|
HC DFIB STJ FORTIFY ASSURA CD1357 40Q
|
Facility
|
OP
|
$18,312.00
|
|
|
Service Code
|
CPT C1722
|
| Hospital Charge Code |
906813731
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,662.40 |
| Max. Negotiated Rate |
$16,480.80 |
| Rate for Payer: Adventist Health Commercial |
$3,662.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15,565.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,071.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,734.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8,361.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,139.35
|
| Rate for Payer: Blue Shield of California Commercial |
$14,155.18
|
| Rate for Payer: Blue Shield of California EPN |
$9,229.25
|
| Rate for Payer: Cash Price |
$8,240.40
|
| Rate for Payer: Central Health Plan Commercial |
$14,649.60
|
| Rate for Payer: Cigna of CA HMO |
$12,818.40
|
| Rate for Payer: Cigna of CA PPO |
$12,818.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15,565.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,565.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15,565.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,324.80
|
| Rate for Payer: EPIC Health Plan Senior |
$7,324.80
|
| Rate for Payer: Galaxy Health WC |
$15,565.20
|
| Rate for Payer: Global Benefits Group Commercial |
$10,987.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$16,480.80
|
| Rate for Payer: InnovAge PACE Commercial |
$9,156.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,214.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,335.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,662.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12,818.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12,818.40
|
| Rate for Payer: Multiplan Commercial |
$13,734.00
|
| Rate for Payer: Networks By Design Commercial |
$9,156.00
|
| Rate for Payer: Prime Health Services Commercial |
$15,565.20
|
| Rate for Payer: Riverside University Health System MISP |
$7,324.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,987.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10,987.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,872.49
|
| Rate for Payer: United Healthcare All Other HMO |
$6,689.37
|
| Rate for Payer: United Healthcare HMO Rider |
$6,544.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,997.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15,565.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,565.20
|
| Rate for Payer: Vantage Medical Group Senior |
$15,565.20
|
|
|
HC DFIB STJ FORTIFY ASSURA CD2257
|
Facility
|
IP
|
$27,000.00
|
|
|
Service Code
|
CPT C1721
|
| Hospital Charge Code |
906813703
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,400.00 |
| Max. Negotiated Rate |
$24,300.00 |
| Rate for Payer: Adventist Health Commercial |
$5,400.00
|
| Rate for Payer: Blue Shield of California Commercial |
$20,871.00
|
| Rate for Payer: Blue Shield of California EPN |
$13,608.00
|
| Rate for Payer: Cash Price |
$12,150.00
|
| Rate for Payer: Central Health Plan Commercial |
$21,600.00
|
| Rate for Payer: Cigna of CA HMO |
$18,900.00
|
| Rate for Payer: Cigna of CA PPO |
$18,900.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,800.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10,800.00
|
| Rate for Payer: Galaxy Health WC |
$22,950.00
|
| Rate for Payer: Global Benefits Group Commercial |
$16,200.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$24,300.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18,009.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,287.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,713.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,400.00
|
| Rate for Payer: Multiplan Commercial |
$20,250.00
|
| Rate for Payer: Networks By Design Commercial |
$13,500.00
|
| Rate for Payer: Prime Health Services Commercial |
$22,950.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,133.10
|
| Rate for Payer: United Healthcare All Other HMO |
$9,863.10
|
| Rate for Payer: United Healthcare HMO Rider |
$9,649.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,842.50
|
|
|
HC DFIB STJ FORTIFY ASSURA CD2257
|
Facility
|
OP
|
$27,000.00
|
|
|
Service Code
|
CPT C1721
|
| Hospital Charge Code |
906813703
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,400.00 |
| Max. Negotiated Rate |
$24,300.00 |
| Rate for Payer: Adventist Health Commercial |
$5,400.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22,950.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14,850.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20,250.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$12,328.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,949.90
|
| Rate for Payer: Blue Shield of California Commercial |
$20,871.00
|
| Rate for Payer: Blue Shield of California EPN |
$13,608.00
|
| Rate for Payer: Cash Price |
$12,150.00
|
| Rate for Payer: Central Health Plan Commercial |
$21,600.00
|
| Rate for Payer: Cigna of CA HMO |
$18,900.00
|
| Rate for Payer: Cigna of CA PPO |
$18,900.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22,950.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$22,950.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22,950.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,800.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10,800.00
|
| Rate for Payer: Galaxy Health WC |
$22,950.00
|
| Rate for Payer: Global Benefits Group Commercial |
$16,200.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$24,300.00
|
| Rate for Payer: InnovAge PACE Commercial |
$13,500.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18,009.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,713.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,400.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,900.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18,900.00
