|
HC DFIB MED VISIA AF VR DVAB1D4
|
Facility
|
OP
|
$25,000.00
|
|
|
Service Code
|
CPT C1722
|
| Hospital Charge Code |
906813776
|
|
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 VISIA MRI VR DVFB1D4
|
Facility
|
IP
|
$25,000.00
|
|
|
Service Code
|
CPT C1722
|
| Hospital Charge Code |
906813779
|
|
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 VISIA MRI VR DVFB1D4
|
Facility
|
OP
|
$25,000.00
|
|
|
Service Code
|
CPT C1722
|
| Hospital Charge Code |
906813779
|
|
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 VIVA QUAD XT DTBA1Q1
|
Facility
|
OP
|
$27,933.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813753
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,586.60 |
| Max. Negotiated Rate |
$25,139.70 |
| Rate for Payer: Adventist Health Commercial |
$5,586.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23,743.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,363.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20,949.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$12,754.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,466.50
|
| Rate for Payer: Blue Shield of California Commercial |
$21,592.21
|
| Rate for Payer: Blue Shield of California EPN |
$14,078.23
|
| Rate for Payer: Cash Price |
$15,363.15
|
| Rate for Payer: Central Health Plan Commercial |
$22,346.40
|
| Rate for Payer: Cigna of CA HMO |
$19,553.10
|
| Rate for Payer: Cigna of CA PPO |
$19,553.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23,743.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$23,743.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23,743.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,173.20
|
| Rate for Payer: EPIC Health Plan Senior |
$11,173.20
|
| Rate for Payer: Galaxy Health WC |
$23,743.05
|
| Rate for Payer: Global Benefits Group Commercial |
$16,759.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$25,139.70
|
| Rate for Payer: InnovAge PACE Commercial |
$13,966.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18,631.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17,290.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,586.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19,553.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,553.10
|
| Rate for Payer: Multiplan Commercial |
$20,949.75
|
| Rate for Payer: Networks By Design Commercial |
$13,966.50
|
| Rate for Payer: Prime Health Services Commercial |
$23,743.05
|
| Rate for Payer: Riverside University Health System MISP |
$11,173.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16,759.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16,759.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,483.25
|
| Rate for Payer: United Healthcare All Other HMO |
$10,203.92
|
| Rate for Payer: United Healthcare HMO Rider |
$9,983.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,148.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23,743.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23,743.05
|
| Rate for Payer: Vantage Medical Group Senior |
$23,743.05
|
|
|
HC DFIB MED VIVA QUAD XT DTBA1Q1
|
Facility
|
IP
|
$27,933.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813753
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,586.60 |
| Max. Negotiated Rate |
$25,139.70 |
| Rate for Payer: Adventist Health Commercial |
$5,586.60
|
| Rate for Payer: Blue Shield of California Commercial |
$21,592.21
|
| Rate for Payer: Blue Shield of California EPN |
$14,078.23
|
| Rate for Payer: Cash Price |
$15,363.15
|
| Rate for Payer: Central Health Plan Commercial |
$22,346.40
|
| Rate for Payer: Cigna of CA HMO |
$19,553.10
|
| Rate for Payer: Cigna of CA PPO |
$19,553.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,173.20
|
| Rate for Payer: EPIC Health Plan Senior |
$11,173.20
|
| Rate for Payer: Galaxy Health WC |
$23,743.05
|
| Rate for Payer: Global Benefits Group Commercial |
$16,759.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$25,139.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18,631.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,642.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17,290.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,586.60
|
| Rate for Payer: Multiplan Commercial |
$20,949.75
|
| Rate for Payer: Networks By Design Commercial |
$13,966.50
|
| Rate for Payer: Prime Health Services Commercial |
$23,743.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,483.25
|
| Rate for Payer: United Healthcare All Other HMO |
$10,203.92
|
| Rate for Payer: United Healthcare HMO Rider |
$9,983.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,148.06
|
|
|
HC DFIB MED VIVA QUAD XT DTBA1QQ
|
Facility
|
OP
|
$27,933.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813733
