|
HC PACE ST J ASSURITY MRI PM2272
|
Facility
|
IP
|
$8,563.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813801
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,712.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,712.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$3,853.35
|
| Rate for Payer: Cash Price |
$3,853.35
|
| Rate for Payer: Cigna of CA HMO |
$5,994.10
|
| Rate for Payer: Cigna of CA PPO |
$5,994.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,425.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,425.20
|
| Rate for Payer: Galaxy Health WC |
$7,278.55
|
| Rate for Payer: Global Benefits Group Commercial |
$5,137.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,711.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,262.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,300.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,055.12
|
| Rate for Payer: Multiplan Commercial |
$6,850.40
|
| Rate for Payer: Networks By Design Commercial |
$4,281.50
|
| Rate for Payer: Prime Health Services Commercial |
$7,278.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,213.69
|
| Rate for Payer: United Healthcare All Other HMO |
$3,128.06
|
| Rate for Payer: United Healthcare HMO Rider |
$3,060.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,804.38
|
|
|
HC PACE ST J ASSURITY MRI PM2272
|
Facility
|
OP
|
$8,563.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813801
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,712.60 |
| Max. Negotiated Rate |
$7,278.55 |
| Rate for Payer: Adventist Health Commercial |
$1,712.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,278.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,709.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,422.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,258.54
|
| Rate for Payer: Blue Shield of California Commercial |
$6,319.49
|
| Rate for Payer: Blue Shield of California EPN |
$4,161.62
|
| Rate for Payer: Cash Price |
$3,853.35
|
| Rate for Payer: Cigna of CA HMO |
$5,994.10
|
| Rate for Payer: Cigna of CA PPO |
$5,994.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,278.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,278.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,278.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,425.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,425.20
|
| Rate for Payer: Galaxy Health WC |
$7,278.55
|
| Rate for Payer: Global Benefits Group Commercial |
$5,137.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,711.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,300.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,055.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,994.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,994.10
|
| Rate for Payer: Multiplan Commercial |
$6,850.40
|
| Rate for Payer: Networks By Design Commercial |
$4,281.50
|
| Rate for Payer: Prime Health Services Commercial |
$7,278.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,137.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,137.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,213.69
|
| Rate for Payer: United Healthcare All Other HMO |
$3,128.06
|
| Rate for Payer: United Healthcare HMO Rider |
$3,060.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,804.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,278.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,278.55
|
| Rate for Payer: Vantage Medical Group Senior |
$7,278.55
|
|
|
HC PACE STJ ASSURITY MRI SR PM1272
|
Facility
|
IP
|
$7,673.00
|
|
|
Service Code
|
CPT C1786
|
| Hospital Charge Code |
906813791
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,534.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,534.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$3,452.85
|
| Rate for Payer: Cash Price |
$3,452.85
|
| Rate for Payer: Cigna of CA HMO |
$5,371.10
|
| Rate for Payer: Cigna of CA PPO |
$5,371.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,069.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,069.20
|
| Rate for Payer: Galaxy Health WC |
$6,522.05
|
| Rate for Payer: Global Benefits Group Commercial |
$4,603.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,117.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,923.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,749.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,841.52
|
| Rate for Payer: Multiplan Commercial |
$6,138.40
|
| Rate for Payer: Networks By Design Commercial |
$3,836.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,522.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,879.68
|
| Rate for Payer: United Healthcare All Other HMO |
$2,802.95
|
| Rate for Payer: United Healthcare HMO Rider |
$2,742.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,512.91
|
|
|
HC PACE STJ ASSURITY MRI SR PM1272
|
Facility
|
OP
|
$7,673.00
|
|
|
Service Code
|
CPT C1786
|
| Hospital Charge Code |
906813791
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,534.60 |
| Max. Negotiated Rate |
$6,522.05 |
| Rate for Payer: Adventist Health Commercial |
$1,534.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,522.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,220.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,754.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,711.99
|
| Rate for Payer: Blue Shield of California Commercial |
$5,662.67
|
| Rate for Payer: Blue Shield of California EPN |
$3,729.08
|
| Rate for Payer: Cash Price |
$3,452.85
|
| Rate for Payer: Cigna of CA HMO |
$5,371.10
|
| Rate for Payer: Cigna of CA PPO |
$5,371.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,522.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,522.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,522.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,069.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,069.20
|
| Rate for Payer: Galaxy Health WC |
$6,522.05
|
| Rate for Payer: Global Benefits Group Commercial |
$4,603.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,117.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,749.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,841.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,371.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,371.10
