|
HC PACE B/S ALTRUA 60 S603
|
Facility
|
IP
|
$10,325.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813629
|
|
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 |
$4,646.25
|
| 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
|
|
|
HC PACE B/S ALTRUA 60 S603
|
Facility
|
OP
|
$10,325.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813629
|
|
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 |
$4,646.25
|
| 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 ALTRUA 60 SR S601
|
Facility
|
IP
|
$9,250.00
|
|
|
Service Code
|
CPT C1786
|
| Hospital Charge Code |
906813623
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,850.00 |
| Max. Negotiated Rate |
$8,325.00 |
| Rate for Payer: Adventist Health Commercial |
$1,850.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,150.25
|
| Rate for Payer: Blue Shield of California EPN |
$4,662.00
|
| Rate for Payer: Cash Price |
$4,162.50
|
| Rate for Payer: Central Health Plan Commercial |
$7,400.00
|
| Rate for Payer: Cigna of CA HMO |
$6,475.00
|
| Rate for Payer: Cigna of CA PPO |
$6,475.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,700.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,700.00
|
| Rate for Payer: Galaxy Health WC |
$7,862.50
|
| Rate for Payer: Global Benefits Group Commercial |
$5,550.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,325.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,169.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,524.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,725.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,850.00
|
| Rate for Payer: Multiplan Commercial |
$6,937.50
|
| Rate for Payer: Networks By Design Commercial |
$4,625.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,862.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,471.53
|
| Rate for Payer: United Healthcare All Other HMO |
$3,379.03
|
| Rate for Payer: United Healthcare HMO Rider |
$3,305.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,029.38
|
|
|
HC PACE B/S ALTRUA 60 SR S601
|
Facility
|
OP
|
$9,250.00
|
|
|
Service Code
|
CPT C1786
|
| Hospital Charge Code |
906813623
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,850.00 |
| Max. Negotiated Rate |
$8,325.00 |
| Rate for Payer: Adventist Health Commercial |
$1,850.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,862.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,087.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,937.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,478.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,432.52
|
| Rate for Payer: Blue Shield of California Commercial |
$7,150.25
|
| Rate for Payer: Blue Shield of California EPN |
$4,662.00
|
| Rate for Payer: Cash Price |
$4,162.50
|
| Rate for Payer: Central Health Plan Commercial |
$7,400.00
|
| Rate for Payer: Cigna of CA HMO |
$6,475.00
|
| Rate for Payer: Cigna of CA PPO |
$6,475.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,862.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,862.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,862.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,700.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,700.00
|
| Rate for Payer: Galaxy Health WC |
$7,862.50
|
| Rate for Payer: Global Benefits Group Commercial |
$5,550.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,325.00
|
| Rate for Payer: InnovAge PACE Commercial |
$4,625.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,169.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,725.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,850.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,475.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,475.00
|
| Rate for Payer: Multiplan Commercial |
$6,937.50
|
| Rate for Payer: Networks By Design Commercial |
$4,625.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,862.50
|
| Rate for Payer: Riverside University Health System MISP |
$3,700.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,550.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,550.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,471.53
|
| Rate for Payer: United Healthcare All Other HMO |
$3,379.03
|
| Rate for Payer: United Healthcare HMO Rider |
$3,305.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,029.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,862.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,862.50
|
| Rate for Payer: Vantage Medical Group Senior |
$7,862.50
|
|
|
HC PACE B/S ALTRUA DR EL S208
|
Facility
|
OP
|
$8,150.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813638
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,630.00 |
| Max. Negotiated Rate |
$7,335.00 |
| Rate for Payer: Adventist Health Commercial |
$1,630.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,927.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,482.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,112.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,946.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,786.49
|
| Rate for Payer: Blue Shield of California Commercial |
$6,299.95
|
| Rate for Payer: Blue Shield of California EPN |
$4,107.60
|
| Rate for Payer: Cash Price |
$3,667.50
|
| Rate for Payer: Central Health Plan Commercial |
$6,520.00
|
| Rate for Payer: Cigna of CA HMO |
$5,705.00
|
| Rate for Payer: Cigna of CA PPO |
