|
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 |
$6,043.40
|
| 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: 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 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 |
$6,132.50
|
| 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 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 |
$6,132.50
|
| Rate for Payer: Cash Price |
$6,132.50
|
| 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 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 |
$5,493.40
|
| 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 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 |
$5,493.40
|
| Rate for Payer: Cash Price |
$5,493.40
|
| 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 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 |
$7,198.13
|
| 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 |
$7,198.13
|
| Rate for Payer: Cash Price |
$7,198.13
|
| 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
|
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 |
$6,785.90
|
| Rate for Payer: Cash Price |
$6,785.90
|
| 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 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 |
$6,785.90
|
| 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 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 |
$5,905.90
|
| Rate for Payer: Cash Price |
$5,905.90
|
| 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 |
$5,905.90
|
| 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 |
$6,785.90
|
| Rate for Payer: Cash Price |
$6,785.90
|
| 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 |
$6,785.90
|
| 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 |
$6,785.90
|
| 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 |
$6,785.90
|
| Rate for Payer: Cash Price |
$6,785.90
|
| 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 |
$5,905.90
|
| Rate for Payer: Cash Price |
$5,905.90
|
| 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 ZEPHYR XL SR 5626
|
Facility
|
OP
|
$10,738.00
|
|
|
Service Code
|
CPT C1786
|
| Hospital Charge Code |
906813603
|
|
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 |
$5,905.90
|
| 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 VS INVIVE CRT V173
|
Facility
|
IP
|
$18,125.00
|
|
|
Service Code
|
CPT C2621
|
| Hospital Charge Code |
906813718
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,625.00 |
| Max. Negotiated Rate |
$15,406.25 |
| Rate for Payer: Adventist Health Commercial |
$3,625.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$9,968.75
|
| Rate for Payer: Cash Price |
$9,968.75
|
| Rate for Payer: Cigna of CA HMO |
$12,687.50
|
| Rate for Payer: Cigna of CA PPO |
$12,687.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,250.00
|
| Rate for Payer: EPIC Health Plan Senior |
$7,250.00
|
| Rate for Payer: Galaxy Health WC |
$15,406.25
|
| Rate for Payer: Global Benefits Group Commercial |
$10,875.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,089.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,905.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,219.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,350.00
|
| Rate for Payer: Multiplan Commercial |
$14,500.00
|
| Rate for Payer: Networks By Design Commercial |
$9,062.50
|
| Rate for Payer: Prime Health Services Commercial |
$15,406.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,802.31
|
| Rate for Payer: United Healthcare All Other HMO |
$6,621.06
|
| Rate for Payer: United Healthcare HMO Rider |
$6,477.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,935.94
|
|
|
HC PACE VS INVIVE CRT V173
|
Facility
|
OP
|
$18,125.00
|
|
|
Service Code
|
CPT C2621
|
| Hospital Charge Code |
906813718
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,625.00 |
| Max. Negotiated Rate |
$15,406.25 |
| Rate for Payer: Adventist Health Commercial |
$3,625.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15,406.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,968.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,593.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,130.56
|
| Rate for Payer: Blue Shield of California Commercial |
$13,376.25
|
| Rate for Payer: Blue Shield of California EPN |
$8,808.75
|
| Rate for Payer: Cash Price |
$9,968.75
|
| Rate for Payer: Cigna of CA HMO |
$12,687.50
|
| Rate for Payer: Cigna of CA PPO |
$12,687.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15,406.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,406.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15,406.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,250.00
|
| Rate for Payer: EPIC Health Plan Senior |
$7,250.00
|
| Rate for Payer: Galaxy Health WC |
$15,406.25
|
| Rate for Payer: Global Benefits Group Commercial |
$10,875.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,089.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,219.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,350.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12,687.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12,687.50
|
| Rate for Payer: Multiplan Commercial |
$14,500.00
|
| Rate for Payer: Networks By Design Commercial |
$9,062.50
|
| Rate for Payer: Prime Health Services Commercial |
$15,406.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,875.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10,875.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,802.31
|
| Rate for Payer: United Healthcare All Other HMO |
$6,621.06
|
| Rate for Payer: United Healthcare HMO Rider |
$6,477.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,935.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15,406.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,406.25
|
| Rate for Payer: Vantage Medical Group Senior |
$15,406.25
|
|
|
HC PACING SPECT LEAD LOCK DEVICE
|
Facility
|
OP
|
$2,300.00
|
|
|
Service Code
|
CPT C1773
|
| Hospital Charge Code |
906812681
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$460.00 |
| Max. Negotiated Rate |
$1,955.00 |
| Rate for Payer: Adventist Health Commercial |
$460.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,508.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,955.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,265.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,725.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,412.43
|
| Rate for Payer: Cash Price |
$1,265.00
|
| Rate for Payer: Cigna of CA HMO |
$1,472.00
|
| Rate for Payer: Cigna of CA PPO |
$1,702.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,955.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,955.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,955.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$920.00
|
| Rate for Payer: EPIC Health Plan Senior |
