|
HC PACE MED ADAPTA ADSRO1
|
Facility
|
OP
|
$8,388.00
|
|
|
Service Code
|
CPT C1786
|
| Hospital Charge Code |
906813588
|
|
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 DR ADDR03
|
Facility
|
OP
|
$9,570.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813632
|
|
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 DR ADDR03
|
Facility
|
IP
|
$9,570.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813632
|
|
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 L ADDRL1
|
Facility
|
IP
|
$9,570.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813579
|
|
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 L ADDRL1
|
Facility
|
OP
|
$9,570.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813579
|
|
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 S ADDRS1
|
Facility
|
IP
|
$9,570.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813583
|
|
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 S ADDRS1
|
Facility
|
OP
|
$9,570.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813583
|
|
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 ADVISA DR MRI A2DR01
|
Facility
|
IP
|
$11,000.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813694
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,200.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$2,200.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$6,050.00
|
| Rate for Payer: Cash Price |
$6,050.00
|
| Rate for Payer: Cigna of CA HMO |
$7,700.00
|
| Rate for Payer: Cigna of CA PPO |
$7,700.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,400.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,400.00
|
| Rate for Payer: Galaxy Health WC |
$9,350.00
|
| Rate for Payer: Global Benefits Group Commercial |
$6,600.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,337.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,191.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,809.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,640.00
|
| Rate for Payer: Multiplan Commercial |
$8,800.00
|
| Rate for Payer: Networks By Design Commercial |
$5,500.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,350.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,128.30
|
| Rate for Payer: United Healthcare All Other HMO |
$4,018.30
|
| Rate for Payer: United Healthcare HMO Rider |
$3,931.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,602.50
|
|
|
HC PACE MED ADVISA DR MRI A2DR01
|
Facility
|
OP
|
$11,000.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813694
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,200.00 |
| Max. Negotiated Rate |
$9,350.00 |
| Rate for Payer: Adventist Health Commercial |
$2,200.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,350.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,050.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,250.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,755.10
|
| Rate for Payer: Blue Shield of California Commercial |
$8,118.00
|
| Rate for Payer: Blue Shield of California EPN |
$5,346.00
|
| Rate for Payer: Cash Price |
$6,050.00
|
| Rate for Payer: Cigna of CA HMO |
$7,700.00
|
| Rate for Payer: Cigna of CA PPO |
$7,700.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,350.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,350.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,350.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,400.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,400.00
|
| Rate for Payer: Galaxy Health WC |
$9,350.00
|
| Rate for Payer: Global Benefits Group Commercial |
$6,600.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,337.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,809.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,640.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,700.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,700.00
|
| Rate for Payer: Multiplan Commercial |
$8,800.00
|
| Rate for Payer: Networks By Design Commercial |
$5,500.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,350.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,600.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,600.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,128.30
|
| Rate for Payer: United Healthcare All Other HMO |
$4,018.30
|
| Rate for Payer: United Healthcare HMO Rider |
$3,931.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,602.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,350.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,350.00
|
| Rate for Payer: Vantage Medical Group Senior |
$9,350.00
|
|
|
HC PACE MED ADVISA MRI A3SR01
|
Facility
|
IP
|
$10,638.00
|
|
|
Service Code
|
CPT C1786
|
| Hospital Charge Code |
906813754
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,127.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$2,127.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$5,850.90
|
| Rate for Payer: Cash Price |
$5,850.90
|
| Rate for Payer: Cigna of CA HMO |
$7,446.60
|
| Rate for Payer: Cigna of CA PPO |
$7,446.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,255.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,255.20
|
| Rate for Payer: Galaxy Health WC |
$9,042.30
|
| Rate for Payer: Global Benefits Group Commercial |
$6,382.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,095.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,053.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,584.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,553.12
|
| Rate for Payer: Multiplan Commercial |
$8,510.40
|
| Rate for Payer: Networks By Design Commercial |
$5,319.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,042.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,992.44
|
| Rate for Payer: United Healthcare All Other HMO |
$3,886.06
|
| Rate for Payer: United Healthcare HMO Rider |
$3,802.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,483.95
|
|
|
HC PACE MED ADVISA MRI A3SR01
|
Facility
|
OP
|
$10,638.00
|
|
|
Service Code
|
CPT C1786
|
| Hospital Charge Code |
906813754
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,127.60 |
| Max. Negotiated Rate |
$9,042.30 |
| Rate for Payer: EPIC Health Plan Senior |
$4,255.20
|
| Rate for Payer: Adventist Health Commercial |
$2,127.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,042.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,850.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,978.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,532.80
|
| Rate for Payer: Blue Shield of California Commercial |
