|
HC OXYGEN PER HOUR
|
Facility
|
IP
|
$30.00
|
|
| Hospital Charge Code |
900800650
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$25.50 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Senior |
$12.00
|
| Rate for Payer: Galaxy Health WC |
$25.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.20
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: Networks By Design Commercial |
$19.50
|
| Rate for Payer: Prime Health Services Commercial |
$25.50
|
|
|
HC OXYGEN PER HOUR
|
Facility
|
IP
|
$29.00
|
|
| Hospital Charge Code |
900802001
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5.80 |
| Max. Negotiated Rate |
$24.65 |
| Rate for Payer: Adventist Health Commercial |
$5.80
|
| Rate for Payer: Cash Price |
$13.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.60
|
| Rate for Payer: EPIC Health Plan Senior |
$11.60
|
| Rate for Payer: Galaxy Health WC |
$24.65
|
| Rate for Payer: Global Benefits Group Commercial |
$17.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.96
|
| Rate for Payer: Multiplan Commercial |
$23.20
|
| Rate for Payer: Networks By Design Commercial |
$18.85
|
| Rate for Payer: Prime Health Services Commercial |
$24.65
|
|
|
HC OXYGEN PER HOUR
|
Facility
|
OP
|
$29.00
|
|
| Hospital Charge Code |
900802001
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5.80 |
| Max. Negotiated Rate |
$24.65 |
| Rate for Payer: Adventist Health Commercial |
$5.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$19.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.81
|
| Rate for Payer: Cash Price |
$13.05
|
| Rate for Payer: Cigna of CA HMO |
$18.56
|
| Rate for Payer: Cigna of CA PPO |
$21.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.60
|
| Rate for Payer: EPIC Health Plan Senior |
$11.60
|
| Rate for Payer: Galaxy Health WC |
$24.65
|
| Rate for Payer: Global Benefits Group Commercial |
$17.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.30
|
| Rate for Payer: Multiplan Commercial |
$23.20
|
| Rate for Payer: Networks By Design Commercial |
$18.85
|
| Rate for Payer: Prime Health Services Commercial |
$24.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.50
|
| Rate for Payer: United Healthcare All Other HMO |
$14.50
|
| Rate for Payer: United Healthcare HMO Rider |
$14.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.65
|
| Rate for Payer: Vantage Medical Group Senior |
$24.65
|
|
|
HC OXYGEN PER HOUR PACU
|
Facility
|
OP
|
$29.00
|
|
| Hospital Charge Code |
900100043
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5.80 |
| Max. Negotiated Rate |
$24.65 |
| Rate for Payer: Adventist Health Commercial |
$5.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$19.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.81
|
| Rate for Payer: Cash Price |
$13.05
|
| Rate for Payer: Cigna of CA HMO |
$18.56
|
| Rate for Payer: Cigna of CA PPO |
$21.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.60
|
| Rate for Payer: EPIC Health Plan Senior |
$11.60
|
| Rate for Payer: Galaxy Health WC |
$24.65
|
| Rate for Payer: Global Benefits Group Commercial |
$17.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.30
|
| Rate for Payer: Multiplan Commercial |
$23.20
|
| Rate for Payer: Networks By Design Commercial |
$18.85
|
| Rate for Payer: Prime Health Services Commercial |
$24.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.50
|
| Rate for Payer: United Healthcare All Other HMO |
$14.50
|
| Rate for Payer: United Healthcare HMO Rider |
$14.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.65
|
| Rate for Payer: Vantage Medical Group Senior |
$24.65
|
|
|
HC OXYGEN PER HOUR PACU
|
Facility
|
IP
|
$29.00
|
|
| Hospital Charge Code |
900100043
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5.80 |
| Max. Negotiated Rate |
$24.65 |
| Rate for Payer: Adventist Health Commercial |
$5.80
|
| Rate for Payer: Cash Price |
$13.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.60
|
| Rate for Payer: EPIC Health Plan Senior |
$11.60
|
| Rate for Payer: Galaxy Health WC |
$24.65
|
| Rate for Payer: Global Benefits Group Commercial |
$17.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.96
|
| Rate for Payer: Multiplan Commercial |
$23.20
|
| Rate for Payer: Networks By Design Commercial |
$18.85
|
| Rate for Payer: Prime Health Services Commercial |
$24.65
|
|
|
HC P32 CHROMIC PHOSPHATE PER MCI
|
Facility
|
OP
|
$23,326.00
|
|
|
Service Code
|
CPT A9564
|
| Hospital Charge Code |
909301556
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$883.04 |
| Max. Negotiated Rate |
$19,827.10 |
| Rate for Payer: Adventist Health Commercial |
$4,665.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15,299.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19,827.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12,829.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17,494.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,324.50
|
| Rate for Payer: Blue Shield of California Commercial |
$14,275.51
|
| Rate for Payer: Blue Shield of California EPN |
$9,423.70
|
| Rate for Payer: Cash Price |
$10,496.70
|
| Rate for Payer: Cash Price |
$10,496.70
|
| Rate for Payer: Cigna of CA HMO |
$14,928.64
|
| Rate for Payer: Cigna of CA PPO |
$17,261.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19,827.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$19,827.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19,827.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,330.40
|
| Rate for Payer: EPIC Health Plan Senior |
$9,330.40
|
| Rate for Payer: Galaxy Health WC |
$19,827.10
|
| Rate for Payer: Global Benefits Group Commercial |