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,586.60 |
| Max. Negotiated Rate |
$25,139.70 |
| Rate for Payer: Adventist Health Commercial |
$5,586.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23,743.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,363.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20,949.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$12,754.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,466.50
|
| Rate for Payer: Blue Shield of California Commercial |
$21,592.21
|
| Rate for Payer: Blue Shield of California EPN |
$14,078.23
|
| Rate for Payer: Cash Price |
$15,363.15
|
| Rate for Payer: Central Health Plan Commercial |
$22,346.40
|
| Rate for Payer: Cigna of CA HMO |
$19,553.10
|
| Rate for Payer: Cigna of CA PPO |
$19,553.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23,743.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$23,743.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23,743.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,173.20
|
| Rate for Payer: EPIC Health Plan Senior |
$11,173.20
|
| Rate for Payer: Galaxy Health WC |
$23,743.05
|
| Rate for Payer: Global Benefits Group Commercial |
$16,759.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$25,139.70
|
| Rate for Payer: InnovAge PACE Commercial |
$13,966.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18,631.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17,290.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,586.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19,553.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,553.10
|
| Rate for Payer: Multiplan Commercial |
$20,949.75
|
| Rate for Payer: Networks By Design Commercial |
$13,966.50
|
| Rate for Payer: Prime Health Services Commercial |
$23,743.05
|
| Rate for Payer: Riverside University Health System MISP |
$11,173.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16,759.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16,759.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,483.25
|
| Rate for Payer: United Healthcare All Other HMO |
$10,203.92
|
| Rate for Payer: United Healthcare HMO Rider |
$9,983.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,148.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23,743.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23,743.05
|
| Rate for Payer: Vantage Medical Group Senior |
$23,743.05
|
|
|
HC DFIB MED VIVA QUAD XT DTBA1QQ
|
Facility
|
IP
|
$27,933.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813733
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,586.60 |
| Max. Negotiated Rate |
$25,139.70 |
| Rate for Payer: Adventist Health Commercial |
$5,586.60
|
| Rate for Payer: Blue Shield of California Commercial |
$21,592.21
|
| Rate for Payer: Blue Shield of California EPN |
$14,078.23
|
| Rate for Payer: Cash Price |
$15,363.15
|
| Rate for Payer: Central Health Plan Commercial |
$22,346.40
|
| Rate for Payer: Cigna of CA HMO |
$19,553.10
|
| Rate for Payer: Cigna of CA PPO |
$19,553.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,173.20
|
| Rate for Payer: EPIC Health Plan Senior |
$11,173.20
|
| Rate for Payer: Galaxy Health WC |
$23,743.05
|
| Rate for Payer: Global Benefits Group Commercial |
$16,759.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$25,139.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18,631.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,642.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17,290.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,586.60
|
| Rate for Payer: Multiplan Commercial |
$20,949.75
|
| Rate for Payer: Networks By Design Commercial |
$13,966.50
|
| Rate for Payer: Prime Health Services Commercial |
$23,743.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,483.25
|
| Rate for Payer: United Healthcare All Other HMO |
$10,203.92
|
| Rate for Payer: United Healthcare HMO Rider |
$9,983.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,148.06
|
|
|
HC DFIB MED VIVA S CRT DTBB1D1
|
Facility
|
OP
|
$25,500.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813715
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,100.00 |
| Max. Negotiated Rate |
$22,950.00 |
| Rate for Payer: Adventist Health Commercial |
$5,100.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,675.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14,025.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19,125.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,643.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,119.35
|
| Rate for Payer: Blue Shield of California Commercial |
$19,711.50
|
| Rate for Payer: Blue Shield of California EPN |
$12,852.00
|
| Rate for Payer: Cash Price |
$14,025.00
|
| Rate for Payer: Central Health Plan Commercial |
$20,400.00
