|
HC PACE BS INGENIO DR K173
|
Facility
|
OP
|
$10,622.50
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813686
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,124.50 |
| Max. Negotiated Rate |
$9,029.12 |
| Rate for Payer: Adventist Health Commercial |
$2,124.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,029.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,842.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,966.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,523.28
|
| Rate for Payer: Blue Shield of California Commercial |
$7,839.40
|
| Rate for Payer: Blue Shield of California EPN |
$5,162.53
|
| Rate for Payer: Cash Price |
$5,842.38
|
| Rate for Payer: Cigna of CA HMO |
$7,435.75
|
| Rate for Payer: Cigna of CA PPO |
$7,435.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,029.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,029.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,029.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,249.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,249.00
|
| Rate for Payer: Galaxy Health WC |
$9,029.12
|
| Rate for Payer: Global Benefits Group Commercial |
$6,373.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,085.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,575.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,549.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,435.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,435.75
|
| Rate for Payer: Multiplan Commercial |
$8,498.00
|
| Rate for Payer: Networks By Design Commercial |
$5,311.25
|
| Rate for Payer: Prime Health Services Commercial |
$9,029.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,373.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,373.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,986.62
|
| Rate for Payer: United Healthcare All Other HMO |
$3,880.40
|
| Rate for Payer: United Healthcare HMO Rider |
$3,796.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,478.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,029.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,029.12
|
| Rate for Payer: Vantage Medical Group Senior |
$9,029.12
|
|
|
HC PACE BS INGENIO DR K173
|
Facility
|
IP
|
$10,622.50
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813686
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,124.50 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: EPIC Health Plan Senior |
$4,249.00
|
| Rate for Payer: Adventist Health Commercial |
$2,124.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$5,842.38
|
| Rate for Payer: Cash Price |
$5,842.38
|
| Rate for Payer: Cigna of CA HMO |
$7,435.75
|
| Rate for Payer: Cigna of CA PPO |
$7,435.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,249.00
|
| Rate for Payer: Galaxy Health WC |
$9,029.12
|
| Rate for Payer: Global Benefits Group Commercial |
$6,373.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,085.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,047.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,575.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,549.40
|
| Rate for Payer: Multiplan Commercial |
$8,498.00
|
| Rate for Payer: Networks By Design Commercial |
$5,311.25
|
| Rate for Payer: Prime Health Services Commercial |
$9,029.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,986.62
|
| Rate for Payer: United Healthcare All Other HMO |
$3,880.40
|
| Rate for Payer: United Healthcare HMO Rider |
$3,796.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,478.87
|
|
|
HC PACE BS INGENIO SR K172
|
Facility
|
IP
|
$9,875.00
|
|
|
Service Code
|
CPT C1786
|
| Hospital Charge Code |
906813689
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,975.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,975.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$5,431.25
|
| Rate for Payer: Cash Price |
$5,431.25
|
| Rate for Payer: Cigna of CA HMO |
$6,912.50
|
| Rate for Payer: Cigna of CA PPO |
$6,912.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,950.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,950.00
|
| Rate for Payer: Galaxy Health WC |
$8,393.75
|
| Rate for Payer: Global Benefits Group Commercial |
$5,925.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,586.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,762.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,112.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,370.00
|
| Rate for Payer: Multiplan Commercial |
$7,900.00
|
| Rate for Payer: Networks By Design Commercial |
$4,937.50
|
| Rate for Payer: Prime Health Services Commercial |
$8,393.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,706.09
|
| Rate for Payer: United Healthcare All Other HMO |
$3,607.34
|
| Rate for Payer: United Healthcare HMO Rider |
$3,529.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,234.06
|
|
|
HC PACE BS INGENIO SR K172
|
Facility
|
OP
|
$9,875.00
|
|
|
Service Code
|
CPT C1786
|
| Hospital Charge Code |
906813689
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,975.00 |
| Max. Negotiated Rate |
$8,393.75 |
| Rate for Payer: Adventist Health Commercial |
$1,975.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,393.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,431.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,406.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,064.24
|
| Rate for Payer: Blue Shield of California Commercial |
$7,287.75
|
| Rate for Payer: Blue Shield of California EPN |
$4,799.25
|
| Rate for Payer: Cash Price |
$5,431.25
|
| Rate for Payer: Cigna of CA HMO |
$6,912.50
|
| Rate for Payer: Cigna of CA PPO |
$6,912.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,393.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,393.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,393.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,950.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,950.00
|
| Rate for Payer: Galaxy Health WC |