$13,995.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$883.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15,558.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$998.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,438.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,598.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16,328.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16,328.20
|
| Rate for Payer: Multiplan Commercial |
$18,660.80
|
| Rate for Payer: Networks By Design Commercial |
$15,161.90
|
| Rate for Payer: Prime Health Services Commercial |
$19,827.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13,995.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13,995.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,663.00
|
| Rate for Payer: United Healthcare All Other HMO |
$11,663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$11,663.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,663.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19,827.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19,827.10
|
| Rate for Payer: Vantage Medical Group Senior |
$19,827.10
|
|
|
HC P32 CHROMIC PHOSPHATE PER MCI
|
Facility
|
IP
|
$23,326.00
|
|
|
Service Code
|
CPT A9564
|
| Hospital Charge Code |
909301556
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$4,665.20 |
| Max. Negotiated Rate |
$19,827.10 |
| Rate for Payer: Adventist Health Commercial |
$4,665.20
|
| Rate for Payer: Cash Price |
$10,496.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,330.40
|
| Rate for Payer: EPIC Health Plan Senior |
$9,330.40
|
| Rate for Payer: Galaxy Health WC |
$19,827.10
|
| Rate for Payer: Global Benefits Group Commercial |
$13,995.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15,558.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,887.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,438.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,598.24
|
| Rate for Payer: Multiplan Commercial |
$18,660.80
|
| Rate for Payer: Networks By Design Commercial |
$15,161.90
|
| Rate for Payer: Prime Health Services Commercial |
$19,827.10
|
|
|
HC P32 SODIUM PHOSPHATE PER MCI
|
Facility
|
OP
|
$4,647.00
|
|
|
Service Code
|
CPT A9563
|
| Hospital Charge Code |
909301555
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$164.94 |
| Max. Negotiated Rate |
$3,949.95 |
| Rate for Payer: Adventist Health Commercial |
$929.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,047.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$223.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$197.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$197.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,853.72
|
| Rate for Payer: Blue Shield of California Commercial |
$2,843.96
|
| Rate for Payer: Blue Shield of California EPN |
$1,877.39
|
| Rate for Payer: Cash Price |
$2,091.15
|
| Rate for Payer: Cash Price |
$2,091.15
|
| Rate for Payer: Cigna of CA HMO |
$2,974.08
|
| Rate for Payer: Cigna of CA PPO |
$3,438.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$223.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$197.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$197.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$241.81
|
| Rate for Payer: EPIC Health Plan Senior |
$179.12
|
| Rate for Payer: Galaxy Health WC |
$3,949.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,788.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$293.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$164.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$179.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,099.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$186.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$179.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,115.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$225.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$240.02
|
| Rate for Payer: Multiplan Commercial |
$3,717.60
|
| Rate for Payer: Networks By Design Commercial |
$3,020.55
|
| Rate for Payer: Prime Health Services Commercial |
$3,949.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,788.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,788.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,744.02
|
| Rate for Payer: United Healthcare All Other HMO |
$1,697.55
|
| Rate for Payer: United Healthcare HMO Rider |
$1,660.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,521.89
|
| Rate for Payer: Upland Medical Group Pediatric |
$179.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$223.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$197.03
|
| Rate for Payer: Vantage Medical Group Senior |
$197.03
|
|
|
HC P32 SODIUM PHOSPHATE PER MCI
|
Facility
|
IP
|
$4,647.00
|
|
|
Service Code
|
CPT A9563
|
| Hospital Charge Code |
909301555
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$929.40 |
| Max. Negotiated Rate |
$3,949.95 |
| Rate for Payer: Adventist Health Commercial |
$929.40
|
| Rate for Payer: Blue Shield of California Commercial |
$3,429.49
|
| Rate for Payer: Blue Shield of California EPN |
$2,258.44
|
| Rate for Payer: Cash Price |
$2,091.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,858.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,858.80
|
| Rate for Payer: Galaxy Health WC |
$3,949.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,788.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,099.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,770.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,876.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,115.28
|
| Rate for Payer: Multiplan Commercial |
$3,717.60
|
| Rate for Payer: Networks By Design Commercial |
$3,020.55
|