|
| Rate for Payer: Multiplan Commercial |
$6,138.40
|
| Rate for Payer: Networks By Design Commercial |
$3,836.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,522.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,603.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,603.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,879.68
|
| Rate for Payer: United Healthcare All Other HMO |
$2,802.95
|
| Rate for Payer: United Healthcare HMO Rider |
$2,742.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,512.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,522.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,522.05
|
| Rate for Payer: Vantage Medical Group Senior |
$6,522.05
|
|
|
HC PACE ST J ASSURITY SR PM1240
|
Facility
|
OP
|
$7,673.00
|
|
|
Service Code
|
CPT C1786
|
| Hospital Charge Code |
906813735
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,534.60 |
| Max. Negotiated Rate |
$6,522.05 |
| Rate for Payer: Adventist Health Commercial |
$1,534.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,522.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,220.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,754.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,711.99
|
| Rate for Payer: Blue Shield of California Commercial |
$5,662.67
|
| Rate for Payer: Blue Shield of California EPN |
$3,729.08
|
| Rate for Payer: Cash Price |
$3,452.85
|
| Rate for Payer: Cigna of CA HMO |
$5,371.10
|
| Rate for Payer: Cigna of CA PPO |
$5,371.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,522.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,522.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,522.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,069.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,069.20
|
| Rate for Payer: Galaxy Health WC |
$6,522.05
|
| Rate for Payer: Global Benefits Group Commercial |
$4,603.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,117.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,749.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,841.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,371.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,371.10
|
| Rate for Payer: Multiplan Commercial |
$6,138.40
|
| Rate for Payer: Networks By Design Commercial |
$3,836.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,522.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,603.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,603.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,879.68
|
| Rate for Payer: United Healthcare All Other HMO |
$2,802.95
|
| Rate for Payer: United Healthcare HMO Rider |
$2,742.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,512.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,522.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,522.05
|
| Rate for Payer: Vantage Medical Group Senior |
$6,522.05
|
|
|
HC PACE ST J ASSURITY SR PM1240
|
Facility
|
IP
|
$7,673.00
|
|
|
Service Code
|
CPT C1786
|
| Hospital Charge Code |
906813735
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,534.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,534.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$3,452.85
|
| Rate for Payer: Cash Price |
$3,452.85
|
| Rate for Payer: Cigna of CA HMO |
$5,371.10
|
| Rate for Payer: Cigna of CA PPO |
$5,371.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,069.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,069.20
|
| Rate for Payer: Galaxy Health WC |
$6,522.05
|
| Rate for Payer: Global Benefits Group Commercial |
$4,603.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,117.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,923.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,749.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,841.52
|
| Rate for Payer: Multiplan Commercial |
$6,138.40
|
| Rate for Payer: Networks By Design Commercial |
$3,836.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,522.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,879.68
|
| Rate for Payer: United Healthcare All Other HMO |
$2,802.95
|
| Rate for Payer: United Healthcare HMO Rider |
$2,742.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,512.91
|
|
|
HC PACE STJ IDENT ADX DR 5380
|
Facility
|
OP
|
$7,193.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813561
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,438.60 |
| Max. Negotiated Rate |
$6,114.05 |
| Rate for Payer: Adventist Health Commercial |
$1,438.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,114.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,956.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,394.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,417.22
|
| Rate for Payer: Blue Shield of California Commercial |
$5,308.43
|
| Rate for Payer: Blue Shield of California EPN |
$3,495.80
|
| Rate for Payer: Cash Price |
$3,236.85
|
| Rate for Payer: Cigna of CA HMO |
$5,035.10
|
| Rate for Payer: Cigna of CA PPO |
$5,035.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,114.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,114.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,114.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,877.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,877.20
|
| Rate for Payer: Galaxy Health WC |
$6,114.05
|
| Rate for Payer: Global Benefits Group Commercial |
$4,315.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,797.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,452.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,726.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,035.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,035.10
|
| Rate for Payer: Multiplan Commercial |
$5,754.40
|
| Rate for Payer: Networks By Design Commercial |
$3,596.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,114.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,315.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,315.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,699.53
|
| Rate for Payer: United Healthcare All Other HMO |
