,207.50
|
| Rate for Payer: Networks By Design Commercial |
$14,805.00
|
| Rate for Payer: Prime Health Services Commercial |
$25,168.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,112.63
|
| Rate for Payer: United Healthcare All Other HMO |
$10,816.53
|
| Rate for Payer: United Healthcare HMO Rider |
$10,582.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,697.27
|
|
|
HC DFIB BS INCEPTA CRT-D N164
|
Facility
|
OP
|
$29,610.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813687
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,922.00 |
| Max. Negotiated Rate |
$26,649.00 |
| Rate for Payer: Adventist Health Commercial |
$5,922.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25,168.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16,285.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22,207.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$13,519.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16,395.06
|
| Rate for Payer: Blue Shield of California Commercial |
$22,888.53
|
| Rate for Payer: Blue Shield of California EPN |
$14,923.44
|
| Rate for Payer: Cash Price |
$16,285.50
|
| Rate for Payer: Central Health Plan Commercial |
$23,688.00
|
| Rate for Payer: Cigna of CA HMO |
$20,727.00
|
| Rate for Payer: Cigna of CA PPO |
$20,727.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25,168.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,168.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25,168.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,844.00
|
| Rate for Payer: EPIC Health Plan Senior |
$11,844.00
|
| Rate for Payer: Galaxy Health WC |
$25,168.50
|
| Rate for Payer: Global Benefits Group Commercial |
$17,766.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$26,649.00
|
| Rate for Payer: InnovAge PACE Commercial |
$14,805.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19,749.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18,328.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,922.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20,727.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20,727.00
|
| Rate for Payer: Multiplan Commercial |
$22,207.50
|
| Rate for Payer: Networks By Design Commercial |
$14,805.00
|
| Rate for Payer: Prime Health Services Commercial |
$25,168.50
|
| Rate for Payer: Riverside University Health System MISP |
$11,844.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17,766.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17,766.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,112.63
|
| Rate for Payer: United Healthcare All Other HMO |
$10,816.53
|
| Rate for Payer: United Healthcare HMO Rider |
$10,582.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,697.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25,168.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,168.50
|
| Rate for Payer: Vantage Medical Group Senior |
$25,168.50
|
|
|
HC DFIB BS INCEPTA DF4 N160
|
Facility
|
OP
|
$29,910.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813701
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,982.00 |
| Max. Negotiated Rate |
$26,919.00 |
| Rate for Payer: Adventist Health Commercial |
$5,982.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25,423.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16,450.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22,432.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$13,656.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16,561.17
|
| Rate for Payer: Blue Shield of California Commercial |
$23,120.43
|
| Rate for Payer: Blue Shield of California EPN |
$15,074.64
|
| Rate for Payer: Cash Price |
$16,450.50
|
| Rate for Payer: Central Health Plan Commercial |
$23,928.00
|
| Rate for Payer: Cigna of CA HMO |
$20,937.00
|
| Rate for Payer: Cigna of CA PPO |
$20,937.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25,423.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,423.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25,423.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,964.00
|
| Rate for Payer: EPIC Health Plan Senior |
$11,964.00
|
| Rate for Payer: Galaxy Health WC |
$25,423.50
|
| Rate for Payer: Global Benefits Group Commercial |
$17,946.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$26,919.00
|
| Rate for Payer: InnovAge PACE Commercial |
$14,955.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19,949.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18,514.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,982.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20,937.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20,937.00
|
| Rate for Payer: Multiplan Commercial |
$22,432.50
|
| Rate for Payer: Networks By Design Commercial |
$14,955.00
|
| Rate for Payer: Prime Health Services Commercial |
$25,423.50
|
| Rate for Payer: Riverside University Health System MISP |
$11,964.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17,946.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17,946.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,225.22
|
| Rate for Payer: United Healthcare All Other HMO |
$10,926.12
|
| Rate for Payer: United Healthcare HMO Rider |
$10,689.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,795.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25,423.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,423.50
|
| Rate for Payer: Vantage Medical Group Senior |
$25,423.50
|
|
|
HC DFIB BS INCEPTA DF4 N160
|
Facility
|
IP
|
$29,910.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813701
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,982.00 |
| Max. Negotiated Rate |
$26,919.00 |
| Rate for Payer: Adventist Health Commercial |
$5,982.00
|
| Rate for Payer: Blue Shield of California Commercial |
$23,120.43
|
| Rate for Payer: Blue Shield of California EPN |
$15,074.64
|
| Rate for Payer: Cash Price |
$16,450.50
|
| Rate for Payer: Central Health Plan Commercial |
$23,928.00
|
| Rate for Payer: Cigna of CA HMO |
$20,937.00
|
| Rate for Payer: Cigna of CA PPO |
$20,937.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,964.00
|
| Rate for Payer: EPIC Health Plan Senior |
$11,964.00
|
| Rate for Payer: Galaxy Health WC |
$25,423.50
|
| Rate for Payer: Global Benefits Group Commercial |
