|
HC PACE INSERT EXIST MULT HC LEADS
|
Facility
|
IP
|
$22,080.00
|
|
|
Service Code
|
CPT 33221
|
| Hospital Charge Code |
906811421
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,416.00 |
| Max. Negotiated Rate |
$19,872.00 |
| Rate for Payer: Adventist Health Commercial |
$4,416.00
|
| Rate for Payer: Cash Price |
$9,936.00
|
| Rate for Payer: Central Health Plan Commercial |
$17,664.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,832.00
|
| Rate for Payer: EPIC Health Plan Senior |
$8,832.00
|
| Rate for Payer: Galaxy Health WC |
$18,768.00
|
| Rate for Payer: Global Benefits Group Commercial |
$13,248.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$19,872.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,727.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,412.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,667.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,416.00
|
| Rate for Payer: Multiplan Commercial |
$16,560.00
|
| Rate for Payer: Networks By Design Commercial |
$14,352.00
|
| Rate for Payer: Prime Health Services Commercial |
$18,768.00
|
|
|
HC PACE INSERT EXIST MULT HC LEADS
|
Facility
|
OP
|
$25,976.00
|
|
|
Service Code
|
CPT 33221
|
| Hospital Charge Code |
906820254
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$500.76 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$5,195.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$24,231.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36,347.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26,655.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24,231.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10,526.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,070.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$38,609.08
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$11,689.20
|
| Rate for Payer: Cash Price |
$11,689.20
|
| Rate for Payer: Cash Price |
$11,689.20
|
| Rate for Payer: Central Health Plan Commercial |
$20,780.80
|
| Rate for Payer: Cigna of CA HMO |
$16,624.64
|
| Rate for Payer: Cigna of CA PPO |
$19,222.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36,347.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$26,655.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24,231.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$32,712.96
|
| Rate for Payer: EPIC Health Plan Senior |
$24,231.82
|
| 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: Heritage Provider Network Commercial/Senior |
$39,740.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$500.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24,231.82
|
| Rate for Payer: InnovAge PACE Commercial |
$36,347.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17,325.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$553.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24,231.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,195.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32,470.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32,470.64
|
| Rate for Payer: Multiplan Commercial |
$19,482.00
|
| Rate for Payer: Multiplan WC |
$38,609.08
|
| Rate for Payer: Networks By Design Commercial |
$16,884.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$24,231.82
|
| Rate for Payer: Preferred Health Network WC |
$39,397.02
|
| Rate for Payer: Prime Health Services Commercial |
$22,079.60
|
| Rate for Payer: Prime Health Services Medicare |
$25,685.73
|
| Rate for Payer: Prime Health Services WC |
$38,215.11
|
| Rate for Payer: Riverside University Health System MISP |
$26,655.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15,585.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$31,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$24,231.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36,347.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26,655.00
|
| Rate for Payer: Vantage Medical Group Senior |
$24,231.82
|
|
|
HC PACE INSERT EXIST MULT HC LEADS
|
Facility
|
OP
|
$22,080.00
|
|
|
Service Code
|
CPT 33221
|
| Hospital Charge Code |
906811421
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$500.76 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$4,416.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$24,231.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36,347.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26,655.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24,231.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10,526.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,070.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$38,609.08
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$9,936.00
|
| Rate for Payer: Cash Price |
$9,936.00
|
| Rate for Payer: Cash Price |
$9,936.00
|
| Rate for Payer: Central Health Plan Commercial |
$17,664.00
|
| Rate for Payer: Cigna of CA HMO |
$14,131.20
|
| Rate for Payer: Cigna of CA PPO |
$16,339.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36,347.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$26,655.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24,231.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$32,712.96
|
| Rate for Payer: EPIC Health Plan Senior |
$24,231.82
|
| Rate for Payer: Galaxy Health WC |
$18,768.00
|
| Rate for Payer: Global Benefits Group Commercial |