|
| Rate for Payer: Multiplan Commercial |
$20,250.00
|
| Rate for Payer: Networks By Design Commercial |
$13,500.00
|
| Rate for Payer: Prime Health Services Commercial |
$22,950.00
|
| Rate for Payer: Riverside University Health System MISP |
$10,800.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16,200.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16,200.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,133.10
|
| Rate for Payer: United Healthcare All Other HMO |
$9,863.10
|
| Rate for Payer: United Healthcare HMO Rider |
$9,649.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,842.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22,950.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22,950.00
|
| Rate for Payer: Vantage Medical Group Senior |
$22,950.00
|
|
|
HC DFIB STJ FORTIFY DR CD2231
|
Facility
|
OP
|
$36,052.50
|
|
|
Service Code
|
CPT C1721
|
| Hospital Charge Code |
906813685
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,210.50 |
| Max. Negotiated Rate |
$32,447.25 |
| Rate for Payer: Adventist Health Commercial |
$7,210.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30,644.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19,828.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27,039.38
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$16,461.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19,962.27
|
| Rate for Payer: Blue Shield of California Commercial |
$27,868.58
|
| Rate for Payer: Blue Shield of California EPN |
$18,170.46
|
| Rate for Payer: Cash Price |
$16,223.62
|
| Rate for Payer: Central Health Plan Commercial |
$28,842.00
|
| Rate for Payer: Cigna of CA HMO |
$25,236.75
|
| Rate for Payer: Cigna of CA PPO |
$25,236.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30,644.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$30,644.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$30,644.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,421.00
|
| Rate for Payer: EPIC Health Plan Senior |
$14,421.00
|
| Rate for Payer: Galaxy Health WC |
$30,644.62
|
| Rate for Payer: Global Benefits Group Commercial |
$21,631.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$32,447.25
|
| Rate for Payer: InnovAge PACE Commercial |
$18,026.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24,047.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,316.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,210.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25,236.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25,236.75
|
| Rate for Payer: Multiplan Commercial |
$27,039.38
|
| Rate for Payer: Networks By Design Commercial |
$18,026.25
|
| Rate for Payer: Prime Health Services Commercial |
$30,644.62
|
| Rate for Payer: Riverside University Health System MISP |
$14,421.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21,631.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21,631.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,530.50
|
| Rate for Payer: United Healthcare All Other HMO |
$13,169.98
|
| Rate for Payer: United Healthcare HMO Rider |
$12,885.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,807.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30,644.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30,644.62
|
| Rate for Payer: Vantage Medical Group Senior |
$30,644.62
|
|
|
HC DFIB STJ FORTIFY DR CD2231
|
Facility
|
IP
|
$36,052.50
|
|
|
Service Code
|
CPT C1721
|
| Hospital Charge Code |
906813685
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,210.50 |
| Max. Negotiated Rate |
$32,447.25 |
| Rate for Payer: Adventist Health Commercial |
$7,210.50
|
| Rate for Payer: Blue Shield of California Commercial |
$27,868.58
|
| Rate for Payer: Blue Shield of California EPN |
$18,170.46
|
| Rate for Payer: Cash Price |
$16,223.62
|
| Rate for Payer: Central Health Plan Commercial |
$28,842.00
|
| Rate for Payer: Cigna of CA HMO |
$25,236.75
|
| Rate for Payer: Cigna of CA PPO |
$25,236.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,421.00
|
| Rate for Payer: EPIC Health Plan Senior |
$14,421.00
|
| Rate for Payer: Galaxy Health WC |
$30,644.62
|
| Rate for Payer: Global Benefits Group Commercial |
$21,631.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$32,447.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24,047.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,736.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,316.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,210.50
|
| Rate for Payer: Multiplan Commercial |
$27,039.38
|
| Rate for Payer: Networks By Design Commercial |
$18,026.25
|
| Rate for Payer: Prime Health Services Commercial |
$30,644.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,530.50
|
| Rate for Payer: United Healthcare All Other HMO |
$13,169.98
|
| Rate for Payer: United Healthcare HMO Rider |
$12,885.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,807.19
|
|
|
HC DFIB STJ PROMOTE RF 3207-36
|
Facility
|
IP
|
$36,000.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813594
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,200.00 |
| Max. Negotiated Rate |
$32,400.00 |
| Rate for Payer: Adventist Health Commercial |
$7,200.00
|
| Rate for Payer: Blue Shield of California Commercial |
$27,828.00
|
| Rate for Payer: Blue Shield of California EPN |
$18,144.00
|
| Rate for Payer: Cash Price |
$16,200.00
|
| Rate for Payer: Central Health Plan Commercial |
$28,800.00
|
| Rate for Payer: Cigna of CA HMO |
$25,200.00
|
| Rate for Payer: Cigna of CA PPO |
$25,200.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,400.00
|
| Rate for Payer: EPIC Health Plan Senior |