$5,705.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,927.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,927.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,927.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,260.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,260.00
|
| Rate for Payer: Galaxy Health WC |
$6,927.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,890.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,335.00
|
| Rate for Payer: InnovAge PACE Commercial |
$4,075.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,436.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,044.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,630.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,705.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,705.00
|
| Rate for Payer: Multiplan Commercial |
$6,112.50
|
| Rate for Payer: Networks By Design Commercial |
$4,075.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,927.50
|
| Rate for Payer: Riverside University Health System MISP |
$3,260.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,890.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,890.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,058.70
|
| Rate for Payer: United Healthcare All Other HMO |
$2,977.20
|
| Rate for Payer: United Healthcare HMO Rider |
$2,912.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,669.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,927.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,927.50
|
| Rate for Payer: Vantage Medical Group Senior |
$6,927.50
|
|
|
HC PACE B/S ALTRUA DR EL S208
|
Facility
|
IP
|
$8,150.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813638
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,630.00 |
| Max. Negotiated Rate |
$7,335.00 |
| Rate for Payer: Adventist Health Commercial |
$1,630.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,299.95
|
| Rate for Payer: Blue Shield of California EPN |
$4,107.60
|
| Rate for Payer: Cash Price |
$3,667.50
|
| Rate for Payer: Central Health Plan Commercial |
$6,520.00
|
| Rate for Payer: Cigna of CA HMO |
$5,705.00
|
| Rate for Payer: Cigna of CA PPO |
$5,705.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,260.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,260.00
|
| Rate for Payer: Galaxy Health WC |
$6,927.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,890.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,335.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,436.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,105.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,044.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,630.00
|
| Rate for Payer: Multiplan Commercial |
$6,112.50
|
| Rate for Payer: Networks By Design Commercial |
$4,075.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,927.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,058.70
|
| Rate for Payer: United Healthcare All Other HMO |
$2,977.20
|
| Rate for Payer: United Healthcare HMO Rider |
$2,912.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,669.12
|
|
|
HC PACE B/S ALTRUA DR EL S602
|
Facility
|
OP
|
$10,325.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813640
|
|
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 |
$4,646.25
|
| 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 ALTRUA DR EL S602
|
Facility
|
IP
|
$10,325.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813640
|
|
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 |
$4,646.25
|
| 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
|
|
|
HC PACE B/S ALTRUA DR EL S606
|
Facility
|
IP
|
$10,325.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813643
|
|
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 |
$4,646.25
|
| 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
|
|
|
HC PACE B/S ALTRUA DR EL S606
|
Facility
|
OP
|
$10,325.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813643
|
|
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 |
$4,646.25
|
| 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 ALTRUA DR S205
|
Facility
|
OP
|
$8,150.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813641
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,630.00 |
| Max. Negotiated Rate |
$7,335.00 |
| Rate for Payer: Adventist Health Commercial |
$1,630.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,927.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,482.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,112.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,946.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,786.49
|
| Rate for Payer: Blue Shield of California Commercial |
$6,299.95
|
| Rate for Payer: Blue Shield of California EPN |
$4,107.60
|
| Rate for Payer: Cash Price |
$3,667.50
|
| Rate for Payer: Central Health Plan Commercial |
$6,520.00
|
| Rate for Payer: Cigna of CA HMO |
$5,705.00
|
| Rate for Payer: Cigna of CA PPO |
$5,705.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,927.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,927.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,927.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,260.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,260.00
|
| Rate for Payer: Galaxy Health WC |
$6,927.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,890.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,335.00
|
| Rate for Payer: InnovAge PACE Commercial |
$4,075.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,436.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,044.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,630.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,705.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,705.00
