|
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 |
$11,250.00
|
| 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 |
$11,250.00
|
| 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 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 |
$11,250.00
|
| 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 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 |
$11,250.00
|
| 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
|
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 |
$11,250.00
|
| 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 |
$11,250.00
|
| 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 |
$11,250.00
|
| 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 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 |
$11,250.00
|
| 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 |
$11,250.00
|
| 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 |
$11,250.00
|
| 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 |
$11,250.00
|
| 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 |
$11,250.00
|
| 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 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 |
$11,900.25
|
| 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 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 |
$11,900.25
|
| 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 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 |
$11,220.75
|
| 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 |
$11,220.75
|
| 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
|
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 |
$11,220.75
|
| 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 |
$11,220.75
|
| 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 DR D314DRM
|
Facility
|
IP
|
$21,476.00
|
|
|
Service Code
|
CPT C1721
|
| Hospital Charge Code |
906813670
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,295.20 |
| Max. Negotiated Rate |
$19,328.40 |
| Rate for Payer: Adventist Health Commercial |
$4,295.20
|
| Rate for Payer: Blue Shield of California Commercial |
$16,600.95
|
| Rate for Payer: Blue Shield of California EPN |
$10,823.90
|
| Rate for Payer: Cash Price |
$9,664.20
|
| Rate for Payer: Central Health Plan Commercial |
$17,180.80
|
| Rate for Payer: Cigna of CA HMO |
$15,033.20
|
| Rate for Payer: Cigna of CA PPO |
$15,033.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,590.40
|
| Rate for Payer: EPIC Health Plan Senior |
$8,590.40
|
| Rate for Payer: Galaxy Health WC |
$18,254.60
|
| Rate for Payer: Global Benefits Group Commercial |
$12,885.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$19,328.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,324.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,182.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,293.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,295.20
|
| Rate for Payer: Multiplan Commercial |
$16,107.00
|
| Rate for Payer: Networks By Design Commercial |
$10,738.00
|
| Rate for Payer: Prime Health Services Commercial |
$18,254.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,059.94
|
| Rate for Payer: United Healthcare All Other HMO |
$7,845.18
|
| Rate for Payer: United Healthcare HMO Rider |
$7,675.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,033.39
|
|
|
HC DFIB MED PROTECTA DR D314DRM
|
Facility
|
OP
|
$21,476.00
|
|
|
Service Code
|
CPT C1721
|
| Hospital Charge Code |
906813670
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,295.20 |
| Max. Negotiated Rate |
$19,328.40 |
| Rate for Payer: Adventist Health Commercial |
$4,295.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18,254.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11,811.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16,107.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9,805.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,891.26
|
| Rate for Payer: Blue Shield of California Commercial |
$16,600.95
|
| Rate for Payer: Blue Shield of California EPN |
$10,823.90
|
| Rate for Payer: Cash Price |
$9,664.20
|
| Rate for Payer: Central Health Plan Commercial |
$17,180.80
|
| Rate for Payer: Cigna of CA HMO |
$15,033.20
|
| Rate for Payer: Cigna of CA PPO |
$15,033.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18,254.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$18,254.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18,254.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,590.40
|
| Rate for Payer: EPIC Health Plan Senior |
$8,590.40
|
| Rate for Payer: Galaxy Health WC |
$18,254.60
|
| Rate for Payer: Global Benefits Group Commercial |
$12,885.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$19,328.40
|
| Rate for Payer: InnovAge PACE Commercial |
$10,738.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,324.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,293.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,295.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15,033.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15,033.20
|
| Rate for Payer: Multiplan Commercial |
$16,107.00
|
| Rate for Payer: Networks By Design Commercial |
$10,738.00
|
| Rate for Payer: Prime Health Services Commercial |
$18,254.60
|
| Rate for Payer: Riverside University Health System MISP |
$8,590.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12,885.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12,885.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,059.94
|
| Rate for Payer: United Healthcare All Other HMO |
