|
HC EP DF BARD CONFORMA 7F
|
Facility
|
OP
|
$3,803.00
|
|
|
Service Code
|
CPT C1731
|
| Hospital Charge Code |
906812374
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$760.60 |
| Max. Negotiated Rate |
$3,422.70 |
| Rate for Payer: Adventist Health Commercial |
$760.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,309.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,232.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,091.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,852.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,841.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,233.50
|
| Rate for Payer: Blue Shield of California Commercial |
$2,323.63
|
| Rate for Payer: Blue Shield of California EPN |
$1,517.40
|
| Rate for Payer: Cash Price |
$1,711.35
|
| Rate for Payer: Central Health Plan Commercial |
$3,042.40
|
| Rate for Payer: Cigna of CA HMO |
$2,433.92
|
| Rate for Payer: Cigna of CA PPO |
$2,814.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,232.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,232.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,232.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,521.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,521.20
|
| Rate for Payer: Galaxy Health WC |
$3,232.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,281.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,422.70
|
| Rate for Payer: InnovAge PACE Commercial |
$1,901.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,536.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,448.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,354.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$760.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,662.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,662.10
|
| Rate for Payer: Multiplan Commercial |
$2,852.25
|
| Rate for Payer: Networks By Design Commercial |
$2,471.95
|
| Rate for Payer: Prime Health Services Commercial |
$3,232.55
|
| Rate for Payer: Riverside University Health System MISP |
$1,521.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,281.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,281.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,901.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,901.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,901.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,901.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,232.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,232.55
|
| Rate for Payer: Vantage Medical Group Senior |
$3,232.55
|
|
|
HC EP DF BIO WEB CS DECA
|
Facility
|
IP
|
$2,295.40
|
|
| Hospital Charge Code |
906812451
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$459.08 |
| Max. Negotiated Rate |
$2,065.86 |
| Rate for Payer: Adventist Health Commercial |
$459.08
|
| Rate for Payer: Cash Price |
$1,032.93
|
| Rate for Payer: Central Health Plan Commercial |
$1,836.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$918.16
|
| Rate for Payer: EPIC Health Plan Senior |
$918.16
|
| Rate for Payer: Galaxy Health WC |
$1,951.09
|
| Rate for Payer: Global Benefits Group Commercial |
$1,377.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,065.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,531.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$874.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,420.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$459.08
|
| Rate for Payer: Multiplan Commercial |
$1,721.55
|
| Rate for Payer: Networks By Design Commercial |
$1,492.01
|
| Rate for Payer: Prime Health Services Commercial |
$1,951.09
|
|
|
HC EP DF BIO WEB CS DECA
|
Facility
|
OP
|
$2,295.40
|
|
| Hospital Charge Code |
906812451
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$459.08 |
| Max. Negotiated Rate |
$2,065.86 |
| Rate for Payer: Adventist Health Commercial |
$459.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,394.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,951.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,262.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,721.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,111.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,348.09
|
| Rate for Payer: Blue Shield of California Commercial |
$1,402.49
|
| Rate for Payer: Blue Shield of California EPN |
$915.86
|
| Rate for Payer: Cash Price |
$1,032.93
|
| Rate for Payer: Central Health Plan Commercial |
$1,836.32
|
| Rate for Payer: Cigna of CA HMO |
$1,469.06
|
| Rate for Payer: Cigna of CA PPO |
$1,698.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,951.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,951.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,951.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$918.16
|
| Rate for Payer: EPIC Health Plan Senior |
$918.16
|
| Rate for Payer: Galaxy Health WC |
$1,951.09
|
| Rate for Payer: Global Benefits Group Commercial |
$1,377.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,065.86
|
| Rate for Payer: InnovAge PACE Commercial |
$1,147.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,531.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$874.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,420.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$459.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,606.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,606.78
|
| Rate for Payer: Multiplan Commercial |
$1,721.55
|
| Rate for Payer: Networks By Design Commercial |
$1,492.01
|
| Rate for Payer: Prime Health Services Commercial |
$1,951.09
|
| Rate for Payer: Riverside University Health System MISP |
$918.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,377.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,377.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,147.70
|
| Rate for Payer: United Healthcare All Other HMO |
$1,147.70
|
| Rate for Payer: United Healthcare HMO Rider |
$1,147.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,147.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,951.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,951.09
|
| Rate for Payer: Vantage Medical Group Senior |
$1,951.09
|
|
