|
HC PACE B/S ACCOLADE DR MRI L311
|
Facility
|
IP
|
$12,200.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813767
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,440.00 |
| Max. Negotiated Rate |
$10,980.00 |
| Rate for Payer: Adventist Health Commercial |
$2,440.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,430.60
|
| Rate for Payer: Blue Shield of California EPN |
$6,148.80
|
| Rate for Payer: Cash Price |
$6,710.00
|
| Rate for Payer: Central Health Plan Commercial |
$9,760.00
|
| Rate for Payer: Cigna of CA HMO |
$8,540.00
|
| Rate for Payer: Cigna of CA PPO |
$8,540.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,880.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,880.00
|
| Rate for Payer: Galaxy Health WC |
$10,370.00
|
| Rate for Payer: Global Benefits Group Commercial |
$7,320.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,980.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,137.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,648.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,551.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,440.00
|
| Rate for Payer: Multiplan Commercial |
$9,150.00
|
| Rate for Payer: Networks By Design Commercial |
$6,100.00
|
| Rate for Payer: Prime Health Services Commercial |
$10,370.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,578.66
|
| Rate for Payer: United Healthcare All Other HMO |
$4,456.66
|
| Rate for Payer: United Healthcare HMO Rider |
$4,360.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,995.50
|
|
|
HC PACE B/S ACCOLADE DR MRI L311
|
Facility
|
OP
|
$12,200.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813767
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,440.00 |
| Max. Negotiated Rate |
$10,980.00 |
| Rate for Payer: Adventist Health Commercial |
$2,440.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,370.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,710.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,150.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,907.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,165.06
|
| Rate for Payer: Blue Shield of California Commercial |
$9,430.60
|
| Rate for Payer: Blue Shield of California EPN |
$6,148.80
|
| Rate for Payer: Cash Price |
$6,710.00
|
| Rate for Payer: Central Health Plan Commercial |
$9,760.00
|
| Rate for Payer: Cigna of CA HMO |
$8,540.00
|
| Rate for Payer: Cigna of CA PPO |
$8,540.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,370.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,370.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,370.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,880.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,880.00
|
| Rate for Payer: Galaxy Health WC |
$10,370.00
|
| Rate for Payer: Global Benefits Group Commercial |
$7,320.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,980.00
|
| Rate for Payer: InnovAge PACE Commercial |
$6,100.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,137.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,551.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,440.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,540.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,540.00
|
| Rate for Payer: Multiplan Commercial |
$9,150.00
|
| Rate for Payer: Networks By Design Commercial |
$6,100.00
|
| Rate for Payer: Prime Health Services Commercial |
$10,370.00
|
| Rate for Payer: Riverside University Health System MISP |
$4,880.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,320.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,320.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,578.66
|
| Rate for Payer: United Healthcare All Other HMO |
$4,456.66
|
| Rate for Payer: United Healthcare HMO Rider |
$4,360.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,995.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,370.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,370.00
|
| Rate for Payer: Vantage Medical Group Senior |
$10,370.00
|
|
|
HC PACE BS ACCOLADE EL DR L321
|
Facility
|
IP
|
$10,825.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813743
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,165.00 |
| Max. Negotiated Rate |
$9,742.50 |
| Rate for Payer: Adventist Health Commercial |
$2,165.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,367.73
|
| Rate for Payer: Blue Shield of California EPN |
$5,455.80
|
| Rate for Payer: Cash Price |
$5,953.75
|
| Rate for Payer: Central Health Plan Commercial |
$8,660.00
|
| Rate for Payer: Cigna of CA HMO |
$7,577.50
|
| Rate for Payer: Cigna of CA PPO |
$7,577.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,330.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,330.00
|
| Rate for Payer: Galaxy Health WC |
$9,201.25
|
| Rate for Payer: Global Benefits Group Commercial |
$6,495.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,742.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,220.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,124.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,700.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,165.00
|
| Rate for Payer: Multiplan Commercial |
$8,118.75
|
| Rate for Payer: Networks By Design Commercial |
$5,412.50
|
| Rate for Payer: Prime Health Services Commercial |
$9,201.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,062.62
|
| Rate for Payer: United Healthcare All Other HMO |
$3,954.37
|
| Rate for Payer: United Healthcare HMO Rider |
$3,868.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,545.19
|
|
|
HC PACE BS ACCOLADE EL DR L321
|
Facility
|
OP
|
$10,825.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813743
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,165.00 |
| Max. Negotiated Rate |
$9,742.50 |
| Rate for Payer: Adventist Health Commercial |
$2,165.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,201.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,953.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,118.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,241.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,357.52
|
| Rate for Payer: Blue Shield of California Commercial |
$8,367.73
|
| Rate for Payer: Blue Shield of California EPN |
$5,455.80
|
| Rate for Payer: Cash Price |
$5,953.75
|
| Rate for Payer: Central Health Plan Commercial |
$8,660.00
|
| Rate for Payer: Cigna of CA HMO |
$7,577.50
|
| Rate for Payer: Cigna of CA PPO |
