|
HC OXYGEN PER HOUR
|
Facility
|
OP
|
$30.00
|
|
| Hospital Charge Code |
900800650
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$14.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.62
|
| Rate for Payer: Blue Shield of California Commercial |
$18.33
|
| Rate for Payer: Blue Shield of California EPN |
$11.97
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Central Health Plan Commercial |
$24.00
|
| Rate for Payer: Cigna of CA HMO |
$19.20
|
| Rate for Payer: Cigna of CA PPO |
$22.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Senior |
$12.00
|
| Rate for Payer: Galaxy Health WC |
$25.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.00
|
| Rate for Payer: InnovAge PACE Commercial |
$15.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.00
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
| Rate for Payer: Networks By Design Commercial |
$19.50
|
| Rate for Payer: Prime Health Services Commercial |
$25.50
|
| Rate for Payer: Riverside University Health System MISP |
$12.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15.00
|
| Rate for Payer: United Healthcare HMO Rider |
$15.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.50
|
| Rate for Payer: Vantage Medical Group Senior |
$25.50
|
|
|
HC OXYGEN PER HOUR
|
Facility
|
OP
|
$29.00
|
|
| Hospital Charge Code |
900802001
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5.80 |
| Max. Negotiated Rate |
$26.10 |
| Rate for Payer: Adventist Health Commercial |
$5.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$17.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$14.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.03
|
| Rate for Payer: Blue Shield of California Commercial |
$17.72
|
| Rate for Payer: Blue Shield of California EPN |
$11.57
|
| Rate for Payer: Cash Price |
$15.95
|
| Rate for Payer: Central Health Plan Commercial |
$23.20
|
| Rate for Payer: Cigna of CA HMO |
$18.56
|
| Rate for Payer: Cigna of CA PPO |
$21.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.60
|
| Rate for Payer: EPIC Health Plan Senior |
$11.60
|
| Rate for Payer: Galaxy Health WC |
$24.65
|
| Rate for Payer: Global Benefits Group Commercial |
$17.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$26.10
|
| Rate for Payer: InnovAge PACE Commercial |
$14.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.30
|
| Rate for Payer: Multiplan Commercial |
$21.75
|
| Rate for Payer: Networks By Design Commercial |
$18.85
|
| Rate for Payer: Prime Health Services Commercial |
$24.65
|
| Rate for Payer: Riverside University Health System MISP |
$11.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.50
|
| Rate for Payer: United Healthcare All Other HMO |
$14.50
|
| Rate for Payer: United Healthcare HMO Rider |
$14.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.65
|
| Rate for Payer: Vantage Medical Group Senior |
$24.65
|
|
|
HC OXYGEN PER HOUR
|
Facility
|
IP
|
$30.00
|
|
| Hospital Charge Code |
900800650
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Central Health Plan Commercial |
$24.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Senior |
$12.00
|
| Rate for Payer: Galaxy Health WC |
$25.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
| Rate for Payer: Networks By Design Commercial |
$19.50
|
| Rate for Payer: Prime Health Services Commercial |
$25.50
|
|
|
HC OXYGEN PER HOUR PACU
|
Facility
|
IP
|
$29.00
|
|
| Hospital Charge Code |
900100043
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5.80 |
| Max. Negotiated Rate |
$26.10 |
| Rate for Payer: Adventist Health Commercial |
$5.80
|
| Rate for Payer: Cash Price |
$15.95
|
| Rate for Payer: Central Health Plan Commercial |
$23.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.60
|
| Rate for Payer: EPIC Health Plan Senior |
$11.60
|
| Rate for Payer: Galaxy Health WC |
$24.65
|
| Rate for Payer: Global Benefits Group Commercial |
$17.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$26.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.80
|
| Rate for Payer: Multiplan Commercial |
$21.75
|
| Rate for Payer: Networks By Design Commercial |
$18.85
|
| Rate for Payer: Prime Health Services Commercial |
$24.65
|
|
|
HC OXYGEN PER HOUR PACU
|
Facility
|
OP
|
$29.00
|
|
| Hospital Charge Code |
900100043
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5.80 |
| Max. Negotiated Rate |
$26.10 |
| Rate for Payer: Adventist Health Commercial |
$5.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$17.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$14.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.03
|
| Rate for Payer: Blue Shield of California Commercial |
$17.72
|
| Rate for Payer: Blue Shield of California EPN |
$11.57
|
| Rate for Payer: Cash Price |
$15.95
|
| Rate for Payer: Central Health Plan Commercial |
$23.20
|
| Rate for Payer: Cigna of CA HMO |
$18.56
|
| Rate for Payer: Cigna of CA PPO |
$21.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.60
|
| Rate for Payer: EPIC Health Plan Senior |
$11.60
|
| Rate for Payer: Galaxy Health WC |
$24.65
|
| Rate for Payer: Global Benefits Group Commercial |
$17.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$26.10
|
| Rate for Payer: InnovAge PACE Commercial |
$14.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.30
|
| Rate for Payer: Multiplan Commercial |
$21.75
|
| Rate for Payer: Networks By Design Commercial |
$18.85
|
| Rate for Payer: Prime Health Services Commercial |
$24.65
|