$8,393.75
|
| Rate for Payer: Global Benefits Group Commercial |
$5,925.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,586.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,112.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,370.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,912.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,912.50
|
| Rate for Payer: Multiplan Commercial |
$7,900.00
|
| Rate for Payer: Networks By Design Commercial |
$4,937.50
|
| Rate for Payer: Prime Health Services Commercial |
$8,393.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,925.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,925.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,706.09
|
| Rate for Payer: United Healthcare All Other HMO |
$3,607.34
|
| Rate for Payer: United Healthcare HMO Rider |
$3,529.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,234.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,393.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,393.75
|
| Rate for Payer: Vantage Medical Group Senior |
$8,393.75
|
|
|
HC PACE BS INVIVE CRT V172
|
Facility
|
IP
|
$7,250.00
|
|
|
Service Code
|
CPT C2621
|
| Hospital Charge Code |
906813695
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,450.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,450.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$3,987.50
|
| Rate for Payer: Cash Price |
$3,987.50
|
| Rate for Payer: Cigna of CA HMO |
$5,075.00
|
| Rate for Payer: Cigna of CA PPO |
$5,075.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,900.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,900.00
|
| Rate for Payer: Galaxy Health WC |
$6,162.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,350.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,835.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,762.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,487.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,740.00
|
| Rate for Payer: Multiplan Commercial |
$5,800.00
|
| Rate for Payer: Networks By Design Commercial |
$3,625.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,162.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,720.93
|
| Rate for Payer: United Healthcare All Other HMO |
$2,648.43
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.38
|
|
|
HC PACE BS INVIVE CRT V172
|
Facility
|
OP
|
$7,250.00
|
|
|
Service Code
|
CPT C2621
|
| Hospital Charge Code |
906813695
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,450.00 |
| Max. Negotiated Rate |
$6,162.50 |
| Rate for Payer: Adventist Health Commercial |
$1,450.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,162.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,987.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,437.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,452.23
|
| Rate for Payer: Blue Shield of California Commercial |
$5,350.50
|
| Rate for Payer: Blue Shield of California EPN |
$3,523.50
|
| Rate for Payer: Cash Price |
$3,987.50
|
| Rate for Payer: Cigna of CA HMO |
$5,075.00
|
| Rate for Payer: Cigna of CA PPO |
$5,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,162.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,162.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,162.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,900.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,900.00
|
| Rate for Payer: Galaxy Health WC |
$6,162.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,350.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,835.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,487.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,740.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,075.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,075.00
|
| Rate for Payer: Multiplan Commercial |
$5,800.00
|
| Rate for Payer: Networks By Design Commercial |
$3,625.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,162.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,350.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,350.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,720.93
|
| Rate for Payer: United Healthcare All Other HMO |
$2,648.43
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,162.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,162.50
|
| Rate for Payer: Vantage Medical Group Senior |
$6,162.50
|
|
|
HC PACE B/S VALITUDE X4 U128
|
Facility
|
IP
|
$18,625.00
|
|
|
Service Code
|
CPT C2621
|
| Hospital Charge Code |
906813805
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,725.00 |
| Max. Negotiated Rate |
$15,831.25 |
| Rate for Payer: Adventist Health Commercial |
$3,725.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$10,243.75
|
| Rate for Payer: Cash Price |
$10,243.75
|
| Rate for Payer: Cigna of CA HMO |
$13,037.50
|
| Rate for Payer: Cigna of CA PPO |
$13,037.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,450.00
|
| Rate for Payer: EPIC Health Plan Senior |
$7,450.00
|
| Rate for Payer: Galaxy Health WC |
$15,831.25
|
| Rate for Payer: Global Benefits Group Commercial |
$11,175.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,422.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,096.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,528.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,470.00
|
| Rate for Payer: Multiplan Commercial |
$14,900.00
|
| Rate for Payer: Networks By Design Commercial |
$9,312.50
|
| Rate for Payer: Prime Health Services Commercial |
$15,831.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,989.96
|
| Rate for Payer: United Healthcare All Other HMO |
$6,803.71
|
| Rate for Payer: United Healthcare HMO Rider |
$6,656.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,099.69
|
|
|
HC PACE B/S VALITUDE X4 U128
|
Facility
|
OP
|
$18,625.00
|
|
|
Service Code
|
CPT C2621
|
| Hospital Charge Code |
906813805
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,725.00 |
| Max. Negotiated Rate |