$2,627.60
|
| Rate for Payer: United Healthcare HMO Rider |
$2,570.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,355.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,114.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,114.05
|
| Rate for Payer: Vantage Medical Group Senior |
$6,114.05
|
|
|
HC PACE STJ IDENT ADX DR 5380
|
Facility
|
IP
|
$7,193.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813561
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,438.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,438.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$3,236.85
|
| Rate for Payer: Cash Price |
$3,236.85
|
| Rate for Payer: Cigna of CA HMO |
$5,035.10
|
| Rate for Payer: Cigna of CA PPO |
$5,035.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,877.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,877.20
|
| Rate for Payer: Galaxy Health WC |
$6,114.05
|
| Rate for Payer: Global Benefits Group Commercial |
$4,315.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,797.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,740.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,452.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,726.32
|
| Rate for Payer: Multiplan Commercial |
$5,754.40
|
| Rate for Payer: Networks By Design Commercial |
$3,596.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,114.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,699.53
|
| Rate for Payer: United Healthcare All Other HMO |
$2,627.60
|
| Rate for Payer: United Healthcare HMO Rider |
$2,570.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,355.71
|
|
|
HC PACE STJ IDENT ADX SR 5180
|
Facility
|
IP
|
$10,988.00
|
|
|
Service Code
|
CPT C1786
|
| Hospital Charge Code |
906813564
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,197.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$2,197.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$4,944.60
|
| Rate for Payer: Cash Price |
$4,944.60
|
| Rate for Payer: Cigna of CA HMO |
$7,691.60
|
| Rate for Payer: Cigna of CA PPO |
$7,691.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,395.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,395.20
|
| Rate for Payer: Galaxy Health WC |
$9,339.80
|
| Rate for Payer: Global Benefits Group Commercial |
$6,592.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,329.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,186.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,801.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,637.12
|
| Rate for Payer: Multiplan Commercial |
$8,790.40
|
| Rate for Payer: Networks By Design Commercial |
$5,494.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,339.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,123.80
|
| Rate for Payer: United Healthcare All Other HMO |
$4,013.92
|
| Rate for Payer: United Healthcare HMO Rider |
$3,927.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,598.57
|
|
|
HC PACE STJ IDENT ADX SR 5180
|
Facility
|
OP
|
$10,988.00
|
|
|
Service Code
|
CPT C1786
|
| Hospital Charge Code |
906813564
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,197.60 |
| Max. Negotiated Rate |
$9,339.80 |
| Rate for Payer: Adventist Health Commercial |
$2,197.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,339.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,043.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,241.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,747.73
|
| Rate for Payer: Blue Shield of California Commercial |
$8,109.14
|
| Rate for Payer: Blue Shield of California EPN |
$5,340.17
|
| Rate for Payer: Cash Price |
$4,944.60
|
| Rate for Payer: Cigna of CA HMO |
$7,691.60
|
| Rate for Payer: Cigna of CA PPO |
$7,691.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,339.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,339.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,339.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,395.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,395.20
|
| Rate for Payer: Galaxy Health WC |
$9,339.80
|
| Rate for Payer: Global Benefits Group Commercial |
$6,592.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,329.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,801.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,637.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,691.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,691.60
|
| Rate for Payer: Multiplan Commercial |
$8,790.40
|
| Rate for Payer: Networks By Design Commercial |
$5,494.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,339.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,592.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,592.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,123.80
|
| Rate for Payer: United Healthcare All Other HMO |
$4,013.92
|
| Rate for Payer: United Healthcare HMO Rider |
$3,927.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,598.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,339.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,339.80
|
| Rate for Payer: Vantage Medical Group Senior |
$9,339.80
|
|
|
HC PACE STJ IDENT XL DR 5386
|
Facility
|
IP
|
$11,150.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813568
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,230.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$2,230.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$5,017.50
|
| Rate for Payer: Cash Price |
$5,017.50
|
| Rate for Payer: Cigna of CA HMO |
$7,805.00
|
| Rate for Payer: Cigna of CA PPO |
$7,805.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,460.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,460.00
|
| Rate for Payer: Galaxy Health WC |
$9,477.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6,690.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,437.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,248.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,901.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,676.00
|
| Rate for Payer: Multiplan Commercial |
$8,920.00
|
| Rate for Payer: Networks By Design Commercial |
$5,575.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,477.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,184.60