$14,400.00
|
| Rate for Payer: Galaxy Health WC |
$30,600.00
|
| Rate for Payer: Global Benefits Group Commercial |
$21,600.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$32,400.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24,012.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,716.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,284.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,200.00
|
| Rate for Payer: Multiplan Commercial |
$27,000.00
|
| Rate for Payer: Networks By Design Commercial |
$18,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$30,600.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,510.80
|
| Rate for Payer: United Healthcare All Other HMO |
$13,150.80
|
| Rate for Payer: United Healthcare HMO Rider |
$12,866.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,790.00
|
|
|
HC DFIB STJ PROMOTE RF 3207-36
|
Facility
|
OP
|
$36,000.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813594
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,200.00 |
| Max. Negotiated Rate |
$32,400.00 |
| Rate for Payer: Adventist Health Commercial |
$7,200.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30,600.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19,800.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27,000.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$16,437.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19,933.20
|
| Rate for Payer: Blue Shield of California Commercial |
$27,828.00
|
| Rate for Payer: Blue Shield of California EPN |
$18,144.00
|
| Rate for Payer: Cash Price |
$16,200.00
|
| Rate for Payer: Central Health Plan Commercial |
$28,800.00
|
| Rate for Payer: Cigna of CA HMO |
$25,200.00
|
| Rate for Payer: Cigna of CA PPO |
$25,200.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30,600.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$30,600.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$30,600.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,400.00
|
| Rate for Payer: EPIC Health Plan Senior |
$14,400.00
|
| Rate for Payer: Galaxy Health WC |
$30,600.00
|
| Rate for Payer: Global Benefits Group Commercial |
$21,600.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$32,400.00
|
| Rate for Payer: InnovAge PACE Commercial |
$18,000.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24,012.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,284.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,200.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25,200.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25,200.00
|
| Rate for Payer: Multiplan Commercial |
$27,000.00
|
| Rate for Payer: Networks By Design Commercial |
$18,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$30,600.00
|
| Rate for Payer: Riverside University Health System MISP |
$14,400.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21,600.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21,600.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,510.80
|
| Rate for Payer: United Healthcare All Other HMO |
$13,150.80
|
| Rate for Payer: United Healthcare HMO Rider |
$12,866.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,790.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30,600.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30,600.00
|
| Rate for Payer: Vantage Medical Group Senior |
$30,600.00
|
|
|
HC DFIB STJ QUADRA A CD3365-40C
|
Facility
|
IP
|
$25,080.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813762
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,016.00 |
| Max. Negotiated Rate |
$22,572.00 |
| Rate for Payer: Adventist Health Commercial |
$5,016.00
|
| Rate for Payer: Blue Shield of California Commercial |
$19,386.84
|
| Rate for Payer: Blue Shield of California EPN |
$12,640.32
|
| Rate for Payer: Cash Price |
$11,286.00
|
| Rate for Payer: Central Health Plan Commercial |
$20,064.00
|
| Rate for Payer: Cigna of CA HMO |
$17,556.00
|
| Rate for Payer: Cigna of CA PPO |
$17,556.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,032.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10,032.00
|
| Rate for Payer: Galaxy Health WC |
$21,318.00
|
| Rate for Payer: Global Benefits Group Commercial |
$15,048.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22,572.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,728.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,555.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,524.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,016.00
|
| Rate for Payer: Multiplan Commercial |
$18,810.00
|
| Rate for Payer: Networks By Design Commercial |
$12,540.00
|
| Rate for Payer: Prime Health Services Commercial |
$21,318.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,412.52
|
| Rate for Payer: United Healthcare All Other HMO |
$9,161.72
|
| Rate for Payer: United Healthcare HMO Rider |
$8,963.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,213.70
|
|
|
HC DFIB STJ QUADRA A CD3365-40C
|
Facility
|
OP
|
$25,080.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813762
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,016.00 |
| Max. Negotiated Rate |
$22,572.00 |
| Rate for Payer: Adventist Health Commercial |
$5,016.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,318.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13,794.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18,810.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,451.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,886.80
|
| Rate for Payer: Blue Shield of California Commercial |
$19,386.84
|
| Rate for Payer: Blue Shield of California EPN |
$12,640.32
|
| Rate for Payer: Cash Price |
$11,286.00
|
| Rate for Payer: Central Health Plan Commercial |