$13,248.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$19,872.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$39,740.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$500.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24,231.82
|
| Rate for Payer: InnovAge PACE Commercial |
$36,347.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,727.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$553.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24,231.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,416.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32,470.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32,470.64
|
| Rate for Payer: Multiplan Commercial |
$16,560.00
|
| Rate for Payer: Multiplan WC |
$38,609.08
|
| Rate for Payer: Networks By Design Commercial |
$14,352.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$24,231.82
|
| Rate for Payer: Preferred Health Network WC |
$39,397.02
|
| Rate for Payer: Prime Health Services Commercial |
$18,768.00
|
| Rate for Payer: Prime Health Services Medicare |
$25,685.73
|
| Rate for Payer: Prime Health Services WC |
$38,215.11
|
| Rate for Payer: Riverside University Health System MISP |
$26,655.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13,248.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$31,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$24,231.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36,347.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26,655.00
|
| Rate for Payer: Vantage Medical Group Senior |
$24,231.82
|
|
|
HC PACEMAKER INSERTION KIT
|
Facility
|
IP
|
$508.97
|
|
| Hospital Charge Code |
901698281
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.79 |
| Max. Negotiated Rate |
$458.07 |
| Rate for Payer: Adventist Health Commercial |
$101.79
|
| Rate for Payer: Cash Price |
$229.04
|
| Rate for Payer: Central Health Plan Commercial |
$407.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$203.59
|
| Rate for Payer: EPIC Health Plan Senior |
$203.59
|
| Rate for Payer: Galaxy Health WC |
$432.62
|
| Rate for Payer: Global Benefits Group Commercial |
$305.38
|
| Rate for Payer: Health Management Network EPO/PPO |
$458.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$339.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$193.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$315.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$101.79
|
| Rate for Payer: Multiplan Commercial |
$381.73
|
| Rate for Payer: Networks By Design Commercial |
$330.83
|
| Rate for Payer: Prime Health Services Commercial |
$432.62
|
|
|
HC PACEMAKER INSERTION KIT
|
Facility
|
OP
|
$508.97
|
|
| Hospital Charge Code |
901698281
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.79 |
| Max. Negotiated Rate |
$458.07 |
| Rate for Payer: Adventist Health Commercial |
$101.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$309.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$432.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$279.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$381.73
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$246.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$298.92
|
| Rate for Payer: Blue Shield of California Commercial |
$310.98
|
| Rate for Payer: Blue Shield of California EPN |
$203.08
|
| Rate for Payer: Cash Price |
$229.04
|
| Rate for Payer: Central Health Plan Commercial |
$407.18
|
| Rate for Payer: Cigna of CA HMO |
$325.74
|
| Rate for Payer: Cigna of CA PPO |
$376.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$432.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$432.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$432.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$203.59
|
| Rate for Payer: EPIC Health Plan Senior |
$203.59
|
| Rate for Payer: Galaxy Health WC |
$432.62
|
| Rate for Payer: Global Benefits Group Commercial |
$305.38
|
| Rate for Payer: Health Management Network EPO/PPO |
$458.07
|
| Rate for Payer: InnovAge PACE Commercial |
$254.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$339.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$193.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$315.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$101.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$356.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$356.28
|
| Rate for Payer: Multiplan Commercial |
$381.73
|
| Rate for Payer: Networks By Design Commercial |
$330.83
|
| Rate for Payer: Prime Health Services Commercial |
$432.62
|
| Rate for Payer: Riverside University Health System MISP |
$203.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$305.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$305.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$254.49
|
| Rate for Payer: United Healthcare All Other HMO |
$254.49
|
| Rate for Payer: United Healthcare HMO Rider |
$254.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$254.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$432.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$432.62
|
| Rate for Payer: Vantage Medical Group Senior |
$432.62
|
|
|
HC PACE MAKER MODEL KIT
|
Facility
|
OP
|
$265.44
|
|
| Hospital Charge Code |
901698277
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$53.09 |
| Max. Negotiated Rate |
$238.90 |
| Rate for Payer: Adventist Health Commercial |