|
HC EP DF BIO WEB DUODECA NAV
|
Facility
|
OP
|
$2,760.00
|
|
|
Service Code
|
CPT C1731
|
| Hospital Charge Code |
906812546
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$552.00 |
| Max. Negotiated Rate |
$2,484.00 |
| Rate for Payer: Adventist Health Commercial |
$552.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,346.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,518.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,070.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,260.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,528.21
|
| Rate for Payer: Blue Shield of California Commercial |
$2,133.48
|
| Rate for Payer: Blue Shield of California EPN |
$1,391.04
|
| Rate for Payer: Cash Price |
$1,242.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,208.00
|
| Rate for Payer: Cigna of CA HMO |
$1,932.00
|
| Rate for Payer: Cigna of CA PPO |
$1,932.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,346.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,346.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,346.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,104.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,104.00
|
| Rate for Payer: Galaxy Health WC |
$2,346.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,656.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,484.00
|
| Rate for Payer: InnovAge PACE Commercial |
$1,380.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,840.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,051.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,708.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$552.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,932.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,932.00
|
| Rate for Payer: Multiplan Commercial |
$2,070.00
|
| Rate for Payer: Networks By Design Commercial |
$1,380.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,346.00
|
| Rate for Payer: Riverside University Health System MISP |
$1,104.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,656.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,656.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,035.83
|
| Rate for Payer: United Healthcare All Other HMO |
$1,008.23
|
| Rate for Payer: United Healthcare HMO Rider |
$986.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$903.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,346.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,346.00
|
| Rate for Payer: Vantage Medical Group Senior |
$2,346.00
|
|
|
HC EP DF BIO WEB DUODECA NAV
|
Facility
|
IP
|
$2,760.00
|
|
|
Service Code
|
CPT C1731
|
| Hospital Charge Code |
906812546
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$552.00 |
| Max. Negotiated Rate |
$2,484.00 |
| Rate for Payer: Adventist Health Commercial |
$552.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,133.48
|
| Rate for Payer: Blue Shield of California EPN |
$1,391.04
|
| Rate for Payer: Cash Price |
$1,242.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,208.00
|
| Rate for Payer: Cigna of CA HMO |
$1,932.00
|
| Rate for Payer: Cigna of CA PPO |
$1,932.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,104.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,104.00
|
| Rate for Payer: Galaxy Health WC |
$2,346.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,656.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,484.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,840.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,051.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,708.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$552.00
|
| Rate for Payer: Multiplan Commercial |
$2,070.00
|
| Rate for Payer: Networks By Design Commercial |
$1,380.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,346.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,035.83
|
| Rate for Payer: United Healthcare All Other HMO |
$1,008.23
|
| Rate for Payer: United Healthcare HMO Rider |
$986.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$903.90
|
|
|
HC EP DF BIO/WEB ISMUS
|
Facility
|
OP
|
$3,654.00
|
|
|
Service Code
|
CPT C1731
|
| Hospital Charge Code |
906812369
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$730.80 |
| Max. Negotiated Rate |
$3,288.60 |
| Rate for Payer: Adventist Health Commercial |
$730.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,219.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,105.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,009.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,740.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,769.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,145.99
|
| Rate for Payer: Blue Shield of California Commercial |
$2,232.59
|
| Rate for Payer: Blue Shield of California EPN |
$1,457.95
|
| Rate for Payer: Cash Price |
$1,644.30
|
| Rate for Payer: Central Health Plan Commercial |
$2,923.20
|
| Rate for Payer: Cigna of CA HMO |
$2,338.56
|
| Rate for Payer: Cigna of CA PPO |
$2,703.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,105.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,105.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,105.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,461.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,461.60
|
| Rate for Payer: Galaxy Health WC |
$3,105.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,192.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,288.60
|
| Rate for Payer: InnovAge PACE Commercial |
$1,827.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,437.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,392.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,261.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$730.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,557.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,557.80
|
| Rate for Payer: Multiplan Commercial |
$2,740.50
|
| Rate for Payer: Networks By Design Commercial |
$2,375.10
|
| Rate for Payer: Prime Health Services Commercial |
$3,105.90
|
| Rate for Payer: Riverside University Health System MISP |
