|
HC DFIB STJ FORTIFY A CD135740C
|
Facility
|
IP
|
$25,000.00
|
|
|
Service Code
|
CPT C1722
|
| Hospital Charge Code |
906813750
|
|
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 FORTIFY A CD135740C
|
Facility
|
OP
|
$25,000.00
|
|
|
Service Code
|
CPT C1722
|
| Hospital Charge Code |
906813750
|
|
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 FORTIFY A CD2357-40C
|
Facility
|
OP
|
$19,808.00
|
|
|
Service Code
|
CPT C1721
|
| Hospital Charge Code |
906813757
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,961.60 |
| Max. Negotiated Rate |
$17,827.20 |
| Rate for Payer: Adventist Health Commercial |
$3,961.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16,836.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,894.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,856.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9,044.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,967.69
|
| Rate for Payer: Blue Shield of California Commercial |
$15,311.58
|
| Rate for Payer: Blue Shield of California EPN |
$9,983.23
|
| Rate for Payer: Cash Price |
$10,894.40
|
| Rate for Payer: Central Health Plan Commercial |
$15,846.40
|
| Rate for Payer: Cigna of CA HMO |
$13,865.60
|
| Rate for Payer: Cigna of CA PPO |
$13,865.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16,836.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$16,836.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16,836.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,923.20
|
| Rate for Payer: EPIC Health Plan Senior |
$7,923.20
|
| Rate for Payer: Galaxy Health WC |
$16,836.80
|
| Rate for Payer: Global Benefits Group Commercial |
$11,884.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$17,827.20
|
| Rate for Payer: InnovAge PACE Commercial |
$9,904.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,211.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,261.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,961.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13,865.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13,865.60
|
| Rate for Payer: Multiplan Commercial |
$14,856.00
|
| Rate for Payer: Networks By Design Commercial |
$9,904.00
|
| Rate for Payer: Prime Health Services Commercial |
$16,836.80
|
| Rate for Payer: Riverside University Health System MISP |
$7,923.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11,884.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11,884.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,433.94
|
| Rate for Payer: United Healthcare All Other HMO |
$7,235.86
|
| Rate for Payer: United Healthcare HMO Rider |
$7,079.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,487.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16,836.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16,836.80
|
| Rate for Payer: Vantage Medical Group Senior |
$16,836.80
|
|
|
HC DFIB STJ FORTIFY A CD2357-40C
|
Facility
|
IP
|
$19,808.00
|
|
|
Service Code
|
CPT C1721
|
| Hospital Charge Code |
906813757
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,961.60 |
| Max. Negotiated Rate |
$17,827.20 |
| Rate for Payer: Adventist Health Commercial |
$3,961.60
|
| Rate for Payer: Blue Shield of California Commercial |
$15,311.58
|
| Rate for Payer: Blue Shield of California EPN |
$9,983.23
|
| Rate for Payer: Cash Price |
$10,894.40
|
| Rate for Payer: Central Health Plan Commercial |
$15,846.40
|
| Rate for Payer: Cigna of CA HMO |
$13,865.60
|
| Rate for Payer: Cigna of CA PPO |
$13,865.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,923.20
|
| Rate for Payer: EPIC Health Plan Senior |
$7,923.20
|
| Rate for Payer: Galaxy Health WC |
$16,836.80
|
| Rate for Payer: Global Benefits Group Commercial |
$11,884.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$17,827.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,211.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,546.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,261.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,961.60
|
| Rate for Payer: Multiplan Commercial |
$14,856.00
|
| Rate for Payer: Networks By Design Commercial |
$9,904.00
|
| Rate for Payer: Prime Health Services Commercial |
$16,836.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,433.94
|
| Rate for Payer: United Healthcare All Other HMO |
$7,235.86
|
| Rate for Payer: United Healthcare HMO Rider |
$7,079.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,487.12
|
|
|
HC DFIB STJ FORTIFY A CD2357 40Q
|
Facility
|
OP
|
$19,914.00
|
|
|
Service Code
|
CPT C1721
|
| Hospital Charge Code |
906813729
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,982.80 |
| Max. Negotiated Rate |
$17,922.60 |
| Rate for Payer: Adventist Health Commercial |
$3,982.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16,926.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,952.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,935.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9,092.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,026.38
|
| Rate for Payer: Blue Shield of California Commercial |
$15,393.52
|
| Rate for Payer: Blue Shield of California EPN |
$10,036.66
|
| Rate for Payer: Cash Price |
$10,952.70
|
| Rate for Payer: Central Health Plan Commercial |
$15,931.20
|
| Rate for Payer: Cigna of CA HMO |
$13,939.80
|
| Rate for Payer: Cigna of CA PPO |
$13,939.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16,926.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$16,926.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16,926.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,965.60
|
| Rate for Payer: EPIC Health Plan Senior |
$7,965.60
|
| Rate for Payer: Galaxy Health WC |
$16,926.90
|
| Rate for Payer: Global Benefits Group Commercial |
$11,948.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$17,922.60
|
| Rate for Payer: InnovAge PACE Commercial |
$9,957.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,282.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,326.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,982.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13,939.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13,939.80
|
| Rate for Payer: Multiplan Commercial |
$14,935.50
|
| Rate for Payer: Networks By Design Commercial |
$9,957.00
|
| Rate for Payer: Prime Health Services Commercial |
$16,926.90
|
| Rate for Payer: Riverside University Health System MISP |
$7,965.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11,948.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11,948.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,473.72
|
| Rate for Payer: United Healthcare All Other HMO |
$7,274.58
|
| Rate for Payer: United Healthcare HMO Rider |
$7,117.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,521.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16,926.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16,926.90
