|
HC PACE B/S ALTRUA 20 DR S202
|
Facility
|
OP
|
$6,875.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813622
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,375.00 |
| Max. Negotiated Rate |
$5,843.75 |
| Rate for Payer: Adventist Health Commercial |
$1,375.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,843.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,781.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,156.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,221.94
|
| Rate for Payer: Blue Shield of California Commercial |
$5,073.75
|
| Rate for Payer: Blue Shield of California EPN |
$3,341.25
|
| Rate for Payer: Cash Price |
$3,781.25
|
| Rate for Payer: Cigna of CA HMO |
$4,812.50
|
| Rate for Payer: Cigna of CA PPO |
$4,812.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,843.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,843.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,843.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,750.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,750.00
|
| Rate for Payer: Galaxy Health WC |
$5,843.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4,125.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,585.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,255.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,650.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,812.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,812.50
|
| Rate for Payer: Multiplan Commercial |
$5,500.00
|
| Rate for Payer: Networks By Design Commercial |
$3,437.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,843.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,125.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,125.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,580.19
|
| Rate for Payer: United Healthcare All Other HMO |
$2,511.44
|
| Rate for Payer: United Healthcare HMO Rider |
$2,457.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,251.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,843.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,843.75
|
| Rate for Payer: Vantage Medical Group Senior |
$5,843.75
|
|
|
HC PACE B/S ALTRUA 20 SR S201
|
Facility
|
OP
|
$6,875.00
|
|
|
Service Code
|
CPT C1786
|
| Hospital Charge Code |
906813625
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,375.00 |
| Max. Negotiated Rate |
$5,843.75 |
| Rate for Payer: Adventist Health Commercial |
$1,375.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,843.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,781.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,156.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,221.94
|
| Rate for Payer: Blue Shield of California Commercial |
$5,073.75
|
| Rate for Payer: Blue Shield of California EPN |
$3,341.25
|
| Rate for Payer: Cash Price |
$3,781.25
|
| Rate for Payer: Cigna of CA HMO |
$4,812.50
|
| Rate for Payer: Cigna of CA PPO |
$4,812.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,843.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,843.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,843.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,750.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,750.00
|
| Rate for Payer: Galaxy Health WC |
$5,843.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4,125.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,585.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,255.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,650.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,812.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,812.50
|
| Rate for Payer: Multiplan Commercial |
$5,500.00
|
| Rate for Payer: Networks By Design Commercial |
$3,437.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,843.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,125.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,125.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,580.19
|
| Rate for Payer: United Healthcare All Other HMO |
$2,511.44
|
| Rate for Payer: United Healthcare HMO Rider |
$2,457.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,251.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,843.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,843.75
|
| Rate for Payer: Vantage Medical Group Senior |
$5,843.75
|
|
|
HC PACE B/S ALTRUA 20 SR S201
|
Facility
|
IP
|
$6,875.00
|
|
|
Service Code
|
CPT C1786
|
| Hospital Charge Code |
906813625
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,375.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,375.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$3,781.25
|
| Rate for Payer: Cash Price |
$3,781.25
|
| Rate for Payer: Cigna of CA HMO |
$4,812.50
|
| Rate for Payer: Cigna of CA PPO |
$4,812.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,750.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,750.00
|
| Rate for Payer: Galaxy Health WC |
$5,843.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4,125.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,585.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,619.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,255.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,650.00
|
| Rate for Payer: Multiplan Commercial |
$5,500.00
|
| Rate for Payer: Networks By Design Commercial |
$3,437.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,843.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,580.19
|
| Rate for Payer: United Healthcare All Other HMO |
$2,511.44
|
| Rate for Payer: United Healthcare HMO Rider |
$2,457.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,251.56
|
|
|
HC PACE B/S ALTRUA 40 DR S402
|
Facility
|
OP
|
$9,250.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813621
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,850.00 |
| Max. Negotiated Rate |
$7,862.50 |
| Rate for Payer: Adventist Health Commercial |
$1,850.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,862.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,087.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,937.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,680.43
|
| Rate for Payer: Blue Shield of California Commercial |
$6,826.50
|
| Rate for Payer: Blue Shield of California EPN |
$4,495.50
|
| Rate for Payer: Cash Price |
$5,087.50
|
| Rate for Payer: Cigna of CA HMO |
$6,475.00
|
| Rate for Payer: Cigna of CA PPO |
