|
HC DFIB BS INCEPTA VR DF4 E160
|
Facility
|
IP
|
$25,000.00
|
|
|
Service Code
|
CPT C1722
|
| Hospital Charge Code |
906813699
|
|
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 VR DF4 E160
|
Facility
|
OP
|
$25,000.00
|
|
|
Service Code
|
CPT C1722
|
| Hospital Charge Code |
906813699
|
|
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 VR E161
|
Facility
|
OP
|
$25,000.00
|
|
|
Service Code
|
CPT C1722
|
| Hospital Charge Code |
906813700
|
|
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 VR E161
|
Facility
|
IP
|
$25,000.00
|
|
|
Service Code
|
CPT C1722
|
| Hospital Charge Code |
906813700
|
|
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 SQ RX PULSE 1010
|
Facility
|
IP
|
$31,500.00
|
|
|
Service Code
|
CPT C1722
|
| Hospital Charge Code |
906813706
|
|
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: 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: 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: Kaiser Permanente of CA Commercial/Self Funded |
$21,010.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,001.50
|
| 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: 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: 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
|
|
|
HC DFIB BS SQ RX PULSE 1010
|
Facility
|
OP
|
$31,500.00
|
|
|
Service Code
|
CPT C1722
|
| Hospital Charge Code |
906813706
|
|
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 TELIGEN 100 E110
|
Facility
|
OP
|
$21,735.00
|
|
|
Service Code
|
CPT C1721
|
| Hospital Charge Code |
906813610
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,347.00 |
| Max. Negotiated Rate |
$19,561.50 |
| Rate for Payer: Adventist Health Commercial |
$4,347.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18,474.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11,954.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16,301.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9,924.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,034.67
|
| Rate for Payer: Blue Shield of California Commercial |
$16,801.15
|
| Rate for Payer: Blue Shield of California EPN |
$10,954.44
|
| Rate for Payer: Cash Price |
$11,954.25
|
| Rate for Payer: Central Health Plan Commercial |
$17,388.00
|
| Rate for Payer: Cigna of CA HMO |
$15,214.50
|
| Rate for Payer: Cigna of CA PPO |
$15,214.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18,474.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$18,474.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18,474.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,694.00
|
| Rate for Payer: EPIC Health Plan Senior |
$8,694.00
|
| Rate for Payer: Galaxy Health WC |
$18,474.75
|
| Rate for Payer: Global Benefits Group Commercial |
$13,041.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$19,561.50
|
| Rate for Payer: InnovAge PACE Commercial |
$10,867.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,497.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,453.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,347.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15,214.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15,214.50
|
| Rate for Payer: Multiplan Commercial |
$16,301.25
|
| Rate for Payer: Networks By Design Commercial |
$10,867.50
|
| Rate for Payer: Prime Health Services Commercial |
$18,474.75
|
| Rate for Payer: Riverside University Health System MISP |
$8,694.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13,041.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13,041.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,157.15
|
| Rate for Payer: United Healthcare All Other HMO |
$7,939.80
|
| Rate for Payer: United Healthcare HMO Rider |
$7,768.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,118.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18,474.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18,474.75
|
| Rate for Payer: Vantage Medical Group Senior |
$18,474.75
|
|
|
HC DFIB B/S TELIGEN 100 E110
|
Facility
|
IP
|
$21,735.00
|
|
|
Service Code
|
CPT C1721
|
| Hospital Charge Code |
906813610
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,347.00 |
| Max. Negotiated Rate |
$19,561.50 |
| Rate for Payer: Adventist Health Commercial |
$4,347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$16,801.15
|
| Rate for Payer: Blue Shield of California EPN |
$10,954.44
|
| Rate for Payer: Cash Price |
$11,954.25
|
| Rate for Payer: Central Health Plan Commercial |
$17,388.00
|
| Rate for Payer: Cigna of CA HMO |
$15,214.50
|
| Rate for Payer: Cigna of CA PPO |
$15,214.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,694.00
|
| Rate for Payer: EPIC Health Plan Senior |
$8,694.00
|
| Rate for Payer: Galaxy Health WC |
$18,474.75
|
| Rate for Payer: Global Benefits Group Commercial |
$13,041.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$19,561.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,497.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,281.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,453.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,347.00
|
| Rate for Payer: Multiplan Commercial |
$16,301.25