$7,577.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,201.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,201.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,201.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,330.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,330.00
|
| Rate for Payer: Galaxy Health WC |
$9,201.25
|
| Rate for Payer: Global Benefits Group Commercial |
$6,495.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,742.50
|
| Rate for Payer: InnovAge PACE Commercial |
$5,412.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,220.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,700.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,165.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,577.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,577.50
|
| Rate for Payer: Multiplan Commercial |
$8,118.75
|
| Rate for Payer: Networks By Design Commercial |
$5,412.50
|
| Rate for Payer: Prime Health Services Commercial |
$9,201.25
|
| Rate for Payer: Riverside University Health System MISP |
$4,330.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,495.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,495.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,062.62
|
| Rate for Payer: United Healthcare All Other HMO |
$3,954.37
|
| Rate for Payer: United Healthcare HMO Rider |
$3,868.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,545.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,201.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,201.25
|
| Rate for Payer: Vantage Medical Group Senior |
$9,201.25
|
|
|
HC PACE B/S ACCOLADE EL MRI L331
|
Facility
|
IP
|
$12,700.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813766
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,540.00 |
| Max. Negotiated Rate |
$11,430.00 |
| Rate for Payer: Adventist Health Commercial |
$2,540.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,817.10
|
| Rate for Payer: Blue Shield of California EPN |
$6,400.80
|
| Rate for Payer: Cash Price |
$6,985.00
|
| Rate for Payer: Central Health Plan Commercial |
$10,160.00
|
| Rate for Payer: Cigna of CA HMO |
$8,890.00
|
| Rate for Payer: Cigna of CA PPO |
$8,890.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,080.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,080.00
|
| Rate for Payer: Galaxy Health WC |
$10,795.00
|
| Rate for Payer: Global Benefits Group Commercial |
$7,620.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,430.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,470.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,838.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,861.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,540.00
|
| Rate for Payer: Multiplan Commercial |
$9,525.00
|
| Rate for Payer: Networks By Design Commercial |
$6,350.00
|
| Rate for Payer: Prime Health Services Commercial |
$10,795.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,766.31
|
| Rate for Payer: United Healthcare All Other HMO |
$4,639.31
|
| Rate for Payer: United Healthcare HMO Rider |
$4,538.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,159.25
|
|
|
HC PACE B/S ACCOLADE EL MRI L331
|
Facility
|
OP
|
$12,700.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813766
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,540.00 |
| Max. Negotiated Rate |
$11,430.00 |
| Rate for Payer: Adventist Health Commercial |
$2,540.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,795.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,985.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,525.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,149.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,458.71
|
| Rate for Payer: Blue Shield of California Commercial |
$9,817.10
|
| Rate for Payer: Blue Shield of California EPN |
$6,400.80
|
| Rate for Payer: Cash Price |
$6,985.00
|
| Rate for Payer: Central Health Plan Commercial |
$10,160.00
|
| Rate for Payer: Cigna of CA HMO |
$8,890.00
|
| Rate for Payer: Cigna of CA PPO |
$8,890.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,795.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,795.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,795.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,080.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,080.00
|
| Rate for Payer: Galaxy Health WC |
$10,795.00
|
| Rate for Payer: Global Benefits Group Commercial |
$7,620.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,430.00
|
| Rate for Payer: InnovAge PACE Commercial |
$6,350.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,470.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,861.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,540.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,890.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,890.00
|
| Rate for Payer: Multiplan Commercial |
$9,525.00
|
| Rate for Payer: Networks By Design Commercial |
$6,350.00
|
| Rate for Payer: Prime Health Services Commercial |
$10,795.00
|
| Rate for Payer: Riverside University Health System MISP |
$5,080.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,620.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,620.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,766.31
|
| Rate for Payer: United Healthcare All Other HMO |
$4,639.31
|
| Rate for Payer: United Healthcare HMO Rider |
$4,538.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,159.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,795.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,795.00
|
| Rate for Payer: Vantage Medical Group Senior |
$10,795.00
|
|
|
HC PACE B/S ACCOLADE SR L300
|
Facility
|
OP
|
$9,250.00
|
|
|
Service Code
|
CPT C1786
|
| Hospital Charge Code |
906813783
|
|
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 |
$5,087.50
|
| 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 ACCOLADE SR L300
|
Facility
|
IP
|
$9,250.00
|
|
|
Service Code
|
CPT C1786
|
| Hospital Charge Code |
906813783
|
|
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 |
$5,087.50
|
| 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 BS ADVANTIO DR K063
|
Facility
|
OP
|
$10,325.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813717
|
|
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 BS ADVANTIO DR K063
|
Facility
|
IP
|
$10,325.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813717
|
|
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
|
|
|
HC PACE B/S ALTRUA 20 DR S202
|
Facility
|
IP
|
$6,875.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813622
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,375.00 |
| Max. Negotiated Rate |
$6,187.50 |
| Rate for Payer: Adventist Health Commercial |