$15,831.25 |
| Rate for Payer: Adventist Health Commercial |
$3,725.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15,831.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,243.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,968.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,437.61
|
| Rate for Payer: Blue Shield of California Commercial |
$13,745.25
|
| Rate for Payer: Blue Shield of California EPN |
$9,051.75
|
| Rate for Payer: Cash Price |
$10,243.75
|
| Rate for Payer: Cigna of CA HMO |
$13,037.50
|
| Rate for Payer: Cigna of CA PPO |
$13,037.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15,831.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,831.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15,831.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,450.00
|
| Rate for Payer: EPIC Health Plan Senior |
$7,450.00
|
| Rate for Payer: Galaxy Health WC |
$15,831.25
|
| Rate for Payer: Global Benefits Group Commercial |
$11,175.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,422.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,528.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,470.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13,037.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13,037.50
|
| Rate for Payer: Multiplan Commercial |
$14,900.00
|
| Rate for Payer: Networks By Design Commercial |
$9,312.50
|
| Rate for Payer: Prime Health Services Commercial |
$15,831.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11,175.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11,175.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,989.96
|
| Rate for Payer: United Healthcare All Other HMO |
$6,803.71
|
| Rate for Payer: United Healthcare HMO Rider |
$6,656.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,099.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15,831.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,831.25
|
| Rate for Payer: Vantage Medical Group Senior |
$15,831.25
|
|
|
HC PACE INSERT EXIST MULT HC LEADS
|
Facility
|
IP
|
$25,976.00
|
|
|
Service Code
|
CPT 33221
|
| Hospital Charge Code |
906820254
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,195.20 |
| Max. Negotiated Rate |
$22,079.60 |
| Rate for Payer: Adventist Health Commercial |
$5,195.20
|
| Rate for Payer: Cash Price |
$14,286.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,390.40
|
| Rate for Payer: EPIC Health Plan Senior |
$10,390.40
|
| Rate for Payer: Galaxy Health WC |
$22,079.60
|
| Rate for Payer: Global Benefits Group Commercial |
$15,585.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17,325.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,896.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,079.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,234.24
|
| Rate for Payer: Multiplan Commercial |
$20,780.80
|
| Rate for Payer: Networks By Design Commercial |
$16,884.40
|
| Rate for Payer: Prime Health Services Commercial |
$22,079.60
|
|
|
HC PACE INSERT EXIST MULT HC LEADS
|
Facility
|
OP
|
$26,727.00
|
|
|
Service Code
|
CPT 33221
|
| Hospital Charge Code |
906811421
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$489.12 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$5,345.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36,347.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26,655.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24,231.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,291.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$14,699.85
|
| Rate for Payer: Cash Price |
$14,699.85
|
| Rate for Payer: Cash Price |
$14,699.85
|
| Rate for Payer: Cigna of CA HMO |
$17,105.28
|
| Rate for Payer: Cigna of CA PPO |
$19,777.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36,347.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$26,655.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24,231.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$32,712.96
|
| Rate for Payer: EPIC Health Plan Senior |
$24,231.82
|
| Rate for Payer: Galaxy Health WC |
$22,717.95
|
| Rate for Payer: Global Benefits Group Commercial |
$16,036.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$39,740.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$489.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24,231.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17,826.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$553.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24,231.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,414.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30,532.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32,470.64
|
| Rate for Payer: Multiplan Commercial |
$21,381.60
|
| Rate for Payer: Multiplan WC |
$38,609.08
|
| Rate for Payer: Networks By Design Commercial |
$17,372.55
|
| Rate for Payer: Prime Health Services Commercial |
$22,717.95
|
| Rate for Payer: Prime Health Services WC |
$38,215.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16,036.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$31,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$24,231.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36,347.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26,655.00
|
| Rate for Payer: Vantage Medical Group Senior |
$24,231.82
|
|
|
HC PACE INSERT EXIST MULT HC LEADS
|
Facility
|
IP
|
$26,727.00
|
|
|
Service Code
|
CPT 33221
|
| Hospital Charge Code |
906811421
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,345.40 |
| Max. Negotiated Rate |
$22,717.95 |
| Rate for Payer: Adventist Health Commercial |
$5,345.40
|
| Rate for Payer: Cash Price |
$14,699.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,690.80
|
| Rate for Payer: EPIC Health Plan Senior |
$10,690.80
|
| Rate for Payer: Galaxy Health WC |
$22,717.95
|
| Rate for Payer: Global Benefits Group Commercial |