|
| Rate for Payer: Multiplan Commercial |
$6,112.50
|
| Rate for Payer: Networks By Design Commercial |
$4,075.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,927.50
|
| Rate for Payer: Riverside University Health System MISP |
$3,260.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,890.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,890.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,058.70
|
| Rate for Payer: United Healthcare All Other HMO |
$2,977.20
|
| Rate for Payer: United Healthcare HMO Rider |
$2,912.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,669.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,927.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,927.50
|
| Rate for Payer: Vantage Medical Group Senior |
$6,927.50
|
|
|
HC PACE B/S ALTRUA DR S205
|
Facility
|
IP
|
$8,150.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813641
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,630.00 |
| Max. Negotiated Rate |
$7,335.00 |
| Rate for Payer: Adventist Health Commercial |
$1,630.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,299.95
|
| Rate for Payer: Blue Shield of California EPN |
$4,107.60
|
| Rate for Payer: Cash Price |
$3,667.50
|
| Rate for Payer: Central Health Plan Commercial |
$6,520.00
|
| Rate for Payer: Cigna of CA HMO |
$5,705.00
|
| Rate for Payer: Cigna of CA PPO |
$5,705.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,260.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,260.00
|
| Rate for Payer: Galaxy Health WC |
$6,927.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,890.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,335.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,436.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,105.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,044.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,630.00
|
| Rate for Payer: Multiplan Commercial |
$6,112.50
|
| Rate for Payer: Networks By Design Commercial |
$4,075.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,927.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,058.70
|
| Rate for Payer: United Healthcare All Other HMO |
$2,977.20
|
| Rate for Payer: United Healthcare HMO Rider |
$2,912.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,669.12
|
|
|
HC PACE B/S CONTAK H120
|
Facility
|
OP
|
$16,875.00
|
|
|
Service Code
|
CPT C2621
|
| Hospital Charge Code |
906813637
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,375.00 |
| Max. Negotiated Rate |
$15,187.50 |
| Rate for Payer: Adventist Health Commercial |
$3,375.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14,343.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,281.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12,656.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8,170.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,910.69
|
| Rate for Payer: Blue Shield of California Commercial |
$13,044.38
|
| Rate for Payer: Blue Shield of California EPN |
$8,505.00
|
| Rate for Payer: Cash Price |
$7,593.75
|
| Rate for Payer: Central Health Plan Commercial |
$13,500.00
|
| Rate for Payer: Cigna of CA HMO |
$11,812.50
|
| Rate for Payer: Cigna of CA PPO |
$11,812.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14,343.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$14,343.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,343.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,750.00
|
| Rate for Payer: EPIC Health Plan Senior |
$6,750.00
|
| Rate for Payer: Galaxy Health WC |
$14,343.75
|
| Rate for Payer: Global Benefits Group Commercial |
$10,125.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,187.50
|
| Rate for Payer: InnovAge PACE Commercial |
$8,437.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,255.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,445.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,375.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,812.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,812.50
|
| Rate for Payer: Multiplan Commercial |
$12,656.25
|
| Rate for Payer: Networks By Design Commercial |
$8,437.50
|
| Rate for Payer: Prime Health Services Commercial |
$14,343.75
|
| Rate for Payer: Riverside University Health System MISP |
$6,750.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,125.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10,125.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,333.19
|
| Rate for Payer: United Healthcare All Other HMO |
$6,164.44
|
| Rate for Payer: United Healthcare HMO Rider |
$6,031.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,526.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14,343.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14,343.75
|
| Rate for Payer: Vantage Medical Group Senior |
$14,343.75
|
|
|
HC PACE B/S CONTAK H120
|
Facility
|
IP
|
$16,875.00
|
|
|
Service Code
|
CPT C2621
|
| Hospital Charge Code |
906813637
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,375.00 |
| Max. Negotiated Rate |
$15,187.50 |
| Rate for Payer: Adventist Health Commercial |
$3,375.00
|
| Rate for Payer: Blue Shield of California Commercial |
$13,044.38
|
| Rate for Payer: Blue Shield of California EPN |
$8,505.00
|
| Rate for Payer: Cash Price |
$7,593.75
|
| Rate for Payer: Central Health Plan Commercial |
$13,500.00
|
| Rate for Payer: Cigna of CA HMO |
$11,812.50
|
| Rate for Payer: Cigna of CA PPO |