| Rate for Payer: Riverside University Health System MISP |
$11.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.50
|
| Rate for Payer: United Healthcare All Other HMO |
$14.50
|
| Rate for Payer: United Healthcare HMO Rider |
$14.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.65
|
| Rate for Payer: Vantage Medical Group Senior |
$24.65
|
|
|
HC P32 CHROMIC PHOSPHATE PER MCI
|
Facility
|
IP
|
$34,181.00
|
|
|
Service Code
|
CPT A9564
|
| Hospital Charge Code |
909301556
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$6,836.20 |
| Max. Negotiated Rate |
$30,762.90 |
| Rate for Payer: Adventist Health Commercial |
$6,836.20
|
| Rate for Payer: Cash Price |
$18,799.55
|
| Rate for Payer: Central Health Plan Commercial |
$27,344.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,672.40
|
| Rate for Payer: EPIC Health Plan Senior |
$13,672.40
|
| Rate for Payer: Galaxy Health WC |
$29,053.85
|
| Rate for Payer: Global Benefits Group Commercial |
$20,508.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$30,762.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22,798.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,022.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21,158.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,836.20
|
| Rate for Payer: Multiplan Commercial |
$25,635.75
|
| Rate for Payer: Networks By Design Commercial |
$22,217.65
|
| Rate for Payer: Prime Health Services Commercial |
$29,053.85
|
|
|
HC P32 CHROMIC PHOSPHATE PER MCI
|
Facility
|
OP
|
$34,181.00
|
|
|
Service Code
|
CPT A9564
|
| Hospital Charge Code |
909301556
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$904.07 |
| Max. Negotiated Rate |
$30,762.90 |
| Rate for Payer: Adventist Health Commercial |
$6,836.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$20,758.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29,053.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18,799.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25,635.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$16,550.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20,074.50
|
| Rate for Payer: Blue Shield of California Commercial |
$20,747.87
|
| Rate for Payer: Blue Shield of California EPN |
$13,569.86
|
| Rate for Payer: Cash Price |
$18,799.55
|
| Rate for Payer: Cash Price |
$18,799.55
|
| Rate for Payer: Central Health Plan Commercial |
$27,344.80
|
| Rate for Payer: Cigna of CA HMO |
$21,875.84
|
| Rate for Payer: Cigna of CA PPO |
$25,293.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29,053.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$29,053.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$29,053.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,672.40
|
| Rate for Payer: EPIC Health Plan Senior |
$13,672.40
|
| Rate for Payer: Galaxy Health WC |
$29,053.85
|
| Rate for Payer: Global Benefits Group Commercial |
$20,508.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$30,762.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$904.07
|
| Rate for Payer: InnovAge PACE Commercial |
$17,090.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22,798.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$998.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21,158.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,836.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23,926.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23,926.70
|
| Rate for Payer: Multiplan Commercial |
$25,635.75
|
| Rate for Payer: Networks By Design Commercial |
$22,217.65
|
| Rate for Payer: Prime Health Services Commercial |
$29,053.85
|
| Rate for Payer: Riverside University Health System MISP |
$13,672.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20,508.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20,508.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,090.50
|
| Rate for Payer: United Healthcare All Other HMO |
$17,090.50
|
| Rate for Payer: United Healthcare HMO Rider |
$17,090.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17,090.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29,053.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29,053.85
|
| Rate for Payer: Vantage Medical Group Senior |
$29,053.85
|
|
|
HC P32 SODIUM PHOSPHATE PER MCI
|
Facility
|
IP
|
$5,922.00
|
|
|
Service Code
|
CPT A9563
|
| Hospital Charge Code |
909301555
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$1,184.40 |
| Max. Negotiated Rate |
$5,329.80 |
| Rate for Payer: Adventist Health Commercial |
$1,184.40
|
| Rate for Payer: Blue Shield of California Commercial |
$4,577.71
|
| Rate for Payer: Blue Shield of California EPN |
$2,984.69
|
| Rate for Payer: Cash Price |
$3,257.10
|
| Rate for Payer: Central Health Plan Commercial |
$4,737.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,368.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,368.80
|
| Rate for Payer: Galaxy Health WC |
$5,033.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,553.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,329.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,949.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,256.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,665.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,184.40
|
| Rate for Payer: Multiplan Commercial |
$4,441.50
|
| Rate for Payer: Networks By Design Commercial |
$3,849.30
|
| Rate for Payer: Prime Health Services Commercial |
