|
HC PACER LEAD REMOVE,SNGL A OR V
|
Facility
|
IP
|
$5,659.00
|
|
|
Service Code
|
CPT 33234
|
| Hospital Charge Code |
906820120
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,131.80 |
| Max. Negotiated Rate |
$4,810.15 |
| Rate for Payer: Adventist Health Commercial |
$1,131.80
|
| Rate for Payer: Cash Price |
$3,112.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,263.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,263.60
|
| Rate for Payer: Galaxy Health WC |
$4,810.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,395.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,774.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,156.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,502.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,358.16
|
| Rate for Payer: Multiplan Commercial |
$4,527.20
|
| Rate for Payer: Networks By Design Commercial |
$3,678.35
|
| Rate for Payer: Prime Health Services Commercial |
$4,810.15
|
|
|
HC PACER LEAD REMOVE,SNGL A OR V
|
Facility
|
IP
|
$5,822.00
|
|
|
Service Code
|
CPT 33234
|
| Hospital Charge Code |
906811363
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,164.40 |
| Max. Negotiated Rate |
$4,948.70 |
| Rate for Payer: Adventist Health Commercial |
$1,164.40
|
| Rate for Payer: Cash Price |
$3,202.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,328.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,328.80
|
| Rate for Payer: Galaxy Health WC |
$4,948.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,493.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,883.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,218.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,603.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,397.28
|
| Rate for Payer: Multiplan Commercial |
$4,657.60
|
| Rate for Payer: Networks By Design Commercial |
$3,784.30
|
| Rate for Payer: Prime Health Services Commercial |
$4,948.70
|
|
|
HC PACER POCKET REVISION/RELOCATE
|
Facility
|
IP
|
$4,214.00
|
|
|
Service Code
|
CPT 33222
|
| Hospital Charge Code |
906820114
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$842.80 |
| Max. Negotiated Rate |
$3,581.90 |
| Rate for Payer: Adventist Health Commercial |
$842.80
|
| Rate for Payer: Cash Price |
$2,317.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,685.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,685.60
|
| Rate for Payer: Galaxy Health WC |
$3,581.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,528.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,810.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,605.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,608.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,011.36
|
| Rate for Payer: Multiplan Commercial |
$3,371.20
|
| Rate for Payer: Networks By Design Commercial |
$2,739.10
|
| Rate for Payer: Prime Health Services Commercial |
$3,581.90
|
|
|
HC PACER POCKET REVISION/RELOCATE
|
Facility
|
IP
|
$4,336.00
|
|
|
Service Code
|
CPT 33222
|
| Hospital Charge Code |
906811357
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$867.20 |
| Max. Negotiated Rate |
$3,685.60 |
| Rate for Payer: Adventist Health Commercial |
$867.20
|
| Rate for Payer: Cash Price |
$2,384.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,734.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,734.40
|
| Rate for Payer: Galaxy Health WC |
$3,685.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,601.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,892.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,652.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,683.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,040.64
|
| Rate for Payer: Multiplan Commercial |
$3,468.80
|
| Rate for Payer: Networks By Design Commercial |
$2,818.40
|
| Rate for Payer: Prime Health Services Commercial |
$3,685.60
|
|
|
HC PACER POCKET REVISION/RELOCATE
|
Facility
|
OP
|
$4,336.00
|
|
|
Service Code
|
CPT 33222
|
| Hospital Charge Code |
906811357
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$516.63 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$867.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,556.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,324.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,470.08
|
| Rate for Payer: Cash Price |
$2,384.80
|
| Rate for Payer: Cash Price |
$2,384.80
|
| Rate for Payer: Cash Price |
$2,384.80
|
| Rate for Payer: Cigna of CA HMO |
$2,775.04
|
| Rate for Payer: Cigna of CA PPO |
$3,208.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,556.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,324.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,137.70
|
| Rate for Payer: EPIC Health Plan Senior |
$2,324.22
|
| Rate for Payer: Galaxy Health WC |
$3,685.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,601.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,811.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$516.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,324.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,892.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$584.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,324.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,040.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,928.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,114.45
|
| Rate for Payer: Multiplan Commercial |
$3,468.80
|
| Rate for Payer: Multiplan WC |
$3,703.23
|
| Rate for Payer: Networks By Design Commercial |
$2,818.40
|
| Rate for Payer: Prime Health Services Commercial |
$3,685.60
|
| Rate for Payer: Prime Health Services WC |
$3,665.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,601.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,324.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,556.64
|
| Rate for Payer: Vantage Medical Group Senior |
$2,324.22
|
|
|
HC PACER POCKET REVISION/RELOCATE
|
Facility
|
OP
|
$4,214.00
|
|
|