$16,036.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17,826.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,182.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,544.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,414.48
|
| Rate for Payer: Multiplan Commercial |
$21,381.60
|
| Rate for Payer: Networks By Design Commercial |
$17,372.55
|
| Rate for Payer: Prime Health Services Commercial |
$22,717.95
|
|
|
HC PACE INSERT EXIST MULT HC LEADS
|
Facility
|
OP
|
$25,976.00
|
|
|
Service Code
|
CPT 33221
|
| Hospital Charge Code |
906820254
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$489.12 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$5,195.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36,347.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26,655.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24,231.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,291.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$14,286.80
|
| Rate for Payer: Cash Price |
$14,286.80
|
| Rate for Payer: Cash Price |
$14,286.80
|
| Rate for Payer: Cigna of CA HMO |
$16,624.64
|
| Rate for Payer: Cigna of CA PPO |
$19,222.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36,347.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$26,655.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24,231.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$32,712.96
|
| Rate for Payer: EPIC Health Plan Senior |
$24,231.82
|
| Rate for Payer: Galaxy Health WC |
$22,079.60
|
| Rate for Payer: Global Benefits Group Commercial |
$15,585.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$39,740.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$489.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24,231.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17,325.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$553.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24,231.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,234.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30,532.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32,470.64
|
| Rate for Payer: Multiplan Commercial |
$20,780.80
|
| Rate for Payer: Multiplan WC |
$38,609.08
|
| Rate for Payer: Networks By Design Commercial |
$16,884.40
|
| Rate for Payer: Prime Health Services Commercial |
$22,079.60
|
| Rate for Payer: Prime Health Services WC |
$38,215.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15,585.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$31,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$24,231.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36,347.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26,655.00
|
| Rate for Payer: Vantage Medical Group Senior |
$24,231.82
|
|
|
HC PACEMAKER INSERTION KIT
|
Facility
|
OP
|
$508.97
|
|
| Hospital Charge Code |
901698281
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.79 |
| Max. Negotiated Rate |
$432.62 |
| Rate for Payer: Adventist Health Commercial |
$101.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$333.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$432.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$279.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$381.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$312.56
|
| Rate for Payer: Cash Price |
$279.93
|
| Rate for Payer: Cigna of CA HMO |
$325.74
|
| Rate for Payer: Cigna of CA PPO |
$376.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$432.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$432.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$432.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$203.59
|
| Rate for Payer: EPIC Health Plan Senior |
$203.59
|
| Rate for Payer: Galaxy Health WC |
$432.62
|
| Rate for Payer: Global Benefits Group Commercial |
$305.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$339.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$193.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$315.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$122.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$356.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$356.28
|
| Rate for Payer: Multiplan Commercial |
$407.18
|
| Rate for Payer: Networks By Design Commercial |
$330.83
|
| Rate for Payer: Prime Health Services Commercial |
$432.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$305.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$305.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$254.49
|
| Rate for Payer: United Healthcare All Other HMO |
$254.49
|
| Rate for Payer: United Healthcare HMO Rider |
$254.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$254.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$432.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$432.62
|
| Rate for Payer: Vantage Medical Group Senior |
$432.62
|
|
|
HC PACEMAKER INSERTION KIT
|
Facility
|
IP
|
$508.97
|
|
| Hospital Charge Code |
901698281
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.79 |
| Max. Negotiated Rate |
$432.62 |
| Rate for Payer: Adventist Health Commercial |
$101.79
|
| Rate for Payer: Cash Price |
$279.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$203.59
|
| Rate for Payer: EPIC Health Plan Senior |
$203.59
|
| Rate for Payer: Galaxy Health WC |
$432.62
|
| Rate for Payer: Global Benefits Group Commercial |
$305.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$339.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$193.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$315.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$122.15
|
| Rate for Payer: Multiplan Commercial |
$407.18
|
| Rate for Payer: Networks By Design Commercial |
$330.83
|
| Rate for Payer: Prime Health Services Commercial |
$432.62
|
|
|
HC PACE MAKER MODEL KIT
|
Facility
|
IP
|
$265.44
|
|
| Hospital Charge Code |
901698277
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$53.09 |
| Max. Negotiated Rate |
$225.62 |
| Rate for Payer: Adventist Health Commercial |
$53.09
|
| Rate for Payer: Cash Price |