$5,033.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,222.53
|
| Rate for Payer: United Healthcare All Other HMO |
$2,163.31
|
| Rate for Payer: United Healthcare HMO Rider |
$2,116.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,939.45
|
|
|
HC P32 SODIUM PHOSPHATE PER MCI
|
Facility
|
OP
|
$5,922.00
|
|
|
Service Code
|
CPT A9563
|
| Hospital Charge Code |
909301555
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$168.87 |
| Max. Negotiated Rate |
$5,329.80 |
| Rate for Payer: Adventist Health Commercial |
$1,184.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$179.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,596.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$223.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$197.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$197.03
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,867.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,477.99
|
| Rate for Payer: Blue Shield of California Commercial |
$3,594.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,351.03
|
| Rate for Payer: Cash Price |
$3,257.10
|
| Rate for Payer: Cash Price |
$3,257.10
|
| Rate for Payer: Central Health Plan Commercial |
$4,737.60
|
| Rate for Payer: Cigna of CA HMO |
$3,790.08
|
| Rate for Payer: Cigna of CA PPO |
$4,382.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$223.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$197.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$197.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$241.81
|
| Rate for Payer: EPIC Health Plan Senior |
$179.12
|
| Rate for Payer: Galaxy Health WC |
$5,033.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,553.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,329.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$293.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$168.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$179.12
|
| Rate for Payer: InnovAge PACE Commercial |
$268.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,949.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$186.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$179.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,184.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$240.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$240.02
|
| Rate for Payer: Multiplan Commercial |
$4,441.50
|
| Rate for Payer: Networks By Design Commercial |
$3,849.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$179.12
|
| Rate for Payer: Prime Health Services Commercial |
$5,033.70
|
| Rate for Payer: Prime Health Services Medicare |
$189.87
|
| Rate for Payer: Riverside University Health System MISP |
$197.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,553.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,553.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,222.53
|
| Rate for Payer: United Healthcare All Other HMO |
$2,163.31
|
| Rate for Payer: United Healthcare HMO Rider |
$2,116.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,939.45
|
| Rate for Payer: Upland Medical Group Pediatric |
$179.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$223.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$197.03
|
| Rate for Payer: Vantage Medical Group Senior |
$197.03
|
|
|
HC PACE ACTIVITY THERAPY, PER SESSION 45 MIN OR MORE
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G0176
|
| Hospital Charge Code |
900200013
|
|
Hospital Revenue Code
|
904
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Central Health Plan Commercial |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
|
|
HC PACE ACTIVITY THERAPY, PER SESSION 45 MIN OR MORE
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G0176
|
| Hospital Charge Code |
900200013
|
|
Hospital Revenue Code
|
904
|
| Max. Negotiated Rate |
$66.50 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Central Health Plan Commercial |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$60.20
|
| Rate for Payer: InnovAge PACE Commercial |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Riverside University Health System MISP |
$0.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.01
|
| Rate for Payer: United Healthcare All Other HMO |
$0.01
|
| Rate for Payer: United Healthcare HMO Rider |
$0.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
HC PACE BIO ELUNA PROMRI 394969
|
Facility
|
IP
|
$12,250.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813747
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,450.00 |
| Max. Negotiated Rate |
$11,025.00 |
| Rate for Payer: Adventist Health Commercial |
$2,450.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,469.25
|
| Rate for Payer: Blue Shield of California EPN |
$6,174.00
|
| Rate for Payer: Cash Price |
$6,737.50
|
| Rate for Payer: Central Health Plan Commercial |
$9,800.00
|
| Rate for Payer: Cigna of CA HMO |
$8,575.00
|
| Rate for Payer: Cigna of CA PPO |
$8,575.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,900.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,900.00
|
| Rate for Payer: Galaxy Health WC |
$10,412.50
|
| Rate for Payer: Global Benefits Group Commercial |
$7,350.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,025.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,170.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,667.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,582.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,450.00