$53.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$161.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$225.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$145.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$199.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$128.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$155.89
|
| Rate for Payer: Blue Shield of California Commercial |
$162.18
|
| Rate for Payer: Blue Shield of California EPN |
$105.91
|
| Rate for Payer: Cash Price |
$119.45
|
| Rate for Payer: Central Health Plan Commercial |
$212.35
|
| Rate for Payer: Cigna of CA HMO |
$169.88
|
| Rate for Payer: Cigna of CA PPO |
$196.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$225.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$225.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.18
|
| Rate for Payer: EPIC Health Plan Senior |
$106.18
|
| Rate for Payer: Galaxy Health WC |
$225.62
|
| Rate for Payer: Global Benefits Group Commercial |
$159.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$238.90
|
| Rate for Payer: InnovAge PACE Commercial |
$132.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$177.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$101.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$164.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$185.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$185.81
|
| Rate for Payer: Multiplan Commercial |
$199.08
|
| Rate for Payer: Networks By Design Commercial |
$172.54
|
| Rate for Payer: Prime Health Services Commercial |
$225.62
|
| Rate for Payer: Riverside University Health System MISP |
$106.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$159.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$159.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$132.72
|
| Rate for Payer: United Healthcare All Other HMO |
$132.72
|
| Rate for Payer: United Healthcare HMO Rider |
$132.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$132.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$225.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$225.62
|
| Rate for Payer: Vantage Medical Group Senior |
$225.62
|
|
|
HC PACE MAKER MODEL KIT
|
Facility
|
IP
|
$265.44
|
|
| Hospital Charge Code |
901698277
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$53.09 |
| Max. Negotiated Rate |
$238.90 |
| Rate for Payer: Adventist Health Commercial |
$53.09
|
| Rate for Payer: Cash Price |
$119.45
|
| Rate for Payer: Central Health Plan Commercial |
$212.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.18
|
| Rate for Payer: EPIC Health Plan Senior |
$106.18
|
| Rate for Payer: Galaxy Health WC |
$225.62
|
| Rate for Payer: Global Benefits Group Commercial |
$159.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$238.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$177.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$101.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$164.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.09
|
| Rate for Payer: Multiplan Commercial |
$199.08
|
| Rate for Payer: Networks By Design Commercial |
$172.54
|
| Rate for Payer: Prime Health Services Commercial |
$225.62
|
|
|
HC PACE MED ADAPTA ADDR01
|
Facility
|
IP
|
$9,570.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813578
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,914.00 |
| Max. Negotiated Rate |
$8,613.00 |
| Rate for Payer: Adventist Health Commercial |
$1,914.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,397.61
|
| Rate for Payer: Blue Shield of California EPN |
$4,823.28
|
| Rate for Payer: Cash Price |
$4,306.50
|
| Rate for Payer: Central Health Plan Commercial |
$7,656.00
|
| Rate for Payer: Cigna of CA HMO |
$6,699.00
|
| Rate for Payer: Cigna of CA PPO |
$6,699.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,828.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,828.00
|
| Rate for Payer: Galaxy Health WC |
$8,134.50
|
| Rate for Payer: Global Benefits Group Commercial |
$5,742.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,613.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,383.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,646.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,923.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,914.00
|
| Rate for Payer: Multiplan Commercial |
$7,177.50
|
| Rate for Payer: Networks By Design Commercial |
$4,785.00
|
| Rate for Payer: Prime Health Services Commercial |
$8,134.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,591.62
|
| Rate for Payer: United Healthcare All Other HMO |
$3,495.92
|
| Rate for Payer: United Healthcare HMO Rider |
$3,420.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,134.18
|
|
|
HC PACE MED ADAPTA ADDR01
|
Facility
|
OP
|
$9,570.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813578
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,914.00 |
| Max. Negotiated Rate |
$8,613.00 |
| Rate for Payer: Adventist Health Commercial |
$1,914.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,134.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,263.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,177.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,633.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,620.46
|
| Rate for Payer: Blue Shield of California Commercial |
$7,397.61
|
| Rate for Payer: Blue Shield of California EPN |
$4,823.28
|
| Rate for Payer: Cash Price |
$4,306.50
|
| Rate for Payer: Central Health Plan Commercial |
$7,656.00
|
| Rate for Payer: Cigna of CA HMO |