|
| Rate for Payer: Cigna of CA HMO |
$17,850.00
|
| Rate for Payer: Cigna of CA PPO |
$17,850.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,675.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$21,675.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21,675.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,200.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10,200.00
|
| Rate for Payer: Galaxy Health WC |
$21,675.00
|
| Rate for Payer: Global Benefits Group Commercial |
$15,300.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22,950.00
|
| Rate for Payer: InnovAge PACE Commercial |
$12,750.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17,008.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,784.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,100.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,850.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17,850.00
|
| Rate for Payer: Multiplan Commercial |
$19,125.00
|
| Rate for Payer: Networks By Design Commercial |
$12,750.00
|
| Rate for Payer: Prime Health Services Commercial |
$21,675.00
|
| Rate for Payer: Riverside University Health System MISP |
$10,200.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15,300.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15,300.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,570.15
|
| Rate for Payer: United Healthcare All Other HMO |
$9,315.15
|
| Rate for Payer: United Healthcare HMO Rider |
$9,113.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,351.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,675.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21,675.00
|
| Rate for Payer: Vantage Medical Group Senior |
$21,675.00
|
|
|
HC DFIB MED VIVA S CRT DTBB1D1
|
Facility
|
IP
|
$25,500.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813715
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,100.00 |
| Max. Negotiated Rate |
$22,950.00 |
| Rate for Payer: Adventist Health Commercial |
$5,100.00
|
| Rate for Payer: Blue Shield of California Commercial |
$19,711.50
|
| Rate for Payer: Blue Shield of California EPN |
$12,852.00
|
| Rate for Payer: Cash Price |
$14,025.00
|
| Rate for Payer: Central Health Plan Commercial |
$20,400.00
|
| Rate for Payer: Cigna of CA HMO |
$17,850.00
|
| Rate for Payer: Cigna of CA PPO |
$17,850.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,200.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10,200.00
|
| Rate for Payer: Galaxy Health WC |
$21,675.00
|
| Rate for Payer: Global Benefits Group Commercial |
$15,300.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22,950.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17,008.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,715.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,784.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,100.00
|
| Rate for Payer: Multiplan Commercial |
$19,125.00
|
| Rate for Payer: Networks By Design Commercial |
$12,750.00
|
| Rate for Payer: Prime Health Services Commercial |
$21,675.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,570.15
|
| Rate for Payer: United Healthcare All Other HMO |
$9,315.15
|
| Rate for Payer: United Healthcare HMO Rider |
$9,113.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,351.25
|
|
|
HC DFIB MED VIVA S CRT DTBB1D4
|
Facility
|
OP
|
$25,500.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813716
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,100.00 |
| Max. Negotiated Rate |
$22,950.00 |
| Rate for Payer: Adventist Health Commercial |
$5,100.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,675.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14,025.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19,125.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,643.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,119.35
|
| Rate for Payer: Blue Shield of California Commercial |
$19,711.50
|
| Rate for Payer: Blue Shield of California EPN |
$12,852.00
|
| Rate for Payer: Cash Price |
$14,025.00
|
| Rate for Payer: Central Health Plan Commercial |
$20,400.00
|
| Rate for Payer: Cigna of CA HMO |
$17,850.00
|
| Rate for Payer: Cigna of CA PPO |
$17,850.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,675.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$21,675.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21,675.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,200.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10,200.00
|
| Rate for Payer: Galaxy Health WC |
$21,675.00
|
| Rate for Payer: Global Benefits Group Commercial |
$15,300.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22,950.00
|
| Rate for Payer: InnovAge PACE Commercial |