$7,845.18
|
| Rate for Payer: United Healthcare HMO Rider |
$7,675.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,033.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18,254.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18,254.60
|
| Rate for Payer: Vantage Medical Group Senior |
$18,254.60
|
|
|
HC DFIB MED PROTECTA DR D334DRG
|
Facility
|
IP
|
$21,015.00
|
|
|
Service Code
|
CPT C1721
|
| Hospital Charge Code |
906813650
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,203.00 |
| Max. Negotiated Rate |
$18,913.50 |
| Rate for Payer: Adventist Health Commercial |
$4,203.00
|
| Rate for Payer: Blue Shield of California Commercial |
$16,244.59
|
| Rate for Payer: Blue Shield of California EPN |
$10,591.56
|
| Rate for Payer: Cash Price |
$9,456.75
|
| Rate for Payer: Central Health Plan Commercial |
$16,812.00
|
| Rate for Payer: Cigna of CA HMO |
$14,710.50
|
| Rate for Payer: Cigna of CA PPO |
$14,710.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,406.00
|
| Rate for Payer: EPIC Health Plan Senior |
$8,406.00
|
| Rate for Payer: Galaxy Health WC |
$17,862.75
|
| Rate for Payer: Global Benefits Group Commercial |
$12,609.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$18,913.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,017.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,006.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,008.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,203.00
|
| Rate for Payer: Multiplan Commercial |
$15,761.25
|
| Rate for Payer: Networks By Design Commercial |
$10,507.50
|
| Rate for Payer: Prime Health Services Commercial |
$17,862.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,886.93
|
| Rate for Payer: United Healthcare All Other HMO |
$7,676.78
|
| Rate for Payer: United Healthcare HMO Rider |
$7,510.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,882.41
|
|
|
HC DFIB MED PROTECTA DR D334DRG
|
Facility
|
OP
|
$21,015.00
|
|
|
Service Code
|
CPT C1721
|
| Hospital Charge Code |
906813650
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,203.00 |
| Max. Negotiated Rate |
$18,913.50 |
| Rate for Payer: Adventist Health Commercial |
$4,203.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17,862.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11,558.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15,761.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9,595.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,636.01
|
| Rate for Payer: Blue Shield of California Commercial |
$16,244.59
|
| Rate for Payer: Blue Shield of California EPN |
$10,591.56
|
| Rate for Payer: Cash Price |
$9,456.75
|
| Rate for Payer: Central Health Plan Commercial |
$16,812.00
|
| Rate for Payer: Cigna of CA HMO |
$14,710.50
|
| Rate for Payer: Cigna of CA PPO |
$14,710.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17,862.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$17,862.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17,862.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,406.00
|
| Rate for Payer: EPIC Health Plan Senior |
$8,406.00
|
| Rate for Payer: Galaxy Health WC |
$17,862.75
|
| Rate for Payer: Global Benefits Group Commercial |
$12,609.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$18,913.50
|
| Rate for Payer: InnovAge PACE Commercial |
$10,507.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,017.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,008.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,203.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14,710.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14,710.50
|
| Rate for Payer: Multiplan Commercial |
$15,761.25
|
| Rate for Payer: Networks By Design Commercial |
$10,507.50
|
| Rate for Payer: Prime Health Services Commercial |
$17,862.75
|
| Rate for Payer: Riverside University Health System MISP |
$8,406.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12,609.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12,609.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,886.93
|
| Rate for Payer: United Healthcare All Other HMO |
$7,676.78
|
| Rate for Payer: United Healthcare HMO Rider |
$7,510.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,882.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17,862.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17,862.75
|
| Rate for Payer: Vantage Medical Group Senior |
$17,862.75
|
|
|
HC DFIB MED PROTECTA DR D334DRM
|
Facility
|
IP
|
$21,015.00
|
|
|
Service Code
|
CPT C1721
|
| Hospital Charge Code |
906813672
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,203.00 |
| Max. Negotiated Rate |
$18,913.50 |
| Rate for Payer: Adventist Health Commercial |
$4,203.00
|
| Rate for Payer: Blue Shield of California Commercial |
$16,244.59
|
| Rate for Payer: Blue Shield of California EPN |
$10,591.56
|
| Rate for Payer: Cash Price |
$9,456.75
|
| Rate for Payer: Central Health Plan Commercial |
$16,812.00
|
| Rate for Payer: Cigna of CA HMO |
$14,710.50
|
| Rate for Payer: Cigna of CA PPO |
$14,710.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,406.00
|
| Rate for Payer: EPIC Health Plan Senior |
$8,406.00
|
| Rate for Payer: Galaxy Health WC |
$17,862.75
|
| Rate for Payer: Global Benefits Group Commercial |
$12,609.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$18,913.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,017.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,006.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,008.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,203.00