$7,850.84
|
| Rate for Payer: Blue Shield of California EPN |
$5,170.07
|
| Rate for Payer: Cash Price |
$5,850.90
|
| Rate for Payer: Cigna of CA HMO |
$7,446.60
|
| Rate for Payer: Cigna of CA PPO |
$7,446.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,042.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,042.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,042.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,255.20
|
| Rate for Payer: Galaxy Health WC |
$9,042.30
|
| Rate for Payer: Global Benefits Group Commercial |
$6,382.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,095.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,584.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,553.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,446.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,446.60
|
| Rate for Payer: Multiplan Commercial |
$8,510.40
|
| Rate for Payer: Networks By Design Commercial |
$5,319.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,042.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,382.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,382.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,992.44
|
| Rate for Payer: United Healthcare All Other HMO |
$3,886.06
|
| Rate for Payer: United Healthcare HMO Rider |
$3,802.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,483.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,042.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,042.30
|
| Rate for Payer: Vantage Medical Group Senior |
$9,042.30
|
|
|
HC PACE MED AZURA DR MRI W3DR01
|
Facility
|
OP
|
$11,000.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813814
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,200.00 |
| Max. Negotiated Rate |
$9,350.00 |
| Rate for Payer: Adventist Health Commercial |
$2,200.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,350.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,050.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,250.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,755.10
|
| Rate for Payer: Blue Shield of California Commercial |
$8,118.00
|
| Rate for Payer: Blue Shield of California EPN |
$5,346.00
|
| Rate for Payer: Cash Price |
$6,050.00
|
| Rate for Payer: Cigna of CA HMO |
$7,700.00
|
| Rate for Payer: Cigna of CA PPO |
$7,700.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,350.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,350.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,350.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,400.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,400.00
|
| Rate for Payer: Galaxy Health WC |
$9,350.00
|
| Rate for Payer: Global Benefits Group Commercial |
$6,600.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,337.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,809.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,640.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,700.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,700.00
|
| Rate for Payer: Multiplan Commercial |
$8,800.00
|
| Rate for Payer: Networks By Design Commercial |
$5,500.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,350.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,600.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,600.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,128.30
|
| Rate for Payer: United Healthcare All Other HMO |
$4,018.30
|
| Rate for Payer: United Healthcare HMO Rider |
$3,931.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,602.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,350.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,350.00
|
| Rate for Payer: Vantage Medical Group Senior |
$9,350.00
|
|
|
HC PACE MED AZURA DR MRI W3DR01
|
Facility
|
IP
|
$11,000.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813814
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,200.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$2,200.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$6,050.00
|
| Rate for Payer: Cash Price |
$6,050.00
|
| Rate for Payer: Cigna of CA HMO |
$7,700.00
|
| Rate for Payer: Cigna of CA PPO |
$7,700.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,400.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,400.00
|
| Rate for Payer: Galaxy Health WC |
$9,350.00
|
| Rate for Payer: Global Benefits Group Commercial |
$6,600.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,337.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,191.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,809.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,640.00
|
| Rate for Payer: Multiplan Commercial |
$8,800.00
|
| Rate for Payer: Networks By Design Commercial |
$5,500.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,350.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,128.30
|
| Rate for Payer: United Healthcare All Other HMO |
$4,018.30
|
| Rate for Payer: United Healthcare HMO Rider |
$3,931.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,602.50
|
|
|
HC PACE MED AZURE S SR MRI W3SR01
|
Facility
|
OP
|
$10,938.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813822
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,187.60 |
| Max. Negotiated Rate |
$9,297.30 |
| Rate for Payer: Adventist Health Commercial |
$2,187.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,297.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,015.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,203.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,717.03
|
| Rate for Payer: Blue Shield of California Commercial |
$8,072.24
|
| Rate for Payer: Blue Shield of California EPN |
$5,315.87
|
| Rate for Payer: Cash Price |
$6,015.90
|
| Rate for Payer: Cigna of CA HMO |
$7,656.60
|
| Rate for Payer: Cigna of CA PPO |
$7,656.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,297.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,297.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,297.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,375.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,375.20
|
| Rate for Payer: Galaxy Health WC |
$9,297.30
|
| Rate for Payer: Global Benefits Group Commercial |
$6,562.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,295.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,770.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,625.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,656.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,656.60
