|
HC DFIB MED CONSULTA D204TRM
|
Facility
|
OP
|
$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: Alpha Care Medical Group Commercial/Exchange |
$29,318.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18,970.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25,869.38
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$15,749.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19,098.50
|
| 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: Dignity Health Commercial/Exchange |
$29,318.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$29,318.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$29,318.62
|
| 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: InnovAge PACE Commercial |
$17,246.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23,006.50
|
| 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: Molina Healthcare of CA Medi-Cal |
$24,144.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24,144.75
|
| 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: Riverside University Health System MISP |
$13,797.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20,695.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20,695.50
|
| 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
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29,318.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29,318.62
|
| Rate for Payer: Vantage Medical Group Senior |
$29,318.62
|
|
|
HC DFIB MED EVERA MRI XT DDMB1D1
|
Facility
|
IP
|
$25,000.00
|
|
|
Service Code
|
CPT C1721
|
| Hospital Charge Code |
906813781
|
|
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 MED EVERA MRI XT DDMB1D1
|
Facility
|
OP
|
$25,000.00
|
|
|
Service Code
|
CPT C1721
|
| Hospital Charge Code |
906813781
|
|
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 MED EVERA S DR DDBC3D1
|
Facility
|
OP
|
$25,000.00
|
|
|
Service Code
|
CPT C1721
|
| Hospital Charge Code |
906813709
|
|
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 MED EVERA S DR DDBC3D1
|
Facility
|
IP
|
$25,000.00
|
|
|
Service Code
|
CPT C1721
|
| Hospital Charge Code |
906813709
|
|
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 MED EVERA S DR DDBC3D4
|
Facility
|
OP
|
$25,000.00
|
|
|
Service Code
|
CPT C1721
|
| Hospital Charge Code |
906813710
|
|
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 MED EVERA S DR DDBC3D4
|
Facility
|
IP
|
$25,000.00
|
|
|
Service Code
|
CPT C1721
|
| Hospital Charge Code |
906813710
|
|
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 MED EVERA S VR DVBC3D1
|
Facility
|
OP
|
$25,000.00
|
|
|
Service Code
|
CPT C1722
|
| Hospital Charge Code |
906813712
|
|
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 MED EVERA S VR DVBC3D1
|
Facility
|
IP
|
$25,000.00
|
|
|
Service Code
|
CPT C1722
|
| Hospital Charge Code |
906813712
|
|
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 MED EVERA S VR DVBC3D4
|
Facility
|
IP
|
$25,000.00
|
|
|
Service Code
|
CPT C1722
|
| Hospital Charge Code |
906813713
|
|
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 MED EVERA S VR DVBC3D4
|
Facility
|
OP
|
$25,000.00
|
|
|
Service Code
|
CPT C1722
|
| Hospital Charge Code |
906813713
|
|
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 MED EVERA XT DR DDBB1D1
|
Facility
|
IP
|
$25,000.00
|
|
|
Service Code
|
CPT C1721
|
| Hospital Charge Code |
906813707
|
|
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 MED EVERA XT DR DDBB1D1
|
Facility
|
OP
|
$25,000.00
|
|
|
Service Code
|
CPT C1721
|
| Hospital Charge Code |
906813707
|
|
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 MED EVERA XT DR DDBB1D4
|
Facility
|
OP
|
$25,000.00
|
|
|
Service Code
|
CPT C1721
|
| Hospital Charge Code |
906813708
|
|
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 MED EVERA XT DR DDBB1D4
|
Facility
|
IP
|
$25,000.00
|
|
|
Service Code
|
CPT C1721
|
| Hospital Charge Code |
906813708
|
|
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 MED EVERA XT VR DVBB1D1
|
Facility
|
OP
|
$25,000.00
|
|
|
Service Code
|
CPT C1722
|
| Hospital Charge Code |
906813711
|
|
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 MED EVERA XT VR DVBB1D1
|
Facility
|
IP
|
$25,000.00
|
|
|
Service Code
|
CPT C1722
|
| Hospital Charge Code |
906813711
|
|
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 MED EVERA XT VR DVBB1D4
|
Facility
|
OP
|
$25,000.00
|
|
|
Service Code
|
CPT C1722
|
| Hospital Charge Code |
906813705
|
|
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 MED EVERA XT VR DVBB1D4
|
Facility
|
IP
|
$25,000.00
|
|
|
Service Code
|
CPT C1722
|
| Hospital Charge Code |
906813705
|
|
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 MED PROTECTA D314TRM
|
Facility
|
IP
|
$26,445.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813673
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,289.00 |
| Max. Negotiated Rate |
$23,800.50 |
| Rate for Payer: Adventist Health Commercial |
$5,289.00
|
| Rate for Payer: Blue Shield of California Commercial |
$20,441.99
|
| Rate for Payer: Blue Shield of California EPN |
$13,328.28
|
| Rate for Payer: Cash Price |
$14,544.75
|
| Rate for Payer: Central Health Plan Commercial |
$21,156.00
|
| Rate for Payer: Cigna of CA HMO |
$18,511.50
|
| Rate for Payer: Cigna of CA PPO |
$18,511.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,578.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10,578.00
|
| Rate for Payer: Galaxy Health WC |
$22,478.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15,867.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$23,800.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17,638.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,075.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,369.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,289.00