$145.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.18
|
| Rate for Payer: EPIC Health Plan Senior |
$106.18
|
| Rate for Payer: Galaxy Health WC |
$225.62
|
| Rate for Payer: Global Benefits Group Commercial |
$159.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$177.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$101.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$164.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.71
|
| Rate for Payer: Multiplan Commercial |
$212.35
|
| Rate for Payer: Networks By Design Commercial |
$172.54
|
| Rate for Payer: Prime Health Services Commercial |
$225.62
|
|
|
HC PACE MAKER MODEL KIT
|
Facility
|
OP
|
$265.44
|
|
| Hospital Charge Code |
901698277
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$53.09 |
| Max. Negotiated Rate |
$225.62 |
| Rate for Payer: Adventist Health Commercial |
$53.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$174.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$225.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$145.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$199.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$163.01
|
| Rate for Payer: Cash Price |
$145.99
|
| Rate for Payer: Cigna of CA HMO |
$169.88
|
| Rate for Payer: Cigna of CA PPO |
$196.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$225.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$225.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.18
|
| Rate for Payer: EPIC Health Plan Senior |
$106.18
|
| Rate for Payer: Galaxy Health WC |
$225.62
|
| Rate for Payer: Global Benefits Group Commercial |
$159.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$177.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$101.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$164.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$185.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$185.81
|
| Rate for Payer: Multiplan Commercial |
$212.35
|
| Rate for Payer: Networks By Design Commercial |
$172.54
|
| Rate for Payer: Prime Health Services Commercial |
$225.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$159.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$159.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$132.72
|
| Rate for Payer: United Healthcare All Other HMO |
$132.72
|
| Rate for Payer: United Healthcare HMO Rider |
$132.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$132.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$225.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$225.62
|
| Rate for Payer: Vantage Medical Group Senior |
$225.62
|
|
|
HC PACE MED ADAPTA ADDR01
|
Facility
|
OP
|
$8,625.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813804
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,725.00 |
| Max. Negotiated Rate |
$7,331.25 |
| Rate for Payer: Adventist Health Commercial |
$1,725.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,331.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,743.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,468.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,296.61
|
| Rate for Payer: Blue Shield of California Commercial |
$6,365.25
|
| Rate for Payer: Blue Shield of California EPN |
$4,191.75
|
| Rate for Payer: Cash Price |
$4,743.75
|
| Rate for Payer: Cigna of CA HMO |
$6,037.50
|
| Rate for Payer: Cigna of CA PPO |
$6,037.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,331.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,331.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,331.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,450.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,450.00
|
| Rate for Payer: Galaxy Health WC |
$7,331.25
|
| Rate for Payer: Global Benefits Group Commercial |
$5,175.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,752.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,338.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,070.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,037.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,037.50
|
| Rate for Payer: Multiplan Commercial |
$6,900.00
|
| Rate for Payer: Networks By Design Commercial |
$4,312.50
|
| Rate for Payer: Prime Health Services Commercial |
$7,331.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,175.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,175.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,236.96
|
| Rate for Payer: United Healthcare All Other HMO |
$3,150.71
|
| Rate for Payer: United Healthcare HMO Rider |
$3,082.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,824.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,331.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,331.25
|
| Rate for Payer: Vantage Medical Group Senior |
$7,331.25
|
|
|
HC PACE MED ADAPTA ADDR01
|
Facility
|
IP
|
$9,570.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813578
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,914.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,914.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$5,263.50
|
| Rate for Payer: Cash Price |
$5,263.50
|
| Rate for Payer: Cigna of CA HMO |
$6,699.00
|
| Rate for Payer: Cigna of CA PPO |
$6,699.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,828.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,828.00
|
| Rate for Payer: Galaxy Health WC |
$8,134.50
|
| Rate for Payer: Global Benefits Group Commercial |
$5,742.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,383.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,646.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,923.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,296.80
|
| Rate for Payer: Multiplan Commercial |
$7,656.00
|
| Rate for Payer: Networks By Design Commercial |
$4,785.00
|
| Rate for Payer: Prime Health Services Commercial |
$8,134.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,591.62
|
| Rate for Payer: United Healthcare All Other HMO |