$11,812.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,750.00
|
| Rate for Payer: EPIC Health Plan Senior |
$6,750.00
|
| Rate for Payer: Galaxy Health WC |
$14,343.75
|
| Rate for Payer: Global Benefits Group Commercial |
$10,125.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,187.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,255.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,429.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,445.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,375.00
|
| Rate for Payer: Multiplan Commercial |
$12,656.25
|
| Rate for Payer: Networks By Design Commercial |
$8,437.50
|
| Rate for Payer: Prime Health Services Commercial |
$14,343.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,333.19
|
| Rate for Payer: United Healthcare All Other HMO |
$6,164.44
|
| Rate for Payer: United Healthcare HMO Rider |
$6,031.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,526.56
|
|
|
HC PACE B/S CONTAK H125
|
Facility
|
IP
|
$16,875.00
|
|
|
Service Code
|
CPT C2621
|
| Hospital Charge Code |
906813585
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,375.00 |
| Max. Negotiated Rate |
$15,187.50 |
| Rate for Payer: Adventist Health Commercial |
$3,375.00
|
| Rate for Payer: Blue Shield of California Commercial |
$13,044.38
|
| Rate for Payer: Blue Shield of California EPN |
$8,505.00
|
| Rate for Payer: Cash Price |
$7,593.75
|
| Rate for Payer: Central Health Plan Commercial |
$13,500.00
|
| Rate for Payer: Cigna of CA HMO |
$11,812.50
|
| Rate for Payer: Cigna of CA PPO |
$11,812.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,750.00
|
| Rate for Payer: EPIC Health Plan Senior |
$6,750.00
|
| Rate for Payer: Galaxy Health WC |
$14,343.75
|
| Rate for Payer: Global Benefits Group Commercial |
$10,125.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,187.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,255.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,429.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,445.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,375.00
|
| Rate for Payer: Multiplan Commercial |
$12,656.25
|
| Rate for Payer: Networks By Design Commercial |
$8,437.50
|
| Rate for Payer: Prime Health Services Commercial |
$14,343.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,333.19
|
| Rate for Payer: United Healthcare All Other HMO |
$6,164.44
|
| Rate for Payer: United Healthcare HMO Rider |
$6,031.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,526.56
|
|
|
HC PACE B/S CONTAK H125
|
Facility
|
OP
|
$16,875.00
|
|
|
Service Code
|
CPT C2621
|
| Hospital Charge Code |
906813585
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,375.00 |
| Max. Negotiated Rate |
$15,187.50 |
| Rate for Payer: Adventist Health Commercial |
$3,375.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14,343.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,281.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12,656.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8,170.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,910.69
|
| Rate for Payer: Blue Shield of California Commercial |
$13,044.38
|
| Rate for Payer: Blue Shield of California EPN |
$8,505.00
|
| Rate for Payer: Cash Price |
$7,593.75
|
| Rate for Payer: Central Health Plan Commercial |
$13,500.00
|
| Rate for Payer: Cigna of CA HMO |
$11,812.50
|
| Rate for Payer: Cigna of CA PPO |
$11,812.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14,343.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$14,343.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,343.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,750.00
|
| Rate for Payer: EPIC Health Plan Senior |
$6,750.00
|
| Rate for Payer: Galaxy Health WC |
$14,343.75
|
| Rate for Payer: Global Benefits Group Commercial |
$10,125.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,187.50
|
| Rate for Payer: InnovAge PACE Commercial |
$8,437.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,255.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,445.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,375.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,812.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,812.50
|
| Rate for Payer: Multiplan Commercial |
$12,656.25
|
| Rate for Payer: Networks By Design Commercial |
$8,437.50
|
| Rate for Payer: Prime Health Services Commercial |
$14,343.75
|
| Rate for Payer: Riverside University Health System MISP |
$6,750.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,125.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10,125.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,333.19
|
| Rate for Payer: United Healthcare All Other HMO |
$6,164.44
|
| Rate for Payer: United Healthcare HMO Rider |
$6,031.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,526.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14,343.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14,343.75
|
| Rate for Payer: Vantage Medical Group Senior |
$14,343.75
|
|
|
HC PACE BS INGENIO DR K173
|
Facility
|
OP
|
$10,622.50
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813686
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,124.50 |
| Max. Negotiated Rate |
$9,560.25 |
| Rate for Payer: Adventist Health Commercial |
$2,124.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,029.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,842.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,966.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,143.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,238.59