$6,699.00
|
| Rate for Payer: Cigna of CA PPO |
$6,699.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,134.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,134.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,134.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,828.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,828.00
|
| Rate for Payer: Galaxy Health WC |
$8,134.50
|
| Rate for Payer: Global Benefits Group Commercial |
$5,742.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,613.00
|
| Rate for Payer: InnovAge PACE Commercial |
$4,785.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,383.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,923.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,914.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,699.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,699.00
|
| Rate for Payer: Multiplan Commercial |
$7,177.50
|
| Rate for Payer: Networks By Design Commercial |
$4,785.00
|
| Rate for Payer: Prime Health Services Commercial |
$8,134.50
|
| Rate for Payer: Riverside University Health System MISP |
$3,828.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,742.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,742.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,591.62
|
| Rate for Payer: United Healthcare All Other HMO |
$3,495.92
|
| Rate for Payer: United Healthcare HMO Rider |
$3,420.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,134.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,134.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,134.50
|
| Rate for Payer: Vantage Medical Group Senior |
$8,134.50
|
|
|
HC PACE MED ADAPTA ADDR01
|
Facility
|
OP
|
$8,625.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813804
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,725.00 |
| Max. Negotiated Rate |
$7,762.50 |
| Rate for Payer: Adventist Health Commercial |
$1,725.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,331.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,743.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,468.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,176.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,065.46
|
| Rate for Payer: Blue Shield of California Commercial |
$6,667.12
|
| Rate for Payer: Blue Shield of California EPN |
$4,347.00
|
| Rate for Payer: Cash Price |
$3,881.25
|
| Rate for Payer: Central Health Plan Commercial |
$6,900.00
|
| Rate for Payer: Cigna of CA HMO |
$6,037.50
|
| Rate for Payer: Cigna of CA PPO |
$6,037.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,331.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,331.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,331.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,450.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,450.00
|
| Rate for Payer: Galaxy Health WC |
$7,331.25
|
| Rate for Payer: Global Benefits Group Commercial |
$5,175.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,762.50
|
| Rate for Payer: InnovAge PACE Commercial |
$4,312.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,752.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,338.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,725.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,037.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,037.50
|
| Rate for Payer: Multiplan Commercial |
$6,468.75
|
| Rate for Payer: Networks By Design Commercial |
$4,312.50
|
| Rate for Payer: Prime Health Services Commercial |
$7,331.25
|
| Rate for Payer: Riverside University Health System MISP |
$3,450.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,175.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,175.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,236.96
|
| Rate for Payer: United Healthcare All Other HMO |
$3,150.71
|
| Rate for Payer: United Healthcare HMO Rider |
$3,082.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,824.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,331.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,331.25
|
| Rate for Payer: Vantage Medical Group Senior |
$7,331.25
|
|
|
HC PACE MED ADAPTA ADDR01
|
Facility
|
IP
|
$8,625.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813804
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,725.00 |
| Max. Negotiated Rate |
$7,762.50 |
| Rate for Payer: Adventist Health Commercial |
$1,725.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,667.12
|
| Rate for Payer: Blue Shield of California EPN |
$4,347.00
|
| Rate for Payer: Cash Price |
$3,881.25
|
| Rate for Payer: Central Health Plan Commercial |
$6,900.00
|
| Rate for Payer: Cigna of CA HMO |
$6,037.50
|
| Rate for Payer: Cigna of CA PPO |
$6,037.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,450.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,450.00
|
| Rate for Payer: Galaxy Health WC |
$7,331.25
|
| Rate for Payer: Global Benefits Group Commercial |
$5,175.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,762.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,752.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,286.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,338.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,725.00
|
| Rate for Payer: Multiplan Commercial |
$6,468.75
|
| Rate for Payer: Networks By Design Commercial |
$4,312.50
|
| Rate for Payer: Prime Health Services Commercial |