| Rate for Payer: Prime Health Services Commercial |
$3,949.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,744.02
|
| Rate for Payer: United Healthcare All Other HMO |
$1,697.55
|
| Rate for Payer: United Healthcare HMO Rider |
$1,660.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,521.89
|
|
|
HC PACE BIO ELUNA PROMRI 394969
|
Facility
|
IP
|
$12,250.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813747
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,450.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$2,450.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$5,512.50
|
| Rate for Payer: Cash Price |
$5,512.50
|
| Rate for Payer: Cigna of CA HMO |
$8,575.00
|
| Rate for Payer: Cigna of CA PPO |
$8,575.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,900.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,900.00
|
| Rate for Payer: Galaxy Health WC |
$10,412.50
|
| Rate for Payer: Global Benefits Group Commercial |
$7,350.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,170.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,667.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,582.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,940.00
|
| Rate for Payer: Multiplan Commercial |
$9,800.00
|
| Rate for Payer: Networks By Design Commercial |
$6,125.00
|
| Rate for Payer: Prime Health Services Commercial |
$10,412.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,597.43
|
| Rate for Payer: United Healthcare All Other HMO |
$4,474.93
|
| Rate for Payer: United Healthcare HMO Rider |
$4,378.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,011.88
|
|
|
HC PACE BIO ELUNA PROMRI 394969
|
Facility
|
OP
|
$12,250.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813747
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,450.00 |
| Max. Negotiated Rate |
$10,412.50 |
| Rate for Payer: Adventist Health Commercial |
$2,450.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,412.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,737.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,187.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,522.73
|
| Rate for Payer: Blue Shield of California Commercial |
$9,040.50
|
| Rate for Payer: Blue Shield of California EPN |
$5,953.50
|
| Rate for Payer: Cash Price |
$5,512.50
|
| Rate for Payer: Cigna of CA HMO |
$8,575.00
|
| Rate for Payer: Cigna of CA PPO |
$8,575.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,412.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,412.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,412.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,900.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,900.00
|
| Rate for Payer: Galaxy Health WC |
$10,412.50
|
| Rate for Payer: Global Benefits Group Commercial |
$7,350.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,170.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,582.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,940.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,575.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,575.00
|
| Rate for Payer: Multiplan Commercial |
$9,800.00
|
| Rate for Payer: Networks By Design Commercial |
$6,125.00
|
| Rate for Payer: Prime Health Services Commercial |
$10,412.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,350.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,350.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,597.43
|
| Rate for Payer: United Healthcare All Other HMO |
$4,474.93
|
| Rate for Payer: United Healthcare HMO Rider |
$4,378.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,011.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,412.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,412.50
|
| Rate for Payer: Vantage Medical Group Senior |
$10,412.50
|
|
|
HC PACE BIOTRONIK EDORA 8 407145
|
Facility
|
OP
|
$13,250.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813797
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,650.00 |
| Max. Negotiated Rate |
$11,262.50 |
| Rate for Payer: Adventist Health Commercial |
$2,650.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,262.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,287.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,937.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,136.82
|
| Rate for Payer: Blue Shield of California Commercial |
$9,778.50
|
| Rate for Payer: Blue Shield of California EPN |
$6,439.50
|
| Rate for Payer: Cash Price |
$5,962.50
|
| Rate for Payer: Cigna of CA HMO |
$9,275.00
|
| Rate for Payer: Cigna of CA PPO |
$9,275.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,262.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,262.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11,262.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,300.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,300.00
|
| Rate for Payer: Galaxy Health WC |
$11,262.50
|
| Rate for Payer: Global Benefits Group Commercial |
$7,950.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,837.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,201.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,180.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,275.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,275.00
|
| Rate for Payer: Multiplan Commercial |
$10,600.00
|
| Rate for Payer: Networks By Design Commercial |
$6,625.00
|
| Rate for Payer: Prime Health Services Commercial |
$11,262.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,950.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,950.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,972.73
|
| Rate for Payer: United Healthcare All Other HMO |