|
| Rate for Payer: Multiplan Commercial |
$8,750.40
|
| Rate for Payer: Networks By Design Commercial |
$5,469.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,297.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,562.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,562.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,105.03
|
| Rate for Payer: United Healthcare All Other HMO |
$3,995.65
|
| Rate for Payer: United Healthcare HMO Rider |
$3,909.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,582.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,297.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,297.30
|
| Rate for Payer: Vantage Medical Group Senior |
$9,297.30
|
|
|
HC PACE MED AZURE S SR MRI W3SR01
|
Facility
|
IP
|
$10,938.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813822
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,187.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$2,187.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$6,015.90
|
| Rate for Payer: Cash Price |
$6,015.90
|
| Rate for Payer: Cigna of CA HMO |
$7,656.60
|
| Rate for Payer: Cigna of CA PPO |
$7,656.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,375.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,375.20
|
| Rate for Payer: Galaxy Health WC |
$9,297.30
|
| Rate for Payer: Global Benefits Group Commercial |
$6,562.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,295.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,167.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,770.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,625.12
|
| Rate for Payer: Multiplan Commercial |
$8,750.40
|
| Rate for Payer: Networks By Design Commercial |
$5,469.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,297.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,105.03
|
| Rate for Payer: United Healthcare All Other HMO |
$3,995.65
|
| Rate for Payer: United Healthcare HMO Rider |
$3,909.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,582.20
|
|
|
HC PACE MED CONSULTA C4TR01
|
Facility
|
OP
|
$18,208.00
|
|
|
Service Code
|
CPT C2621
|
| Hospital Charge Code |
906813646
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,641.60 |
| Max. Negotiated Rate |
$15,476.80 |
| Rate for Payer: Adventist Health Commercial |
$3,641.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15,476.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,014.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,656.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,181.53
|
| Rate for Payer: Blue Shield of California Commercial |
$13,437.50
|
| Rate for Payer: Blue Shield of California EPN |
$8,849.09
|
| Rate for Payer: Cash Price |
$10,014.40
|
| Rate for Payer: Cigna of CA HMO |
$12,745.60
|
| Rate for Payer: Cigna of CA PPO |
$12,745.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15,476.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,476.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15,476.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,283.20
|
| Rate for Payer: EPIC Health Plan Senior |
$7,283.20
|
| Rate for Payer: Galaxy Health WC |
$15,476.80
|
| Rate for Payer: Global Benefits Group Commercial |
$10,924.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,144.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,270.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,369.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12,745.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12,745.60
|
| Rate for Payer: Multiplan Commercial |
$14,566.40
|
| Rate for Payer: Networks By Design Commercial |
$9,104.00
|
| Rate for Payer: Prime Health Services Commercial |
$15,476.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,924.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10,924.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,833.46
|
| Rate for Payer: United Healthcare All Other HMO |
$6,651.38
|
| Rate for Payer: United Healthcare HMO Rider |
$6,507.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,963.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15,476.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,476.80
|
| Rate for Payer: Vantage Medical Group Senior |
$15,476.80
|
|
|
HC PACE MED CONSULTA C4TR01
|
Facility
|
IP
|
$18,208.00
|
|
|
Service Code
|
CPT C2621
|
| Hospital Charge Code |
906813646
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,641.60 |
| Max. Negotiated Rate |
$15,476.80 |
| Rate for Payer: Adventist Health Commercial |
$3,641.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$10,014.40
|
| Rate for Payer: Cash Price |
$10,014.40
|
| Rate for Payer: Cigna of CA HMO |
$12,745.60
|
| Rate for Payer: Cigna of CA PPO |
$12,745.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,283.20
|
| Rate for Payer: EPIC Health Plan Senior |
$7,283.20
|
| Rate for Payer: Galaxy Health WC |
$15,476.80
|
| Rate for Payer: Global Benefits Group Commercial |
$10,924.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,144.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,937.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,270.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,369.92
|
| Rate for Payer: Multiplan Commercial |
$14,566.40
|
| Rate for Payer: Networks By Design Commercial |
$9,104.00
|
| Rate for Payer: Prime Health Services Commercial |
$15,476.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,833.46
|
| Rate for Payer: United Healthcare All Other HMO |
$6,651.38
|
| Rate for Payer: United Healthcare HMO Rider |
$6,507.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,963.12
|
|
|
HC PACE MED MICRA TC SYS MC1VRO1
|
Facility
|
IP
|
$25,000.00
|
|
|
Service Code
|
CPT C1786
|
| Hospital Charge Code |
906813823
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$5,000.00 |
| Max. Negotiated Rate |
$21,250.00 |
| Rate for Payer: Adventist Health Commercial |
$5,000.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$13,750.00
|
| Rate for Payer: Cash Price |
$13,750.00
|
| Rate for Payer: Cigna of CA HMO |
$17,500.00
|
| Rate for Payer: Cigna of CA PPO |
$17,500.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10,000.00
|
| Rate for Payer: Galaxy Health WC |
$21,250.00
|
| Rate for Payer: Global Benefits Group Commercial |
$15,000.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,675.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,525.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,475.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,000.00