$7,331.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,236.96
|
| Rate for Payer: United Healthcare All Other HMO |
$3,150.71
|
| Rate for Payer: United Healthcare HMO Rider |
$3,082.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,824.69
|
|
|
HC PACE MED ADAPTA ADDR06
|
Facility
|
OP
|
$9,570.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813586
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,914.00 |
| Max. Negotiated Rate |
$8,613.00 |
| Rate for Payer: Adventist Health Commercial |
$1,914.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,134.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,263.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,177.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,633.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,620.46
|
| Rate for Payer: Blue Shield of California Commercial |
$7,397.61
|
| Rate for Payer: Blue Shield of California EPN |
$4,823.28
|
| Rate for Payer: Cash Price |
$4,306.50
|
| Rate for Payer: Central Health Plan Commercial |
$7,656.00
|
| Rate for Payer: Cigna of CA HMO |
$6,699.00
|
| Rate for Payer: Cigna of CA PPO |
$6,699.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,134.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,134.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,134.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,828.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,828.00
|
| Rate for Payer: Galaxy Health WC |
$8,134.50
|
| Rate for Payer: Global Benefits Group Commercial |
$5,742.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,613.00
|
| Rate for Payer: InnovAge PACE Commercial |
$4,785.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,383.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,923.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,914.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,699.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,699.00
|
| Rate for Payer: Multiplan Commercial |
$7,177.50
|
| Rate for Payer: Networks By Design Commercial |
$4,785.00
|
| Rate for Payer: Prime Health Services Commercial |
$8,134.50
|
| Rate for Payer: Riverside University Health System MISP |
$3,828.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,742.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,742.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,591.62
|
| Rate for Payer: United Healthcare All Other HMO |
$3,495.92
|
| Rate for Payer: United Healthcare HMO Rider |
$3,420.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,134.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,134.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,134.50
|
| Rate for Payer: Vantage Medical Group Senior |
$8,134.50
|
|
|
HC PACE MED ADAPTA ADDR06
|
Facility
|
IP
|
$9,570.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813586
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,914.00 |
| Max. Negotiated Rate |
$8,613.00 |
| Rate for Payer: Adventist Health Commercial |
$1,914.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,397.61
|
| Rate for Payer: Blue Shield of California EPN |
$4,823.28
|
| Rate for Payer: Cash Price |
$4,306.50
|
| Rate for Payer: Central Health Plan Commercial |
$7,656.00
|
| Rate for Payer: Cigna of CA HMO |
$6,699.00
|
| Rate for Payer: Cigna of CA PPO |
$6,699.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,828.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,828.00
|
| Rate for Payer: Galaxy Health WC |
$8,134.50
|
| Rate for Payer: Global Benefits Group Commercial |
$5,742.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,613.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,383.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,646.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,923.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,914.00
|
| Rate for Payer: Multiplan Commercial |
$7,177.50
|
| Rate for Payer: Networks By Design Commercial |
$4,785.00
|
| Rate for Payer: Prime Health Services Commercial |
$8,134.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,591.62
|
| Rate for Payer: United Healthcare All Other HMO |
$3,495.92
|
| Rate for Payer: United Healthcare HMO Rider |
$3,420.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,134.18
|
|
|
HC PACE MED ADAPTA ADSR03
|
Facility
|
OP
|
$8,388.00
|
|
|
Service Code
|
CPT C1786
|
| Hospital Charge Code |
906813658
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,677.60 |
| Max. Negotiated Rate |
$7,549.20 |
| Rate for Payer: Adventist Health Commercial |
$1,677.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,129.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,613.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,291.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,061.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,926.27
|
| Rate for Payer: Blue Shield of California Commercial |
$6,483.92
|
| Rate for Payer: Blue Shield of California EPN |
$4,227.55
|
| Rate for Payer: Cash Price |
$3,774.60
|
| Rate for Payer: Central Health Plan Commercial |
$6,710.40
|
| Rate for Payer: Cigna of CA HMO |
$5,871.60
|
| Rate for Payer: Cigna of CA PPO |
$5,871.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,129.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,129.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,129.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,355.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,355.20