|
| Rate for Payer: Networks By Design Commercial |
$10,867.50
|
| Rate for Payer: Prime Health Services Commercial |
$18,474.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,157.15
|
| Rate for Payer: United Healthcare All Other HMO |
$7,939.80
|
| Rate for Payer: United Healthcare HMO Rider |
$7,768.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,118.21
|
|
|
HC DFIB B/S TELIGEN VR E102
|
Facility
|
IP
|
$25,000.00
|
|
|
Service Code
|
CPT C1722
|
| Hospital Charge Code |
906813626
|
|
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 TELIGEN VR E102
|
Facility
|
OP
|
$25,000.00
|
|
|
Service Code
|
CPT C1722
|
| Hospital Charge Code |
906813626
|
|
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 INOGEN MINI D013
|
Facility
|
OP
|
$24,775.00
|
|
|
Service Code
|
CPT C1721
|
| Hospital Charge Code |
906813724
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,955.00 |
| Max. Negotiated Rate |
$22,297.50 |
| Rate for Payer: Adventist Health Commercial |
$4,955.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,058.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13,626.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18,581.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,312.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,717.92
|
| Rate for Payer: Blue Shield of California Commercial |
$19,151.08
|
| Rate for Payer: Blue Shield of California EPN |
$12,486.60
|
| Rate for Payer: Cash Price |
$13,626.25
|
| Rate for Payer: Central Health Plan Commercial |
$19,820.00
|
| Rate for Payer: Cigna of CA HMO |
$17,342.50
|
| Rate for Payer: Cigna of CA PPO |
$17,342.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,058.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$21,058.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21,058.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,910.00
|
| Rate for Payer: EPIC Health Plan Senior |
$9,910.00
|
| Rate for Payer: Galaxy Health WC |
$21,058.75
|
| Rate for Payer: Global Benefits Group Commercial |
$14,865.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22,297.50
|
| Rate for Payer: InnovAge PACE Commercial |
$12,387.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,524.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,335.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,955.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,342.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17,342.50
|
| Rate for Payer: Multiplan Commercial |
$18,581.25
|
| Rate for Payer: Networks By Design Commercial |
$12,387.50
|
| Rate for Payer: Prime Health Services Commercial |
$21,058.75
|
| Rate for Payer: Riverside University Health System MISP |
$9,910.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14,865.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14,865.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,298.06
|
| Rate for Payer: United Healthcare All Other HMO |
$9,050.31
|
| Rate for Payer: United Healthcare HMO Rider |
$8,854.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,113.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,058.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21,058.75
|
| Rate for Payer: Vantage Medical Group Senior |
$21,058.75
|
|
|
HC DFIB INOGEN MINI D013
|
Facility
|
IP
|
$24,775.00
|
|
|
Service Code
|
CPT C1721
|
| Hospital Charge Code |
906813724
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,955.00 |
| Max. Negotiated Rate |
$22,297.50 |
| Rate for Payer: Adventist Health Commercial |
$4,955.00
|
| Rate for Payer: Blue Shield of California Commercial |
$19,151.08
|
| Rate for Payer: Blue Shield of California EPN |
$12,486.60
|
| Rate for Payer: Cash Price |
$13,626.25
|
| Rate for Payer: Central Health Plan Commercial |
$19,820.00
|
| Rate for Payer: Cigna of CA HMO |
$17,342.50
|
| Rate for Payer: Cigna of CA PPO |
$17,342.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,910.00
|
| Rate for Payer: EPIC Health Plan Senior |
$9,910.00
|
| Rate for Payer: Galaxy Health WC |
$21,058.75
|
| Rate for Payer: Global Benefits Group Commercial |
$14,865.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22,297.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,524.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,439.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,335.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,955.00
|
| Rate for Payer: Multiplan Commercial |
$18,581.25
|
| Rate for Payer: Networks By Design Commercial |
$12,387.50
|
| Rate for Payer: Prime Health Services Commercial |
$21,058.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,298.06
|
| Rate for Payer: United Healthcare All Other HMO |
$9,050.31
|
| Rate for Payer: United Healthcare HMO Rider |
$8,854.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,113.81
|
|
|
HC DFIB IPERIA 7 HF-T 393009
|
Facility
|
IP
|
$25,725.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813817
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,145.00 |
| Max. Negotiated Rate |
$23,152.50 |
| Rate for Payer: Adventist Health Commercial |
$5,145.00
|
| Rate for Payer: Blue Shield of California Commercial |