$20,064.00
|
| Rate for Payer: Cigna of CA HMO |
$17,556.00
|
| Rate for Payer: Cigna of CA PPO |
$17,556.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,318.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$21,318.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21,318.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,032.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10,032.00
|
| Rate for Payer: Galaxy Health WC |
$21,318.00
|
| Rate for Payer: Global Benefits Group Commercial |
$15,048.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22,572.00
|
| Rate for Payer: InnovAge PACE Commercial |
$12,540.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,728.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,524.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,016.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,556.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17,556.00
|
| Rate for Payer: Multiplan Commercial |
$18,810.00
|
| Rate for Payer: Networks By Design Commercial |
$12,540.00
|
| Rate for Payer: Prime Health Services Commercial |
$21,318.00
|
| Rate for Payer: Riverside University Health System MISP |
$10,032.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15,048.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15,048.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,412.52
|
| Rate for Payer: United Healthcare All Other HMO |
$9,161.72
|
| Rate for Payer: United Healthcare HMO Rider |
$8,963.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,213.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,318.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21,318.00
|
| Rate for Payer: Vantage Medical Group Senior |
$21,318.00
|
|
|
HC DFIB STJ QUADRA A CD3365-40Q
|
Facility
|
IP
|
$25,080.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813725
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,016.00 |
| Max. Negotiated Rate |
$22,572.00 |
| Rate for Payer: Adventist Health Commercial |
$5,016.00
|
| Rate for Payer: Blue Shield of California Commercial |
$19,386.84
|
| Rate for Payer: Blue Shield of California EPN |
$12,640.32
|
| Rate for Payer: Cash Price |
$11,286.00
|
| Rate for Payer: Central Health Plan Commercial |
$20,064.00
|
| Rate for Payer: Cigna of CA HMO |
$17,556.00
|
| Rate for Payer: Cigna of CA PPO |
$17,556.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,032.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10,032.00
|
| Rate for Payer: Galaxy Health WC |
$21,318.00
|
| Rate for Payer: Global Benefits Group Commercial |
$15,048.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22,572.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,728.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,555.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,524.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,016.00
|
| Rate for Payer: Multiplan Commercial |
$18,810.00
|
| Rate for Payer: Networks By Design Commercial |
$12,540.00
|
| Rate for Payer: Prime Health Services Commercial |
$21,318.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,412.52
|
| Rate for Payer: United Healthcare All Other HMO |
$9,161.72
|
| Rate for Payer: United Healthcare HMO Rider |
$8,963.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,213.70
|
|
|
HC DFIB STJ QUADRA A CD3365-40Q
|
Facility
|
OP
|
$25,080.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813725
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,016.00 |
| Max. Negotiated Rate |
$22,572.00 |
| Rate for Payer: Adventist Health Commercial |
$5,016.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,318.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13,794.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18,810.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,451.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,886.80
|
| Rate for Payer: Blue Shield of California Commercial |
$19,386.84
|
| Rate for Payer: Blue Shield of California EPN |
$12,640.32
|
| Rate for Payer: Cash Price |
$11,286.00
|
| Rate for Payer: Central Health Plan Commercial |
$20,064.00
|
| Rate for Payer: Cigna of CA HMO |
$17,556.00
|
| Rate for Payer: Cigna of CA PPO |
$17,556.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,318.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$21,318.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21,318.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,032.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10,032.00
|
| Rate for Payer: Galaxy Health WC |
$21,318.00
|
| Rate for Payer: Global Benefits Group Commercial |
$15,048.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22,572.00
|
| Rate for Payer: InnovAge PACE Commercial |
$12,540.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,728.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,524.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,016.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,556.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17,556.00
|
| Rate for Payer: Multiplan Commercial |
$18,810.00
|
| Rate for Payer: Networks By Design Commercial |
$12,540.00
|
| Rate for Payer: Prime Health Services Commercial |
$21,318.00
|
| Rate for Payer: Riverside University Health System MISP |
$10,032.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15,048.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15,048.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,412.52
|
| Rate for Payer: United Healthcare All Other HMO |
$9,161.72
|
| Rate for Payer: United Healthcare HMO Rider |
$8,963.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,213.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,318.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21,318.00