|
| Rate for Payer: Galaxy Health WC |
$7,129.80
|
| Rate for Payer: Global Benefits Group Commercial |
$5,032.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,549.20
|
| Rate for Payer: InnovAge PACE Commercial |
$4,194.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,594.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,192.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,677.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,871.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,871.60
|
| Rate for Payer: Multiplan Commercial |
$6,291.00
|
| Rate for Payer: Networks By Design Commercial |
$4,194.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,129.80
|
| Rate for Payer: Riverside University Health System MISP |
$3,355.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,032.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,032.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,148.02
|
| Rate for Payer: United Healthcare All Other HMO |
$3,064.14
|
| Rate for Payer: United Healthcare HMO Rider |
$2,997.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,747.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,129.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,129.80
|
| Rate for Payer: Vantage Medical Group Senior |
$7,129.80
|
|
|
HC PACE MED ADAPTA ADSR03
|
Facility
|
IP
|
$8,388.00
|
|
|
Service Code
|
CPT C1786
|
| Hospital Charge Code |
906813658
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,677.60 |
| Max. Negotiated Rate |
$7,549.20 |
| Rate for Payer: Adventist Health Commercial |
$1,677.60
|
| Rate for Payer: Blue Shield of California Commercial |
$6,483.92
|
| Rate for Payer: Blue Shield of California EPN |
$4,227.55
|
| Rate for Payer: Cash Price |
$3,774.60
|
| Rate for Payer: Central Health Plan Commercial |
$6,710.40
|
| Rate for Payer: Cigna of CA HMO |
$5,871.60
|
| Rate for Payer: Cigna of CA PPO |
$5,871.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,355.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,355.20
|
| Rate for Payer: Galaxy Health WC |
$7,129.80
|
| Rate for Payer: Global Benefits Group Commercial |
$5,032.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,549.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,594.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,195.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,192.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,677.60
|
| Rate for Payer: Multiplan Commercial |
$6,291.00
|
| Rate for Payer: Networks By Design Commercial |
$4,194.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,129.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,148.02
|
| Rate for Payer: United Healthcare All Other HMO |
$3,064.14
|
| Rate for Payer: United Healthcare HMO Rider |
$2,997.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,747.07
|
|
|
HC PACE MED ADAPTA ADSRO1
|
Facility
|
OP
|
$8,388.00
|
|
|
Service Code
|
CPT C1786
|
| Hospital Charge Code |
906813588
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,677.60 |
| Max. Negotiated Rate |
$7,549.20 |
| Rate for Payer: Adventist Health Commercial |
$1,677.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,129.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,613.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,291.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,061.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,926.27
|
| Rate for Payer: Blue Shield of California Commercial |
$6,483.92
|
| Rate for Payer: Blue Shield of California EPN |
$4,227.55
|
| Rate for Payer: Cash Price |
$3,774.60
|
| Rate for Payer: Central Health Plan Commercial |
$6,710.40
|
| Rate for Payer: Cigna of CA HMO |
$5,871.60
|
| Rate for Payer: Cigna of CA PPO |
$5,871.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,129.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,129.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,129.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,355.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,355.20
|
| Rate for Payer: Galaxy Health WC |
$7,129.80
|
| Rate for Payer: Global Benefits Group Commercial |
$5,032.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,549.20
|
| Rate for Payer: InnovAge PACE Commercial |
$4,194.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,594.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,192.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,677.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,871.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,871.60
|
| Rate for Payer: Multiplan Commercial |
$6,291.00
|
| Rate for Payer: Networks By Design Commercial |
$4,194.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,129.80
|
| Rate for Payer: Riverside University Health System MISP |
$3,355.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,032.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,032.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,148.02
|
| Rate for Payer: United Healthcare All Other HMO |
$3,064.14
|
| Rate for Payer: United Healthcare HMO Rider |
$2,997.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,747.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,129.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,129.80
|
| Rate for Payer: Vantage Medical Group Senior |
$7,129.80
|
|
|
HC PACE MED ADAPTA ADSRO1
|
Facility
|
IP
|
$8,388.00
|
|
|
Service Code
|