$6,475.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,862.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,862.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,862.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,700.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,700.00
|
| Rate for Payer: Galaxy Health WC |
$7,862.50
|
| Rate for Payer: Global Benefits Group Commercial |
$5,550.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,169.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,725.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,220.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,475.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,475.00
|
| Rate for Payer: Multiplan Commercial |
$7,400.00
|
| Rate for Payer: Networks By Design Commercial |
$4,625.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,862.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,550.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,550.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,471.53
|
| Rate for Payer: United Healthcare All Other HMO |
$3,379.03
|
| Rate for Payer: United Healthcare HMO Rider |
$3,305.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,029.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,862.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,862.50
|
| Rate for Payer: Vantage Medical Group Senior |
$7,862.50
|
|
|
HC PACE B/S ALTRUA 40 DR S402
|
Facility
|
IP
|
$9,250.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813621
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,850.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,850.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$5,087.50
|
| Rate for Payer: Cash Price |
$5,087.50
|
| Rate for Payer: Cigna of CA HMO |
$6,475.00
|
| Rate for Payer: Cigna of CA PPO |
$6,475.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,700.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,700.00
|
| Rate for Payer: Galaxy Health WC |
$7,862.50
|
| Rate for Payer: Global Benefits Group Commercial |
$5,550.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,169.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,524.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,725.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,220.00
|
| Rate for Payer: Multiplan Commercial |
$7,400.00
|
| Rate for Payer: Networks By Design Commercial |
$4,625.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,862.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,471.53
|
| Rate for Payer: United Healthcare All Other HMO |
$3,379.03
|
| Rate for Payer: United Healthcare HMO Rider |
$3,305.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,029.38
|
|
|
HC PACE B/S ALTRUA 40 SR S401
|
Facility
|
IP
|
$7,950.00
|
|
|
Service Code
|
CPT C1786
|
| Hospital Charge Code |
906813624
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,590.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,590.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$4,372.50
|
| Rate for Payer: Cash Price |
$4,372.50
|
| Rate for Payer: Cigna of CA HMO |
$5,565.00
|
| Rate for Payer: Cigna of CA PPO |
$5,565.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,180.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,180.00
|
| Rate for Payer: Galaxy Health WC |
$6,757.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,770.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,302.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,028.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,921.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,908.00
|
| Rate for Payer: Multiplan Commercial |
$6,360.00
|
| Rate for Payer: Networks By Design Commercial |
$3,975.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,757.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,983.64
|
| Rate for Payer: United Healthcare All Other HMO |
$2,904.14
|
| Rate for Payer: United Healthcare HMO Rider |
$2,841.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,603.62
|
|
|
HC PACE B/S ALTRUA 40 SR S401
|
Facility
|
OP
|
$7,950.00
|
|
|
Service Code
|
CPT C1786
|
| Hospital Charge Code |
906813624
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,590.00 |
| Max. Negotiated Rate |
$6,757.50 |
| Rate for Payer: Adventist Health Commercial |
$1,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,757.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,372.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,962.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,882.10
|
| Rate for Payer: Blue Shield of California Commercial |
$5,867.10
|
| Rate for Payer: Blue Shield of California EPN |
$3,863.70
|
| Rate for Payer: Cash Price |
$4,372.50
|
| Rate for Payer: Cigna of CA HMO |
$5,565.00
|
| Rate for Payer: Cigna of CA PPO |
$5,565.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,757.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,757.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,757.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,180.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,180.00
|
| Rate for Payer: Galaxy Health WC |
$6,757.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,770.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,302.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,921.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,908.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,565.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,565.00
|
| Rate for Payer: Multiplan Commercial |
$6,360.00
|
| Rate for Payer: Networks By Design Commercial |
$3,975.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,757.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,770.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,770.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,983.64
|
| Rate for Payer: United Healthcare All Other HMO |
$2,904.14
|
| Rate for Payer: United Healthcare HMO Rider |
$2,841.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,603.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,757.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,757.50
|
| Rate for Payer: Vantage Medical Group Senior |
$6,757.50
|
|
|
HC PACE B/S ALTRUA 60 DR S602
|
Facility
|
OP
|
$10,325.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813620
|
|
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 |
$5,678.75
|
| 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 ALTRUA 60 DR S602