$12,750.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17,008.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,784.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,100.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,850.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17,850.00
|
| Rate for Payer: Multiplan Commercial |
$19,125.00
|
| Rate for Payer: Networks By Design Commercial |
$12,750.00
|
| Rate for Payer: Prime Health Services Commercial |
$21,675.00
|
| Rate for Payer: Riverside University Health System MISP |
$10,200.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15,300.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15,300.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,570.15
|
| Rate for Payer: United Healthcare All Other HMO |
$9,315.15
|
| Rate for Payer: United Healthcare HMO Rider |
$9,113.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,351.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,675.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21,675.00
|
| Rate for Payer: Vantage Medical Group Senior |
$21,675.00
|
|
|
HC DFIB MED VIVA S CRT DTBB1D4
|
Facility
|
IP
|
$25,500.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813716
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,100.00 |
| Max. Negotiated Rate |
$22,950.00 |
| Rate for Payer: Adventist Health Commercial |
$5,100.00
|
| Rate for Payer: Blue Shield of California Commercial |
$19,711.50
|
| Rate for Payer: Blue Shield of California EPN |
$12,852.00
|
| Rate for Payer: Cash Price |
$14,025.00
|
| Rate for Payer: Central Health Plan Commercial |
$20,400.00
|
| Rate for Payer: Cigna of CA HMO |
$17,850.00
|
| Rate for Payer: Cigna of CA PPO |
$17,850.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,200.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10,200.00
|
| Rate for Payer: Galaxy Health WC |
$21,675.00
|
| Rate for Payer: Global Benefits Group Commercial |
$15,300.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22,950.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17,008.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,715.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,784.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,100.00
|
| Rate for Payer: Multiplan Commercial |
$19,125.00
|
| Rate for Payer: Networks By Design Commercial |
$12,750.00
|
| Rate for Payer: Prime Health Services Commercial |
$21,675.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,570.15
|
| Rate for Payer: United Healthcare All Other HMO |
$9,315.15
|
| Rate for Payer: United Healthcare HMO Rider |
$9,113.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,351.25
|
|
|
HC DFIB MED VIVA XT CRT DTBA1D1
|
Facility
|
IP
|
$27,453.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813704
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,490.60 |
| Max. Negotiated Rate |
$24,707.70 |
| Rate for Payer: Adventist Health Commercial |
$5,490.60
|
| Rate for Payer: Blue Shield of California Commercial |
$21,221.17
|
| Rate for Payer: Blue Shield of California EPN |
$13,836.31
|
| Rate for Payer: Cash Price |
$15,099.15
|
| Rate for Payer: Central Health Plan Commercial |
$21,962.40
|
| Rate for Payer: Cigna of CA HMO |
$19,217.10
|
| Rate for Payer: Cigna of CA PPO |
$19,217.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,981.20
|
| Rate for Payer: EPIC Health Plan Senior |
$10,981.20
|
| Rate for Payer: Galaxy Health WC |
$23,335.05
|
| Rate for Payer: Global Benefits Group Commercial |
$16,471.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$24,707.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18,311.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,459.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,993.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,490.60
|
| Rate for Payer: Multiplan Commercial |
$20,589.75
|
| Rate for Payer: Networks By Design Commercial |
$13,726.50
|
| Rate for Payer: Prime Health Services Commercial |
$23,335.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,303.11
|
| Rate for Payer: United Healthcare All Other HMO |
$10,028.58
|
| Rate for Payer: United Healthcare HMO Rider |
$9,811.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,990.86
|
|
|
HC DFIB MED VIVA XT CRT DTBA1D1
|
Facility
|
OP
|
$27,453.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813704
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,490.60 |
| Max. Negotiated Rate |
$24,707.70 |
| Rate for Payer: Adventist Health Commercial |
$5,490.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23,335.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,099.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20,589.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$12,535.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,200.73
|
| Rate for Payer: Blue Shield of California Commercial |