$4,840.23
|
| Rate for Payer: United Healthcare HMO Rider |
$4,735.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,339.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,262.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,262.50
|
| Rate for Payer: Vantage Medical Group Senior |
$11,262.50
|
|
|
HC PACE BIOTRONIK EDORA 8 407145
|
Facility
|
IP
|
$13,250.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813797
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,650.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$2,650.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$5,962.50
|
| Rate for Payer: Cash Price |
$5,962.50
|
| Rate for Payer: Cigna of CA HMO |
$9,275.00
|
| Rate for Payer: Cigna of CA PPO |
$9,275.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,300.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,300.00
|
| Rate for Payer: Galaxy Health WC |
$11,262.50
|
| Rate for Payer: Global Benefits Group Commercial |
$7,950.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,837.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,048.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,201.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,180.00
|
| Rate for Payer: Multiplan Commercial |
$10,600.00
|
| Rate for Payer: Networks By Design Commercial |
$6,625.00
|
| Rate for Payer: Prime Health Services Commercial |
$11,262.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,972.73
|
| Rate for Payer: United Healthcare All Other HMO |
$4,840.23
|
| Rate for Payer: United Healthcare HMO Rider |
$4,735.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,339.38
|
|
|
HC PACE BIOTRONIK EDORA 8 407147
|
Facility
|
OP
|
$9,500.00
|
|
|
Service Code
|
CPT C1786
|
| Hospital Charge Code |
906813816
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,900.00 |
| Max. Negotiated Rate |
$8,075.00 |
| Rate for Payer: Adventist Health Commercial |
$1,900.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,075.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,225.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,125.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,833.95
|
| Rate for Payer: Blue Shield of California Commercial |
$7,011.00
|
| Rate for Payer: Blue Shield of California EPN |
$4,617.00
|
| Rate for Payer: Cash Price |
$4,275.00
|
| Rate for Payer: Cigna of CA HMO |
$6,650.00
|
| Rate for Payer: Cigna of CA PPO |
$6,650.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,075.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,075.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,075.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,800.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,800.00
|
| Rate for Payer: Galaxy Health WC |
$8,075.00
|
| Rate for Payer: Global Benefits Group Commercial |
$5,700.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,336.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,880.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,280.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,650.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,650.00
|
| Rate for Payer: Multiplan Commercial |
$7,600.00
|
| Rate for Payer: Networks By Design Commercial |
$4,750.00
|
| Rate for Payer: Prime Health Services Commercial |
$8,075.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,700.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,700.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,565.35
|
| Rate for Payer: United Healthcare All Other HMO |
$3,470.35
|
| Rate for Payer: United Healthcare HMO Rider |
$3,395.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,111.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,075.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,075.00
|
| Rate for Payer: Vantage Medical Group Senior |
$8,075.00
|
|
|
HC PACE BIOTRONIK EDORA 8 407147
|
Facility
|
IP
|
$9,500.00
|
|
|
Service Code
|
CPT C1786
|
| Hospital Charge Code |
906813816
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,900.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,900.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$4,275.00
|
| Rate for Payer: Cash Price |
$4,275.00
|
| Rate for Payer: Cigna of CA HMO |
$6,650.00
|
| Rate for Payer: Cigna of CA PPO |
$6,650.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,800.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,800.00
|
| Rate for Payer: Galaxy Health WC |
$8,075.00
|
| Rate for Payer: Global Benefits Group Commercial |
$5,700.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,336.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,619.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,880.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,280.00
|
| Rate for Payer: Multiplan Commercial |
$7,600.00
|
| Rate for Payer: Networks By Design Commercial |
$4,750.00
|
| Rate for Payer: Prime Health Services Commercial |
$8,075.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,565.35
|
| Rate for Payer: United Healthcare All Other HMO |
$3,470.35
|
| Rate for Payer: United Healthcare HMO Rider |
$3,395.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,111.25
|
|
|
HC PACE BIOTRONIK ELUNA 8 394971
|
Facility
|
IP
|
$8,750.00
|
|
|
Service Code
|
CPT C1786
|
| Hospital Charge Code |
906813790
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,750.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,750.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$3,937.50
|
| Rate for Payer: Cash Price |
$3,937.50
|
| Rate for Payer: Cigna of CA HMO |
$6,125.00
|
| Rate for Payer: Cigna of CA PPO |
$6,125.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,500.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,500.00