$1,461.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,192.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,192.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,827.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,827.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,827.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,827.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,105.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,105.90
|
| Rate for Payer: Vantage Medical Group Senior |
$3,105.90
|
|
|
HC EP DF BIO/WEB ISMUS
|
Facility
|
IP
|
$3,654.00
|
|
|
Service Code
|
CPT C1731
|
| Hospital Charge Code |
906812369
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$730.80 |
| Max. Negotiated Rate |
$3,288.60 |
| Rate for Payer: Adventist Health Commercial |
$730.80
|
| Rate for Payer: Cash Price |
$1,644.30
|
| Rate for Payer: Central Health Plan Commercial |
$2,923.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,461.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,461.60
|
| Rate for Payer: Galaxy Health WC |
$3,105.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,192.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,288.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,437.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,392.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,261.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$730.80
|
| Rate for Payer: Multiplan Commercial |
$2,740.50
|
| Rate for Payer: Networks By Design Commercial |
$2,375.10
|
| Rate for Payer: Prime Health Services Commercial |
$3,105.90
|
|
|
HC EP DF BIO/WEB LASSO 10 POLE
|
Facility
|
OP
|
$3,900.00
|
|
|
Service Code
|
CPT C1730
|
| Hospital Charge Code |
906812365
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,510.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,368.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,145.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,925.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,888.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,290.47
|
| Rate for Payer: Blue Shield of California Commercial |
$2,382.90
|
| Rate for Payer: Blue Shield of California EPN |
$1,556.10
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.00
|
| Rate for Payer: Cigna of CA HMO |
$2,496.00
|
| Rate for Payer: Cigna of CA PPO |
$2,886.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,315.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,315.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,510.00
|
| Rate for Payer: InnovAge PACE Commercial |
$1,950.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$780.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,730.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,730.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: Networks By Design Commercial |
$2,535.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| Rate for Payer: Riverside University Health System MISP |
$1,560.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,340.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,340.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,950.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,950.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,950.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,950.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,315.00
|
|
|
HC EP DF BIO/WEB LASSO 10 POLE
|
Facility
|
IP
|
$3,900.00
|
|
|
Service Code
|
CPT C1730
|
| Hospital Charge Code |
906812365
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,510.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,510.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$780.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: Networks By Design Commercial |
$2,535.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
|
|
HC EP DF BIO/WEB LASSO NAV 20MM
|
Facility
|
IP
|
$3,900.00
|
|
|
Service Code
|
CPT C1730
|
| Hospital Charge Code |
906812411
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,510.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,510.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$780.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: Networks By Design Commercial |
$2,535.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
|
|
HC EP DF BIO/WEB LASSO NAV 20MM
|
Facility
|
OP
|
$3,900.00
|
|
|
Service Code
|
CPT C1730
|
| Hospital Charge Code |
906812411
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,510.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,368.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,145.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,925.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,888.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,290.47
|
| Rate for Payer: Blue Shield of California Commercial |
$2,382.90
|
| Rate for Payer: Blue Shield of California EPN |
$1,556.10
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.00
|
| Rate for Payer: Cigna of CA HMO |
$2,496.00
|
| Rate for Payer: Cigna of CA PPO |
$2,886.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,315.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,315.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,510.00
|
| Rate for Payer: InnovAge PACE Commercial |
$1,950.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$780.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,730.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,730.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: Networks By Design Commercial |
$2,535.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| Rate for Payer: Riverside University Health System MISP |
$1,560.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,340.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,340.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,950.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,950.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,950.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,950.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,315.00
|
|
|
HC EP DF MED ACHIEVE
|
Facility
|
IP
|
$3,705.00
|
|
|
Service Code
|
CPT C1730
|
| Hospital Charge Code |
906812544
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$741.00 |
| Max. Negotiated Rate |
$3,334.50 |