|
| Rate for Payer: Blue Shield of California Commercial |
$8,211.19
|
| Rate for Payer: Blue Shield of California EPN |
$5,353.74
|
| Rate for Payer: Cash Price |
$4,780.12
|
| Rate for Payer: Central Health Plan Commercial |
$8,498.00
|
| Rate for Payer: Cigna of CA HMO |
$7,435.75
|
| Rate for Payer: Cigna of CA PPO |
$7,435.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,029.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,029.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,029.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,249.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,249.00
|
| Rate for Payer: Galaxy Health WC |
$9,029.12
|
| Rate for Payer: Global Benefits Group Commercial |
$6,373.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,560.25
|
| Rate for Payer: InnovAge PACE Commercial |
$5,311.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,085.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,575.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,124.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,435.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,435.75
|
| Rate for Payer: Multiplan Commercial |
$7,966.88
|
| Rate for Payer: Networks By Design Commercial |
$5,311.25
|
| Rate for Payer: Prime Health Services Commercial |
$9,029.12
|
| Rate for Payer: Riverside University Health System MISP |
$4,249.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,373.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,373.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,986.62
|
| Rate for Payer: United Healthcare All Other HMO |
$3,880.40
|
| Rate for Payer: United Healthcare HMO Rider |
$3,796.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,478.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,029.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,029.12
|
| Rate for Payer: Vantage Medical Group Senior |
$9,029.12
|
|
|
HC PACE BS INGENIO DR K173
|
Facility
|
IP
|
$10,622.50
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813686
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,124.50 |
| Max. Negotiated Rate |
$9,560.25 |
| Rate for Payer: Adventist Health Commercial |
$2,124.50
|
| Rate for Payer: Blue Shield of California Commercial |
$8,211.19
|
| Rate for Payer: Blue Shield of California EPN |
$5,353.74
|
| Rate for Payer: Cash Price |
$4,780.12
|
| Rate for Payer: Central Health Plan Commercial |
$8,498.00
|
| Rate for Payer: Cigna of CA HMO |
$7,435.75
|
| Rate for Payer: Cigna of CA PPO |
$7,435.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,249.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,249.00
|
| Rate for Payer: Galaxy Health WC |
$9,029.12
|
| Rate for Payer: Global Benefits Group Commercial |
$6,373.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,560.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,085.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,047.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,575.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,124.50
|
| Rate for Payer: Multiplan Commercial |
$7,966.88
|
| Rate for Payer: Networks By Design Commercial |
$5,311.25
|
| Rate for Payer: Prime Health Services Commercial |
$9,029.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,986.62
|
| Rate for Payer: United Healthcare All Other HMO |
$3,880.40
|
| Rate for Payer: United Healthcare HMO Rider |
$3,796.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,478.87
|
|
|
HC PACE BS INGENIO SR K172
|
Facility
|
OP
|
$9,875.00
|
|
|
Service Code
|
CPT C1786
|
| Hospital Charge Code |
906813689
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,975.00 |
| Max. Negotiated Rate |
$8,887.50 |
| Rate for Payer: Adventist Health Commercial |
$1,975.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,393.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,431.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,406.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,781.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,799.59
|
| Rate for Payer: Blue Shield of California Commercial |
$7,633.38
|
| Rate for Payer: Blue Shield of California EPN |
$4,977.00
|
| Rate for Payer: Cash Price |
$4,443.75
|
| Rate for Payer: Central Health Plan Commercial |
$7,900.00
|
| Rate for Payer: Cigna of CA HMO |
$6,912.50
|
| Rate for Payer: Cigna of CA PPO |
$6,912.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,393.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,393.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,393.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,950.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,950.00
|
| Rate for Payer: Galaxy Health WC |
$8,393.75
|
| Rate for Payer: Global Benefits Group Commercial |
$5,925.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,887.50
|
| Rate for Payer: InnovAge PACE Commercial |
$4,937.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,586.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,112.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,975.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,912.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,912.50
|
| Rate for Payer: Multiplan Commercial |
$7,406.25
|
| Rate for Payer: Networks By Design Commercial |
$4,937.50
|
| Rate for Payer: Prime Health Services Commercial |
$8,393.75
|
| Rate for Payer: Riverside University Health System MISP |