|
| Rate for Payer: Galaxy Health WC |
$7,437.50
|
| Rate for Payer: Global Benefits Group Commercial |
$5,250.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,836.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,333.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,416.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,100.00
|
| Rate for Payer: Multiplan Commercial |
$7,000.00
|
| Rate for Payer: Networks By Design Commercial |
$4,375.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,437.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,283.88
|
| Rate for Payer: United Healthcare All Other HMO |
$3,196.38
|
| Rate for Payer: United Healthcare HMO Rider |
$3,127.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,865.62
|
|
|
HC PACE BIOTRONIK ELUNA 8 394971
|
Facility
|
OP
|
$8,750.00
|
|
|
Service Code
|
CPT C1786
|
| Hospital Charge Code |
906813790
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,750.00 |
| Max. Negotiated Rate |
$7,437.50 |
| Rate for Payer: Adventist Health Commercial |
$1,750.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,437.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,812.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,562.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,373.38
|
| Rate for Payer: Blue Shield of California Commercial |
$6,457.50
|
| Rate for Payer: Blue Shield of California EPN |
$4,252.50
|
| Rate for Payer: Cash Price |
$3,937.50
|
| Rate for Payer: Cigna of CA HMO |
$6,125.00
|
| Rate for Payer: Cigna of CA PPO |
$6,125.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,437.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,437.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,437.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,500.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,500.00
|
| Rate for Payer: Galaxy Health WC |
$7,437.50
|
| Rate for Payer: Global Benefits Group Commercial |
$5,250.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,836.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,416.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,100.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,125.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,125.00
|
| Rate for Payer: Multiplan Commercial |
$7,000.00
|
| Rate for Payer: Networks By Design Commercial |
$4,375.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,437.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,250.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,250.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,283.88
|
| Rate for Payer: United Healthcare All Other HMO |
$3,196.38
|
| Rate for Payer: United Healthcare HMO Rider |
$3,127.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,865.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,437.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,437.50
|
| Rate for Payer: Vantage Medical Group Senior |
$7,437.50
|
|
|
HC PACE BIOTRONIK ETRINSA 394919
|
Facility
|
IP
|
$15,750.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813811
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,150.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$3,150.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$7,087.50
|
| Rate for Payer: Cash Price |
$7,087.50
|
| Rate for Payer: Cigna of CA HMO |
$11,025.00
|
| Rate for Payer: Cigna of CA PPO |
$11,025.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,300.00
|
| Rate for Payer: EPIC Health Plan Senior |
$6,300.00
|
| Rate for Payer: Galaxy Health WC |
$13,387.50
|
| Rate for Payer: Global Benefits Group Commercial |
$9,450.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,505.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,000.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,749.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,780.00
|
| Rate for Payer: Multiplan Commercial |
$12,600.00
|
| Rate for Payer: Networks By Design Commercial |
$7,875.00
|
| Rate for Payer: Prime Health Services Commercial |
$13,387.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,910.98
|
| Rate for Payer: United Healthcare All Other HMO |
$5,753.48
|
| Rate for Payer: United Healthcare HMO Rider |
$5,629.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,158.12
|
|
|
HC PACE BIOTRONIK ETRINSA 394919
|
Facility
|
OP
|
$15,750.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813811
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,150.00 |
| Max. Negotiated Rate |
$13,387.50 |
| Rate for Payer: Adventist Health Commercial |
$3,150.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,387.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,662.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11,812.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,672.08
|
| Rate for Payer: Blue Shield of California Commercial |
$11,623.50
|
| Rate for Payer: Blue Shield of California EPN |
$7,654.50
|
| Rate for Payer: Cash Price |
$7,087.50
|
| Rate for Payer: Cigna of CA HMO |
$11,025.00
|
| Rate for Payer: Cigna of CA PPO |
$11,025.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,387.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$13,387.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13,387.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,300.00
|
| Rate for Payer: EPIC Health Plan Senior |
$6,300.00
|
| Rate for Payer: Galaxy Health WC |
$13,387.50
|
| Rate for Payer: Global Benefits Group Commercial |
$9,450.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,505.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,749.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,780.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,025.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,025.00