|
| Rate for Payer: Multiplan Commercial |
$9,187.50
|
| Rate for Payer: Networks By Design Commercial |
$6,125.00
|
| Rate for Payer: Prime Health Services Commercial |
$10,412.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,597.43
|
| Rate for Payer: United Healthcare All Other HMO |
$4,474.93
|
| Rate for Payer: United Healthcare HMO Rider |
$4,378.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,011.88
|
|
|
HC PACE BIO ELUNA PROMRI 394969
|
Facility
|
OP
|
$12,250.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813747
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,450.00 |
| Max. Negotiated Rate |
$11,025.00 |
| Rate for Payer: Adventist Health Commercial |
$2,450.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,412.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,737.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,187.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,931.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,194.43
|
| Rate for Payer: Blue Shield of California Commercial |
$9,469.25
|
| Rate for Payer: Blue Shield of California EPN |
$6,174.00
|
| Rate for Payer: Cash Price |
$6,737.50
|
| Rate for Payer: Central Health Plan Commercial |
$9,800.00
|
| Rate for Payer: Cigna of CA HMO |
$8,575.00
|
| Rate for Payer: Cigna of CA PPO |
$8,575.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,412.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,412.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,412.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,900.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,900.00
|
| Rate for Payer: Galaxy Health WC |
$10,412.50
|
| Rate for Payer: Global Benefits Group Commercial |
$7,350.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,025.00
|
| Rate for Payer: InnovAge PACE Commercial |
$6,125.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,170.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,582.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,450.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,575.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,575.00
|
| Rate for Payer: Multiplan Commercial |
$9,187.50
|
| Rate for Payer: Networks By Design Commercial |
$6,125.00
|
| Rate for Payer: Prime Health Services Commercial |
$10,412.50
|
| Rate for Payer: Riverside University Health System MISP |
$4,900.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,350.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,350.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,597.43
|
| Rate for Payer: United Healthcare All Other HMO |
$4,474.93
|
| Rate for Payer: United Healthcare HMO Rider |
$4,378.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,011.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,412.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,412.50
|
| Rate for Payer: Vantage Medical Group Senior |
$10,412.50
|
|
|
HC PACE BIOTRONIK EDORA 8 407145
|
Facility
|
IP
|
$13,250.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813797
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,650.00 |
| Max. Negotiated Rate |
$11,925.00 |
| Rate for Payer: Adventist Health Commercial |
$2,650.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,242.25
|
| Rate for Payer: Blue Shield of California EPN |
$6,678.00
|
| Rate for Payer: Cash Price |
$7,287.50
|
| Rate for Payer: Central Health Plan Commercial |
$10,600.00
|
| Rate for Payer: Cigna of CA HMO |
$9,275.00
|
| Rate for Payer: Cigna of CA PPO |
$9,275.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,300.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,300.00
|
| Rate for Payer: Galaxy Health WC |
$11,262.50
|
| Rate for Payer: Global Benefits Group Commercial |
$7,950.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,925.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,837.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,048.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,201.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,650.00
|
| Rate for Payer: Multiplan Commercial |
$9,937.50
|
| Rate for Payer: Networks By Design Commercial |
$6,625.00
|
| Rate for Payer: Prime Health Services Commercial |
$11,262.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,972.73
|
| Rate for Payer: United Healthcare All Other HMO |
$4,840.23
|
| Rate for Payer: United Healthcare HMO Rider |
$4,735.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,339.38
|
|
|
HC PACE BIOTRONIK EDORA 8 407145
|
Facility
|
OP
|
$13,250.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813797
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,650.00 |
| Max. Negotiated Rate |
$11,925.00 |
| Rate for Payer: Adventist Health Commercial |
$2,650.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,262.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,287.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,937.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,415.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,781.73
|
| Rate for Payer: Blue Shield of California Commercial |
$10,242.25
|
| Rate for Payer: Blue Shield of California EPN |
$6,678.00
|
| Rate for Payer: Cash Price |
$7,287.50
|
| Rate for Payer: Central Health Plan Commercial |
$10,600.00
|
| Rate for Payer: Cigna of CA HMO |
$9,275.00
|
| Rate for Payer: Cigna of CA PPO |