$19,885.42
|
| Rate for Payer: Blue Shield of California EPN |
$12,965.40
|
| Rate for Payer: Cash Price |
$14,148.75
|
| Rate for Payer: Central Health Plan Commercial |
$20,580.00
|
| Rate for Payer: Cigna of CA HMO |
$18,007.50
|
| Rate for Payer: Cigna of CA PPO |
$18,007.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,290.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10,290.00
|
| Rate for Payer: Galaxy Health WC |
$21,866.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15,435.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$23,152.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17,158.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,801.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,923.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,145.00
|
| Rate for Payer: Multiplan Commercial |
$19,293.75
|
| Rate for Payer: Networks By Design Commercial |
$12,862.50
|
| Rate for Payer: Prime Health Services Commercial |
$21,866.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,654.59
|
| Rate for Payer: United Healthcare All Other HMO |
$9,397.34
|
| Rate for Payer: United Healthcare HMO Rider |
$9,194.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,424.94
|
|
|
HC DFIB IPERIA 7 HF-T 393009
|
Facility
|
OP
|
$25,725.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813817
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,145.00 |
| Max. Negotiated Rate |
$23,152.50 |
| Rate for Payer: Adventist Health Commercial |
$5,145.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,866.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14,148.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19,293.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,746.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,243.93
|
| Rate for Payer: Blue Shield of California Commercial |
$19,885.42
|
| Rate for Payer: Blue Shield of California EPN |
$12,965.40
|
| Rate for Payer: Cash Price |
$14,148.75
|
| Rate for Payer: Central Health Plan Commercial |
$20,580.00
|
| Rate for Payer: Cigna of CA HMO |
$18,007.50
|
| Rate for Payer: Cigna of CA PPO |
$18,007.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,866.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$21,866.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21,866.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,290.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10,290.00
|
| Rate for Payer: Galaxy Health WC |
$21,866.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15,435.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$23,152.50
|
| Rate for Payer: InnovAge PACE Commercial |
$12,862.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17,158.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,923.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,145.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,007.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18,007.50
|
| Rate for Payer: Multiplan Commercial |
$19,293.75
|
| Rate for Payer: Networks By Design Commercial |
$12,862.50
|
| Rate for Payer: Prime Health Services Commercial |
$21,866.25
|
| Rate for Payer: Riverside University Health System MISP |
$10,290.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15,435.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15,435.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,654.59
|
| Rate for Payer: United Healthcare All Other HMO |
$9,397.34
|
| Rate for Payer: United Healthcare HMO Rider |
$9,194.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,424.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,866.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21,866.25
|
| Rate for Payer: Vantage Medical Group Senior |
$21,866.25
|
|
|
HC DFIB MED AMPLIA MRI DTMB1D1
|
Facility
|
IP
|
$29,250.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813787
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,850.00 |
| Max. Negotiated Rate |
$26,325.00 |
| Rate for Payer: Adventist Health Commercial |
$5,850.00
|
| Rate for Payer: Blue Shield of California Commercial |
$22,610.25
|
| Rate for Payer: Blue Shield of California EPN |
$14,742.00
|
| Rate for Payer: Cash Price |
$16,087.50
|
| Rate for Payer: Central Health Plan Commercial |
$23,400.00
|
| Rate for Payer: Cigna of CA HMO |
$20,475.00
|
| Rate for Payer: Cigna of CA PPO |
$20,475.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,700.00
|
| Rate for Payer: EPIC Health Plan Senior |
$11,700.00
|
| Rate for Payer: Galaxy Health WC |
$24,862.50
|
| Rate for Payer: Global Benefits Group Commercial |
$17,550.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$26,325.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19,509.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,144.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18,105.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,850.00
|
| Rate for Payer: Multiplan Commercial |
$21,937.50
|
| Rate for Payer: Networks By Design Commercial |
$14,625.00
|
| Rate for Payer: Prime Health Services Commercial |
$24,862.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,977.52
|