Service Code
|
CPT 33222
|
| Hospital Charge Code |
906820114
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$516.63 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$842.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,556.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,324.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,470.08
|
| Rate for Payer: Cash Price |
$2,317.70
|
| Rate for Payer: Cash Price |
$2,317.70
|
| Rate for Payer: Cash Price |
$2,317.70
|
| Rate for Payer: Cigna of CA HMO |
$2,696.96
|
| Rate for Payer: Cigna of CA PPO |
$3,118.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,556.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,324.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,137.70
|
| Rate for Payer: EPIC Health Plan Senior |
$2,324.22
|
| Rate for Payer: Galaxy Health WC |
$3,581.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,528.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,811.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$516.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,324.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,810.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$584.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,324.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,011.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,928.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,114.45
|
| Rate for Payer: Multiplan Commercial |
$3,371.20
|
| Rate for Payer: Multiplan WC |
$3,703.23
|
| Rate for Payer: Networks By Design Commercial |
$2,739.10
|
| Rate for Payer: Prime Health Services Commercial |
$3,581.90
|
| Rate for Payer: Prime Health Services WC |
$3,665.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,528.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,324.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,556.64
|
| Rate for Payer: Vantage Medical Group Senior |
$2,324.22
|
|
|
HC PACER UPGRADE SINGLE TO DUAL
|
Facility
|
IP
|
$35,599.00
|
|
|
Service Code
|
CPT 33214
|
| Hospital Charge Code |
906811362
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,119.80 |
| Max. Negotiated Rate |
$30,259.15 |
| Rate for Payer: Adventist Health Commercial |
$7,119.80
|
| Rate for Payer: Cash Price |
$19,579.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,239.60
|
| Rate for Payer: EPIC Health Plan Senior |
$14,239.60
|
| Rate for Payer: Galaxy Health WC |
$30,259.15
|
| Rate for Payer: Global Benefits Group Commercial |
$21,359.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23,744.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,563.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,035.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,543.76
|
| Rate for Payer: Multiplan Commercial |
$28,479.20
|
| Rate for Payer: Networks By Design Commercial |
$23,139.35
|
| Rate for Payer: Prime Health Services Commercial |
$30,259.15
|
|
|
HC PACER UPGRADE SINGLE TO DUAL
|
Facility
|
IP
|
$34,598.00
|
|
|
Service Code
|
CPT 33214
|
| Hospital Charge Code |
906820119
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,919.60 |
| Max. Negotiated Rate |
$29,408.30 |
| Rate for Payer: Adventist Health Commercial |
$6,919.60
|
| Rate for Payer: Cash Price |
$19,028.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,839.20
|
| Rate for Payer: EPIC Health Plan Senior |
$13,839.20
|
| Rate for Payer: Galaxy Health WC |
$29,408.30
|
| Rate for Payer: Global Benefits Group Commercial |
$20,758.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23,076.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,181.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21,416.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,303.52
|
| Rate for Payer: Multiplan Commercial |
$27,678.40
|
| Rate for Payer: Networks By Design Commercial |
$22,488.70
|
| Rate for Payer: Prime Health Services Commercial |
$29,408.30
|
|
|
HC PACER UPGRADE SINGLE TO DUAL
|
Facility
|
OP
|
$35,599.00
|
|
|
Service Code
|
CPT 33214
|
| Hospital Charge Code |
906811362
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$666.74 |
| Max. Negotiated Rate |
$53,714.00 |
| Rate for Payer: Adventist Health Commercial |
$7,119.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,370.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19,945.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14,626.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,297.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,291.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$7,415.66
|
| Rate for Payer: Cash Price |
$19,579.45
|
| Rate for Payer: Cash Price |
$19,579.45
|
| Rate for Payer: Cash Price |
$19,579.45
|
| Rate for Payer: Cigna of CA HMO |
$22,783.36
|
| Rate for Payer: Cigna of CA PPO |
$26,343.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19,945.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$14,626.98
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13,297.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$17,951.29
|
| Rate for Payer: EPIC Health Plan Senior |
$13,297.25
|
| Rate for Payer: Galaxy Health WC |
$30,259.15
|
| Rate for Payer: Global Benefits Group Commercial |
$21,359.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$21,807.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$666.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13,297.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23,744.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$754.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,297.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,543.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16,754.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17,818.31
|
| Rate for Payer: Multiplan Commercial |
$28,479.20
|
| Rate for Payer: Multiplan WC |
$21,186.79
|
| Rate for Payer: Networks By Design Commercial |
$23,139.35
|
| Rate for Payer: Prime Health Services Commercial |
$30,259.15