$3,950.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,925.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,925.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,706.09
|
| Rate for Payer: United Healthcare All Other HMO |
$3,607.34
|
| Rate for Payer: United Healthcare HMO Rider |
$3,529.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,234.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,393.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,393.75
|
| Rate for Payer: Vantage Medical Group Senior |
$8,393.75
|
|
|
HC PACE BS INGENIO SR K172
|
Facility
|
IP
|
$9,875.00
|
|
|
Service Code
|
CPT C1786
|
| Hospital Charge Code |
906813689
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,975.00 |
| Max. Negotiated Rate |
$8,887.50 |
| Rate for Payer: Adventist Health Commercial |
$1,975.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,633.38
|
| Rate for Payer: Blue Shield of California EPN |
$4,977.00
|
| Rate for Payer: Cash Price |
$4,443.75
|
| Rate for Payer: Central Health Plan Commercial |
$7,900.00
|
| Rate for Payer: Cigna of CA HMO |
$6,912.50
|
| Rate for Payer: Cigna of CA PPO |
$6,912.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,950.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,950.00
|
| Rate for Payer: Galaxy Health WC |
$8,393.75
|
| Rate for Payer: Global Benefits Group Commercial |
$5,925.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,887.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,586.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,762.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,112.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,975.00
|
| Rate for Payer: Multiplan Commercial |
$7,406.25
|
| Rate for Payer: Networks By Design Commercial |
$4,937.50
|
| Rate for Payer: Prime Health Services Commercial |
$8,393.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,706.09
|
| Rate for Payer: United Healthcare All Other HMO |
$3,607.34
|
| Rate for Payer: United Healthcare HMO Rider |
$3,529.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,234.06
|
|
|
HC PACE BS INVIVE CRT V172
|
Facility
|
OP
|
$7,250.00
|
|
|
Service Code
|
CPT C2621
|
| Hospital Charge Code |
906813695
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,450.00 |
| Max. Negotiated Rate |
$6,525.00 |
| Rate for Payer: Adventist Health Commercial |
$1,450.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,162.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,987.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,437.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,510.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,257.93
|
| Rate for Payer: Blue Shield of California Commercial |
$5,604.25
|
| Rate for Payer: Blue Shield of California EPN |
$3,654.00
|
| Rate for Payer: Cash Price |
$3,262.50
|
| Rate for Payer: Central Health Plan Commercial |
$5,800.00
|
| Rate for Payer: Cigna of CA HMO |
$5,075.00
|
| Rate for Payer: Cigna of CA PPO |
$5,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,162.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,162.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,162.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,900.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,900.00
|
| Rate for Payer: Galaxy Health WC |
$6,162.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,350.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,525.00
|
| Rate for Payer: InnovAge PACE Commercial |
$3,625.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,835.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,487.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,450.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,075.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,075.00
|
| Rate for Payer: Multiplan Commercial |
$5,437.50
|
| Rate for Payer: Networks By Design Commercial |
$3,625.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,162.50
|
| Rate for Payer: Riverside University Health System MISP |
$2,900.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,350.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,350.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,720.93
|
| Rate for Payer: United Healthcare All Other HMO |
$2,648.43
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,162.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,162.50
|
| Rate for Payer: Vantage Medical Group Senior |
$6,162.50
|
|
|
HC PACE BS INVIVE CRT V172
|
Facility
|
IP
|
$7,250.00
|
|
|
Service Code
|
CPT C2621
|
| Hospital Charge Code |
906813695
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,450.00 |
| Max. Negotiated Rate |
$6,525.00 |
| Rate for Payer: Adventist Health Commercial |
$1,450.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,604.25
|
| Rate for Payer: Blue Shield of California EPN |
$3,654.00
|
| Rate for Payer: Cash Price |
$3,262.50
|
| Rate for Payer: Central Health Plan Commercial |
$5,800.00
|
| Rate for Payer: Cigna of CA HMO |
$5,075.00
|
| Rate for Payer: Cigna of CA PPO |
$5,075.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,900.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,900.00
|
| Rate for Payer: Galaxy Health WC |
$6,162.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,350.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,525.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,835.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,762.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,487.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,450.00
|
| Rate for Payer: Multiplan Commercial |