| Rate for Payer: United Healthcare All Other HMO |
$10,685.02
|
| Rate for Payer: United Healthcare HMO Rider |
$10,453.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,579.38
|
|
|
HC DFIB MED AMPLIA MRI DTMB1D1
|
Facility
|
OP
|
$29,250.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813787
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,850.00 |
| Max. Negotiated Rate |
$26,325.00 |
| Rate for Payer: Adventist Health Commercial |
$5,850.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24,862.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16,087.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21,937.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$13,355.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16,195.73
|
| Rate for Payer: Blue Shield of California Commercial |
$22,610.25
|
| Rate for Payer: Blue Shield of California EPN |
$14,742.00
|
| Rate for Payer: Cash Price |
$16,087.50
|
| Rate for Payer: Central Health Plan Commercial |
$23,400.00
|
| Rate for Payer: Cigna of CA HMO |
$20,475.00
|
| Rate for Payer: Cigna of CA PPO |
$20,475.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24,862.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$24,862.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24,862.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,700.00
|
| Rate for Payer: EPIC Health Plan Senior |
$11,700.00
|
| Rate for Payer: Galaxy Health WC |
$24,862.50
|
| Rate for Payer: Global Benefits Group Commercial |
$17,550.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$26,325.00
|
| Rate for Payer: InnovAge PACE Commercial |
$14,625.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19,509.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18,105.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,850.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20,475.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20,475.00
|
| Rate for Payer: Multiplan Commercial |
$21,937.50
|
| Rate for Payer: Networks By Design Commercial |
$14,625.00
|
| Rate for Payer: Prime Health Services Commercial |
$24,862.50
|
| Rate for Payer: Riverside University Health System MISP |
$11,700.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17,550.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17,550.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,977.52
|
| Rate for Payer: United Healthcare All Other HMO |
$10,685.02
|
| Rate for Payer: United Healthcare HMO Rider |
$10,453.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,579.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24,862.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24,862.50
|
| Rate for Payer: Vantage Medical Group Senior |
$24,862.50
|
|
|
HC DFIB MED AMPLIA MRI DTMB1D4
|
Facility
|
OP
|
$29,250.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813771
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,850.00 |
| Max. Negotiated Rate |
$26,325.00 |
| Rate for Payer: Adventist Health Commercial |
$5,850.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24,862.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16,087.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21,937.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$13,355.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16,195.73
|
| Rate for Payer: Blue Shield of California Commercial |
$22,610.25
|
| Rate for Payer: Blue Shield of California EPN |
$14,742.00
|
| Rate for Payer: Cash Price |
$16,087.50
|
| Rate for Payer: Central Health Plan Commercial |
$23,400.00
|
| Rate for Payer: Cigna of CA HMO |
$20,475.00
|
| Rate for Payer: Cigna of CA PPO |
$20,475.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24,862.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$24,862.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24,862.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,700.00
|
| Rate for Payer: EPIC Health Plan Senior |
$11,700.00
|
| Rate for Payer: Galaxy Health WC |
$24,862.50
|
| Rate for Payer: Global Benefits Group Commercial |
$17,550.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$26,325.00
|
| Rate for Payer: InnovAge PACE Commercial |
$14,625.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19,509.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18,105.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,850.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20,475.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20,475.00
|
| Rate for Payer: Multiplan Commercial |
$21,937.50
|
| Rate for Payer: Networks By Design Commercial |
$14,625.00
|
| Rate for Payer: Prime Health Services Commercial |
$24,862.50
|
| Rate for Payer: Riverside University Health System MISP |
$11,700.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17,550.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17,550.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,977.52
|
| Rate for Payer: United Healthcare All Other HMO |
$10,685.02
|
| Rate for Payer: United Healthcare HMO Rider |
$10,453.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,579.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24,862.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24,862.50