$920.00
|
| Rate for Payer: Galaxy Health WC |
$1,955.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,380.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,534.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$876.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,423.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$552.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,610.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,610.00
|
| Rate for Payer: Multiplan Commercial |
$1,840.00
|
| Rate for Payer: Networks By Design Commercial |
$1,495.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,955.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,380.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,380.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,150.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,150.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,150.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,150.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,955.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,955.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,955.00
|
|
|
HC PACING SPECT LEAD LOCK DEVICE
|
Facility
|
IP
|
$2,300.00
|
|
|
Service Code
|
CPT C1773
|
| Hospital Charge Code |
906812681
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$460.00 |
| Max. Negotiated Rate |
$1,955.00 |
| Rate for Payer: Adventist Health Commercial |
$460.00
|
| Rate for Payer: Cash Price |
$1,265.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$920.00
|
| Rate for Payer: EPIC Health Plan Senior |
$920.00
|
| Rate for Payer: Galaxy Health WC |
$1,955.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,380.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,534.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$876.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,423.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$552.00
|
| Rate for Payer: Multiplan Commercial |
$1,840.00
|
| Rate for Payer: Networks By Design Commercial |
$1,495.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,955.00
|
|
|
HC PACKING MAXORB XTRA ROPE
|
Facility
|
IP
|
$26.16
|
|
|
Service Code
|
CPT A6199
|
| Hospital Charge Code |
901605851
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.23 |
| Max. Negotiated Rate |
$22.24 |
| Rate for Payer: Adventist Health Commercial |
$5.23
|
| Rate for Payer: Cash Price |
$14.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.46
|
| Rate for Payer: EPIC Health Plan Senior |
$10.46
|
| Rate for Payer: Galaxy Health WC |
$22.24
|
| Rate for Payer: Global Benefits Group Commercial |
$15.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.28
|
| Rate for Payer: Multiplan Commercial |
$20.93
|
| Rate for Payer: Networks By Design Commercial |
$17.00
|
| Rate for Payer: Prime Health Services Commercial |
$22.24
|
|
|
HC PACKING MAXORB XTRA ROPE
|
Facility
|
OP
|
$26.16
|
|
|
Service Code
|
CPT A6199
|
| Hospital Charge Code |
901605851
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.23 |
| Max. Negotiated Rate |
$22.24 |
| Rate for Payer: Adventist Health Commercial |
$5.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$17.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.06
|
| Rate for Payer: Cash Price |
$14.39
|
| Rate for Payer: Cigna of CA HMO |
$16.74
|
| Rate for Payer: Cigna of CA PPO |
$19.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.46
|
| Rate for Payer: EPIC Health Plan Senior |
$10.46
|
| Rate for Payer: Galaxy Health WC |
$22.24
|
| Rate for Payer: Global Benefits Group Commercial |
$15.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.31
|
| Rate for Payer: Multiplan Commercial |
$20.93
|
| Rate for Payer: Networks By Design Commercial |
$17.00
|
| Rate for Payer: Prime Health Services Commercial |
$22.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.08
|
| Rate for Payer: United Healthcare All Other HMO |
$13.08
|
| Rate for Payer: United Healthcare HMO Rider |
$13.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.24
|
| Rate for Payer: Vantage Medical Group Senior |
$22.24
|
|
|
HC PACKING NASAL EPISTAXIS 10CM
|
Facility
|
OP
|
$242.90
|
|
|
Service Code
|
CPT A6216
|
| Hospital Charge Code |
901603220
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$48.58 |
| Max. Negotiated Rate |
$206.47 |
| Rate for Payer: Adventist Health Commercial |
$48.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$159.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$133.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$182.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$149.16
|
| Rate for Payer: Cash Price |
$133.60
|
| Rate for Payer: Cigna of CA HMO |
$155.46
|
| Rate for Payer: Cigna of CA PPO |
$179.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$206.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$206.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$97.16
|
| Rate for Payer: EPIC Health Plan Senior |
$97.16
|
| Rate for Payer: Galaxy Health WC |
$206.47
|
| Rate for Payer: Global Benefits Group Commercial |
$145.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$162.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$150.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$170.03
|
| Rate for Payer: Multiplan Commercial |
$194.32
|
| Rate for Payer: Networks By Design Commercial |
$157.88
|
| Rate for Payer: Prime Health Services Commercial |
$206.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$145.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$145.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$121.45
|
| Rate for Payer: United Healthcare All Other HMO |
$121.45
|
| Rate for Payer: United Healthcare HMO Rider |
$121.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$121.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$206.47
|
| Rate for Payer: Vantage Medical Group Senior |
$206.47
|
|
|
HC PACKING NASAL EPISTAXIS 10CM
|
Facility
|
IP
|
$242.90
|
|
|
Service Code
|
CPT A6216
|
| Hospital Charge Code |
901603220
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$48.58 |
| Max. Negotiated Rate |
$206.47 |
| Rate for Payer: Adventist Health Commercial |
$48.58
|
| Rate for Payer: Cash Price |
$133.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$97.16
|
| Rate for Payer: EPIC Health Plan Senior |
$97.16
|
| Rate for Payer: Galaxy Health WC |
$206.47
|
| Rate for Payer: Global Benefits Group Commercial |
$145.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$162.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$150.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.30
|
| Rate for Payer: Multiplan Commercial |
$194.32
|
| Rate for Payer: Networks By Design Commercial |
$157.88
|
| Rate for Payer: Prime Health Services Commercial |
$206.47
|
|