|
| Rate for Payer: Vantage Medical Group Senior |
$16,926.90
|
|
|
HC DFIB STJ FORTIFY A CD2357 40Q
|
Facility
|
IP
|
$19,914.00
|
|
|
Service Code
|
CPT C1721
|
| Hospital Charge Code |
906813729
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,982.80 |
| Max. Negotiated Rate |
$17,922.60 |
| Rate for Payer: Adventist Health Commercial |
$3,982.80
|
| Rate for Payer: Blue Shield of California Commercial |
$15,393.52
|
| Rate for Payer: Blue Shield of California EPN |
$10,036.66
|
| Rate for Payer: Cash Price |
$10,952.70
|
| Rate for Payer: Central Health Plan Commercial |
$15,931.20
|
| Rate for Payer: Cigna of CA HMO |
$13,939.80
|
| Rate for Payer: Cigna of CA PPO |
$13,939.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,965.60
|
| Rate for Payer: EPIC Health Plan Senior |
$7,965.60
|
| Rate for Payer: Galaxy Health WC |
$16,926.90
|
| Rate for Payer: Global Benefits Group Commercial |
$11,948.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$17,922.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,282.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,587.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,326.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,982.80
|
| Rate for Payer: Multiplan Commercial |
$14,935.50
|
| Rate for Payer: Networks By Design Commercial |
$9,957.00
|
| Rate for Payer: Prime Health Services Commercial |
$16,926.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,473.72
|
| Rate for Payer: United Healthcare All Other HMO |
$7,274.58
|
| Rate for Payer: United Healthcare HMO Rider |
$7,117.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,521.84
|
|
|
HC DFIB STJ FORTIFY ASSURA CD1357 40Q
|
Facility
|
IP
|
$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: Blue Shield of California Commercial |
$14,155.18
|
| Rate for Payer: Blue Shield of California EPN |
$9,229.25
|
| Rate for Payer: Cash Price |
$10,071.60
|
| 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: 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: Kaiser Permanente of CA Commercial/Self Funded |
$12,214.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,976.87
|
| 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: 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: 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
|
|
|
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 |
$10,071.60
|
| 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 |
$14,850.00
|
| 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 |
$14,850.00
|
| 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 |
$19,828.88
|
| 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 |
$19,828.88
|
| 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
|
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 |
$19,800.00
|
| 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 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 |
$19,800.00
|
| 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 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 |
$13,794.00
|
| 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 |
$13,794.00
|
| 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 |
$13,794.00
|
| 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 |
$13,794.00
|
| 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 |
$13,794.00
|
| 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 |
$13,794.00
|
| 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
|
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 |
$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 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 |
$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 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 |
$16,087.50
|
| Rate for Payer: Central Health Plan Commercial |
$23,400.00
|
| Rate for Payer: Cigna of CA HMO |
$20,475.00
|
| Rate for Payer: Cigna of CA PPO |
$20,475.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24,862.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$24,862.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24,862.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,700.00
|
| Rate for Payer: EPIC Health Plan Senior |
$11,700.00
|
| Rate for Payer: Galaxy Health WC |
$24,862.50
|
| Rate for Payer: Global Benefits Group Commercial |
$17,550.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$26,325.00
|
| Rate for Payer: InnovAge PACE Commercial |
$14,625.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19,509.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18,105.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,850.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20,475.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20,475.00
|
| Rate for Payer: Multiplan Commercial |
$21,937.50
|
| Rate for Payer: Networks By Design Commercial |
$14,625.00
|
| Rate for Payer: Prime Health Services Commercial |
$24,862.50
|
| Rate for Payer: Riverside University Health System MISP |
$11,700.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17,550.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17,550.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,977.52
|
| Rate for Payer: United Healthcare All Other HMO |
$10,685.02
|
| Rate for Payer: United Healthcare HMO Rider |
$10,453.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,579.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24,862.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24,862.50
|
| Rate for Payer: Vantage Medical Group Senior |
$24,862.50
|
|
|
HC DFIB 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 |
$16,087.50
|
| Rate for Payer: Central Health Plan Commercial |
$23,400.00
|
| Rate for Payer: Cigna of CA HMO |
$20,475.00
|
| Rate for Payer: Cigna of CA PPO |
$20,475.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,700.00
|
| Rate for Payer: EPIC Health Plan Senior |
$11,700.00
|
| Rate for Payer: Galaxy Health WC |
$24,862.50
|
| Rate for Payer: Global Benefits Group Commercial |
$17,550.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$26,325.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19,509.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,144.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18,105.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,850.00
|
| Rate for Payer: Multiplan Commercial |
$21,937.50
|
| Rate for Payer: Networks By Design Commercial |
$14,625.00
|
| Rate for Payer: Prime Health Services Commercial |
$24,862.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,977.52
|
| Rate for Payer: United Healthcare All Other HMO |
$10,685.02
|
| Rate for Payer: United Healthcare HMO Rider |
$10,453.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,579.38
|
|
|
HC DFIB 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 |
$17,875.00
|
| 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
|
|