|
Facility
|
IP
|
$10,325.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813620
|
|
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 |
$5,678.75
|
| Rate for Payer: Cash Price |
$5,678.75
|
| 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 ALTRUA 60 S603
|
Facility
|
IP
|
$10,325.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813629
|
|
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 |
$5,678.75
|
| Rate for Payer: Cash Price |
$5,678.75
|
| 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 ALTRUA 60 S603
|
Facility
|
OP
|
$10,325.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813629
|
|
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 |
$5,678.75
|
| 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 ALTRUA 60 SR S601
|
Facility
|
IP
|
$9,250.00
|
|
|
Service Code
|
CPT C1786
|
| Hospital Charge Code |
906813623
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,850.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,850.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$5,087.50
|
| Rate for Payer: Cash Price |
$5,087.50
|
| Rate for Payer: Cigna of CA HMO |
$6,475.00
|
| Rate for Payer: Cigna of CA PPO |
$6,475.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,700.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,700.00
|
| Rate for Payer: Galaxy Health WC |
$7,862.50
|
| Rate for Payer: Global Benefits Group Commercial |
$5,550.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,169.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,524.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,725.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,220.00
|
| Rate for Payer: Multiplan Commercial |
$7,400.00
|
| Rate for Payer: Networks By Design Commercial |
$4,625.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,862.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,471.53
|
| Rate for Payer: United Healthcare All Other HMO |
$3,379.03
|
| Rate for Payer: United Healthcare HMO Rider |
$3,305.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,029.38
|
|
|
HC PACE B/S ALTRUA 60 SR S601
|
Facility
|
OP
|
$9,250.00
|
|
|
Service Code
|
CPT C1786
|
| Hospital Charge Code |
906813623
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,850.00 |
| Max. Negotiated Rate |
$7,862.50 |
| Rate for Payer: Adventist Health Commercial |
$1,850.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,862.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,087.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,937.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,680.43
|
| Rate for Payer: Blue Shield of California Commercial |
$6,826.50
|
| Rate for Payer: Blue Shield of California EPN |
$4,495.50
|
| Rate for Payer: Cash Price |
$5,087.50
|
| Rate for Payer: Cigna of CA HMO |
$6,475.00
|
| Rate for Payer: Cigna of CA PPO |
$6,475.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,862.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,862.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,862.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,700.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,700.00
|
| Rate for Payer: Galaxy Health WC |
$7,862.50
|
| Rate for Payer: Global Benefits Group Commercial |
$5,550.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,169.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,725.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,220.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,475.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,475.00
|
| Rate for Payer: Multiplan Commercial |
$7,400.00
|
| Rate for Payer: Networks By Design Commercial |
$4,625.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,862.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,550.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,550.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,471.53
|
| Rate for Payer: United Healthcare All Other HMO |
$3,379.03
|
| Rate for Payer: United Healthcare HMO Rider |
$3,305.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,029.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,862.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,862.50
|
| Rate for Payer: Vantage Medical Group Senior |
$7,862.50
|
|
|
HC PACE B/S ALTRUA DR EL S208
|
Facility
|
OP
|
$8,150.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813638
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,630.00 |
| Max. Negotiated Rate |
$6,927.50 |
| Rate for Payer: Adventist Health Commercial |
$1,630.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,927.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,482.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,112.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,004.91
|
| Rate for Payer: Blue Shield of California Commercial |
$6,014.70
|
| Rate for Payer: Blue Shield of California EPN |
$3,960.90
|
| Rate for Payer: Cash Price |
$4,482.50
|
| Rate for Payer: Cigna of CA HMO |
$5,705.00
|
| Rate for Payer: Cigna of CA PPO |
$5,705.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,927.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,927.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,927.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,260.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,260.00
|
| Rate for Payer: Galaxy Health WC |
$6,927.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,890.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,436.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,044.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,956.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,705.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,705.00
|
| Rate for Payer: Multiplan Commercial |
$6,520.00
|
| Rate for Payer: Networks By Design Commercial |
$4,075.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,927.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,890.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,890.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,058.70
|
| Rate for Payer: United Healthcare All Other HMO |
$2,977.20
|
| Rate for Payer: United Healthcare HMO Rider |
$2,912.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,669.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,927.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,927.50
|
| Rate for Payer: Vantage Medical Group Senior |
$6,927.50
|
|
|
HC PACE B/S ALTRUA DR EL S208