$21,221.17
|
| Rate for Payer: Blue Shield of California EPN |
$13,836.31
|
| Rate for Payer: Cash Price |
$15,099.15
|
| Rate for Payer: Central Health Plan Commercial |
$21,962.40
|
| Rate for Payer: Cigna of CA HMO |
$19,217.10
|
| Rate for Payer: Cigna of CA PPO |
$19,217.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23,335.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$23,335.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23,335.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,981.20
|
| Rate for Payer: EPIC Health Plan Senior |
$10,981.20
|
| Rate for Payer: Galaxy Health WC |
$23,335.05
|
| Rate for Payer: Global Benefits Group Commercial |
$16,471.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$24,707.70
|
| Rate for Payer: InnovAge PACE Commercial |
$13,726.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18,311.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,993.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,490.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19,217.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,217.10
|
| Rate for Payer: Multiplan Commercial |
$20,589.75
|
| Rate for Payer: Networks By Design Commercial |
$13,726.50
|
| Rate for Payer: Prime Health Services Commercial |
$23,335.05
|
| Rate for Payer: Riverside University Health System MISP |
$10,981.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16,471.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16,471.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,303.11
|
| Rate for Payer: United Healthcare All Other HMO |
$10,028.58
|
| Rate for Payer: United Healthcare HMO Rider |
$9,811.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,990.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23,335.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23,335.05
|
| Rate for Payer: Vantage Medical Group Senior |
$23,335.05
|
|
|
HC DFIB MED VIVA XT CRT DTBA1D4
|
Facility
|
IP
|
$26,250.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813714
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,250.00 |
| Max. Negotiated Rate |
$23,625.00 |
| Rate for Payer: Adventist Health Commercial |
$5,250.00
|
| Rate for Payer: Blue Shield of California Commercial |
$20,291.25
|
| Rate for Payer: Blue Shield of California EPN |
$13,230.00
|
| Rate for Payer: Cash Price |
$14,437.50
|
| Rate for Payer: Central Health Plan Commercial |
$21,000.00
|
| Rate for Payer: Cigna of CA HMO |
$18,375.00
|
| Rate for Payer: Cigna of CA PPO |
$18,375.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,500.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10,500.00
|
| Rate for Payer: Galaxy Health WC |
$22,312.50
|
| Rate for Payer: Global Benefits Group Commercial |
$15,750.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$23,625.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17,508.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,001.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,248.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,250.00
|
| Rate for Payer: Multiplan Commercial |
$19,687.50
|
| Rate for Payer: Networks By Design Commercial |
$13,125.00
|
| Rate for Payer: Prime Health Services Commercial |
$22,312.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,851.62
|
| Rate for Payer: United Healthcare All Other HMO |
$9,589.12
|
| Rate for Payer: United Healthcare HMO Rider |
$9,381.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,596.88
|
|
|
HC DFIB MED VIVA XT CRT DTBA1D4
|
Facility
|
OP
|
$26,250.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813714
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,250.00 |
| Max. Negotiated Rate |
$23,625.00 |
| Rate for Payer: Adventist Health Commercial |
$5,250.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22,312.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14,437.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19,687.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,985.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,534.62
|
| Rate for Payer: Blue Shield of California Commercial |
$20,291.25
|
| Rate for Payer: Blue Shield of California EPN |
$13,230.00
|
| Rate for Payer: Cash Price |
$14,437.50
|
| Rate for Payer: Central Health Plan Commercial |
$21,000.00
|
| Rate for Payer: Cigna of CA HMO |
$18,375.00
|
| Rate for Payer: Cigna of CA PPO |
$18,375.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22,312.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$22,312.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22,312.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,500.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10,500.00
|
| Rate for Payer: Galaxy Health WC |
$22,312.50
|