| Rate for Payer: Adventist Health Commercial |
$741.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,863.97
|
| Rate for Payer: Blue Shield of California EPN |
$1,867.32
|
| Rate for Payer: Cash Price |
$1,667.25
|
| Rate for Payer: Central Health Plan Commercial |
$2,964.00
|
| Rate for Payer: Cigna of CA HMO |
$2,593.50
|
| Rate for Payer: Cigna of CA PPO |
$2,593.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,482.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,482.00
|
| Rate for Payer: Galaxy Health WC |
$3,149.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,223.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,334.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,471.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,411.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,293.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$741.00
|
| Rate for Payer: Multiplan Commercial |
$2,778.75
|
| Rate for Payer: Networks By Design Commercial |
$1,852.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,149.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,390.49
|
| Rate for Payer: United Healthcare All Other HMO |
$1,353.44
|
| Rate for Payer: United Healthcare HMO Rider |
$1,324.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,213.39
|
|
|
HC EP DF MED ACHIEVE
|
Facility
|
OP
|
$3,705.00
|
|
|
Service Code
|
CPT C1730
|
| Hospital Charge Code |
906812544
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$741.00 |
| Max. Negotiated Rate |
$3,334.50 |
| Rate for Payer: Adventist Health Commercial |
$741.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,149.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,037.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,778.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,691.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,051.46
|
| Rate for Payer: Blue Shield of California Commercial |
$2,863.97
|
| Rate for Payer: Blue Shield of California EPN |
$1,867.32
|
| Rate for Payer: Cash Price |
$1,667.25
|
| Rate for Payer: Central Health Plan Commercial |
$2,964.00
|
| Rate for Payer: Cigna of CA HMO |
$2,593.50
|
| Rate for Payer: Cigna of CA PPO |
$2,593.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,149.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,149.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,149.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,482.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,482.00
|
| Rate for Payer: Galaxy Health WC |
$3,149.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,223.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,334.50
|
| Rate for Payer: InnovAge PACE Commercial |
$1,852.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,471.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,411.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,293.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$741.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,593.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,593.50
|
| Rate for Payer: Multiplan Commercial |
$2,778.75
|
| Rate for Payer: Networks By Design Commercial |
$1,852.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,149.25
|
| Rate for Payer: Riverside University Health System MISP |
$1,482.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,223.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,223.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,390.49
|
| Rate for Payer: United Healthcare All Other HMO |
$1,353.44
|
| Rate for Payer: United Healthcare HMO Rider |
$1,324.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,213.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,149.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,149.25
|
| Rate for Payer: Vantage Medical Group Senior |
$3,149.25
|
|
|
HC EP DF STJ AFOCUS II
|
Facility
|
OP
|
$3,335.00
|
|
|
Service Code
|
CPT C1732
|
| Hospital Charge Code |
906812583
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$667.00 |
| Max. Negotiated Rate |
$3,001.50 |
| Rate for Payer: Adventist Health Commercial |
$667.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,834.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,834.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,501.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,522.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,846.59
|
| Rate for Payer: Blue Shield of California Commercial |
$2,577.95
|
| Rate for Payer: Blue Shield of California EPN |
$1,680.84
|
| Rate for Payer: Cash Price |
$1,500.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,668.00
|
| Rate for Payer: Cigna of CA HMO |
$2,334.50
|
| Rate for Payer: Cigna of CA PPO |
$2,334.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,834.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,834.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,834.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,334.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,334.00
|
| Rate for Payer: Galaxy Health WC |
$2,834.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,001.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,001.50
|
| Rate for Payer: InnovAge PACE Commercial |
$1,667.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,224.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,270.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,064.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$667.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,334.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,334.50
|
| Rate for Payer: Multiplan Commercial |
$2,501.25
|
| Rate for Payer: Networks By Design Commercial |
$1,667.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,834.75
|
| Rate for Payer: Riverside University Health System MISP |
$1,334.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,001.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,001.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,251.63
|
| Rate for Payer: United Healthcare All Other HMO |
$1,218.28
|
| Rate for Payer: United Healthcare HMO Rider |
$1,191.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,092.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,834.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,834.75