|
| Rate for Payer: Vantage Medical Group Senior |
$21,318.00
|
|
|
HC DFIB STJ QUADRA A CD3369-40Q
|
Facility
|
IP
|
$25,080.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813819
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,016.00 |
| Max. Negotiated Rate |
$22,572.00 |
| Rate for Payer: Adventist Health Commercial |
$5,016.00
|
| Rate for Payer: Blue Shield of California Commercial |
$19,386.84
|
| Rate for Payer: Blue Shield of California EPN |
$12,640.32
|
| Rate for Payer: Cash Price |
$11,286.00
|
| Rate for Payer: Central Health Plan Commercial |
$20,064.00
|
| Rate for Payer: Cigna of CA HMO |
$17,556.00
|
| Rate for Payer: Cigna of CA PPO |
$17,556.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,032.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10,032.00
|
| Rate for Payer: Galaxy Health WC |
$21,318.00
|
| Rate for Payer: Global Benefits Group Commercial |
$15,048.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22,572.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,728.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,555.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,524.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,016.00
|
| Rate for Payer: Multiplan Commercial |
$18,810.00
|
| Rate for Payer: Networks By Design Commercial |
$12,540.00
|
| Rate for Payer: Prime Health Services Commercial |
$21,318.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,412.52
|
| Rate for Payer: United Healthcare All Other HMO |
$9,161.72
|
| Rate for Payer: United Healthcare HMO Rider |
$8,963.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,213.70
|
|
|
HC DFIB STJ QUADRA A CD3369-40Q
|
Facility
|
OP
|
$25,080.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813819
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,016.00 |
| Max. Negotiated Rate |
$22,572.00 |
| Rate for Payer: Adventist Health Commercial |
$5,016.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,318.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13,794.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18,810.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,451.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,886.80
|
| Rate for Payer: Blue Shield of California Commercial |
$19,386.84
|
| Rate for Payer: Blue Shield of California EPN |
$12,640.32
|
| Rate for Payer: Cash Price |
$11,286.00
|
| Rate for Payer: Central Health Plan Commercial |
$20,064.00
|
| Rate for Payer: Cigna of CA HMO |
$17,556.00
|
| Rate for Payer: Cigna of CA PPO |
$17,556.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,318.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$21,318.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21,318.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,032.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10,032.00
|
| Rate for Payer: Galaxy Health WC |
$21,318.00
|
| Rate for Payer: Global Benefits Group Commercial |
$15,048.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22,572.00
|
| Rate for Payer: InnovAge PACE Commercial |
$12,540.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,728.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,524.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,016.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,556.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17,556.00
|
| Rate for Payer: Multiplan Commercial |
$18,810.00
|
| Rate for Payer: Networks By Design Commercial |
$12,540.00
|
| Rate for Payer: Prime Health Services Commercial |
$21,318.00
|
| Rate for Payer: Riverside University Health System MISP |
$10,032.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15,048.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15,048.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,412.52
|
| Rate for Payer: United Healthcare All Other HMO |
$9,161.72
|
| Rate for Payer: United Healthcare HMO Rider |
$8,963.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,213.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,318.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21,318.00
|
| Rate for Payer: Vantage Medical Group Senior |
$21,318.00
|
|
|
HC DFIB STJ UNIFY A CD335740Q
|
Facility
|
IP
|
$25,000.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813748
|
|
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 STJ UNIFY A CD335740Q
|
Facility
|
OP
|
$25,000.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813748
|
|
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 STJ UNIFY ASSURA CD325740
|
Facility
|
IP
|
$29,250.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813696
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,850.00 |
| Max. Negotiated Rate |
$26,325.00 |
| Rate for Payer: Adventist Health Commercial |
$5,850.00
|
| Rate for Payer: Blue Shield of California Commercial |
$22,610.25
|
| Rate for Payer: Blue Shield of California EPN |
$14,742.00
|
| Rate for Payer: Cash Price |
$13,162.50
|
| Rate for Payer: Central Health Plan Commercial |
$23,400.00
|
| Rate for Payer: Cigna of CA HMO |
$20,475.00
|
| Rate for Payer: Cigna of CA PPO |
$20,475.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,700.00
|
| Rate for Payer: EPIC Health Plan Senior |
$11,700.00
|
| Rate for Payer: Galaxy Health WC |
$24,862.50
|
| Rate for Payer: Global Benefits Group Commercial |
$17,550.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$26,325.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19,509.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,144.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18,105.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,850.00
|
| Rate for Payer: Multiplan Commercial |
$21,937.50
|
| Rate for Payer: Networks By Design Commercial |