|
| Rate for Payer: Multiplan Commercial |
$19,833.75
|
| Rate for Payer: Networks By Design Commercial |
$13,222.50
|
| Rate for Payer: Prime Health Services Commercial |
$22,478.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,924.81
|
| Rate for Payer: United Healthcare All Other HMO |
$9,660.36
|
| Rate for Payer: United Healthcare HMO Rider |
$9,451.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,660.74
|
|
|
HC DFIB MED PROTECTA D314TRM
|
Facility
|
OP
|
$26,445.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813673
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,289.00 |
| Max. Negotiated Rate |
$23,800.50 |
| Rate for Payer: Adventist Health Commercial |
$5,289.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22,478.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14,544.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19,833.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$12,074.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,642.60
|
| Rate for Payer: Blue Shield of California Commercial |
$20,441.99
|
| Rate for Payer: Blue Shield of California EPN |
$13,328.28
|
| Rate for Payer: Cash Price |
$14,544.75
|
| Rate for Payer: Central Health Plan Commercial |
$21,156.00
|
| Rate for Payer: Cigna of CA HMO |
$18,511.50
|
| Rate for Payer: Cigna of CA PPO |
$18,511.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22,478.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$22,478.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22,478.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,578.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10,578.00
|
| Rate for Payer: Galaxy Health WC |
$22,478.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15,867.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$23,800.50
|
| Rate for Payer: InnovAge PACE Commercial |
$13,222.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17,638.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,369.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,289.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,511.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18,511.50
|
| Rate for Payer: Multiplan Commercial |
$19,833.75
|
| Rate for Payer: Networks By Design Commercial |
$13,222.50
|
| Rate for Payer: Prime Health Services Commercial |
$22,478.25
|
| Rate for Payer: Riverside University Health System MISP |
$10,578.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15,867.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15,867.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,924.81
|
| Rate for Payer: United Healthcare All Other HMO |
$9,660.36
|
| Rate for Payer: United Healthcare HMO Rider |
$9,451.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,660.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22,478.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22,478.25
|
| Rate for Payer: Vantage Medical Group Senior |
$22,478.25
|
|
|
HC DFIB MED PROTECTA D334TRG
|
Facility
|
IP
|
$24,935.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813653
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,987.00 |
| Max. Negotiated Rate |
$22,441.50 |
| Rate for Payer: Adventist Health Commercial |
$4,987.00
|
| Rate for Payer: Blue Shield of California Commercial |
$19,274.76
|
| Rate for Payer: Blue Shield of California EPN |
$12,567.24
|
| Rate for Payer: Cash Price |
$13,714.25
|
| Rate for Payer: Central Health Plan Commercial |
$19,948.00
|
| Rate for Payer: Cigna of CA HMO |
$17,454.50
|
| Rate for Payer: Cigna of CA PPO |
$17,454.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,974.00
|
| Rate for Payer: EPIC Health Plan Senior |
$9,974.00
|
| Rate for Payer: Galaxy Health WC |
$21,194.75
|
| Rate for Payer: Global Benefits Group Commercial |
$14,961.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22,441.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,631.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,500.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,434.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,987.00
|
| Rate for Payer: Multiplan Commercial |
$18,701.25
|
| Rate for Payer: Networks By Design Commercial |
$12,467.50
|
| Rate for Payer: Prime Health Services Commercial |
$21,194.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,358.11
|
| Rate for Payer: United Healthcare All Other HMO |
$9,108.76
|
| Rate for Payer: United Healthcare HMO Rider |
$8,911.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,166.21
|
|
|
HC DFIB MED PROTECTA D334TRG
|
Facility
|
OP
|
$24,935.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813653
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,987.00 |
| Max. Negotiated Rate |
$22,441.50 |
| Rate for Payer: Adventist Health Commercial |
$4,987.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,194.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13,714.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18,701.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,385.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,806.51
|
| Rate for Payer: Blue Shield of California Commercial |
$19,274.76
|
| Rate for Payer: Blue Shield of California EPN |
$12,567.24
|
| Rate for Payer: Cash Price |
$13,714.25
|
| Rate for Payer: Central Health Plan Commercial |
$19,948.00
|
| Rate for Payer: Cigna of CA HMO |
$17,454.50
|
| Rate for Payer: Cigna of CA PPO |