|
| Rate for Payer: Prime Health Services WC |
$20,970.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21,359.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$43,822.00
|
| Rate for Payer: United Healthcare All Other HMO |
$53,714.00
|
| Rate for Payer: United Healthcare HMO Rider |
$37,572.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34,424.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$13,297.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19,945.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14,626.98
|
| Rate for Payer: Vantage Medical Group Senior |
$13,297.25
|
|
|
HC PACER UPGRADE SINGLE TO DUAL
|
Facility
|
OP
|
$34,598.00
|
|
|
Service Code
|
CPT 33214
|
| Hospital Charge Code |
906820119
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$666.74 |
| Max. Negotiated Rate |
$53,714.00 |
| Rate for Payer: Adventist Health Commercial |
$6,919.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,370.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19,945.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14,626.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,297.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,291.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$7,415.66
|
| Rate for Payer: Cash Price |
$19,028.90
|
| Rate for Payer: Cash Price |
$19,028.90
|
| Rate for Payer: Cash Price |
$19,028.90
|
| Rate for Payer: Cigna of CA HMO |
$22,142.72
|
| Rate for Payer: Cigna of CA PPO |
$25,602.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19,945.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$14,626.98
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13,297.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$17,951.29
|
| Rate for Payer: EPIC Health Plan Senior |
$13,297.25
|
| Rate for Payer: Galaxy Health WC |
$29,408.30
|
| Rate for Payer: Global Benefits Group Commercial |
$20,758.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$21,807.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$666.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13,297.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23,076.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$754.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,297.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,303.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16,754.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17,818.31
|
| Rate for Payer: Multiplan Commercial |
$27,678.40
|
| Rate for Payer: Multiplan WC |
$21,186.79
|
| Rate for Payer: Networks By Design Commercial |
$22,488.70
|
| Rate for Payer: Prime Health Services Commercial |
$29,408.30
|
| Rate for Payer: Prime Health Services WC |
$20,970.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20,758.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$43,822.00
|
| Rate for Payer: United Healthcare All Other HMO |
$53,714.00
|
| Rate for Payer: United Healthcare HMO Rider |
$37,572.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34,424.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$13,297.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19,945.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14,626.98
|
| Rate for Payer: Vantage Medical Group Senior |
$13,297.25
|
|
|
HC PACE ST J ALLURE QUADRA PM3242
|
Facility
|
IP
|
$16,270.00
|
|
|
Service Code
|
CPT C2621
|
| Hospital Charge Code |
906813746
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,254.00 |
| Max. Negotiated Rate |
$13,829.50 |
| Rate for Payer: Adventist Health Commercial |
$3,254.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$8,948.50
|
| Rate for Payer: Cash Price |
$8,948.50
|
| Rate for Payer: Cigna of CA HMO |
$11,389.00
|
| Rate for Payer: Cigna of CA PPO |
$11,389.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,508.00
|
| Rate for Payer: EPIC Health Plan Senior |
$6,508.00
|
| Rate for Payer: Galaxy Health WC |
$13,829.50
|
| Rate for Payer: Global Benefits Group Commercial |
$9,762.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,852.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,198.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,071.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,904.80
|
| Rate for Payer: Multiplan Commercial |
$13,016.00
|
| Rate for Payer: Networks By Design Commercial |
$8,135.00
|
| Rate for Payer: Prime Health Services Commercial |
$13,829.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,106.13
|
| Rate for Payer: United Healthcare All Other HMO |
$5,943.43
|
| Rate for Payer: United Healthcare HMO Rider |
$5,814.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,328.43
|
|
|
HC PACE ST J ALLURE QUADRA PM3242
|
Facility
|
OP
|
$16,270.00
|
|
|
Service Code
|
CPT C2621
|
| Hospital Charge Code |
906813746
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,254.00 |
| Max. Negotiated Rate |
$13,829.50 |
| Rate for Payer: Adventist Health Commercial |
$3,254.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,829.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,948.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12,202.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,991.41
|
| Rate for Payer: Blue Shield of California Commercial |
$12,007.26
|
| Rate for Payer: Blue Shield of California EPN |
$7,907.22
|
| Rate for Payer: Cash Price |
$8,948.50
|
| Rate for Payer: Cigna of CA HMO |
$11,389.00
|
| Rate for Payer: Cigna of CA PPO |
$11,389.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,829.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$13,829.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13,829.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,508.00
|
| Rate for Payer: EPIC Health Plan Senior |
$6,508.00
|
| Rate for Payer: Galaxy Health WC |
$13,829.50
|
| Rate for Payer: Global Benefits Group Commercial |