$14,625.00
|
| Rate for Payer: Prime Health Services Commercial |
$24,862.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,977.52
|
| Rate for Payer: United Healthcare All Other HMO |
$10,685.02
|
| Rate for Payer: United Healthcare HMO Rider |
$10,453.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,579.38
|
|
|
HC DFIB STJ UNIFY ASSURA CD325740
|
Facility
|
OP
|
$29,250.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813696
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,850.00 |
| Max. Negotiated Rate |
$26,325.00 |
| Rate for Payer: Adventist Health Commercial |
$5,850.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24,862.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16,087.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21,937.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$13,355.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16,195.73
|
| Rate for Payer: Blue Shield of California Commercial |
$22,610.25
|
| Rate for Payer: Blue Shield of California EPN |
$14,742.00
|
| Rate for Payer: Cash Price |
$13,162.50
|
| Rate for Payer: Central Health Plan Commercial |
$23,400.00
|
| Rate for Payer: Cigna of CA HMO |
$20,475.00
|
| Rate for Payer: Cigna of CA PPO |
$20,475.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24,862.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$24,862.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24,862.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,700.00
|
| Rate for Payer: EPIC Health Plan Senior |
$11,700.00
|
| Rate for Payer: Galaxy Health WC |
$24,862.50
|
| Rate for Payer: Global Benefits Group Commercial |
$17,550.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$26,325.00
|
| Rate for Payer: InnovAge PACE Commercial |
$14,625.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19,509.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18,105.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,850.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20,475.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20,475.00
|
| Rate for Payer: Multiplan Commercial |
$21,937.50
|
| Rate for Payer: Networks By Design Commercial |
$14,625.00
|
| Rate for Payer: Prime Health Services Commercial |
$24,862.50
|
| Rate for Payer: Riverside University Health System MISP |
$11,700.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17,550.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17,550.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,977.52
|
| Rate for Payer: United Healthcare All Other HMO |
$10,685.02
|
| Rate for Payer: United Healthcare HMO Rider |
$10,453.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,579.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24,862.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24,862.50
|
| Rate for Payer: Vantage Medical Group Senior |
$24,862.50
|
|
|
HC DFIB ST J UNIFY CD3231-40Q
|
Facility
|
OP
|
$32,500.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813656
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,500.00 |
| Max. Negotiated Rate |
$29,250.00 |
| Rate for Payer: Adventist Health Commercial |
$6,500.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27,625.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17,875.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24,375.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$14,839.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17,995.25
|
| Rate for Payer: Blue Shield of California Commercial |
$25,122.50
|
| Rate for Payer: Blue Shield of California EPN |
$16,380.00
|
| Rate for Payer: Cash Price |
$14,625.00
|
| Rate for Payer: Central Health Plan Commercial |
$26,000.00
|
| Rate for Payer: Cigna of CA HMO |
$22,750.00
|
| Rate for Payer: Cigna of CA PPO |
$22,750.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27,625.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$27,625.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$27,625.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$13,000.00
|
| Rate for Payer: Galaxy Health WC |
$27,625.00
|
| Rate for Payer: Global Benefits Group Commercial |
$19,500.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$29,250.00
|
| Rate for Payer: InnovAge PACE Commercial |
$16,250.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21,677.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20,117.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,500.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22,750.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22,750.00
|
| Rate for Payer: Multiplan Commercial |
$24,375.00
|
| Rate for Payer: Networks By Design Commercial |
$16,250.00
|
| Rate for Payer: Prime Health Services Commercial |
$27,625.00
|
| Rate for Payer: Riverside University Health System MISP |
$13,000.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19,500.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$19,500.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,197.25
|
| Rate for Payer: United Healthcare All Other HMO |
$11,872.25
|
| Rate for Payer: United Healthcare HMO Rider |
$11,615.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10,643.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27,625.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27,625.00
|
| Rate for Payer: Vantage Medical Group Senior |
$27,625.00
|
|
|
HC DFIB ST J UNIFY CD3231-40Q
|
Facility
|
IP
|
$32,500.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813656
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,500.00 |
| Max. Negotiated Rate |
$29,250.00 |
| Rate for Payer: Adventist Health Commercial |
$6,500.00
|
| Rate for Payer: Blue Shield of California Commercial |
$25,122.50
|
| Rate for Payer: Blue Shield of California EPN |