$5,437.50
|
| Rate for Payer: Networks By Design Commercial |
$3,625.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,162.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,720.93
|
| Rate for Payer: United Healthcare All Other HMO |
$2,648.43
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.38
|
|
|
HC PACE B/S VALITUDE X4 U128
|
Facility
|
IP
|
$18,625.00
|
|
|
Service Code
|
CPT C2621
|
| Hospital Charge Code |
906813805
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,725.00 |
| Max. Negotiated Rate |
$16,762.50 |
| Rate for Payer: Adventist Health Commercial |
$3,725.00
|
| Rate for Payer: Blue Shield of California Commercial |
$14,397.12
|
| Rate for Payer: Blue Shield of California EPN |
$9,387.00
|
| Rate for Payer: Cash Price |
$8,381.25
|
| Rate for Payer: Central Health Plan Commercial |
$14,900.00
|
| Rate for Payer: Cigna of CA HMO |
$13,037.50
|
| Rate for Payer: Cigna of CA PPO |
$13,037.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,450.00
|
| Rate for Payer: EPIC Health Plan Senior |
$7,450.00
|
| Rate for Payer: Galaxy Health WC |
$15,831.25
|
| Rate for Payer: Global Benefits Group Commercial |
$11,175.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$16,762.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,422.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,096.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,528.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,725.00
|
| Rate for Payer: Multiplan Commercial |
$13,968.75
|
| Rate for Payer: Networks By Design Commercial |
$9,312.50
|
| Rate for Payer: Prime Health Services Commercial |
$15,831.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,989.96
|
| Rate for Payer: United Healthcare All Other HMO |
$6,803.71
|
| Rate for Payer: United Healthcare HMO Rider |
$6,656.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,099.69
|
|
|
HC PACE B/S VALITUDE X4 U128
|
Facility
|
OP
|
$18,625.00
|
|
|
Service Code
|
CPT C2621
|
| Hospital Charge Code |
906813805
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,725.00 |
| Max. Negotiated Rate |
$16,762.50 |
| Rate for Payer: Adventist Health Commercial |
$3,725.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15,831.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,243.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,968.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9,018.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,938.46
|
| Rate for Payer: Blue Shield of California Commercial |
$14,397.12
|
| Rate for Payer: Blue Shield of California EPN |
$9,387.00
|
| Rate for Payer: Cash Price |
$8,381.25
|
| Rate for Payer: Central Health Plan Commercial |
$14,900.00
|
| Rate for Payer: Cigna of CA HMO |
$13,037.50
|
| Rate for Payer: Cigna of CA PPO |
$13,037.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15,831.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,831.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15,831.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,450.00
|
| Rate for Payer: EPIC Health Plan Senior |
$7,450.00
|
| Rate for Payer: Galaxy Health WC |
$15,831.25
|
| Rate for Payer: Global Benefits Group Commercial |
$11,175.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$16,762.50
|
| Rate for Payer: InnovAge PACE Commercial |
$9,312.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,422.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,528.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,725.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13,037.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13,037.50
|
| Rate for Payer: Multiplan Commercial |
$13,968.75
|
| Rate for Payer: Networks By Design Commercial |
$9,312.50
|
| Rate for Payer: Prime Health Services Commercial |
$15,831.25
|
| Rate for Payer: Riverside University Health System MISP |
$7,450.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11,175.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11,175.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,989.96
|
| Rate for Payer: United Healthcare All Other HMO |
$6,803.71
|
| Rate for Payer: United Healthcare HMO Rider |
$6,656.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,099.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15,831.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,831.25
|
| Rate for Payer: Vantage Medical Group Senior |
$15,831.25
|
|
|
HC PACE INSERT EXIST MULT HC LEADS
|
Facility
|
IP
|
$25,976.00
|
|
|
Service Code
|
CPT 33221
|
| Hospital Charge Code |
906820254
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,195.20 |
| Max. Negotiated Rate |
$23,378.40 |
| Rate for Payer: Adventist Health Commercial |
$5,195.20
|
| Rate for Payer: Cash Price |
$11,689.20
|
| Rate for Payer: Central Health Plan Commercial |
$20,780.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,390.40
|
| Rate for Payer: EPIC Health Plan Senior |
$10,390.40
|
| Rate for Payer: Galaxy Health WC |
$22,079.60
|
| Rate for Payer: Global Benefits Group Commercial |
$15,585.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$23,378.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17,325.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,896.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,079.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,195.20
|
| Rate for Payer: Multiplan Commercial |
$19,482.00
|
| Rate for Payer: Networks By Design Commercial |
$16,884.40
|
| Rate for Payer: Prime Health Services Commercial |
$22,079.60
|
|