|
| Rate for Payer: Multiplan Commercial |
$12,600.00
|
| Rate for Payer: Networks By Design Commercial |
$7,875.00
|
| Rate for Payer: Prime Health Services Commercial |
$13,387.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,450.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,450.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,910.98
|
| Rate for Payer: United Healthcare All Other HMO |
$5,753.48
|
| Rate for Payer: United Healthcare HMO Rider |
$5,629.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,158.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,387.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13,387.50
|
| Rate for Payer: Vantage Medical Group Senior |
$13,387.50
|
|
|
HC PACE BIOTRONIK EVIA DR 359529
|
Facility
|
IP
|
$12,400.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813719
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,480.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$2,480.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$5,580.00
|
| Rate for Payer: Cash Price |
$5,580.00
|
| Rate for Payer: Cigna of CA HMO |
$8,680.00
|
| Rate for Payer: Cigna of CA PPO |
$8,680.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,960.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,960.00
|
| Rate for Payer: Galaxy Health WC |
$10,540.00
|
| Rate for Payer: Global Benefits Group Commercial |
$7,440.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,270.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,724.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,675.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,976.00
|
| Rate for Payer: Multiplan Commercial |
$9,920.00
|
| Rate for Payer: Networks By Design Commercial |
$6,200.00
|
| Rate for Payer: Prime Health Services Commercial |
$10,540.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,653.72
|
| Rate for Payer: United Healthcare All Other HMO |
$4,529.72
|
| Rate for Payer: United Healthcare HMO Rider |
$4,431.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,061.00
|
|
|
HC PACE BIOTRONIK EVIA DR 359529
|
Facility
|
OP
|
$12,400.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813719
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,480.00 |
| Max. Negotiated Rate |
$10,540.00 |
| Rate for Payer: Adventist Health Commercial |
$2,480.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,540.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,820.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,300.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,614.84
|
| Rate for Payer: Blue Shield of California Commercial |
$9,151.20
|
| Rate for Payer: Blue Shield of California EPN |
$6,026.40
|
| Rate for Payer: Cash Price |
$5,580.00
|
| Rate for Payer: Cigna of CA HMO |
$8,680.00
|
| Rate for Payer: Cigna of CA PPO |
$8,680.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,540.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,540.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,540.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,960.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,960.00
|
| Rate for Payer: Galaxy Health WC |
$10,540.00
|
| Rate for Payer: Global Benefits Group Commercial |
$7,440.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,270.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,675.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,976.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,680.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,680.00
|
| Rate for Payer: Multiplan Commercial |
$9,920.00
|
| Rate for Payer: Networks By Design Commercial |
$6,200.00
|
| Rate for Payer: Prime Health Services Commercial |
$10,540.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,440.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,440.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,653.72
|
| Rate for Payer: United Healthcare All Other HMO |
$4,529.72
|
| Rate for Payer: United Healthcare HMO Rider |
$4,431.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,061.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,540.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,540.00
|
| Rate for Payer: Vantage Medical Group Senior |
$10,540.00
|
|
|
HC PACE B/S ACCOLADE DR L301
|
Facility
|
IP
|
$10,325.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813794
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,065.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$2,065.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$4,646.25
|
| Rate for Payer: Cash Price |
$4,646.25
|
| Rate for Payer: Cigna of CA HMO |
$7,227.50
|
| Rate for Payer: Cigna of CA PPO |
$7,227.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,130.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,130.00
|
| Rate for Payer: Galaxy Health WC |
$8,776.25
|
| Rate for Payer: Global Benefits Group Commercial |
$6,195.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,886.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,933.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,391.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,478.00
|
| Rate for Payer: Multiplan Commercial |
$8,260.00
|
| Rate for Payer: Networks By Design Commercial |
$5,162.50
|
| Rate for Payer: Prime Health Services Commercial |
$8,776.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,874.97
|
| Rate for Payer: United Healthcare All Other HMO |
$3,771.72
|
| Rate for Payer: United Healthcare HMO Rider |
$3,690.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,381.44
|
|
|