| Rate for Payer: Global Benefits Group Commercial |
$15,750.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$23,625.00
|
| Rate for Payer: InnovAge PACE Commercial |
$13,125.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17,508.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,248.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,250.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,375.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18,375.00
|
| Rate for Payer: Multiplan Commercial |
$19,687.50
|
| Rate for Payer: Networks By Design Commercial |
$13,125.00
|
| Rate for Payer: Prime Health Services Commercial |
$22,312.50
|
| Rate for Payer: Riverside University Health System MISP |
$10,500.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15,750.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15,750.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,851.62
|
| Rate for Payer: United Healthcare All Other HMO |
$9,589.12
|
| Rate for Payer: United Healthcare HMO Rider |
$9,381.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,596.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22,312.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22,312.50
|
| Rate for Payer: Vantage Medical Group Senior |
$22,312.50
|
|
|
HC DFIB STJ ASSURA DR CD2357-40Q
|
Facility
|
OP
|
$25,000.00
|
|
|
Service Code
|
CPT C1721
|
| Hospital Charge Code |
906813824
|
|
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 STJ ASSURA DR CD2357-40Q
|
Facility
|
IP
|
$25,000.00
|
|
|
Service Code
|
CPT C1721
|
| Hospital Charge Code |
906813824
|
|
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 STJ CURRNT DR RF 2207-3
|
Facility
|
IP
|
$28,500.00
|
|
|
Service Code
|
CPT C1721
|
| Hospital Charge Code |
906813607
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,700.00 |
| Max. Negotiated Rate |
$25,650.00 |
| Rate for Payer: Adventist Health Commercial |
$5,700.00
|
| Rate for Payer: Blue Shield of California Commercial |
$22,030.50
|
| Rate for Payer: Blue Shield of California EPN |
$14,364.00
|
| Rate for Payer: Cash Price |
$15,675.00
|
| Rate for Payer: Central Health Plan Commercial |
$22,800.00
|
| Rate for Payer: Cigna of CA HMO |
$19,950.00
|
| Rate for Payer: Cigna of CA PPO |
$19,950.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,400.00
|
| Rate for Payer: EPIC Health Plan Senior |
$11,400.00
|
| Rate for Payer: Galaxy Health WC |
$24,225.00
|
| Rate for Payer: Global Benefits Group Commercial |
$17,100.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$25,650.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19,009.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,858.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17,641.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,700.00
|
| Rate for Payer: Multiplan Commercial |
$21,375.00
|
| Rate for Payer: Networks By Design Commercial |
$14,250.00
|
| Rate for Payer: Prime Health Services Commercial |
$24,225.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,696.05
|
| Rate for Payer: United Healthcare All Other HMO |
$10,411.05
|
| Rate for Payer: United Healthcare HMO Rider |
$10,185.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,333.75
|
|
|
HC DFIB STJ CURRNT DR RF 2207-3
|
Facility
|
OP
|
$28,500.00
|
|
|
Service Code
|
CPT C1721
|
| Hospital Charge Code |
906813607
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,700.00 |
| Max. Negotiated Rate |
$25,650.00 |
| Rate for Payer: Adventist Health Commercial |
$5,700.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24,225.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,675.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21,375.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$13,013.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,780.45
|
| Rate for Payer: Blue Shield of California Commercial |
$22,030.50
|
| Rate for Payer: Blue Shield of California EPN |
$14,364.00
|
| Rate for Payer: Cash Price |
$15,675.00
|
| Rate for Payer: Central Health Plan Commercial |
$22,800.00
|
| Rate for Payer: Cigna of CA HMO |
$19,950.00
|
| Rate for Payer: Cigna of CA PPO |
$19,950.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24,225.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$24,225.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24,225.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,400.00
|
| Rate for Payer: EPIC Health Plan Senior |
$11,400.00
|
| Rate for Payer: Galaxy Health WC |
$24,225.00
|
| Rate for Payer: Global Benefits Group Commercial |
$17,100.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$25,650.00
|
| Rate for Payer: InnovAge PACE Commercial |