$17,454.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,194.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$21,194.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21,194.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,974.00
|
| Rate for Payer: EPIC Health Plan Senior |
$9,974.00
|
| Rate for Payer: Galaxy Health WC |
$21,194.75
|
| Rate for Payer: Global Benefits Group Commercial |
$14,961.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22,441.50
|
| Rate for Payer: InnovAge PACE Commercial |
$12,467.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,631.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,434.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,987.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,454.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17,454.50
|
| Rate for Payer: Multiplan Commercial |
$18,701.25
|
| Rate for Payer: Networks By Design Commercial |
$12,467.50
|
| Rate for Payer: Prime Health Services Commercial |
$21,194.75
|
| Rate for Payer: Riverside University Health System MISP |
$9,974.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14,961.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14,961.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,358.11
|
| Rate for Payer: United Healthcare All Other HMO |
$9,108.76
|
| Rate for Payer: United Healthcare HMO Rider |
$8,911.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,166.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,194.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21,194.75
|
| Rate for Payer: Vantage Medical Group Senior |
$21,194.75
|
|
|
HC DFIB MED PROTECTA D334TRM
|
Facility
|
IP
|
$24,935.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813675
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,987.00 |
| Max. Negotiated Rate |
$22,441.50 |
| Rate for Payer: Adventist Health Commercial |
$4,987.00
|
| Rate for Payer: Blue Shield of California Commercial |
$19,274.76
|
| Rate for Payer: Blue Shield of California EPN |
$12,567.24
|
| Rate for Payer: Cash Price |
$13,714.25
|
| Rate for Payer: Central Health Plan Commercial |
$19,948.00
|
| Rate for Payer: Cigna of CA HMO |
$17,454.50
|
| Rate for Payer: Cigna of CA PPO |
$17,454.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,974.00
|
| Rate for Payer: EPIC Health Plan Senior |
$9,974.00
|
| Rate for Payer: Galaxy Health WC |
$21,194.75
|
| Rate for Payer: Global Benefits Group Commercial |
$14,961.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22,441.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,631.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,500.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,434.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,987.00
|
| Rate for Payer: Multiplan Commercial |
$18,701.25
|
| Rate for Payer: Networks By Design Commercial |
$12,467.50
|
| Rate for Payer: Prime Health Services Commercial |
$21,194.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,358.11
|
| Rate for Payer: United Healthcare All Other HMO |
$9,108.76
|
| Rate for Payer: United Healthcare HMO Rider |
$8,911.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,166.21
|
|
|
HC DFIB MED PROTECTA D334TRM
|
Facility
|
OP
|
$24,935.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813675
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,987.00 |
| Max. Negotiated Rate |
$22,441.50 |
| Rate for Payer: Adventist Health Commercial |
$4,987.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,194.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13,714.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18,701.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,385.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,806.51
|
| Rate for Payer: Blue Shield of California Commercial |
$19,274.76
|
| Rate for Payer: Blue Shield of California EPN |
$12,567.24
|
| Rate for Payer: Cash Price |
$13,714.25
|
| Rate for Payer: Central Health Plan Commercial |
$19,948.00
|
| Rate for Payer: Cigna of CA HMO |
$17,454.50
|
| Rate for Payer: Cigna of CA PPO |
$17,454.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,194.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$21,194.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21,194.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,974.00
|
| Rate for Payer: EPIC Health Plan Senior |
$9,974.00
|
| Rate for Payer: Galaxy Health WC |
$21,194.75
|
| Rate for Payer: Global Benefits Group Commercial |
$14,961.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22,441.50
|
| Rate for Payer: InnovAge PACE Commercial |
$12,467.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,631.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,434.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,987.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,454.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17,454.50
|
| Rate for Payer: Multiplan Commercial |
$18,701.25
|
| Rate for Payer: Networks By Design Commercial |
$12,467.50
|
| Rate for Payer: Prime Health Services Commercial |
$21,194.75
|
| Rate for Payer: Riverside University Health System MISP |
$9,974.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14,961.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14,961.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,358.11
|
| Rate for Payer: United Healthcare All Other HMO |
$9,108.76
|
| Rate for Payer: United Healthcare HMO Rider |
$8,911.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,166.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,194.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21,194.75
|
| Rate for Payer: Vantage Medical Group Senior |
$21,194.75
|
|