|
| Rate for Payer: Vantage Medical Group Senior |
$24,862.50
|
|
|
HC DFIB MED AMPLIA MRI DTMB1D4
|
Facility
|
IP
|
$29,250.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813771
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,850.00 |
| Max. Negotiated Rate |
$26,325.00 |
| Rate for Payer: Adventist Health Commercial |
$5,850.00
|
| Rate for Payer: Blue Shield of California Commercial |
$22,610.25
|
| Rate for Payer: Blue Shield of California EPN |
$14,742.00
|
| Rate for Payer: Cash Price |
$16,087.50
|
| Rate for Payer: Central Health Plan Commercial |
$23,400.00
|
| Rate for Payer: Cigna of CA HMO |
$20,475.00
|
| Rate for Payer: Cigna of CA PPO |
$20,475.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,700.00
|
| Rate for Payer: EPIC Health Plan Senior |
$11,700.00
|
| Rate for Payer: Galaxy Health WC |
$24,862.50
|
| Rate for Payer: Global Benefits Group Commercial |
$17,550.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$26,325.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19,509.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,144.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18,105.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,850.00
|
| Rate for Payer: Multiplan Commercial |
$21,937.50
|
| Rate for Payer: Networks By Design Commercial |
$14,625.00
|
| Rate for Payer: Prime Health Services Commercial |
$24,862.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,977.52
|
| Rate for Payer: United Healthcare All Other HMO |
$10,685.02
|
| Rate for Payer: United Healthcare HMO Rider |
$10,453.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,579.38
|
|
|
HC DFIB MED AMPLIA MRI DTMB1Q1
|
Facility
|
IP
|
$30,000.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813793
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,000.00 |
| Max. Negotiated Rate |
$27,000.00 |
| Rate for Payer: Adventist Health Commercial |
$6,000.00
|
| Rate for Payer: Blue Shield of California Commercial |
$23,190.00
|
| Rate for Payer: Blue Shield of California EPN |
$15,120.00
|
| Rate for Payer: Cash Price |
$16,500.00
|
| Rate for Payer: Central Health Plan Commercial |
$24,000.00
|
| Rate for Payer: Cigna of CA HMO |
$21,000.00
|
| Rate for Payer: Cigna of CA PPO |
$21,000.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$12,000.00
|
| Rate for Payer: Galaxy Health WC |
$25,500.00
|
| Rate for Payer: Global Benefits Group Commercial |
$18,000.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$27,000.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20,010.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,430.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18,570.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,000.00
|
| Rate for Payer: Multiplan Commercial |
$22,500.00
|
| Rate for Payer: Networks By Design Commercial |
$15,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$25,500.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,259.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,959.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,722.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,825.00
|
|
|
HC DFIB MED AMPLIA MRI DTMB1Q1
|
Facility
|
OP
|
$30,000.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813793
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,000.00 |
| Max. Negotiated Rate |
$27,000.00 |
| Rate for Payer: Adventist Health Commercial |
$6,000.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25,500.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16,500.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22,500.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$13,698.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16,611.00
|
| Rate for Payer: Blue Shield of California Commercial |
$23,190.00
|
| Rate for Payer: Blue Shield of California EPN |
$15,120.00
|
| Rate for Payer: Cash Price |
$16,500.00
|
| Rate for Payer: Central Health Plan Commercial |
$24,000.00
|
| Rate for Payer: Cigna of CA HMO |
$21,000.00
|
| Rate for Payer: Cigna of CA PPO |
$21,000.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25,500.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,500.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25,500.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$12,000.00
|
| Rate for Payer: Galaxy Health WC |
$25,500.00
|
| Rate for Payer: Global Benefits Group Commercial |
$18,000.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$27,000.00
|
| Rate for Payer: InnovAge PACE Commercial |
$15,000.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20,010.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18,570.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,000.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21,000.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21,000.00
|
| Rate for Payer: Multiplan Commercial |
$22,500.00
|
| Rate for Payer: Networks By Design Commercial |
$15,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$25,500.00
|
| Rate for Payer: Riverside University Health System MISP |