|
| Rate for Payer: Vantage Medical Group Senior |
$2,834.75
|
|
|
HC EP DF STJ AFOCUS II
|
Facility
|
IP
|
$3,335.00
|
|
|
Service Code
|
CPT C1732
|
| Hospital Charge Code |
906812583
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$667.00 |
| Max. Negotiated Rate |
$3,001.50 |
| Rate for Payer: Adventist Health Commercial |
$667.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,577.95
|
| Rate for Payer: Blue Shield of California EPN |
$1,680.84
|
| Rate for Payer: Cash Price |
$1,500.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,668.00
|
| Rate for Payer: Cigna of CA HMO |
$2,334.50
|
| Rate for Payer: Cigna of CA PPO |
$2,334.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,334.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,334.00
|
| Rate for Payer: Galaxy Health WC |
$2,834.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,001.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,001.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,224.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,270.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,064.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$667.00
|
| Rate for Payer: Multiplan Commercial |
$2,501.25
|
| Rate for Payer: Networks By Design Commercial |
$1,667.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,834.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,251.63
|
| Rate for Payer: United Healthcare All Other HMO |
$1,218.28
|
| Rate for Payer: United Healthcare HMO Rider |
$1,191.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,092.21
|
|
|
HC EP DF ST J INQUIRY OPTIMA PLUS
|
Facility
|
OP
|
$4,000.00
|
|
|
Service Code
|
CPT C1730
|
| Hospital Charge Code |
906812410
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$800.00 |
| Max. Negotiated Rate |
$3,600.00 |
| Rate for Payer: Adventist Health Commercial |
$800.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,429.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,400.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,200.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,000.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,936.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,349.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,444.00
|
| Rate for Payer: Blue Shield of California EPN |
$1,596.00
|
| Rate for Payer: Cash Price |
$1,800.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,200.00
|
| Rate for Payer: Cigna of CA HMO |
$2,560.00
|
| Rate for Payer: Cigna of CA PPO |
$2,960.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,400.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,400.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,400.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,600.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,600.00
|
| Rate for Payer: Galaxy Health WC |
$3,400.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,400.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,600.00
|
| Rate for Payer: InnovAge PACE Commercial |
$2,000.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,668.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,524.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,476.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$800.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,800.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,800.00
|
| Rate for Payer: Multiplan Commercial |
$3,000.00
|
| Rate for Payer: Networks By Design Commercial |
$2,600.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,400.00
|
| Rate for Payer: Riverside University Health System MISP |
$1,600.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,400.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,400.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,000.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,000.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,000.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,400.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,400.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,400.00
|
|
|
HC EP DF ST J INQUIRY OPTIMA PLUS
|
Facility
|
IP
|
$4,000.00
|
|
|
Service Code
|
CPT C1730
|
| Hospital Charge Code |
906812410
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$800.00 |
| Max. Negotiated Rate |
$3,600.00 |
| Rate for Payer: Adventist Health Commercial |
$800.00
|
| Rate for Payer: Cash Price |
$1,800.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,200.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,600.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,600.00
|
| Rate for Payer: Galaxy Health WC |
$3,400.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,400.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,600.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,668.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,524.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,476.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$800.00
|
| Rate for Payer: Multiplan Commercial |
$3,000.00
|
| Rate for Payer: Networks By Design Commercial |
$2,600.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,400.00
|
|
|
HC EP FX CARDIMA PATHFINDER
|
Facility
|
IP
|
$3,900.00
|
|
|
Service Code
|
CPT C1730
|
| Hospital Charge Code |
906812404
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,510.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,510.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$780.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: Networks By Design Commercial |
$2,535.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
|
|
HC EP FX CARDIMA PATHFINDER
|
Facility
|
OP
|
$3,900.00
|
|
|
Service Code
|
CPT C1730
|
| Hospital Charge Code |
906812404
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,510.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,368.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,145.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,925.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,888.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,290.47
|
| Rate for Payer: Blue Shield of California Commercial |