|
| Rate for Payer: United Healthcare All Other HMO |
$4,073.09
|
| Rate for Payer: United Healthcare HMO Rider |
$3,985.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,651.62
|
|
|
HC PACE STJ IDENT XL DR 5386
|
Facility
|
OP
|
$11,150.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813568
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,230.00 |
| Max. Negotiated Rate |
$9,477.50 |
| Rate for Payer: Adventist Health Commercial |
$2,230.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,477.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,132.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,362.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,847.22
|
| Rate for Payer: Blue Shield of California Commercial |
$8,228.70
|
| Rate for Payer: Blue Shield of California EPN |
$5,418.90
|
| Rate for Payer: Cash Price |
$5,017.50
|
| Rate for Payer: Cigna of CA HMO |
$7,805.00
|
| Rate for Payer: Cigna of CA PPO |
$7,805.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,477.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,477.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,477.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,460.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,460.00
|
| Rate for Payer: Galaxy Health WC |
$9,477.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6,690.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,437.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,901.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,676.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,805.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,805.00
|
| Rate for Payer: Multiplan Commercial |
$8,920.00
|
| Rate for Payer: Networks By Design Commercial |
$5,575.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,477.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,690.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,690.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,184.60
|
| Rate for Payer: United Healthcare All Other HMO |
$4,073.09
|
| Rate for Payer: United Healthcare HMO Rider |
$3,985.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,651.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,477.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,477.50
|
| Rate for Payer: Vantage Medical Group Senior |
$9,477.50
|
|
|
HC PACE STJ MICRONY II SR 2525T
|
Facility
|
IP
|
$9,988.00
|
|
|
Service Code
|
CPT C1786
|
| Hospital Charge Code |
906813774
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,997.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,997.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$4,494.60
|
| Rate for Payer: Cash Price |
$4,494.60
|
| Rate for Payer: Cigna of CA HMO |
$6,991.60
|
| Rate for Payer: Cigna of CA PPO |
$6,991.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,995.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,995.20
|
| Rate for Payer: Galaxy Health WC |
$8,489.80
|
| Rate for Payer: Global Benefits Group Commercial |
$5,992.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,662.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,805.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,182.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,397.12
|
| Rate for Payer: Multiplan Commercial |
$7,990.40
|
| Rate for Payer: Networks By Design Commercial |
$4,994.00
|
| Rate for Payer: Prime Health Services Commercial |
$8,489.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,748.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,648.62
|
| Rate for Payer: United Healthcare HMO Rider |
$3,569.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,271.07
|
|
|
HC PACE STJ MICRONY II SR 2525T
|
Facility
|
OP
|
$9,988.00
|
|
|
Service Code
|
CPT C1786
|
| Hospital Charge Code |
906813774
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,997.60 |
| Max. Negotiated Rate |
$8,489.80 |
| Rate for Payer: Adventist Health Commercial |
$1,997.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,489.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,493.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,491.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,133.63
|
| Rate for Payer: Blue Shield of California Commercial |
$7,371.14
|
| Rate for Payer: Blue Shield of California EPN |
$4,854.17
|
| Rate for Payer: Cash Price |
$4,494.60
|
| Rate for Payer: Cigna of CA HMO |
$6,991.60
|
| Rate for Payer: Cigna of CA PPO |
$6,991.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,489.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,489.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,489.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,995.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,995.20
|
| Rate for Payer: Galaxy Health WC |
$8,489.80
|
| Rate for Payer: Global Benefits Group Commercial |
$5,992.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,662.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,182.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,397.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,991.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,991.60
|
| Rate for Payer: Multiplan Commercial |
$7,990.40
|
| Rate for Payer: Networks By Design Commercial |
$4,994.00
|
| Rate for Payer: Prime Health Services Commercial |
$8,489.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,992.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,992.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,748.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,648.62
|
| Rate for Payer: United Healthcare HMO Rider |
$3,569.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,271.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,489.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,489.80
|
| Rate for Payer: Vantage Medical Group Senior |
$8,489.80
|
|
|
HC PACE ST JUDE ZEPHYR DR 5820
|
Facility
|
OP
|
$13,087.50
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813693
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,617.50 |
| Max. Negotiated Rate |
$11,124.38 |
| Rate for Payer: Adventist Health Commercial |