$12,000.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18,000.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18,000.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,259.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,959.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,722.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,825.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25,500.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,500.00
|
| Rate for Payer: Vantage Medical Group Senior |
$25,500.00
|
|
|
HC DFIB MED AMPLIA MRI DTMC1QQ
|
Facility
|
OP
|
$29,250.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813772
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,850.00 |
| Max. Negotiated Rate |
$26,325.00 |
| Rate for Payer: Adventist Health Commercial |
$5,850.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24,862.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16,087.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21,937.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$13,355.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16,195.73
|
| Rate for Payer: Blue Shield of California Commercial |
$22,610.25
|
| Rate for Payer: Blue Shield of California EPN |
$14,742.00
|
| Rate for Payer: Cash Price |
$16,087.50
|
| Rate for Payer: Central Health Plan Commercial |
$23,400.00
|
| Rate for Payer: Cigna of CA HMO |
$20,475.00
|
| Rate for Payer: Cigna of CA PPO |
$20,475.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24,862.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$24,862.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24,862.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,700.00
|
| Rate for Payer: EPIC Health Plan Senior |
$11,700.00
|
| Rate for Payer: Galaxy Health WC |
$24,862.50
|
| Rate for Payer: Global Benefits Group Commercial |
$17,550.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$26,325.00
|
| Rate for Payer: InnovAge PACE Commercial |
$14,625.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19,509.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18,105.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,850.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20,475.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20,475.00
|
| Rate for Payer: Multiplan Commercial |
$21,937.50
|
| Rate for Payer: Networks By Design Commercial |
$14,625.00
|
| Rate for Payer: Prime Health Services Commercial |
$24,862.50
|
| Rate for Payer: Riverside University Health System MISP |
$11,700.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17,550.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17,550.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,977.52
|
| Rate for Payer: United Healthcare All Other HMO |
$10,685.02
|
| Rate for Payer: United Healthcare HMO Rider |
$10,453.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,579.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24,862.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24,862.50
|
| Rate for Payer: Vantage Medical Group Senior |
$24,862.50
|
|
|
HC DFIB MED AMPLIA MRI DTMC1QQ
|
Facility
|
IP
|
$29,250.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813772
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,850.00 |
| Max. Negotiated Rate |
$26,325.00 |
| Rate for Payer: Adventist Health Commercial |
$5,850.00
|
| Rate for Payer: Blue Shield of California Commercial |
$22,610.25
|
| Rate for Payer: Blue Shield of California EPN |
$14,742.00
|
| Rate for Payer: Cash Price |
$16,087.50
|
| Rate for Payer: Central Health Plan Commercial |
$23,400.00
|
| Rate for Payer: Cigna of CA HMO |
$20,475.00
|
| Rate for Payer: Cigna of CA PPO |
$20,475.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,700.00
|
| Rate for Payer: EPIC Health Plan Senior |
$11,700.00
|
| Rate for Payer: Galaxy Health WC |
$24,862.50
|
| Rate for Payer: Global Benefits Group Commercial |
$17,550.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$26,325.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19,509.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,144.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18,105.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,850.00
|
| Rate for Payer: Multiplan Commercial |
$21,937.50
|
| Rate for Payer: Networks By Design Commercial |
$14,625.00
|
| Rate for Payer: Prime Health Services Commercial |
$24,862.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,977.52
|
| Rate for Payer: United Healthcare All Other HMO |
$10,685.02
|
| Rate for Payer: United Healthcare HMO Rider |
$10,453.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,579.38
|
|
|
HC DFIB MED CLARIA MRI QD DTMA1QQ
|
Facility
|
OP
|
$27,492.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813825
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,498.40 |
| Max. Negotiated Rate |
$24,742.80 |
| Rate for Payer: Adventist Health Commercial |
$5,498.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23,368.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,120.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20,619.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$12,552.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,222.32