$1,375.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,314.38
|
| Rate for Payer: Blue Shield of California EPN |
$3,465.00
|
| Rate for Payer: Cash Price |
$3,781.25
|
| Rate for Payer: Central Health Plan Commercial |
$5,500.00
|
| Rate for Payer: Cigna of CA HMO |
$4,812.50
|
| Rate for Payer: Cigna of CA PPO |
$4,812.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,750.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,750.00
|
| Rate for Payer: Galaxy Health WC |
$5,843.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4,125.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,187.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,585.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,619.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,255.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,375.00
|
| Rate for Payer: Multiplan Commercial |
$5,156.25
|
| Rate for Payer: Networks By Design Commercial |
$3,437.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,843.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,580.19
|
| Rate for Payer: United Healthcare All Other HMO |
$2,511.44
|
| Rate for Payer: United Healthcare HMO Rider |
$2,457.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,251.56
|
|
|
HC PACE B/S ALTRUA 20 DR S202
|
Facility
|
OP
|
$6,875.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813622
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,375.00 |
| Max. Negotiated Rate |
$6,187.50 |
| Rate for Payer: Adventist Health Commercial |
$1,375.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,843.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,781.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,156.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,328.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,037.69
|
| Rate for Payer: Blue Shield of California Commercial |
$5,314.38
|
| Rate for Payer: Blue Shield of California EPN |
$3,465.00
|
| Rate for Payer: Cash Price |
$3,781.25
|
| Rate for Payer: Central Health Plan Commercial |
$5,500.00
|
| Rate for Payer: Cigna of CA HMO |
$4,812.50
|
| Rate for Payer: Cigna of CA PPO |
$4,812.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,843.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,843.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,843.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,750.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,750.00
|
| Rate for Payer: Galaxy Health WC |
$5,843.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4,125.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,187.50
|
| Rate for Payer: InnovAge PACE Commercial |
$3,437.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,585.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,255.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,375.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,812.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,812.50
|
| Rate for Payer: Multiplan Commercial |
$5,156.25
|
| Rate for Payer: Networks By Design Commercial |
$3,437.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,843.75
|
| Rate for Payer: Riverside University Health System MISP |
$2,750.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,125.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,125.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,580.19
|
| Rate for Payer: United Healthcare All Other HMO |
$2,511.44
|
| Rate for Payer: United Healthcare HMO Rider |
$2,457.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,251.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,843.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,843.75
|
| Rate for Payer: Vantage Medical Group Senior |
$5,843.75
|
|
|
HC PACE B/S ALTRUA 20 SR S201
|
Facility
|
IP
|
$6,875.00
|
|
|
Service Code
|
CPT C1786
|
| Hospital Charge Code |
906813625
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,375.00 |
| Max. Negotiated Rate |
$6,187.50 |
| Rate for Payer: Adventist Health Commercial |
$1,375.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,314.38
|
| Rate for Payer: Blue Shield of California EPN |
$3,465.00
|
| Rate for Payer: Cash Price |
$3,781.25
|
| Rate for Payer: Central Health Plan Commercial |
$5,500.00
|
| Rate for Payer: Cigna of CA HMO |
$4,812.50
|
| Rate for Payer: Cigna of CA PPO |
$4,812.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,750.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,750.00
|
| Rate for Payer: Galaxy Health WC |
$5,843.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4,125.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,187.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,585.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,619.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,255.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,375.00
|
| Rate for Payer: Multiplan Commercial |
$5,156.25
|
| Rate for Payer: Networks By Design Commercial |
$3,437.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,843.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,580.19
|
| Rate for Payer: United Healthcare All Other HMO |
$2,511.44
|
| Rate for Payer: United Healthcare HMO Rider |
$2,457.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,251.56
|
|
|
HC PACE B/S ALTRUA 20 SR S201
|
Facility
|
OP
|
$6,875.00
|
|
|
Service Code
|
CPT C1786
|
| Hospital Charge Code |
906813625
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,375.00 |
| Max. Negotiated Rate |
$6,187.50 |
| Rate for Payer: Adventist Health Commercial |
$1,375.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,843.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,781.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,156.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,328.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,037.69
|
| Rate for Payer: Blue Shield of California Commercial |
$5,314.38
|
| Rate for Payer: Blue Shield of California EPN |
$3,465.00
|
| Rate for Payer: Cash Price |
$3,781.25
|
| Rate for Payer: Central Health Plan Commercial |
$5,500.00
|
| Rate for Payer: Cigna of CA HMO |
$4,812.50
|
| Rate for Payer: Cigna of CA PPO |
$4,812.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,843.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,843.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,843.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,750.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,750.00
|
| Rate for Payer: Galaxy Health WC |
$5,843.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4,125.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,187.50