$2,617.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,124.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,198.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,815.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,580.28
|
| Rate for Payer: Blue Shield of California Commercial |
$9,658.58
|
| Rate for Payer: Blue Shield of California EPN |
$6,360.52
|
| Rate for Payer: Cash Price |
$5,889.38
|
| Rate for Payer: Cigna of CA HMO |
$9,161.25
|
| Rate for Payer: Cigna of CA PPO |
$9,161.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,124.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,124.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11,124.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,235.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,235.00
|
| Rate for Payer: Galaxy Health WC |
$11,124.38
|
| Rate for Payer: Global Benefits Group Commercial |
$7,852.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,729.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,101.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,141.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,161.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,161.25
|
| Rate for Payer: Multiplan Commercial |
$10,470.00
|
| Rate for Payer: Networks By Design Commercial |
$6,543.75
|
| Rate for Payer: Prime Health Services Commercial |
$11,124.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,852.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,852.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,911.74
|
| Rate for Payer: United Healthcare All Other HMO |
$4,780.86
|
| Rate for Payer: United Healthcare HMO Rider |
$4,677.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,286.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,124.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,124.38
|
| Rate for Payer: Vantage Medical Group Senior |
$11,124.38
|
|
|
HC PACE ST JUDE ZEPHYR DR 5820
|
Facility
|
IP
|
$13,087.50
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813693
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,617.50 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$2,617.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$5,889.38
|
| Rate for Payer: Cash Price |
$5,889.38
|
| Rate for Payer: Cigna of CA HMO |
$9,161.25
|
| Rate for Payer: Cigna of CA PPO |
$9,161.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,235.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,235.00
|
| Rate for Payer: Galaxy Health WC |
$11,124.38
|
| Rate for Payer: Global Benefits Group Commercial |
$7,852.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,729.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,986.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,101.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,141.00
|
| Rate for Payer: Multiplan Commercial |
$10,470.00
|
| Rate for Payer: Networks By Design Commercial |
$6,543.75
|
| Rate for Payer: Prime Health Services Commercial |
$11,124.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,911.74
|
| Rate for Payer: United Healthcare All Other HMO |
$4,780.86
|
| Rate for Payer: United Healthcare HMO Rider |
$4,677.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,286.16
|
|
|
HC PACE STJ VICTORY DR 5810
|
Facility
|
OP
|
$12,338.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813589
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,467.60 |
| Max. Negotiated Rate |
$10,487.30 |
| Rate for Payer: Adventist Health Commercial |
$2,467.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,487.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,785.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,253.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,576.77
|
| Rate for Payer: Blue Shield of California Commercial |
$9,105.44
|
| Rate for Payer: Blue Shield of California EPN |
$5,996.27
|
| Rate for Payer: Cash Price |
$5,552.10
|
| Rate for Payer: Cigna of CA HMO |
$8,636.60
|
| Rate for Payer: Cigna of CA PPO |
$8,636.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,487.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,487.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,487.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,935.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,935.20
|
| Rate for Payer: Galaxy Health WC |
$10,487.30
|
| Rate for Payer: Global Benefits Group Commercial |
$7,402.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,229.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,637.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,961.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,636.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,636.60
|
| Rate for Payer: Multiplan Commercial |
$9,870.40
|
| Rate for Payer: Networks By Design Commercial |
$6,169.00
|
| Rate for Payer: Prime Health Services Commercial |
$10,487.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,402.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,402.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,630.45
|
| Rate for Payer: United Healthcare All Other HMO |
$4,507.07
|
| Rate for Payer: United Healthcare HMO Rider |
$4,409.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,040.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,487.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,487.30
|
| Rate for Payer: Vantage Medical Group Senior |
$10,487.30
|
|
|
HC PACE STJ VICTORY DR 5810
|
Facility
|
IP
|
$12,338.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813589
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,467.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$2,467.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$5,552.10
|
| Rate for Payer: Cash Price |
$5,552.10
|
| Rate for Payer: Cigna of CA HMO |
$8,636.60
|
| Rate for Payer: Cigna of CA PPO |
$8,636.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,935.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,935.20
|
| Rate for Payer: Galaxy Health WC |
$10,487.30
|
| Rate for Payer: Global Benefits Group Commercial |