CPT C1786
|
| Hospital Charge Code |
906813588
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,677.60 |
| Max. Negotiated Rate |
$7,549.20 |
| Rate for Payer: Adventist Health Commercial |
$1,677.60
|
| Rate for Payer: Blue Shield of California Commercial |
$6,483.92
|
| Rate for Payer: Blue Shield of California EPN |
$4,227.55
|
| Rate for Payer: Cash Price |
$3,774.60
|
| Rate for Payer: Central Health Plan Commercial |
$6,710.40
|
| Rate for Payer: Cigna of CA HMO |
$5,871.60
|
| Rate for Payer: Cigna of CA PPO |
$5,871.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,355.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,355.20
|
| Rate for Payer: Galaxy Health WC |
$7,129.80
|
| Rate for Payer: Global Benefits Group Commercial |
$5,032.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,549.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,594.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,195.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,192.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,677.60
|
| Rate for Payer: Multiplan Commercial |
$6,291.00
|
| Rate for Payer: Networks By Design Commercial |
$4,194.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,129.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,148.02
|
| Rate for Payer: United Healthcare All Other HMO |
$3,064.14
|
| Rate for Payer: United Healthcare HMO Rider |
$2,997.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,747.07
|
|
|
HC PACE MED ADAPTA DR ADDR03
|
Facility
|
OP
|
$9,570.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813632
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,914.00 |
| Max. Negotiated Rate |
$8,613.00 |
| Rate for Payer: Adventist Health Commercial |
$1,914.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,134.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,263.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,177.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,633.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,620.46
|
| Rate for Payer: Blue Shield of California Commercial |
$7,397.61
|
| Rate for Payer: Blue Shield of California EPN |
$4,823.28
|
| Rate for Payer: Cash Price |
$4,306.50
|
| Rate for Payer: Central Health Plan Commercial |
$7,656.00
|
| Rate for Payer: Cigna of CA HMO |
$6,699.00
|
| Rate for Payer: Cigna of CA PPO |
$6,699.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,134.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,134.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,134.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,828.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,828.00
|
| Rate for Payer: Galaxy Health WC |
$8,134.50
|
| Rate for Payer: Global Benefits Group Commercial |
$5,742.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,613.00
|
| Rate for Payer: InnovAge PACE Commercial |
$4,785.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,383.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,923.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,914.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,699.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,699.00
|
| Rate for Payer: Multiplan Commercial |
$7,177.50
|
| Rate for Payer: Networks By Design Commercial |
$4,785.00
|
| Rate for Payer: Prime Health Services Commercial |
$8,134.50
|
| Rate for Payer: Riverside University Health System MISP |
$3,828.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,742.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,742.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,591.62
|
| Rate for Payer: United Healthcare All Other HMO |
$3,495.92
|
| Rate for Payer: United Healthcare HMO Rider |
$3,420.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,134.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,134.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,134.50
|
| Rate for Payer: Vantage Medical Group Senior |
$8,134.50
|
|
|
HC PACE MED ADAPTA DR ADDR03
|
Facility
|
IP
|
$9,570.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813632
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,914.00 |
| Max. Negotiated Rate |
$8,613.00 |
| Rate for Payer: Adventist Health Commercial |
$1,914.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,397.61
|
| Rate for Payer: Blue Shield of California EPN |
$4,823.28
|
| Rate for Payer: Cash Price |
$4,306.50
|
| Rate for Payer: Central Health Plan Commercial |
$7,656.00
|
| Rate for Payer: Cigna of CA HMO |
$6,699.00
|
| Rate for Payer: Cigna of CA PPO |
$6,699.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,828.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,828.00
|
| Rate for Payer: Galaxy Health WC |
$8,134.50
|
| Rate for Payer: Global Benefits Group Commercial |
$5,742.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,613.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,383.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,646.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,923.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,914.00
|
| Rate for Payer: Multiplan Commercial |
$7,177.50
|
| Rate for Payer: Networks By Design Commercial |
$4,785.00
|
| Rate for Payer: Prime Health Services Commercial |
$8,134.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,591.62
|
| Rate for Payer: United Healthcare All Other HMO |
$3,495.92
|
| Rate for Payer: United Healthcare HMO Rider |