$16,380.00
|
| Rate for Payer: Cash Price |
$14,625.00
|
| Rate for Payer: Central Health Plan Commercial |
$26,000.00
|
| Rate for Payer: Cigna of CA HMO |
$22,750.00
|
| Rate for Payer: Cigna of CA PPO |
$22,750.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$13,000.00
|
| Rate for Payer: Galaxy Health WC |
$27,625.00
|
| Rate for Payer: Global Benefits Group Commercial |
$19,500.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$29,250.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21,677.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,382.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20,117.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,500.00
|
| Rate for Payer: Multiplan Commercial |
$24,375.00
|
| Rate for Payer: Networks By Design Commercial |
$16,250.00
|
| Rate for Payer: Prime Health Services Commercial |
$27,625.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,197.25
|
| Rate for Payer: United Healthcare All Other HMO |
$11,872.25
|
| Rate for Payer: United Healthcare HMO Rider |
$11,615.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10,643.75
|
|
|
HC DHEA-S
|
Facility
|
OP
|
$77.00
|
|
|
Service Code
|
CPT 82627
|
| Hospital Charge Code |
900912126
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.40 |
| Max. Negotiated Rate |
$161.72 |
| Rate for Payer: Adventist Health Commercial |
$15.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$22.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$46.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.23
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$161.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.82
|
| Rate for Payer: Blue Shield of California Commercial |
$46.74
|
| Rate for Payer: Blue Shield of California EPN |
$30.57
|
| Rate for Payer: Cash Price |
$34.65
|
| Rate for Payer: Cash Price |
$34.65
|
| Rate for Payer: Central Health Plan Commercial |
$61.60
|
| Rate for Payer: Cigna of CA HMO |
$49.28
|
| Rate for Payer: Cigna of CA PPO |
$56.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.01
|
| Rate for Payer: EPIC Health Plan Senior |
$22.23
|
| Rate for Payer: Galaxy Health WC |
$65.45
|
| Rate for Payer: Global Benefits Group Commercial |
$46.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$69.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$36.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$33.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22.23
|
| Rate for Payer: InnovAge PACE Commercial |
$33.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$51.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29.79
|
| Rate for Payer: Multiplan Commercial |
$57.75
|
| Rate for Payer: Networks By Design Commercial |
$50.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$22.23
|
| Rate for Payer: Prime Health Services Commercial |
$65.45
|
| Rate for Payer: Prime Health Services Medicare |
$23.56
|
| Rate for Payer: Riverside University Health System MISP |
$24.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$46.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$46.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.01
|
| Rate for Payer: United Healthcare All Other HMO |
$18.01
|
| Rate for Payer: United Healthcare HMO Rider |
$18.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.01
|
| Rate for Payer: Upland Medical Group Pediatric |
$22.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.45
|
| Rate for Payer: Vantage Medical Group Senior |
$22.23
|
|
|
HC DHEA-S
|
Facility
|
IP
|
$121.00
|
|
|
Service Code
|
CPT 82627
|
| Hospital Charge Code |
900912126
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.20 |
| Max. Negotiated Rate |
$108.90 |
| Rate for Payer: Adventist Health Commercial |
$24.20
|
| Rate for Payer: Cash Price |
$54.45
|
| Rate for Payer: Central Health Plan Commercial |
$96.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.40
|
| Rate for Payer: EPIC Health Plan Senior |
$48.40
|
| Rate for Payer: Galaxy Health WC |
$102.85
|
| Rate for Payer: Global Benefits Group Commercial |
$72.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$108.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$74.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.20
|
| Rate for Payer: Multiplan Commercial |
$90.75
|
| Rate for Payer: Networks By Design Commercial |
$78.65
|
| Rate for Payer: Prime Health Services Commercial |
$102.85
|
|
|
HC DIABETIC SHOE X DEPTH USE/DENS
|
Facility
|
IP
|
$195.00
|
|
|
Service Code
|
CPT A5500
|
| Hospital Charge Code |
905365500
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$39.00 |
| Max. Negotiated Rate |
$175.50 |
| Rate for Payer: Adventist Health Commercial |
$39.00
|
| Rate for Payer: Cash Price |
$87.75
|
| Rate for Payer: Central Health Plan Commercial |
$156.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.00
|
| Rate for Payer: EPIC Health Plan Senior |
$78.00
|
| Rate for Payer: Galaxy Health WC |
$165.75
|
| Rate for Payer: Global Benefits Group Commercial |
$117.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$175.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$130.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$74.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$120.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.00
|
| Rate for Payer: Multiplan Commercial |
$146.25
|
| Rate for Payer: Networks By Design Commercial |
$126.75
|
| Rate for Payer: Prime Health Services Commercial |
$165.75
|
|
|
HC DIABETIC SHOE X DEPTH USE/DENS
|
Facility
|
OP
|
$222.00
|
|
|
Service Code
|
CPT A5500
|
| Hospital Charge Code |
915365500
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$44.40 |
| Max. Negotiated Rate |
$199.80 |
| Rate for Payer: Adventist Health Commercial |