$3,495.92
|
| Rate for Payer: United Healthcare HMO Rider |
$3,420.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,134.18
|
|
|
HC PACE MED ADAPTA ADDR01
|
Facility
|
OP
|
$9,570.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813578
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,914.00 |
| Max. Negotiated Rate |
$8,134.50 |
| Rate for Payer: Adventist Health Commercial |
$1,914.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,134.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,263.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,177.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,876.94
|
| Rate for Payer: Blue Shield of California Commercial |
$7,062.66
|
| Rate for Payer: Blue Shield of California EPN |
$4,651.02
|
| Rate for Payer: Cash Price |
$5,263.50
|
| Rate for Payer: Cigna of CA HMO |
$6,699.00
|
| Rate for Payer: Cigna of CA PPO |
$6,699.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,134.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,134.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,134.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,828.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,828.00
|
| Rate for Payer: Galaxy Health WC |
$8,134.50
|
| Rate for Payer: Global Benefits Group Commercial |
$5,742.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,383.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,923.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,296.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,699.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,699.00
|
| Rate for Payer: Multiplan Commercial |
$7,656.00
|
| Rate for Payer: Networks By Design Commercial |
$4,785.00
|
| Rate for Payer: Prime Health Services Commercial |
$8,134.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,742.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,742.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,591.62
|
| Rate for Payer: United Healthcare All Other HMO |
$3,495.92
|
| Rate for Payer: United Healthcare HMO Rider |
$3,420.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,134.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,134.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,134.50
|
| Rate for Payer: Vantage Medical Group Senior |
$8,134.50
|
|
|
HC PACE MED ADAPTA ADDR01
|
Facility
|
IP
|
$8,625.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813804
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,725.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,725.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$4,743.75
|
| Rate for Payer: Cash Price |
$4,743.75
|
| Rate for Payer: Cigna of CA HMO |
$6,037.50
|
| Rate for Payer: Cigna of CA PPO |
$6,037.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,450.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,450.00
|
| Rate for Payer: Galaxy Health WC |
$7,331.25
|
| Rate for Payer: Global Benefits Group Commercial |
$5,175.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,752.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,286.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,338.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,070.00
|
| Rate for Payer: Multiplan Commercial |
$6,900.00
|
| Rate for Payer: Networks By Design Commercial |
$4,312.50
|
| Rate for Payer: Prime Health Services Commercial |
$7,331.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,236.96
|
| Rate for Payer: United Healthcare All Other HMO |
$3,150.71
|
| Rate for Payer: United Healthcare HMO Rider |
$3,082.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,824.69
|
|
|
HC PACE MED ADAPTA ADDR06
|
Facility
|
IP
|
$9,570.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813586
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,914.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,914.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$5,263.50
|
| Rate for Payer: Cash Price |
$5,263.50
|
| Rate for Payer: Cigna of CA HMO |
$6,699.00
|
| Rate for Payer: Cigna of CA PPO |
$6,699.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,828.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,828.00
|
| Rate for Payer: Galaxy Health WC |
$8,134.50
|
| Rate for Payer: Global Benefits Group Commercial |
$5,742.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,383.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,646.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,923.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,296.80
|
| Rate for Payer: Multiplan Commercial |
$7,656.00
|
| Rate for Payer: Networks By Design Commercial |
$4,785.00
|
| Rate for Payer: Prime Health Services Commercial |
$8,134.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,591.62
|
| Rate for Payer: United Healthcare All Other HMO |
$3,495.92
|
| Rate for Payer: United Healthcare HMO Rider |
$3,420.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,134.18
|
|
|
HC PACE MED ADAPTA ADDR06
|
Facility
|
OP
|
$9,570.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813586
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,914.00 |
| Max. Negotiated Rate |
$8,134.50 |
| Rate for Payer: Adventist Health Commercial |
$1,914.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,134.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,263.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,177.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,876.94
|
| Rate for Payer: Blue Shield of California Commercial |
$7,062.66
|
| Rate for Payer: Blue Shield of California EPN |
$4,651.02
|
| Rate for Payer: Cash Price |
$5,263.50
|
| Rate for Payer: Cigna of CA HMO |
$6,699.00
|
| Rate for Payer: Cigna of CA PPO |
$6,699.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,134.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,134.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,134.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,828.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,828.00