|
| Rate for Payer: Blue Shield of California Commercial |
$21,251.32
|
| Rate for Payer: Blue Shield of California EPN |
$13,855.97
|
| Rate for Payer: Cash Price |
$15,120.60
|
| Rate for Payer: Central Health Plan Commercial |
$21,993.60
|
| Rate for Payer: Cigna of CA HMO |
$19,244.40
|
| Rate for Payer: Cigna of CA PPO |
$19,244.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23,368.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$23,368.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23,368.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,996.80
|
| Rate for Payer: EPIC Health Plan Senior |
$10,996.80
|
| Rate for Payer: Galaxy Health WC |
$23,368.20
|
| Rate for Payer: Global Benefits Group Commercial |
$16,495.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$24,742.80
|
| Rate for Payer: InnovAge PACE Commercial |
$13,746.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18,337.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17,017.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,498.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19,244.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,244.40
|
| Rate for Payer: Multiplan Commercial |
$20,619.00
|
| Rate for Payer: Networks By Design Commercial |
$13,746.00
|
| Rate for Payer: Prime Health Services Commercial |
$23,368.20
|
| Rate for Payer: Riverside University Health System MISP |
$10,996.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16,495.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16,495.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,317.75
|
| Rate for Payer: United Healthcare All Other HMO |
$10,042.83
|
| Rate for Payer: United Healthcare HMO Rider |
$9,825.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,003.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23,368.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23,368.20
|
| Rate for Payer: Vantage Medical Group Senior |
$23,368.20
|
|
|
HC DFIB MED CLARIA MRI QD DTMA1QQ
|
Facility
|
IP
|
$27,492.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813825
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,498.40 |
| Max. Negotiated Rate |
$24,742.80 |
| Rate for Payer: Adventist Health Commercial |
$5,498.40
|
| Rate for Payer: Blue Shield of California Commercial |
$21,251.32
|
| Rate for Payer: Blue Shield of California EPN |
$13,855.97
|
| Rate for Payer: Cash Price |
$15,120.60
|
| Rate for Payer: Central Health Plan Commercial |
$21,993.60
|
| Rate for Payer: Cigna of CA HMO |
$19,244.40
|
| Rate for Payer: Cigna of CA PPO |
$19,244.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,996.80
|
| Rate for Payer: EPIC Health Plan Senior |
$10,996.80
|
| Rate for Payer: Galaxy Health WC |
$23,368.20
|
| Rate for Payer: Global Benefits Group Commercial |
$16,495.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$24,742.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18,337.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,474.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17,017.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,498.40
|
| Rate for Payer: Multiplan Commercial |
$20,619.00
|
| Rate for Payer: Networks By Design Commercial |
$13,746.00
|
| Rate for Payer: Prime Health Services Commercial |
$23,368.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,317.75
|
| Rate for Payer: United Healthcare All Other HMO |
$10,042.83
|
| Rate for Payer: United Healthcare HMO Rider |
$9,825.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,003.63
|
|
|
HC DFIB MED CONSULTA D204TRM
|
Facility
|
IP
|
$34,492.50
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813674
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,898.50 |
| Max. Negotiated Rate |
$31,043.25 |
| Rate for Payer: Adventist Health Commercial |
$6,898.50
|
| Rate for Payer: Blue Shield of California Commercial |
$26,662.70
|
| Rate for Payer: Blue Shield of California EPN |
$17,384.22
|
| Rate for Payer: Cash Price |
$18,970.88
|
| Rate for Payer: Central Health Plan Commercial |
$27,594.00
|
| Rate for Payer: Cigna of CA HMO |
$24,144.75
|
| Rate for Payer: Cigna of CA PPO |
$24,144.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,797.00
|
| Rate for Payer: EPIC Health Plan Senior |
$13,797.00
|
| Rate for Payer: Galaxy Health WC |
$29,318.62
|
| Rate for Payer: Global Benefits Group Commercial |
$20,695.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$31,043.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23,006.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,141.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21,350.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,898.50
|
| Rate for Payer: Multiplan Commercial |
$25,869.38
|
| Rate for Payer: Networks By Design Commercial |
$17,246.25
|
| Rate for Payer: Prime Health Services Commercial |
$29,318.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,945.04
|
| Rate for Payer: United Healthcare All Other HMO |
$12,600.11
|
| Rate for Payer: United Healthcare HMO Rider |
$12,327.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,296.29
|
|