|
Facility
|
IP
|
$8,150.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813638
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,630.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,630.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$4,482.50
|
| Rate for Payer: Cash Price |
$4,482.50
|
| Rate for Payer: Cigna of CA HMO |
$5,705.00
|
| Rate for Payer: Cigna of CA PPO |
$5,705.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,260.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,260.00
|
| Rate for Payer: Galaxy Health WC |
$6,927.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,890.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,436.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,105.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,044.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,956.00
|
| Rate for Payer: Multiplan Commercial |
$6,520.00
|
| Rate for Payer: Networks By Design Commercial |
$4,075.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,927.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,058.70
|
| Rate for Payer: United Healthcare All Other HMO |
$2,977.20
|
| Rate for Payer: United Healthcare HMO Rider |
$2,912.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,669.12
|
|
|
HC PACE B/S ALTRUA DR EL S602
|
Facility
|
OP
|
$10,325.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813640
|
|
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 |
$5,678.75
|
| 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 ALTRUA DR EL S602
|
Facility
|
IP
|
$10,325.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813640
|
|
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 |
$5,678.75
|
| Rate for Payer: Cash Price |
$5,678.75
|
| 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 ALTRUA DR EL S606
|
Facility
|
OP
|
$10,325.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813643
|
|
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 |
$5,678.75
|
| 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 ALTRUA DR EL S606
|
Facility
|
IP
|
$10,325.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813643
|
|
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 |
$5,678.75
|
| Rate for Payer: Cash Price |
$5,678.75
|
| 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 ALTRUA DR S205
|
Facility
|
OP
|
$8,150.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813641
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,630.00 |
| Max. Negotiated Rate |
$6,927.50 |
| Rate for Payer: Adventist Health Commercial |
$1,630.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,927.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,482.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,112.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,004.91
|
| Rate for Payer: Blue Shield of California Commercial |
$6,014.70
|
| Rate for Payer: Blue Shield of California EPN |
$3,960.90
|
| Rate for Payer: Cash Price |
$4,482.50
|
| Rate for Payer: Cigna of CA HMO |
$5,705.00
|
| Rate for Payer: Cigna of CA PPO |
$5,705.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,927.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,927.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,927.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,260.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,260.00
|
| Rate for Payer: Galaxy Health WC |
$6,927.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,890.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,436.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,044.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,956.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,705.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,705.00
|
| Rate for Payer: Multiplan Commercial |
$6,520.00
|
| Rate for Payer: Networks By Design Commercial |
$4,075.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,927.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,890.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,890.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,058.70
|
| Rate for Payer: United Healthcare All Other HMO |
$2,977.20
|
| Rate for Payer: United Healthcare HMO Rider |
$2,912.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,669.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,927.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,927.50
|
| Rate for Payer: Vantage Medical Group Senior |
$6,927.50
|
|
|
HC PACE B/S ALTRUA DR S205
|
Facility
|
IP
|
$8,150.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813641
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,630.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,630.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$4,482.50
|
| Rate for Payer: Cash Price |
$4,482.50
|
| Rate for Payer: Cigna of CA HMO |
$5,705.00
|
| Rate for Payer: Cigna of CA PPO |
$5,705.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,260.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,260.00
|
| Rate for Payer: Galaxy Health WC |
$6,927.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,890.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,436.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,105.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,044.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,956.00
|
| Rate for Payer: Multiplan Commercial |
$6,520.00
|
| Rate for Payer: Networks By Design Commercial |
$4,075.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,927.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,058.70
|
| Rate for Payer: United Healthcare All Other HMO |
$2,977.20
|
| Rate for Payer: United Healthcare HMO Rider |
$2,912.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,669.12
|
|
|
HC PACE B/S CONTAK H120
|
Facility
|
IP
|
$16,875.00
|
|
|
Service Code
|
CPT C2621
|
| Hospital Charge Code |
906813637
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,375.00 |
| Max. Negotiated Rate |
$14,343.75 |
| Rate for Payer: Multiplan Commercial |
$13,500.00
|
| Rate for Payer: Adventist Health Commercial |
$3,375.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$9,281.25
|
| Rate for Payer: Cash Price |
$9,281.25
|
| Rate for Payer: Cigna of CA HMO |
$11,812.50
|
| Rate for Payer: Cigna of CA PPO |
$11,812.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,750.00
|
| Rate for Payer: EPIC Health Plan Senior |
$6,750.00
|
| Rate for Payer: Galaxy Health WC |
$14,343.75
|