$17,946.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$26,919.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19,949.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,395.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18,514.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,982.00
|
| Rate for Payer: Multiplan Commercial |
$22,432.50
|
| Rate for Payer: Networks By Design Commercial |
$14,955.00
|
| Rate for Payer: Prime Health Services Commercial |
$25,423.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,225.22
|
| Rate for Payer: United Healthcare All Other HMO |
$10,926.12
|
| Rate for Payer: United Healthcare HMO Rider |
$10,689.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,795.52
|
|
|
HC DFIB BS INCEPTA DR DF4 E162
|
Facility
|
IP
|
$25,000.00
|
|
|
Service Code
|
CPT C1721
|
| Hospital Charge Code |
906813697
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,000.00 |
| Max. Negotiated Rate |
$22,500.00 |
| Rate for Payer: Adventist Health Commercial |
$5,000.00
|
| Rate for Payer: Blue Shield of California Commercial |
$19,325.00
|
| Rate for Payer: Blue Shield of California EPN |
$12,600.00
|
| Rate for Payer: Cash Price |
$13,750.00
|
| Rate for Payer: Central Health Plan Commercial |
$20,000.00
|
| Rate for Payer: Cigna of CA HMO |
$17,500.00
|
| Rate for Payer: Cigna of CA PPO |
$17,500.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10,000.00
|
| Rate for Payer: Galaxy Health WC |
$21,250.00
|
| Rate for Payer: Global Benefits Group Commercial |
$15,000.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22,500.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,675.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,525.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,475.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,000.00
|
| Rate for Payer: Multiplan Commercial |
$18,750.00
|
| Rate for Payer: Networks By Design Commercial |
$12,500.00
|
| Rate for Payer: Prime Health Services Commercial |
$21,250.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,382.50
|
| Rate for Payer: United Healthcare All Other HMO |
$9,132.50
|
| Rate for Payer: United Healthcare HMO Rider |
$8,935.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,187.50
|
|
|
HC DFIB BS INCEPTA DR DF4 E162
|
Facility
|
OP
|
$25,000.00
|
|
|
Service Code
|
CPT C1721
|
| Hospital Charge Code |
906813697
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,000.00 |
| Max. Negotiated Rate |
$22,500.00 |
| Rate for Payer: Adventist Health Commercial |
$5,000.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,250.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13,750.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18,750.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,415.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,842.50
|
| Rate for Payer: Blue Shield of California Commercial |
$19,325.00
|
| Rate for Payer: Blue Shield of California EPN |
$12,600.00
|
| Rate for Payer: Cash Price |
$13,750.00
|
| Rate for Payer: Central Health Plan Commercial |
$20,000.00
|
| Rate for Payer: Cigna of CA HMO |
$17,500.00
|
| Rate for Payer: Cigna of CA PPO |
$17,500.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,250.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$21,250.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21,250.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10,000.00
|
| Rate for Payer: Galaxy Health WC |
$21,250.00
|
| Rate for Payer: Global Benefits Group Commercial |
$15,000.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22,500.00
|
| Rate for Payer: InnovAge PACE Commercial |
$12,500.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,675.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,475.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,000.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,500.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17,500.00
|
| Rate for Payer: Multiplan Commercial |
$18,750.00
|
| Rate for Payer: Networks By Design Commercial |
$12,500.00
|
| Rate for Payer: Prime Health Services Commercial |
$21,250.00
|
| Rate for Payer: Riverside University Health System MISP |
$10,000.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15,000.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15,000.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,382.50
|
| Rate for Payer: United Healthcare All Other HMO |
$9,132.50
|
| Rate for Payer: United Healthcare HMO Rider |
$8,935.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,187.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,250.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21,250.00
|
| Rate for Payer: Vantage Medical Group Senior |
$21,250.00
|
|
|
HC DFIB BS INCEPTA DR E163
|
Facility
|
IP
|
$25,000.00
|
|
|
Service Code
|
CPT C1721
|
| Hospital Charge Code |
906813698
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,000.00 |
| Max. Negotiated Rate |
$22,500.00 |
| Rate for Payer: Adventist Health Commercial |
$5,000.00
|
| Rate for Payer: Blue Shield of California Commercial |
$19,325.00
|
| Rate for Payer: Blue Shield of California EPN |
$12,600.00
|
| Rate for Payer: Cash Price |
$13,750.00
|
| Rate for Payer: Central Health Plan Commercial |
$20,000.00
|
| Rate for Payer: Cigna of CA HMO |
$17,500.00
|
| Rate for Payer: Cigna of CA PPO |
$17,500.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10,000.00
|
| Rate for Payer: Galaxy Health WC |
$21,250.00
|
| Rate for Payer: Global Benefits Group Commercial |
$15,000.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22,500.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,675.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,525.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,475.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,000.00
|
| Rate for Payer: Multiplan Commercial |
$18,750.00
|
| Rate for Payer: Networks By Design Commercial |
$12,500.00
|
| Rate for Payer: Prime Health Services Commercial |
$21,250.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,382.50
|
| Rate for Payer: United Healthcare All Other HMO |
$9,132.50
|
| Rate for Payer: United Healthcare HMO Rider |
$8,935.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,187.50
|
|
|
HC DFIB BS INCEPTA DR E163
|
Facility
|
OP
|
$25,000.00
|
|
|
Service Code
|
CPT C1721
|
| Hospital Charge Code |
906813698
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,000.00 |
| Max. Negotiated Rate |