HC PACE B/S ACCOLADE DR L301
|
Facility
|
OP
|
$10,325.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813794
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,065.00 |
| Max. Negotiated Rate |
$8,776.25 |
| Rate for Payer: Adventist Health Commercial |
$2,065.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,776.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,678.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,743.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,340.58
|
| Rate for Payer: Blue Shield of California Commercial |
$7,619.85
|
| Rate for Payer: Blue Shield of California EPN |
$5,017.95
|
| Rate for Payer: Cash Price |
$4,646.25
|
| Rate for Payer: Cigna of CA HMO |
$7,227.50
|
| Rate for Payer: Cigna of CA PPO |
$7,227.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,776.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,776.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,776.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,130.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,130.00
|
| Rate for Payer: Galaxy Health WC |
$8,776.25
|
| Rate for Payer: Global Benefits Group Commercial |
$6,195.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,886.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,391.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,478.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,227.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,227.50
|
| Rate for Payer: Multiplan Commercial |
$8,260.00
|
| Rate for Payer: Networks By Design Commercial |
$5,162.50
|
| Rate for Payer: Prime Health Services Commercial |
$8,776.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,195.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,195.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,874.97
|
| Rate for Payer: United Healthcare All Other HMO |
$3,771.72
|
| Rate for Payer: United Healthcare HMO Rider |
$3,690.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,381.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,776.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,776.25
|
| Rate for Payer: Vantage Medical Group Senior |
$8,776.25
|
|
|
HC PACE B/S ACCOLADE DR MRI L311
|
Facility
|
OP
|
$12,200.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813767
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,440.00 |
| Max. Negotiated Rate |
$10,370.00 |
| Rate for Payer: Adventist Health Commercial |
$2,440.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,370.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,710.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,150.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,492.02
|
| Rate for Payer: Blue Shield of California Commercial |
$9,003.60
|
| Rate for Payer: Blue Shield of California EPN |
$5,929.20
|
| Rate for Payer: Cash Price |
$5,490.00
|
| Rate for Payer: Cigna of CA HMO |
$8,540.00
|
| Rate for Payer: Cigna of CA PPO |
$8,540.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,370.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,370.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,370.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,880.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,880.00
|
| Rate for Payer: Galaxy Health WC |
$10,370.00
|
| Rate for Payer: Global Benefits Group Commercial |
$7,320.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,137.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,551.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,928.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,540.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,540.00
|
| Rate for Payer: Multiplan Commercial |
$9,760.00
|
| Rate for Payer: Networks By Design Commercial |
$6,100.00
|
| Rate for Payer: Prime Health Services Commercial |
$10,370.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,320.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,320.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,578.66
|
| Rate for Payer: United Healthcare All Other HMO |
$4,456.66
|
| Rate for Payer: United Healthcare HMO Rider |
$4,360.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,995.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,370.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,370.00
|
| Rate for Payer: Vantage Medical Group Senior |
$10,370.00
|
|
|
HC PACE B/S ACCOLADE DR MRI L311
|
Facility
|
IP
|
$12,200.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813767
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,440.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$2,440.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$5,490.00
|
| Rate for Payer: Cash Price |
$5,490.00
|
| Rate for Payer: Cigna of CA HMO |
$8,540.00
|
| Rate for Payer: Cigna of CA PPO |
$8,540.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,880.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,880.00
|
| Rate for Payer: Galaxy Health WC |
$10,370.00
|
| Rate for Payer: Global Benefits Group Commercial |
$7,320.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,137.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,648.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,551.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,928.00
|
| Rate for Payer: Multiplan Commercial |
$9,760.00
|
| Rate for Payer: Networks By Design Commercial |
$6,100.00
|
| Rate for Payer: Prime Health Services Commercial |
$10,370.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,578.66
|
| Rate for Payer: United Healthcare All Other HMO |
$4,456.66
|
| Rate for Payer: United Healthcare HMO Rider |
$4,360.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,995.50
|
|