$7,402.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,229.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,700.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,637.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,961.12
|
| Rate for Payer: Multiplan Commercial |
$9,870.40
|
| Rate for Payer: Networks By Design Commercial |
$6,169.00
|
| Rate for Payer: Prime Health Services Commercial |
$10,487.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,630.45
|
| Rate for Payer: United Healthcare All Other HMO |
$4,507.07
|
| Rate for Payer: United Healthcare HMO Rider |
$4,409.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,040.70
|
|
|
HC PACE STJ VICTORY SR 5610
|
Facility
|
IP
|
$10,738.00
|
|
|
Service Code
|
CPT C1786
|
| Hospital Charge Code |
906813602
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,147.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$2,147.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$4,832.10
|
| Rate for Payer: Cash Price |
$4,832.10
|
| Rate for Payer: Cigna of CA HMO |
$7,516.60
|
| Rate for Payer: Cigna of CA PPO |
$7,516.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,295.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,295.20
|
| Rate for Payer: Galaxy Health WC |
$9,127.30
|
| Rate for Payer: Global Benefits Group Commercial |
$6,442.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,162.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,091.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,646.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,577.12
|
| Rate for Payer: Multiplan Commercial |
$8,590.40
|
| Rate for Payer: Networks By Design Commercial |
$5,369.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,127.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,029.97
|
| Rate for Payer: United Healthcare All Other HMO |
$3,922.59
|
| Rate for Payer: United Healthcare HMO Rider |
$3,837.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,516.70
|
|
|
HC PACE STJ VICTORY SR 5610
|
Facility
|
OP
|
$10,738.00
|
|
|
Service Code
|
CPT C1786
|
| Hospital Charge Code |
906813602
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,147.60 |
| Max. Negotiated Rate |
$9,127.30 |
| Rate for Payer: Adventist Health Commercial |
$2,147.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,127.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,905.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,053.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,594.21
|
| Rate for Payer: Blue Shield of California Commercial |
$7,924.64
|
| Rate for Payer: Blue Shield of California EPN |
$5,218.67
|
| Rate for Payer: Cash Price |
$4,832.10
|
| Rate for Payer: Cigna of CA HMO |
$7,516.60
|
| Rate for Payer: Cigna of CA PPO |
$7,516.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,127.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,127.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,127.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,295.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,295.20
|
| Rate for Payer: Galaxy Health WC |
$9,127.30
|
| Rate for Payer: Global Benefits Group Commercial |
$6,442.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,162.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,646.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,577.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,516.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,516.60
|
| Rate for Payer: Multiplan Commercial |
$8,590.40
|
| Rate for Payer: Networks By Design Commercial |
$5,369.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,127.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,442.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,442.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,029.97
|
| Rate for Payer: United Healthcare All Other HMO |
$3,922.59
|
| Rate for Payer: United Healthcare HMO Rider |
$3,837.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,516.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,127.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,127.30
|
| Rate for Payer: Vantage Medical Group Senior |
$9,127.30
|
|
|
HC PACE STJ VICTORY XL DR 5816
|
Facility
|
IP
|
$12,338.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813584
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,467.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$2,467.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$5,552.10
|
| Rate for Payer: Cash Price |
$5,552.10
|
| Rate for Payer: Cigna of CA HMO |
$8,636.60
|
| Rate for Payer: Cigna of CA PPO |
$8,636.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,935.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,935.20
|
| Rate for Payer: Galaxy Health WC |
$10,487.30
|
| Rate for Payer: Global Benefits Group Commercial |
$7,402.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,229.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,700.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,637.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,961.12
|
| Rate for Payer: Multiplan Commercial |
$9,870.40
|
| Rate for Payer: Networks By Design Commercial |
$6,169.00
|
| Rate for Payer: Prime Health Services Commercial |
$10,487.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,630.45
|
| Rate for Payer: United Healthcare All Other HMO |
$4,507.07
|
| Rate for Payer: United Healthcare HMO Rider |
$4,409.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,040.70
|
|
|
HC PACE STJ VICTORY XL DR 5816
|
Facility
|
OP
|
$12,338.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813584
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,467.60 |
| Max. Negotiated Rate |
$10,487.30 |
| Rate for Payer: Adventist Health Commercial |
$2,467.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,487.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,785.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,253.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,576.77
|
| Rate for Payer: Blue Shield of California Commercial |
$9,105.44
|
| Rate for Payer: Blue Shield of California EPN |
$5,996.27
|
| Rate for Payer: Cash Price |
$5,552.10
|
| Rate for Payer: Cigna of CA HMO |
$8,636.60
|
| Rate for Payer: Cigna of CA PPO |