$9,275.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,262.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,262.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11,262.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,300.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,300.00
|
| Rate for Payer: Galaxy Health WC |
$11,262.50
|
| Rate for Payer: Global Benefits Group Commercial |
$7,950.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,925.00
|
| Rate for Payer: InnovAge PACE Commercial |
$6,625.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,837.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,201.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,650.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,275.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,275.00
|
| Rate for Payer: Multiplan Commercial |
$9,937.50
|
| Rate for Payer: Networks By Design Commercial |
$6,625.00
|
| Rate for Payer: Prime Health Services Commercial |
$11,262.50
|
| Rate for Payer: Riverside University Health System MISP |
$5,300.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,950.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,950.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,972.73
|
| Rate for Payer: United Healthcare All Other HMO |
$4,840.23
|
| Rate for Payer: United Healthcare HMO Rider |
$4,735.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,339.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,262.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,262.50
|
| Rate for Payer: Vantage Medical Group Senior |
$11,262.50
|
|
|
HC PACE BIOTRONIK EDORA 8 407147
|
Facility
|
OP
|
$9,500.00
|
|
|
Service Code
|
CPT C1786
|
| Hospital Charge Code |
906813816
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,900.00 |
| Max. Negotiated Rate |
$8,550.00 |
| Rate for Payer: Adventist Health Commercial |
$1,900.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,075.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,225.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,125.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,599.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,579.35
|
| Rate for Payer: Blue Shield of California Commercial |
$7,343.50
|
| Rate for Payer: Blue Shield of California EPN |
$4,788.00
|
| Rate for Payer: Cash Price |
$5,225.00
|
| Rate for Payer: Central Health Plan Commercial |
$7,600.00
|
| Rate for Payer: Cigna of CA HMO |
$6,650.00
|
| Rate for Payer: Cigna of CA PPO |
$6,650.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,075.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,075.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,075.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,800.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,800.00
|
| Rate for Payer: Galaxy Health WC |
$8,075.00
|
| Rate for Payer: Global Benefits Group Commercial |
$5,700.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,550.00
|
| Rate for Payer: InnovAge PACE Commercial |
$4,750.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,336.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,880.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,900.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,650.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,650.00
|
| Rate for Payer: Multiplan Commercial |
$7,125.00
|
| Rate for Payer: Networks By Design Commercial |
$4,750.00
|
| Rate for Payer: Prime Health Services Commercial |
$8,075.00
|
| Rate for Payer: Riverside University Health System MISP |
$3,800.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,700.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,700.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,565.35
|
| Rate for Payer: United Healthcare All Other HMO |
$3,470.35
|
| Rate for Payer: United Healthcare HMO Rider |
$3,395.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,111.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,075.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,075.00
|
| Rate for Payer: Vantage Medical Group Senior |
$8,075.00
|
|
|
HC PACE BIOTRONIK EDORA 8 407147
|
Facility
|
IP
|
$9,500.00
|
|
|
Service Code
|
CPT C1786
|
| Hospital Charge Code |
906813816
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,900.00 |
| Max. Negotiated Rate |
$8,550.00 |
| Rate for Payer: Adventist Health Commercial |
$1,900.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,343.50
|
| Rate for Payer: Blue Shield of California EPN |
$4,788.00
|
| Rate for Payer: Cash Price |
$5,225.00
|
| Rate for Payer: Central Health Plan Commercial |
$7,600.00
|
| Rate for Payer: Cigna of CA HMO |
$6,650.00
|
| Rate for Payer: Cigna of CA PPO |
$6,650.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,800.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,800.00
|
| Rate for Payer: Galaxy Health WC |
$8,075.00
|
| Rate for Payer: Global Benefits Group Commercial |
$5,700.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,550.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,336.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,619.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,880.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,900.00
|
| Rate for Payer: Multiplan Commercial |
$7,125.00
|
| Rate for Payer: Networks By Design Commercial |
$4,750.00
|
| Rate for Payer: Prime Health Services Commercial |
$8,075.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,565.35
|