| Rate for Payer: Global Benefits Group Commercial |
$10,125.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,255.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,429.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,445.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,050.00
|
| Rate for Payer: Networks By Design Commercial |
$8,437.50
|
| Rate for Payer: Prime Health Services Commercial |
$14,343.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,333.19
|
| Rate for Payer: United Healthcare All Other HMO |
$6,164.44
|
| Rate for Payer: United Healthcare HMO Rider |
$6,031.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,526.56
|
|
|
HC PACE B/S CONTAK H120
|
Facility
|
OP
|
$16,875.00
|
|
|
Service Code
|
CPT C2621
|
| Hospital Charge Code |
906813637
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,375.00 |
| Max. Negotiated Rate |
$14,343.75 |
| Rate for Payer: Adventist Health Commercial |
$3,375.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14,343.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,281.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12,656.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,362.94
|
| Rate for Payer: Blue Shield of California Commercial |
$12,453.75
|
| Rate for Payer: Blue Shield of California EPN |
$8,201.25
|
| Rate for Payer: Cash Price |
$9,281.25
|
| Rate for Payer: Cigna of CA HMO |
$11,812.50
|
| Rate for Payer: Cigna of CA PPO |
$11,812.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14,343.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$14,343.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,343.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,750.00
|
| Rate for Payer: EPIC Health Plan Senior |
$6,750.00
|
| Rate for Payer: Galaxy Health WC |
$14,343.75
|
| Rate for Payer: Global Benefits Group Commercial |
$10,125.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,255.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,445.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,050.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,812.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,812.50
|
| Rate for Payer: Multiplan Commercial |
$13,500.00
|
| Rate for Payer: Networks By Design Commercial |
$8,437.50
|
| Rate for Payer: Prime Health Services Commercial |
$14,343.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,125.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10,125.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,333.19
|
| Rate for Payer: United Healthcare All Other HMO |
$6,164.44
|
| Rate for Payer: United Healthcare HMO Rider |
$6,031.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,526.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14,343.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14,343.75
|
| Rate for Payer: Vantage Medical Group Senior |
$14,343.75
|
|
|
HC PACE B/S CONTAK H125
|
Facility
|
IP
|
$16,875.00
|
|
|
Service Code
|
CPT C2621
|
| Hospital Charge Code |
906813585
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,375.00 |
| Max. Negotiated Rate |
$14,343.75 |
| Rate for Payer: Adventist Health Commercial |
$3,375.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$9,281.25
|
| Rate for Payer: Cash Price |
$9,281.25
|
| Rate for Payer: Cigna of CA HMO |
$11,812.50
|
| Rate for Payer: Cigna of CA PPO |
$11,812.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,750.00
|
| Rate for Payer: EPIC Health Plan Senior |
$6,750.00
|
| Rate for Payer: Galaxy Health WC |
$14,343.75
|
| Rate for Payer: Global Benefits Group Commercial |
$10,125.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,255.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,429.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,445.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,050.00
|
| Rate for Payer: Multiplan Commercial |
$13,500.00
|
| Rate for Payer: Networks By Design Commercial |
$8,437.50
|
| Rate for Payer: Prime Health Services Commercial |
$14,343.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,333.19
|
| Rate for Payer: United Healthcare All Other HMO |
$6,164.44
|
| Rate for Payer: United Healthcare HMO Rider |
$6,031.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,526.56
|
|
|
HC PACE B/S CONTAK H125
|
Facility
|
OP
|
$16,875.00
|
|
|
Service Code
|
CPT C2621
|
| Hospital Charge Code |
906813585
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,375.00 |
| Max. Negotiated Rate |
$14,343.75 |
| Rate for Payer: Adventist Health Commercial |
$3,375.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14,343.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,281.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12,656.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,362.94
|
| Rate for Payer: Blue Shield of California Commercial |
$12,453.75
|
| Rate for Payer: Blue Shield of California EPN |
$8,201.25
|
| Rate for Payer: Cash Price |
$9,281.25
|
| Rate for Payer: Cigna of CA HMO |
$11,812.50
|
| Rate for Payer: Cigna of CA PPO |
$11,812.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14,343.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$14,343.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,343.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,750.00
|
| Rate for Payer: EPIC Health Plan Senior |
$6,750.00
|
| Rate for Payer: Galaxy Health WC |
$14,343.75
|
| Rate for Payer: Global Benefits Group Commercial |
$10,125.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,255.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,445.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,050.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,812.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,812.50
|
| Rate for Payer: Multiplan Commercial |
$13,500.00
|
| Rate for Payer: Networks By Design Commercial |
$8,437.50
|
| Rate for Payer: Prime Health Services Commercial |
$14,343.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,125.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10,125.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,333.19
|
| Rate for Payer: United Healthcare All Other HMO |
$6,164.44
|
| Rate for Payer: United Healthcare HMO Rider |
$6,031.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,526.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14,343.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14,343.75
|
| Rate for Payer: Vantage Medical Group Senior |
$14,343.75
|
|