|
| Rate for Payer: Multiplan Commercial |
$15,761.25
|
| Rate for Payer: Networks By Design Commercial |
$10,507.50
|
| Rate for Payer: Prime Health Services Commercial |
$17,862.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,886.93
|
| Rate for Payer: United Healthcare All Other HMO |
$7,676.78
|
| Rate for Payer: United Healthcare HMO Rider |
$7,510.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,882.41
|
|
|
HC DFIB MED PROTECTA DR D334DRM
|
Facility
|
OP
|
$21,015.00
|
|
|
Service Code
|
CPT C1721
|
| Hospital Charge Code |
906813672
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,203.00 |
| Max. Negotiated Rate |
$18,913.50 |
| Rate for Payer: Adventist Health Commercial |
$4,203.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17,862.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11,558.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15,761.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9,595.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,636.01
|
| Rate for Payer: Blue Shield of California Commercial |
$16,244.59
|
| Rate for Payer: Blue Shield of California EPN |
$10,591.56
|
| Rate for Payer: Cash Price |
$9,456.75
|
| Rate for Payer: Central Health Plan Commercial |
$16,812.00
|
| Rate for Payer: Cigna of CA HMO |
$14,710.50
|
| Rate for Payer: Cigna of CA PPO |
$14,710.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17,862.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$17,862.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17,862.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,406.00
|
| Rate for Payer: EPIC Health Plan Senior |
$8,406.00
|
| Rate for Payer: Galaxy Health WC |
$17,862.75
|
| Rate for Payer: Global Benefits Group Commercial |
$12,609.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$18,913.50
|
| Rate for Payer: InnovAge PACE Commercial |
$10,507.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,017.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,008.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,203.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14,710.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14,710.50
|
| Rate for Payer: Multiplan Commercial |
$15,761.25
|
| Rate for Payer: Networks By Design Commercial |
$10,507.50
|
| Rate for Payer: Prime Health Services Commercial |
$17,862.75
|
| Rate for Payer: Riverside University Health System MISP |
$8,406.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12,609.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12,609.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,886.93
|
| Rate for Payer: United Healthcare All Other HMO |
$7,676.78
|
| Rate for Payer: United Healthcare HMO Rider |
$7,510.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,882.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17,862.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17,862.75
|
| Rate for Payer: Vantage Medical Group Senior |
$17,862.75
|
|
|
HC DFIB MED PROTECTA VR D314VRM
|
Facility
|
OP
|
$19,283.00
|
|
|
Service Code
|
CPT C1722
|
| Hospital Charge Code |
906813688
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,856.60 |
| Max. Negotiated Rate |
$17,354.70 |
| Rate for Payer: Adventist Health Commercial |
$3,856.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16,390.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,605.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,462.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8,804.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,677.00
|
| Rate for Payer: Blue Shield of California Commercial |
$14,905.76
|
| Rate for Payer: Blue Shield of California EPN |
$9,718.63
|
| Rate for Payer: Cash Price |
$8,677.35
|
| Rate for Payer: Central Health Plan Commercial |
$15,426.40
|
| Rate for Payer: Cigna of CA HMO |
$13,498.10
|
| Rate for Payer: Cigna of CA PPO |
$13,498.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16,390.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$16,390.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16,390.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,713.20
|
| Rate for Payer: EPIC Health Plan Senior |
$7,713.20
|
| Rate for Payer: Galaxy Health WC |
$16,390.55
|
| Rate for Payer: Global Benefits Group Commercial |
$11,569.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$17,354.70
|
| Rate for Payer: InnovAge PACE Commercial |
$9,641.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,861.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,936.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,856.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13,498.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13,498.10
|
| Rate for Payer: Multiplan Commercial |
$14,462.25
|
| Rate for Payer: Networks By Design Commercial |
$9,641.50
|
| Rate for Payer: Prime Health Services Commercial |
$16,390.55
|
| Rate for Payer: Riverside University Health System MISP |
$7,713.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11,569.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11,569.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,236.91
|
| Rate for Payer: United Healthcare All Other HMO |
$7,044.08
|
| Rate for Payer: United Healthcare HMO Rider |
$6,891.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,315.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16,390.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16,390.55
|
| Rate for Payer: Vantage Medical Group Senior |
$16,390.55
|
|