$2,382.90
|
| Rate for Payer: Blue Shield of California EPN |
$1,556.10
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.00
|
| Rate for Payer: Cigna of CA HMO |
$2,496.00
|
| Rate for Payer: Cigna of CA PPO |
$2,886.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,315.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,315.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,510.00
|
| Rate for Payer: InnovAge PACE Commercial |
$1,950.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$780.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,730.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,730.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: Networks By Design Commercial |
$2,535.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| Rate for Payer: Riverside University Health System MISP |
$1,560.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,340.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,340.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,950.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,950.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,950.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,950.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,315.00
|
|
|
HC EPHYS EVAL CCM DFIB LD INITIAL IMPL
|
Facility
|
OP
|
$3,315.00
|
|
|
Service Code
|
CPT 0930T
|
| Hospital Charge Code |
906811514
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$663.00 |
| Max. Negotiated Rate |
$7,837.47 |
| Rate for Payer: Adventist Health Commercial |
$663.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,542.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,313.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,696.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,542.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,605.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,946.90
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$1,491.75
|
| Rate for Payer: Cash Price |
$1,491.75
|
| Rate for Payer: Cash Price |
$1,491.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,652.00
|
| Rate for Payer: Cigna of CA HMO |
$2,121.60
|
| Rate for Payer: Cigna of CA PPO |
$2,453.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,313.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,696.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,542.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,082.38
|
| Rate for Payer: EPIC Health Plan Senior |
$1,542.50
|
| Rate for Payer: Galaxy Health WC |
$2,817.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,989.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,983.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,529.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,542.50
|
| Rate for Payer: InnovAge PACE Commercial |
$2,313.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,211.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,263.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,542.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$663.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,066.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,066.95
|
| Rate for Payer: Multiplan Commercial |
$2,486.25
|
| Rate for Payer: Networks By Design Commercial |
$2,154.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,542.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,817.75
|
| Rate for Payer: Prime Health Services Medicare |
$1,635.05
|
| Rate for Payer: Riverside University Health System MISP |
$1,696.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,989.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,989.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,542.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,313.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,696.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1,542.50
|
|
|
HC EPHYS EVAL CCM DFIB LD INITIAL IMPL
|
Facility
|
IP
|
$3,315.00
|
|
|
Service Code
|
CPT 0930T
|
| Hospital Charge Code |
906811514
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$663.00 |
| Max. Negotiated Rate |
$2,983.50 |
| Rate for Payer: Adventist Health Commercial |
$663.00
|
| Rate for Payer: Cash Price |
$1,491.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,652.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,326.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,326.00
|
| Rate for Payer: Galaxy Health WC |
$2,817.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,989.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,983.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,211.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,263.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,051.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$663.00
|
| Rate for Payer: Multiplan Commercial |
$2,486.25
|
| Rate for Payer: Networks By Design Commercial |
$2,154.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,817.75
|
|
|
HC EPHYS EVAL CCM DFIB LD SEPARATE
|
Facility
|
OP
|
$3,315.00
|
|
|
Service Code
|
CPT 0931T
|
| Hospital Charge Code |
906811515
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$663.00 |
| Max. Negotiated Rate |
$7,837.47 |
| Rate for Payer: Adventist Health Commercial |
$663.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,542.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,313.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,696.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,542.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,605.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,946.90
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$1,491.75
|
| Rate for Payer: Cash Price |
$1,491.75
|
| Rate for Payer: Cash Price |
$1,491.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,652.00
|
| Rate for Payer: Cigna of CA HMO |
$2,121.60
|
| Rate for Payer: Cigna of CA PPO |
$2,453.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,313.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,696.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,542.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,082.38
|
| Rate for Payer: EPIC Health Plan Senior |
$1,542.50
|
| Rate for Payer: Galaxy Health WC |