$44.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$134.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$188.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$122.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$166.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$107.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$130.38
|
| Rate for Payer: Blue Shield of California Commercial |
$135.64
|
| Rate for Payer: Blue Shield of California EPN |
$88.58
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Central Health Plan Commercial |
$177.60
|
| Rate for Payer: Cigna of CA HMO |
$142.08
|
| Rate for Payer: Cigna of CA PPO |
$164.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$188.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$188.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$88.80
|
| Rate for Payer: EPIC Health Plan Senior |
$88.80
|
| Rate for Payer: Galaxy Health WC |
$188.70
|
| Rate for Payer: Global Benefits Group Commercial |
$133.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$199.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$81.68
|
| Rate for Payer: InnovAge PACE Commercial |
$111.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$148.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$90.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$155.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$155.40
|
| Rate for Payer: Multiplan Commercial |
$166.50
|
| Rate for Payer: Networks By Design Commercial |
$144.30
|
| Rate for Payer: Prime Health Services Commercial |
$188.70
|
| Rate for Payer: Riverside University Health System MISP |
$88.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$133.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$133.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$111.00
|
| Rate for Payer: United Healthcare All Other HMO |
$111.00
|
| Rate for Payer: United Healthcare HMO Rider |
$111.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$111.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$188.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.70
|
| Rate for Payer: Vantage Medical Group Senior |
$188.70
|
|
|
HC DIABETIC SHOE X DEPTH USE/DENS
|
Facility
|
OP
|
$195.00
|
|
|
Service Code
|
CPT A5500
|
| Hospital Charge Code |
905365500
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$39.00 |
| Max. Negotiated Rate |
$175.50 |
| Rate for Payer: Adventist Health Commercial |
$39.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$118.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$165.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$107.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$146.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$94.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$114.52
|
| Rate for Payer: Blue Shield of California Commercial |
$119.14
|
| Rate for Payer: Blue Shield of California EPN |
$77.81
|
| Rate for Payer: Cash Price |
$87.75
|
| Rate for Payer: Cash Price |
$87.75
|
| Rate for Payer: Central Health Plan Commercial |
$156.00
|
| Rate for Payer: Cigna of CA HMO |
$124.80
|
| Rate for Payer: Cigna of CA PPO |
$144.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$165.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$165.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$165.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.00
|
| Rate for Payer: EPIC Health Plan Senior |
$78.00
|
| Rate for Payer: Galaxy Health WC |
$165.75
|
| Rate for Payer: Global Benefits Group Commercial |
$117.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$175.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$81.68
|
| Rate for Payer: InnovAge PACE Commercial |
$97.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$130.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$90.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$120.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$136.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$136.50
|
| Rate for Payer: Multiplan Commercial |
$146.25
|
| Rate for Payer: Networks By Design Commercial |
$126.75
|
| Rate for Payer: Prime Health Services Commercial |
$165.75
|
| Rate for Payer: Riverside University Health System MISP |
$78.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$117.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$117.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$97.50
|
| Rate for Payer: United Healthcare All Other HMO |
$97.50
|
| Rate for Payer: United Healthcare HMO Rider |
$97.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$97.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$165.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$165.75
|
| Rate for Payer: Vantage Medical Group Senior |
$165.75
|
|
|
HC DIABETIC SHOE X DEPTH USE/DENS
|
Facility
|
IP
|
$222.00
|
|
|
Service Code
|
CPT A5500
|
| Hospital Charge Code |
915365500
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$44.40 |
| Max. Negotiated Rate |
$199.80 |
| Rate for Payer: Adventist Health Commercial |
$44.40
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Central Health Plan Commercial |
$177.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$88.80
|
| Rate for Payer: EPIC Health Plan Senior |
$88.80
|
| Rate for Payer: Galaxy Health WC |
$188.70
|
| Rate for Payer: Global Benefits Group Commercial |
$133.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$199.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$148.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$84.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.40
|
| Rate for Payer: Multiplan Commercial |
$166.50
|
| Rate for Payer: Networks By Design Commercial |
$144.30
|
| Rate for Payer: Prime Health Services Commercial |
$188.70
|
|