| Rate for Payer: United Healthcare All Other HMO |
$3,470.35
|
| Rate for Payer: United Healthcare HMO Rider |
$3,395.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,111.25
|
|
|
HC PACE BIOTRONIK ELUNA 8 394971
|
Facility
|
IP
|
$8,750.00
|
|
|
Service Code
|
CPT C1786
|
| Hospital Charge Code |
906813790
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,750.00 |
| Max. Negotiated Rate |
$7,875.00 |
| Rate for Payer: Adventist Health Commercial |
$1,750.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,763.75
|
| Rate for Payer: Blue Shield of California EPN |
$4,410.00
|
| Rate for Payer: Cash Price |
$4,812.50
|
| Rate for Payer: Central Health Plan Commercial |
$7,000.00
|
| Rate for Payer: Cigna of CA HMO |
$6,125.00
|
| Rate for Payer: Cigna of CA PPO |
$6,125.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,500.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,500.00
|
| Rate for Payer: Galaxy Health WC |
$7,437.50
|
| Rate for Payer: Global Benefits Group Commercial |
$5,250.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,875.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,836.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,333.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,416.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,750.00
|
| Rate for Payer: Multiplan Commercial |
$6,562.50
|
| Rate for Payer: Networks By Design Commercial |
$4,375.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,437.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,283.88
|
| Rate for Payer: United Healthcare All Other HMO |
$3,196.38
|
| Rate for Payer: United Healthcare HMO Rider |
$3,127.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,865.62
|
|
|
HC PACE BIOTRONIK ELUNA 8 394971
|
Facility
|
OP
|
$8,750.00
|
|
|
Service Code
|
CPT C1786
|
| Hospital Charge Code |
906813790
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,750.00 |
| Max. Negotiated Rate |
$7,875.00 |
| Rate for Payer: Adventist Health Commercial |
$1,750.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,437.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,812.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,562.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,236.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,138.88
|
| Rate for Payer: Blue Shield of California Commercial |
$6,763.75
|
| Rate for Payer: Blue Shield of California EPN |
$4,410.00
|
| Rate for Payer: Cash Price |
$4,812.50
|
| Rate for Payer: Central Health Plan Commercial |
$7,000.00
|
| Rate for Payer: Cigna of CA HMO |
$6,125.00
|
| Rate for Payer: Cigna of CA PPO |
$6,125.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,437.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,437.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,437.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,500.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,500.00
|
| Rate for Payer: Galaxy Health WC |
$7,437.50
|
| Rate for Payer: Global Benefits Group Commercial |
$5,250.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,875.00
|
| Rate for Payer: InnovAge PACE Commercial |
$4,375.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,836.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,416.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,750.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,125.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,125.00
|
| Rate for Payer: Multiplan Commercial |
$6,562.50
|
| Rate for Payer: Networks By Design Commercial |
$4,375.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,437.50
|
| Rate for Payer: Riverside University Health System MISP |
$3,500.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,250.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,250.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,283.88
|
| Rate for Payer: United Healthcare All Other HMO |
$3,196.38
|
| Rate for Payer: United Healthcare HMO Rider |
$3,127.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,865.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,437.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,437.50
|
| Rate for Payer: Vantage Medical Group Senior |
$7,437.50
|
|
|
HC PACE BIOTRONIK ETRINSA 394919
|
Facility
|
IP
|
$15,750.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813811
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,150.00 |
| Max. Negotiated Rate |
$14,175.00 |
| Rate for Payer: Adventist Health Commercial |
$3,150.00
|
| Rate for Payer: Blue Shield of California Commercial |
$12,174.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,938.00
|
| Rate for Payer: Cash Price |
$8,662.50
|
| Rate for Payer: Central Health Plan Commercial |
$12,600.00
|
| Rate for Payer: Cigna of CA HMO |
$11,025.00
|
| Rate for Payer: Cigna of CA PPO |
$11,025.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,300.00
|
| Rate for Payer: EPIC Health Plan Senior |
$6,300.00
|
| Rate for Payer: Galaxy Health WC |
$13,387.50
|
| Rate for Payer: Global Benefits Group Commercial |
$9,450.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,175.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,505.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,000.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,749.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,150.00
|
| Rate for Payer: Multiplan Commercial |
$11,812.50
|
| Rate for Payer: Networks By Design Commercial |