|
| Rate for Payer: InnovAge PACE Commercial |
$3,437.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,585.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,255.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,375.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,812.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,812.50
|
| Rate for Payer: Multiplan Commercial |
$5,156.25
|
| Rate for Payer: Networks By Design Commercial |
$3,437.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,843.75
|
| Rate for Payer: Riverside University Health System MISP |
$2,750.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,125.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,125.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,580.19
|
| Rate for Payer: United Healthcare All Other HMO |
$2,511.44
|
| Rate for Payer: United Healthcare HMO Rider |
$2,457.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,251.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,843.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,843.75
|
| Rate for Payer: Vantage Medical Group Senior |
$5,843.75
|
|
|
HC PACE B/S ALTRUA 40 DR S402
|
Facility
|
IP
|
$9,250.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813621
|
|
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 |
$5,087.50
|
| 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 40 DR S402
|
Facility
|
OP
|
$9,250.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813621
|
|
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 |
$5,087.50
|
| 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 40 SR S401
|
Facility
|
OP
|
$7,950.00
|
|
|
Service Code
|
CPT C1786
|
| Hospital Charge Code |
906813624
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,590.00 |
| Max. Negotiated Rate |
$7,155.00 |
| Rate for Payer: Adventist Health Commercial |
$1,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,757.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,372.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,962.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,849.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,669.03
|
| Rate for Payer: Blue Shield of California Commercial |
$6,145.35
|
| Rate for Payer: Blue Shield of California EPN |
$4,006.80
|
| Rate for Payer: Cash Price |
$4,372.50
|
| Rate for Payer: Central Health Plan Commercial |
$6,360.00
|
| Rate for Payer: Cigna of CA HMO |
$5,565.00
|
| Rate for Payer: Cigna of CA PPO |
$5,565.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,757.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,757.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,757.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,180.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,180.00
|
| Rate for Payer: Galaxy Health WC |
$6,757.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,770.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,155.00
|
| Rate for Payer: InnovAge PACE Commercial |
$3,975.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,302.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,921.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,590.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,565.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,565.00
|
| Rate for Payer: Multiplan Commercial |
$5,962.50
|
| Rate for Payer: Networks By Design Commercial |
$3,975.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,757.50
|
| Rate for Payer: Riverside University Health System MISP |
$3,180.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,770.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,770.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,983.64
|
| Rate for Payer: United Healthcare All Other HMO |
$2,904.14
|
| Rate for Payer: United Healthcare HMO Rider |
$2,841.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,603.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,757.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,757.50
|
| Rate for Payer: Vantage Medical Group Senior |
$6,757.50
|
|
|
HC PACE B/S ALTRUA 40 SR S401
|
Facility
|
IP
|
$7,950.00
|
|
|
Service Code
|
CPT C1786
|
| Hospital Charge Code |
906813624
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,590.00 |
| Max. Negotiated Rate |
$7,155.00 |
| Rate for Payer: Adventist Health Commercial |
$1,590.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,145.35
|
| Rate for Payer: Blue Shield of California EPN |
$4,006.80
|
| Rate for Payer: Cash Price |
$4,372.50
|
| Rate for Payer: Central Health Plan Commercial |
$6,360.00
|
| Rate for Payer: Cigna of CA HMO |
$5,565.00
|
| Rate for Payer: Cigna of CA PPO |
$5,565.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,180.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,180.00
|
| Rate for Payer: Galaxy Health WC |
$6,757.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,770.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,155.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,302.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,028.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,921.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,590.00
|
| Rate for Payer: Multiplan Commercial |
$5,962.50
|
| Rate for Payer: Networks By Design Commercial |
$3,975.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,757.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,983.64
|
| Rate for Payer: United Healthcare All Other HMO |
$2,904.14
|
| Rate for Payer: United Healthcare HMO Rider |
$2,841.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,603.62
|
|
|
HC PACE B/S ALTRUA 60 DR S602
|
Facility
|
OP
|
$10,325.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813620
|
|
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 ALTRUA 60 DR S602
|
Facility
|
IP
|
$10,325.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813620
|
|
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
|
|
|
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 |
$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
|
|
|
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 |
$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 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 |
$5,087.50
|
| 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 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 |
$5,087.50
|
| 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 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 |
$4,482.50
|
| 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
|
|