$8,636.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,487.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,487.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,487.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,935.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,935.20
|
| Rate for Payer: Galaxy Health WC |
$10,487.30
|
| Rate for Payer: Global Benefits Group Commercial |
$7,402.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,229.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,637.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,961.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,636.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,636.60
|
| Rate for Payer: Multiplan Commercial |
$9,870.40
|
| Rate for Payer: Networks By Design Commercial |
$6,169.00
|
| Rate for Payer: Prime Health Services Commercial |
$10,487.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,402.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,402.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,630.45
|
| Rate for Payer: United Healthcare All Other HMO |
$4,507.07
|
| Rate for Payer: United Healthcare HMO Rider |
$4,409.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,040.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,487.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,487.30
|
| Rate for Payer: Vantage Medical Group Senior |
$10,487.30
|
|
|
HC PACE STJ ZEPHYR XL DR 5826
|
Facility
|
OP
|
$12,338.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813606
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,467.60 |
| Max. Negotiated Rate |
$10,487.30 |
| Rate for Payer: Adventist Health Commercial |
$2,467.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,487.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,785.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,253.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,576.77
|
| Rate for Payer: Blue Shield of California Commercial |
$9,105.44
|
| Rate for Payer: Blue Shield of California EPN |
$5,996.27
|
| Rate for Payer: Cash Price |
$5,552.10
|
| Rate for Payer: Cigna of CA HMO |
$8,636.60
|
| Rate for Payer: Cigna of CA PPO |
$8,636.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,487.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,487.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,487.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,935.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,935.20
|
| Rate for Payer: Galaxy Health WC |
$10,487.30
|
| Rate for Payer: Global Benefits Group Commercial |
$7,402.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,229.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,637.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,961.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,636.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,636.60
|
| Rate for Payer: Multiplan Commercial |
$9,870.40
|
| Rate for Payer: Networks By Design Commercial |
$6,169.00
|
| Rate for Payer: Prime Health Services Commercial |
$10,487.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,402.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,402.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,630.45
|
| Rate for Payer: United Healthcare All Other HMO |
$4,507.07
|
| Rate for Payer: United Healthcare HMO Rider |
$4,409.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,040.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,487.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,487.30
|
| Rate for Payer: Vantage Medical Group Senior |
$10,487.30
|
|
|
HC PACE STJ ZEPHYR XL DR 5826
|
Facility
|
IP
|
$12,338.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813606
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,467.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$2,467.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$5,552.10
|
| Rate for Payer: Cash Price |
$5,552.10
|
| Rate for Payer: Cigna of CA HMO |
$8,636.60
|
| Rate for Payer: Cigna of CA PPO |
$8,636.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,935.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,935.20
|
| Rate for Payer: Galaxy Health WC |
$10,487.30
|
| Rate for Payer: Global Benefits Group Commercial |
$7,402.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,229.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,700.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,637.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,961.12
|
| Rate for Payer: Multiplan Commercial |
$9,870.40
|
| Rate for Payer: Networks By Design Commercial |
$6,169.00
|
| Rate for Payer: Prime Health Services Commercial |
$10,487.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,630.45
|
| Rate for Payer: United Healthcare All Other HMO |
$4,507.07
|
| Rate for Payer: United Healthcare HMO Rider |
$4,409.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,040.70
|
|
|
HC PACE STJ ZEPHYR XL SR 5626
|
Facility
|
IP
|
$10,738.00
|
|
|
Service Code
|
CPT C1786
|
| Hospital Charge Code |
906813603
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,147.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$2,147.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$4,832.10
|
| Rate for Payer: Cash Price |
$4,832.10
|
| Rate for Payer: Cigna of CA HMO |
$7,516.60
|
| Rate for Payer: Cigna of CA PPO |
$7,516.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,295.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,295.20
|
| Rate for Payer: Galaxy Health WC |
$9,127.30
|
| Rate for Payer: Global Benefits Group Commercial |
$6,442.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,162.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,091.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,646.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,577.12
|
| Rate for Payer: Multiplan Commercial |
$8,590.40
|
| Rate for Payer: Networks By Design Commercial |
$5,369.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,127.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,029.97
|
| Rate for Payer: United Healthcare All Other HMO |
$3,922.59
|
| Rate for Payer: United Healthcare HMO Rider |
$3,837.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,516.70
|
|