$7,875.00
|
| Rate for Payer: Prime Health Services Commercial |
$13,387.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,910.98
|
| Rate for Payer: United Healthcare All Other HMO |
$5,753.48
|
| Rate for Payer: United Healthcare HMO Rider |
$5,629.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,158.12
|
|
|
HC PACE BIOTRONIK ETRINSA 394919
|
Facility
|
OP
|
$15,750.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813811
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,150.00 |
| Max. Negotiated Rate |
$14,175.00 |
| Rate for Payer: Adventist Health Commercial |
$3,150.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,387.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,662.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11,812.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7,626.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,249.98
|
| Rate for Payer: Blue Shield of California Commercial |
$12,174.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,938.00
|
| Rate for Payer: Cash Price |
$8,662.50
|
| Rate for Payer: Central Health Plan Commercial |
$12,600.00
|
| Rate for Payer: Cigna of CA HMO |
$11,025.00
|
| Rate for Payer: Cigna of CA PPO |
$11,025.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,387.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$13,387.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13,387.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,300.00
|
| Rate for Payer: EPIC Health Plan Senior |
$6,300.00
|
| Rate for Payer: Galaxy Health WC |
$13,387.50
|
| Rate for Payer: Global Benefits Group Commercial |
$9,450.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,175.00
|
| Rate for Payer: InnovAge PACE Commercial |
$7,875.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,505.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,749.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,150.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,025.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,025.00
|
| Rate for Payer: Multiplan Commercial |
$11,812.50
|
| Rate for Payer: Networks By Design Commercial |
$7,875.00
|
| Rate for Payer: Prime Health Services Commercial |
$13,387.50
|
| Rate for Payer: Riverside University Health System MISP |
$6,300.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,450.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,450.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,910.98
|
| Rate for Payer: United Healthcare All Other HMO |
$5,753.48
|
| Rate for Payer: United Healthcare HMO Rider |
$5,629.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,158.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,387.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13,387.50
|
| Rate for Payer: Vantage Medical Group Senior |
$13,387.50
|
|
|
HC PACE BIOTRONIK EVIA DR 359529
|
Facility
|
OP
|
$12,400.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813719
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,480.00 |
| Max. Negotiated Rate |
$11,160.00 |
| Rate for Payer: Adventist Health Commercial |
$2,480.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,540.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,820.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,300.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,004.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.52
|
| Rate for Payer: Blue Shield of California Commercial |
$9,585.20
|
| Rate for Payer: Blue Shield of California EPN |
$6,249.60
|
| Rate for Payer: Cash Price |
$6,820.00
|
| Rate for Payer: Central Health Plan Commercial |
$9,920.00
|
| Rate for Payer: Cigna of CA HMO |
$8,680.00
|
| Rate for Payer: Cigna of CA PPO |
$8,680.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,540.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,540.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,540.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,960.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,960.00
|
| Rate for Payer: Galaxy Health WC |
$10,540.00
|
| Rate for Payer: Global Benefits Group Commercial |
$7,440.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,160.00
|
| Rate for Payer: InnovAge PACE Commercial |
$6,200.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,270.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,675.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,480.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,680.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,680.00
|
| Rate for Payer: Multiplan Commercial |
$9,300.00
|
| Rate for Payer: Networks By Design Commercial |
$6,200.00
|
| Rate for Payer: Prime Health Services Commercial |
$10,540.00
|
| Rate for Payer: Riverside University Health System MISP |
$4,960.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,440.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,440.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,653.72
|
| Rate for Payer: United Healthcare All Other HMO |
$4,529.72
|
| Rate for Payer: United Healthcare HMO Rider |
$4,431.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,061.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,540.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,540.00
|
| Rate for Payer: Vantage Medical Group Senior |
$10,540.00
|
|
|
HC PACE BIOTRONIK EVIA DR 359529
|
Facility
|
IP
|
$12,400.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813719