$9,762.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,852.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,071.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,904.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,389.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,389.00
|
| Rate for Payer: Multiplan Commercial |
$13,016.00
|
| Rate for Payer: Networks By Design Commercial |
$8,135.00
|
| Rate for Payer: Prime Health Services Commercial |
$13,829.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,762.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,762.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,106.13
|
| Rate for Payer: United Healthcare All Other HMO |
$5,943.43
|
| Rate for Payer: United Healthcare HMO Rider |
$5,814.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,328.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,829.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13,829.50
|
| Rate for Payer: Vantage Medical Group Senior |
$13,829.50
|
|
|
HC PACE STJ ALLURE RF PM3222
|
Facility
|
OP
|
$13,895.00
|
|
|
Service Code
|
CPT C2621
|
| Hospital Charge Code |
906813775
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,779.00 |
| Max. Negotiated Rate |
$11,810.75 |
| Rate for Payer: Adventist Health Commercial |
$2,779.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,810.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,642.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,421.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,532.92
|
| Rate for Payer: Blue Shield of California Commercial |
$10,254.51
|
| Rate for Payer: Blue Shield of California EPN |
$6,752.97
|
| Rate for Payer: Cash Price |
$7,642.25
|
| Rate for Payer: Cigna of CA HMO |
$9,726.50
|
| Rate for Payer: Cigna of CA PPO |
$9,726.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,810.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,810.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11,810.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,558.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,558.00
|
| Rate for Payer: Galaxy Health WC |
$11,810.75
|
| Rate for Payer: Global Benefits Group Commercial |
$8,337.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,267.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,601.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,334.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,726.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,726.50
|
| Rate for Payer: Multiplan Commercial |
$11,116.00
|
| Rate for Payer: Networks By Design Commercial |
$6,947.50
|
| Rate for Payer: Prime Health Services Commercial |
$11,810.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,337.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8,337.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,214.79
|
| Rate for Payer: United Healthcare All Other HMO |
$5,075.84
|
| Rate for Payer: United Healthcare HMO Rider |
$4,966.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,550.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,810.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,810.75
|
| Rate for Payer: Vantage Medical Group Senior |
$11,810.75
|
|
|
HC PACE STJ ALLURE RF PM3222
|
Facility
|
IP
|
$13,895.00
|
|
|
Service Code
|
CPT C2621
|
| Hospital Charge Code |
906813775
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,779.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$2,779.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$7,642.25
|
| Rate for Payer: Cash Price |
$7,642.25
|
| Rate for Payer: Cigna of CA HMO |
$9,726.50
|
| Rate for Payer: Cigna of CA PPO |
$9,726.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,558.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,558.00
|
| Rate for Payer: Galaxy Health WC |
$11,810.75
|
| Rate for Payer: Global Benefits Group Commercial |
$8,337.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,267.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,293.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,601.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,334.80
|
| Rate for Payer: Multiplan Commercial |
$11,116.00
|
| Rate for Payer: Networks By Design Commercial |
$6,947.50
|
| Rate for Payer: Prime Health Services Commercial |
$11,810.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,214.79
|
| Rate for Payer: United Healthcare All Other HMO |
$5,075.84
|
| Rate for Payer: United Healthcare HMO Rider |
$4,966.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,550.61
|
|
|
HC PACE STJ ASSURITY DR PM2240
|
Facility
|
IP
|
$8,563.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813728
|
|
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 |
$4,709.65
|
| Rate for Payer: Cash Price |
$4,709.65
|
| 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 STJ ASSURITY DR PM2240
|
Facility
|
OP
|
$8,563.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813728
|
|
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 |
$4,709.65
|
| 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 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 |
$4,709.65
|
| Rate for Payer: Cash Price |
$4,709.65
|
| 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 |
$4,709.65
|
| 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 |
$4,220.15
|
| Rate for Payer: Cash Price |
$4,220.15
|
| 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 |
$4,220.15
|
| 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 |
$4,220.15
|
| Rate for Payer: Cash Price |
$4,220.15
|
| 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 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 |
$4,220.15
|
| 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 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 |
$3,956.15
|
| 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 |
$3,956.15
|
| Rate for Payer: Cash Price |
$3,956.15
|
| 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
|
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 |
$6,043.40
|
| 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
|
|