$14,250.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19,009.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17,641.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,700.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19,950.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,950.00
|
| Rate for Payer: Multiplan Commercial |
$21,375.00
|
| Rate for Payer: Networks By Design Commercial |
$14,250.00
|
| Rate for Payer: Prime Health Services Commercial |
$24,225.00
|
| Rate for Payer: Riverside University Health System MISP |
$11,400.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17,100.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17,100.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,696.05
|
| Rate for Payer: United Healthcare All Other HMO |
$10,411.05
|
| Rate for Payer: United Healthcare HMO Rider |
$10,185.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,333.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24,225.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24,225.00
|
| Rate for Payer: Vantage Medical Group Senior |
$24,225.00
|
|
|
HC DFIB STJ CURRNT VR FR 1207-3
|
Facility
|
OP
|
$24,000.00
|
|
|
Service Code
|
CPT C1722
|
| Hospital Charge Code |
906813608
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,800.00 |
| Max. Negotiated Rate |
$21,600.00 |
| Rate for Payer: Adventist Health Commercial |
$4,800.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20,400.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13,200.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18,000.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10,958.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,288.80
|
| Rate for Payer: Blue Shield of California Commercial |
$18,552.00
|
| Rate for Payer: Blue Shield of California EPN |
$12,096.00
|
| Rate for Payer: Cash Price |
$13,200.00
|
| Rate for Payer: Central Health Plan Commercial |
$19,200.00
|
| Rate for Payer: Cigna of CA HMO |
$16,800.00
|
| Rate for Payer: Cigna of CA PPO |
$16,800.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20,400.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$20,400.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20,400.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,600.00
|
| Rate for Payer: EPIC Health Plan Senior |
$9,600.00
|
| Rate for Payer: Galaxy Health WC |
$20,400.00
|
| Rate for Payer: Global Benefits Group Commercial |
$14,400.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$21,600.00
|
| Rate for Payer: InnovAge PACE Commercial |
$12,000.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,008.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,856.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,800.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16,800.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16,800.00
|
| Rate for Payer: Multiplan Commercial |
$18,000.00
|
| Rate for Payer: Networks By Design Commercial |
$12,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$20,400.00
|
| Rate for Payer: Riverside University Health System MISP |
$9,600.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14,400.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14,400.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,007.20
|
| Rate for Payer: United Healthcare All Other HMO |
$8,767.20
|
| Rate for Payer: United Healthcare HMO Rider |
$8,577.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,860.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20,400.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20,400.00
|
| Rate for Payer: Vantage Medical Group Senior |
$20,400.00
|
|
|
HC DFIB STJ CURRNT VR FR 1207-3
|
Facility
|
IP
|
$24,000.00
|
|
|
Service Code
|
CPT C1722
|
| Hospital Charge Code |
906813608
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,800.00 |
| Max. Negotiated Rate |
$21,600.00 |
| Rate for Payer: Adventist Health Commercial |
$4,800.00
|
| Rate for Payer: Blue Shield of California Commercial |
$18,552.00
|
| Rate for Payer: Blue Shield of California EPN |
$12,096.00
|
| Rate for Payer: Cash Price |
$13,200.00
|
| Rate for Payer: Central Health Plan Commercial |
$19,200.00
|
| Rate for Payer: Cigna of CA HMO |
$16,800.00
|
| Rate for Payer: Cigna of CA PPO |
$16,800.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,600.00
|
| Rate for Payer: EPIC Health Plan Senior |
$9,600.00
|
| Rate for Payer: Galaxy Health WC |
$20,400.00
|
| Rate for Payer: Global Benefits Group Commercial |
$14,400.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$21,600.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,008.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,144.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,856.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,800.00
|
| Rate for Payer: Multiplan Commercial |
$18,000.00
|
| Rate for Payer: Networks By Design Commercial |