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,480.00 |
| Max. Negotiated Rate |
$11,160.00 |
| Rate for Payer: Adventist Health Commercial |
$2,480.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,585.20
|
| Rate for Payer: Blue Shield of California EPN |
$6,249.60
|
| Rate for Payer: Cash Price |
$6,820.00
|
| Rate for Payer: Central Health Plan Commercial |
$9,920.00
|
| Rate for Payer: Cigna of CA HMO |
$8,680.00
|
| Rate for Payer: Cigna of CA PPO |
$8,680.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,960.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,960.00
|
| Rate for Payer: Galaxy Health WC |
$10,540.00
|
| Rate for Payer: Global Benefits Group Commercial |
$7,440.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,160.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,270.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,724.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,675.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,480.00
|
| Rate for Payer: Multiplan Commercial |
$9,300.00
|
| Rate for Payer: Networks By Design Commercial |
$6,200.00
|
| Rate for Payer: Prime Health Services Commercial |
$10,540.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,653.72
|
| Rate for Payer: United Healthcare All Other HMO |
$4,529.72
|
| Rate for Payer: United Healthcare HMO Rider |
$4,431.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,061.00
|
|
|
HC PACE B/S ACCOLADE DR L301
|
Facility
|
OP
|
$10,325.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813794
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,065.00 |
| Max. Negotiated Rate |
$9,292.50 |
| Rate for Payer: Adventist Health Commercial |
$2,065.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,776.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,678.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,743.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,999.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,063.87
|
| Rate for Payer: Blue Shield of California Commercial |
$7,981.23
|
| Rate for Payer: Blue Shield of California EPN |
$5,203.80
|
| Rate for Payer: Cash Price |
$5,678.75
|
| Rate for Payer: Central Health Plan Commercial |
$8,260.00
|
| Rate for Payer: Cigna of CA HMO |
$7,227.50
|
| Rate for Payer: Cigna of CA PPO |
$7,227.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,776.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,776.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,776.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,130.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,130.00
|
| Rate for Payer: Galaxy Health WC |
$8,776.25
|
| Rate for Payer: Global Benefits Group Commercial |
$6,195.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,292.50
|
| Rate for Payer: InnovAge PACE Commercial |
$5,162.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,886.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,391.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,065.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,227.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,227.50
|
| Rate for Payer: Multiplan Commercial |
$7,743.75
|
| Rate for Payer: Networks By Design Commercial |
$5,162.50
|
| Rate for Payer: Prime Health Services Commercial |
$8,776.25
|
| Rate for Payer: Riverside University Health System MISP |
$4,130.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,195.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,195.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,874.97
|
| Rate for Payer: United Healthcare All Other HMO |
$3,771.72
|
| Rate for Payer: United Healthcare HMO Rider |
$3,690.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,381.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,776.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,776.25
|
| Rate for Payer: Vantage Medical Group Senior |
$8,776.25
|
|
|
HC PACE B/S ACCOLADE DR L301
|
Facility
|
IP
|
$10,325.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813794
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,065.00 |
| Max. Negotiated Rate |
$9,292.50 |
| Rate for Payer: Adventist Health Commercial |
$2,065.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,981.23
|
| Rate for Payer: Blue Shield of California EPN |
$5,203.80
|
| Rate for Payer: Cash Price |
$5,678.75
|
| Rate for Payer: Central Health Plan Commercial |
$8,260.00
|
| Rate for Payer: Cigna of CA HMO |
$7,227.50
|
| Rate for Payer: Cigna of CA PPO |
$7,227.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,130.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,130.00
|
| Rate for Payer: Galaxy Health WC |
$8,776.25
|
| Rate for Payer: Global Benefits Group Commercial |
$6,195.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,292.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,886.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,933.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,391.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,065.00
|
| Rate for Payer: Multiplan Commercial |
$7,743.75
|
| Rate for Payer: Networks By Design Commercial |
$5,162.50
|
| Rate for Payer: Prime Health Services Commercial |
$8,776.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,874.97
|
| Rate for Payer: United Healthcare All Other HMO |
$3,771.72
|
| Rate for Payer: United Healthcare HMO Rider |
$3,690.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,381.44
|
|