$2,817.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,989.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,983.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,529.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,542.50
|
| Rate for Payer: InnovAge PACE Commercial |
$2,313.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,211.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,263.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,542.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$663.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,066.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,066.95
|
| Rate for Payer: Multiplan Commercial |
$2,486.25
|
| Rate for Payer: Networks By Design Commercial |
$2,154.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,542.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,817.75
|
| Rate for Payer: Prime Health Services Medicare |
$1,635.05
|
| Rate for Payer: Riverside University Health System MISP |
$1,696.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,989.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,989.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,542.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,313.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,696.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1,542.50
|
|
|
HC EPHYS EVAL CCM DFIB LD SEPARATE
|
Facility
|
IP
|
$3,315.00
|
|
|
Service Code
|
CPT 0931T
|
| Hospital Charge Code |
906811515
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$663.00 |
| Max. Negotiated Rate |
$2,983.50 |
| Rate for Payer: Adventist Health Commercial |
$663.00
|
| Rate for Payer: Cash Price |
$1,491.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,652.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,326.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,326.00
|
| Rate for Payer: Galaxy Health WC |
$2,817.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,989.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,983.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,211.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,263.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,051.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$663.00
|
| Rate for Payer: Multiplan Commercial |
$2,486.25
|
| Rate for Payer: Networks By Design Commercial |
$2,154.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,817.75
|
|
|
HC EPIDRM AGRFT TRNK ARM LEG LT 100
|
Facility
|
IP
|
$6,284.00
|
|
|
Service Code
|
CPT 15110
|
| Hospital Charge Code |
900501779
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,256.80 |
| Max. Negotiated Rate |
$5,655.60 |
| Rate for Payer: Adventist Health Commercial |
$1,256.80
|
| Rate for Payer: Cash Price |
$2,827.80
|
| Rate for Payer: Central Health Plan Commercial |
$5,027.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,513.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,513.60
|
| Rate for Payer: Galaxy Health WC |
$5,341.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,770.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,655.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,191.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,394.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,889.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,256.80
|
| Rate for Payer: Multiplan Commercial |
$4,713.00
|
| Rate for Payer: Networks By Design Commercial |
$4,084.60
|
| Rate for Payer: Prime Health Services Commercial |
$5,341.40
|
|
|
HC EPIDRM AGRFT TRNK ARM LEG LT 100
|
Facility
|
OP
|
$6,284.00
|
|
|
Service Code
|
CPT 15110
|
| Hospital Charge Code |
900501779
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$6,333.00 |
| Rate for Payer: Adventist Health Commercial |
$1,256.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,556.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,324.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,703.23
|
| Rate for Payer: Cash Price |
$2,827.80
|
| Rate for Payer: Cash Price |
$2,827.80
|
| Rate for Payer: Cash Price |
$2,827.80
|
| Rate for Payer: Cash Price |
$2,827.80
|
| Rate for Payer: Central Health Plan Commercial |
$5,027.20
|
| Rate for Payer: Cigna of CA HMO |
$4,021.76
|
| Rate for Payer: Cigna of CA PPO |
$4,650.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,556.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,324.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,137.70
|
| Rate for Payer: EPIC Health Plan Senior |
$2,324.22
|
| Rate for Payer: Galaxy Health WC |
$5,341.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,770.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,655.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,811.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,324.22
|
| Rate for Payer: InnovAge PACE Commercial |
$3,486.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,191.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,266.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,324.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,256.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,114.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,114.45
|
| Rate for Payer: Multiplan Commercial |
$4,713.00
|
| Rate for Payer: Multiplan WC |
$3,703.23
|
| Rate for Payer: Networks By Design Commercial |
$4,084.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,324.22
|
| Rate for Payer: Preferred Health Network WC |
$3,778.81
|
| Rate for Payer: Prime Health Services Commercial |
$5,341.40
|
| Rate for Payer: Prime Health Services Medicare |
$2,463.67
|
| Rate for Payer: Prime Health Services WC |
$3,665.45
|
| Rate for Payer: Riverside University Health System MISP |
$2,556.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,770.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,142.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,142.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,142.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,142.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,324.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,556.64
|
| Rate for Payer: Vantage Medical Group Senior |
$2,324.22
|
|