$12,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$20,400.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,007.20
|
| Rate for Payer: United Healthcare All Other HMO |
$8,767.20
|
| Rate for Payer: United Healthcare HMO Rider |
$8,577.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,860.00
|
|
|
HC DFIB STJ ELLIPSE CD2411-36Q
|
Facility
|
IP
|
$19,915.00
|
|
|
Service Code
|
CPT C1721
|
| Hospital Charge Code |
906813761
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,983.00 |
| Max. Negotiated Rate |
$17,923.50 |
| Rate for Payer: Adventist Health Commercial |
$3,983.00
|
| Rate for Payer: Blue Shield of California Commercial |
$15,394.30
|
| Rate for Payer: Blue Shield of California EPN |
$10,037.16
|
| Rate for Payer: Cash Price |
$10,953.25
|
| Rate for Payer: Central Health Plan Commercial |
$15,932.00
|
| Rate for Payer: Cigna of CA HMO |
$13,940.50
|
| Rate for Payer: Cigna of CA PPO |
$13,940.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,966.00
|
| Rate for Payer: EPIC Health Plan Senior |
$7,966.00
|
| Rate for Payer: Galaxy Health WC |
$16,927.75
|
| Rate for Payer: Global Benefits Group Commercial |
$11,949.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$17,923.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,283.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,587.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,327.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,983.00
|
| Rate for Payer: Multiplan Commercial |
$14,936.25
|
| Rate for Payer: Networks By Design Commercial |
$9,957.50
|
| Rate for Payer: Prime Health Services Commercial |
$16,927.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,474.10
|
| Rate for Payer: United Healthcare All Other HMO |
$7,274.95
|
| Rate for Payer: United Healthcare HMO Rider |
$7,117.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,522.16
|
|
|
HC DFIB STJ ELLIPSE CD2411-36Q
|
Facility
|
OP
|
$19,915.00
|
|
|
Service Code
|
CPT C1721
|
| Hospital Charge Code |
906813761
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,983.00 |
| Max. Negotiated Rate |
$17,923.50 |
| Rate for Payer: Adventist Health Commercial |
$3,983.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16,927.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,953.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,936.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9,093.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,026.94
|
| Rate for Payer: Blue Shield of California Commercial |
$15,394.30
|
| Rate for Payer: Blue Shield of California EPN |
$10,037.16
|
| Rate for Payer: Cash Price |
$10,953.25
|
| Rate for Payer: Central Health Plan Commercial |
$15,932.00
|
| Rate for Payer: Cigna of CA HMO |
$13,940.50
|
| Rate for Payer: Cigna of CA PPO |
$13,940.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16,927.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$16,927.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16,927.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,966.00
|
| Rate for Payer: EPIC Health Plan Senior |
$7,966.00
|
| Rate for Payer: Galaxy Health WC |
$16,927.75
|
| Rate for Payer: Global Benefits Group Commercial |
$11,949.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$17,923.50
|
| Rate for Payer: InnovAge PACE Commercial |
$9,957.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,283.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,327.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,983.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13,940.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13,940.50
|
| Rate for Payer: Multiplan Commercial |
$14,936.25
|
| Rate for Payer: Networks By Design Commercial |
$9,957.50
|
| Rate for Payer: Prime Health Services Commercial |
$16,927.75
|
| Rate for Payer: Riverside University Health System MISP |
$7,966.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11,949.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11,949.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,474.10
|
| Rate for Payer: United Healthcare All Other HMO |
$7,274.95
|
| Rate for Payer: United Healthcare HMO Rider |
$7,117.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,522.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16,927.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16,927.75
|
| Rate for Payer: Vantage Medical Group Senior |
$16,927.75
|
|
|
HC DFIB STJ ELLIPSE VR CD1411 36Q
|
Facility
|
OP
|
$25,000.00
|
|
|
Service Code
|
CPT C1722
|
| Hospital Charge Code |
906813742
|
|
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 STJ ELLIPSE VR CD1411 36Q
|
Facility
|
IP
|
$25,000.00
|
|
|
Service Code
|
CPT C1722
|
| Hospital Charge Code |
906813742
|
|
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
|
|