|
| Rate for Payer: Galaxy Health WC |
$8,134.50
|
| Rate for Payer: Global Benefits Group Commercial |
$5,742.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,383.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,923.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,296.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,699.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,699.00
|
| Rate for Payer: Multiplan Commercial |
$7,656.00
|
| Rate for Payer: Networks By Design Commercial |
$4,785.00
|
| Rate for Payer: Prime Health Services Commercial |
$8,134.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,742.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,742.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,591.62
|
| Rate for Payer: United Healthcare All Other HMO |
$3,495.92
|
| Rate for Payer: United Healthcare HMO Rider |
$3,420.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,134.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,134.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,134.50
|
| Rate for Payer: Vantage Medical Group Senior |
$8,134.50
|
|
|
HC PACE MED ADAPTA ADSR03
|
Facility
|
OP
|
$8,388.00
|
|
|
Service Code
|
CPT C1786
|
| Hospital Charge Code |
906813658
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,677.60 |
| Max. Negotiated Rate |
$7,129.80 |
| Rate for Payer: Adventist Health Commercial |
$1,677.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,129.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,613.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,291.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,151.07
|
| Rate for Payer: Blue Shield of California Commercial |
$6,190.34
|
| Rate for Payer: Blue Shield of California EPN |
$4,076.57
|
| Rate for Payer: Cash Price |
$4,613.40
|
| Rate for Payer: Cigna of CA HMO |
$5,871.60
|
| Rate for Payer: Cigna of CA PPO |
$5,871.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,129.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,129.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,129.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,355.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,355.20
|
| Rate for Payer: Galaxy Health WC |
$7,129.80
|
| Rate for Payer: Global Benefits Group Commercial |
$5,032.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,594.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,192.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,013.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,871.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,871.60
|
| Rate for Payer: Multiplan Commercial |
$6,710.40
|
| Rate for Payer: Networks By Design Commercial |
$4,194.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,129.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,032.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,032.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,148.02
|
| Rate for Payer: United Healthcare All Other HMO |
$3,064.14
|
| Rate for Payer: United Healthcare HMO Rider |
$2,997.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,747.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,129.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,129.80
|
| Rate for Payer: Vantage Medical Group Senior |
$7,129.80
|
|
|
HC PACE MED ADAPTA ADSR03
|
Facility
|
IP
|
$8,388.00
|
|
|
Service Code
|
CPT C1786
|
| Hospital Charge Code |
906813658
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,677.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,677.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$4,613.40
|
| Rate for Payer: Cash Price |
$4,613.40
|
| Rate for Payer: Cigna of CA HMO |
$5,871.60
|
| Rate for Payer: Cigna of CA PPO |
$5,871.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,355.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,355.20
|
| Rate for Payer: Galaxy Health WC |
$7,129.80
|
| Rate for Payer: Global Benefits Group Commercial |
$5,032.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,594.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,195.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,192.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,013.12
|
| Rate for Payer: Multiplan Commercial |
$6,710.40
|
| Rate for Payer: Networks By Design Commercial |
$4,194.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,129.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,148.02
|
| Rate for Payer: United Healthcare All Other HMO |
$3,064.14
|
| Rate for Payer: United Healthcare HMO Rider |
$2,997.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,747.07
|
|
|
HC PACE MED ADAPTA ADSRO1
|
Facility
|
IP
|
$8,388.00
|
|
|
Service Code
|
CPT C1786
|
| Hospital Charge Code |
906813588
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,677.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,677.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$4,613.40
|
| Rate for Payer: Cash Price |
$4,613.40
|
| Rate for Payer: Cigna of CA HMO |
$5,871.60
|
| Rate for Payer: Cigna of CA PPO |
$5,871.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,355.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,355.20
|
| Rate for Payer: Galaxy Health WC |
$7,129.80
|
| Rate for Payer: Global Benefits Group Commercial |
$5,032.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,594.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,195.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,192.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,013.12
|
| Rate for Payer: Multiplan Commercial |
$6,710.40
|
| Rate for Payer: Networks By Design Commercial |
$4,194.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,129.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,148.02
|
| Rate for Payer: United Healthcare All Other HMO |
$3,064.14
|
| Rate for Payer: United Healthcare HMO Rider |
$2,997.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,747.07
|
|