|
| Rate for Payer: Multiplan Commercial |
$20,000.00
|
| Rate for Payer: Networks By Design Commercial |
$12,500.00
|
| Rate for Payer: Prime Health Services Commercial |
$21,250.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,382.50
|
| Rate for Payer: United Healthcare All Other HMO |
$9,132.50
|
| Rate for Payer: United Healthcare HMO Rider |
$8,935.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,187.50
|
|
|
HC PACE MED MICRA TC SYS MC1VRO1
|
Facility
|
OP
|
$25,000.00
|
|
|
Service Code
|
CPT C1786
|
| Hospital Charge Code |
906813823
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$5,000.00 |
| Max. Negotiated Rate |
$21,250.00 |
| Rate for Payer: Adventist Health Commercial |
$5,000.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,250.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13,750.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18,750.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,352.50
|
| Rate for Payer: Blue Shield of California Commercial |
$18,450.00
|
| Rate for Payer: Blue Shield of California EPN |
$12,150.00
|
| Rate for Payer: Cash Price |
$13,750.00
|
| Rate for Payer: Cigna of CA HMO |
$17,500.00
|
| Rate for Payer: Cigna of CA PPO |
$17,500.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,250.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$21,250.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21,250.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10,000.00
|
| Rate for Payer: Galaxy Health WC |
$21,250.00
|
| Rate for Payer: Global Benefits Group Commercial |
$15,000.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,675.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,475.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,000.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,500.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17,500.00
|
| Rate for Payer: Multiplan Commercial |
$20,000.00
|
| Rate for Payer: Networks By Design Commercial |
$12,500.00
|
| Rate for Payer: Prime Health Services Commercial |
$21,250.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15,000.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15,000.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,382.50
|
| Rate for Payer: United Healthcare All Other HMO |
$9,132.50
|
| Rate for Payer: United Healthcare HMO Rider |
$8,935.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,187.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,250.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21,250.00
|
| Rate for Payer: Vantage Medical Group Senior |
$21,250.00
|
|
|
HC PACE MED REVO MRI RVDR01
|
Facility
|
OP
|
$12,850.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813644
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,570.00 |
| Max. Negotiated Rate |
$10,922.50 |
| Rate for Payer: Adventist Health Commercial |
$2,570.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,922.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,067.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,637.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,891.19
|
| Rate for Payer: Blue Shield of California Commercial |
$9,483.30
|
| Rate for Payer: Blue Shield of California EPN |
$6,245.10
|
| Rate for Payer: Cash Price |
$7,067.50
|
| Rate for Payer: Cigna of CA HMO |
$8,995.00
|
| Rate for Payer: Cigna of CA PPO |
$8,995.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,922.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,922.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,922.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,140.00
|
| Rate for Payer: Galaxy Health WC |
$10,922.50
|
| Rate for Payer: Global Benefits Group Commercial |
$7,710.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,570.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,954.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,084.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,995.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,995.00
|
| Rate for Payer: Multiplan Commercial |
$10,280.00
|
| Rate for Payer: Networks By Design Commercial |
$6,425.00
|
| Rate for Payer: Prime Health Services Commercial |
$10,922.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,710.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,710.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,822.60
|
| Rate for Payer: United Healthcare All Other HMO |
$4,694.10
|
| Rate for Payer: United Healthcare HMO Rider |
$4,592.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,208.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,922.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,922.50
|
| Rate for Payer: Vantage Medical Group Senior |
$10,922.50
|
|
|
HC PACE MED REVO MRI RVDR01
|
Facility
|
IP
|
$12,850.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813644
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,570.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$2,570.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$7,067.50
|
| Rate for Payer: Cash Price |
$7,067.50
|
| Rate for Payer: Cigna of CA HMO |
$8,995.00
|
| Rate for Payer: Cigna of CA PPO |
$8,995.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,140.00
|
| Rate for Payer: Galaxy Health WC |
$10,922.50
|
| Rate for Payer: Global Benefits Group Commercial |
$7,710.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,570.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,895.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,954.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,084.00
|
| Rate for Payer: Multiplan Commercial |
$10,280.00
|
| Rate for Payer: Networks By Design Commercial |
$6,425.00
|
| Rate for Payer: Prime Health Services Commercial |
$10,922.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,822.60
|
| Rate for Payer: United Healthcare All Other HMO |
$4,694.10
|
| Rate for Payer: United Healthcare HMO Rider |
$4,592.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,208.38
|
|
|
HC PACE MED SENSIA DR SEDR01
|
Facility
|
OP
|
$7,635.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813580
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,527.00 |
| Max. Negotiated Rate |
$6,489.75 |
| Rate for Payer: Adventist Health Commercial |
$1,527.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,489.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,199.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,726.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,688.65