$22,500.00 |
| Rate for Payer: Adventist Health Commercial |
$5,000.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,250.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13,750.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18,750.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,415.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,842.50
|
| Rate for Payer: Blue Shield of California Commercial |
$19,325.00
|
| Rate for Payer: Blue Shield of California EPN |
$12,600.00
|
| Rate for Payer: Cash Price |
$13,750.00
|
| Rate for Payer: Central Health Plan Commercial |
$20,000.00
|
| Rate for Payer: Cigna of CA HMO |
$17,500.00
|
| Rate for Payer: Cigna of CA PPO |
$17,500.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,250.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$21,250.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21,250.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10,000.00
|
| Rate for Payer: Galaxy Health WC |
$21,250.00
|
| Rate for Payer: Global Benefits Group Commercial |
$15,000.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22,500.00
|
| Rate for Payer: InnovAge PACE Commercial |
$12,500.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,675.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,475.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,000.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,500.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17,500.00
|
| Rate for Payer: Multiplan Commercial |
$18,750.00
|
| Rate for Payer: Networks By Design Commercial |
$12,500.00
|
| Rate for Payer: Prime Health Services Commercial |
$21,250.00
|
| Rate for Payer: Riverside University Health System MISP |
$10,000.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15,000.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15,000.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,382.50
|
| Rate for Payer: United Healthcare All Other HMO |
$9,132.50
|
| Rate for Payer: United Healthcare HMO Rider |
$8,935.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,187.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,250.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21,250.00
|
| Rate for Payer: Vantage Medical Group Senior |
$21,250.00
|
|
|
HC DFIB BS INCEPTA N161
|
Facility
|
IP
|
$29,910.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813702
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,982.00 |
| Max. Negotiated Rate |
$26,919.00 |
| Rate for Payer: Adventist Health Commercial |
$5,982.00
|
| Rate for Payer: Blue Shield of California Commercial |
$23,120.43
|
| Rate for Payer: Blue Shield of California EPN |
$15,074.64
|
| Rate for Payer: Cash Price |
$16,450.50
|
| Rate for Payer: Central Health Plan Commercial |
$23,928.00
|
| Rate for Payer: Cigna of CA HMO |
$20,937.00
|
| Rate for Payer: Cigna of CA PPO |
$20,937.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,964.00
|
| Rate for Payer: EPIC Health Plan Senior |
$11,964.00
|
| Rate for Payer: Galaxy Health WC |
$25,423.50
|
| Rate for Payer: Global Benefits Group Commercial |
$17,946.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$26,919.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19,949.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,395.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18,514.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,982.00
|
| Rate for Payer: Multiplan Commercial |
$22,432.50
|
| Rate for Payer: Networks By Design Commercial |
$14,955.00
|
| Rate for Payer: Prime Health Services Commercial |
$25,423.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,225.22
|
| Rate for Payer: United Healthcare All Other HMO |
$10,926.12
|
| Rate for Payer: United Healthcare HMO Rider |
$10,689.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,795.52
|
|
|
HC DFIB BS INCEPTA N161
|
Facility
|
OP
|
$29,910.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813702
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,982.00 |
| Max. Negotiated Rate |
$26,919.00 |
| Rate for Payer: Adventist Health Commercial |
$5,982.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25,423.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16,450.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22,432.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$13,656.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16,561.17
|
| Rate for Payer: Blue Shield of California Commercial |
$23,120.43
|
| Rate for Payer: Blue Shield of California EPN |
$15,074.64
|
| Rate for Payer: Cash Price |
$16,450.50
|
| Rate for Payer: Central Health Plan Commercial |
$23,928.00
|
| Rate for Payer: Cigna of CA HMO |
$20,937.00
|
| Rate for Payer: Cigna of CA PPO |
$20,937.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25,423.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,423.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25,423.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,964.00
|
| Rate for Payer: EPIC Health Plan Senior |
$11,964.00
|
| Rate for Payer: Galaxy Health WC |
$25,423.50
|
| Rate for Payer: Global Benefits Group Commercial |
$17,946.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$26,919.00
|
| Rate for Payer: InnovAge PACE Commercial |
$14,955.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19,949.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18,514.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,982.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20,937.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20,937.00
|
| Rate for Payer: Multiplan Commercial |
$22,432.50
|
| Rate for Payer: Networks By Design Commercial |
$14,955.00
|
| Rate for Payer: Prime Health Services Commercial |
$25,423.50
|
| Rate for Payer: Riverside University Health System MISP |
$11,964.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17,946.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17,946.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,225.22
|
| Rate for Payer: United Healthcare All Other HMO |
$10,926.12
|
| Rate for Payer: United Healthcare HMO Rider |
$10,689.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,795.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25,423.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,423.50
|
| Rate for Payer: Vantage Medical Group Senior |
$25,423.50
|
|