|
| Rate for Payer: Blue Shield of California Commercial |
$5,634.63
|
| Rate for Payer: Blue Shield of California EPN |
$3,710.61
|
| Rate for Payer: Cash Price |
$4,199.25
|
| Rate for Payer: Cigna of CA HMO |
$5,344.50
|
| Rate for Payer: Cigna of CA PPO |
$5,344.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,489.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,489.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,489.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,054.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,054.00
|
| Rate for Payer: Galaxy Health WC |
$6,489.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4,581.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,092.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,726.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,832.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,344.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,344.50
|
| Rate for Payer: Multiplan Commercial |
$6,108.00
|
| Rate for Payer: Networks By Design Commercial |
$3,817.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,489.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,581.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,581.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,865.42
|
| Rate for Payer: United Healthcare All Other HMO |
$2,789.07
|
| Rate for Payer: United Healthcare HMO Rider |
$2,728.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,500.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,489.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,489.75
|
| Rate for Payer: Vantage Medical Group Senior |
$6,489.75
|
|
|
HC PACE MED SENSIA DR SEDR01
|
Facility
|
IP
|
$7,635.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813580
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,527.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,527.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$4,199.25
|
| Rate for Payer: Cash Price |
$4,199.25
|
| Rate for Payer: Cigna of CA HMO |
$5,344.50
|
| Rate for Payer: Cigna of CA PPO |
$5,344.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,054.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,054.00
|
| Rate for Payer: Galaxy Health WC |
$6,489.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4,581.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,092.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,908.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,726.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,832.40
|
| Rate for Payer: Multiplan Commercial |
$6,108.00
|
| Rate for Payer: Networks By Design Commercial |
$3,817.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,489.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,865.42
|
| Rate for Payer: United Healthcare All Other HMO |
$2,789.07
|
| Rate for Payer: United Healthcare HMO Rider |
$2,728.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,500.46
|
|
|
HC PACE MED SENSIA SR SESR01
|
Facility
|
IP
|
$7,130.00
|
|
|
Service Code
|
CPT C1786
|
| Hospital Charge Code |
906813590
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,426.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,426.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$3,921.50
|
| Rate for Payer: Cash Price |
$3,921.50
|
| Rate for Payer: Cigna of CA HMO |
$4,991.00
|
| Rate for Payer: Cigna of CA PPO |
$4,991.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,852.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,852.00
|
| Rate for Payer: Galaxy Health WC |
$6,060.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,278.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,755.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,716.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,413.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,711.20
|
| Rate for Payer: Multiplan Commercial |
$5,704.00
|
| Rate for Payer: Networks By Design Commercial |
$3,565.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,060.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,675.89
|
| Rate for Payer: United Healthcare All Other HMO |
$2,604.59
|
| Rate for Payer: United Healthcare HMO Rider |
$2,548.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,335.07
|
|
|
HC PACE MED SENSIA SR SESR01
|
Facility
|
OP
|
$7,130.00
|
|
|
Service Code
|
CPT C1786
|
| Hospital Charge Code |
906813590
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,426.00 |
| Max. Negotiated Rate |
$6,060.50 |
| Rate for Payer: Adventist Health Commercial |
$1,426.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,060.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,921.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,347.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,378.53
|
| Rate for Payer: Blue Shield of California Commercial |
$5,261.94
|
| Rate for Payer: Blue Shield of California EPN |
$3,465.18
|
| Rate for Payer: Cash Price |
$3,921.50
|
| Rate for Payer: Cigna of CA HMO |
$4,991.00
|
| Rate for Payer: Cigna of CA PPO |
$4,991.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,060.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,060.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,060.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,852.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,852.00
|
| Rate for Payer: Galaxy Health WC |
$6,060.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,278.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,755.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,413.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,711.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,991.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,991.00
|
| Rate for Payer: Multiplan Commercial |
$5,704.00
|
| Rate for Payer: Networks By Design Commercial |
$3,565.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,060.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,278.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,278.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,675.89
|
| Rate for Payer: United Healthcare All Other HMO |
$2,604.59
|
| Rate for Payer: United Healthcare HMO Rider |
$2,548.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,335.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,060.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,060.50
|
| Rate for Payer: Vantage Medical Group Senior |
$6,060.50
|
|