$3,420.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,134.18
|
|
|
HC PACE MED ADAPTA L ADDRL1
|
Facility
|
OP
|
$9,570.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813579
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,914.00 |
| Max. Negotiated Rate |
$8,613.00 |
| Rate for Payer: Adventist Health Commercial |
$1,914.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,134.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,263.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,177.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,633.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,620.46
|
| Rate for Payer: Blue Shield of California Commercial |
$7,397.61
|
| Rate for Payer: Blue Shield of California EPN |
$4,823.28
|
| Rate for Payer: Cash Price |
$4,306.50
|
| Rate for Payer: Central Health Plan Commercial |
$7,656.00
|
| Rate for Payer: Cigna of CA HMO |
$6,699.00
|
| Rate for Payer: Cigna of CA PPO |
$6,699.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,134.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,134.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,134.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,828.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,828.00
|
| Rate for Payer: Galaxy Health WC |
$8,134.50
|
| Rate for Payer: Global Benefits Group Commercial |
$5,742.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,613.00
|
| Rate for Payer: InnovAge PACE Commercial |
$4,785.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,383.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,923.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,914.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,699.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,699.00
|
| Rate for Payer: Multiplan Commercial |
$7,177.50
|
| Rate for Payer: Networks By Design Commercial |
$4,785.00
|
| Rate for Payer: Prime Health Services Commercial |
$8,134.50
|
| Rate for Payer: Riverside University Health System MISP |
$3,828.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,742.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,742.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,591.62
|
| Rate for Payer: United Healthcare All Other HMO |
$3,495.92
|
| Rate for Payer: United Healthcare HMO Rider |
$3,420.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,134.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,134.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,134.50
|
| Rate for Payer: Vantage Medical Group Senior |
$8,134.50
|
|
|
HC PACE MED ADAPTA L ADDRL1
|
Facility
|
IP
|
$9,570.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813579
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,914.00 |
| Max. Negotiated Rate |
$8,613.00 |
| Rate for Payer: Adventist Health Commercial |
$1,914.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,397.61
|
| Rate for Payer: Blue Shield of California EPN |
$4,823.28
|
| Rate for Payer: Cash Price |
$4,306.50
|
| Rate for Payer: Central Health Plan Commercial |
$7,656.00
|
| Rate for Payer: Cigna of CA HMO |
$6,699.00
|
| Rate for Payer: Cigna of CA PPO |
$6,699.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,828.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,828.00
|
| Rate for Payer: Galaxy Health WC |
$8,134.50
|
| Rate for Payer: Global Benefits Group Commercial |
$5,742.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,613.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,383.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,646.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,923.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,914.00
|
| Rate for Payer: Multiplan Commercial |
$7,177.50
|
| Rate for Payer: Networks By Design Commercial |
$4,785.00
|
| Rate for Payer: Prime Health Services Commercial |
$8,134.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,591.62
|
| Rate for Payer: United Healthcare All Other HMO |
$3,495.92
|
| Rate for Payer: United Healthcare HMO Rider |
$3,420.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,134.18
|
|
|
HC PACE MED ADAPTA S ADDRS1
|
Facility
|
OP
|
$9,570.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813583
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,914.00 |
| Max. Negotiated Rate |
$8,613.00 |
| Rate for Payer: Adventist Health Commercial |
$1,914.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,134.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,263.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,177.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,633.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,620.46
|
| Rate for Payer: Blue Shield of California Commercial |
$7,397.61
|
| Rate for Payer: Blue Shield of California EPN |
$4,823.28
|
| Rate for Payer: Cash Price |
$4,306.50
|
| Rate for Payer: Central Health Plan Commercial |
$7,656.00
|
| Rate for Payer: Cigna of CA HMO |
$6,699.00
|
| Rate for Payer: Cigna of CA PPO |
$6,699.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,134.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,134.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,134.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,828.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,828.00
|
| Rate for Payer: Galaxy Health WC |
$8,134.50
|
| Rate for Payer: Global Benefits Group Commercial |
$5,742.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,613.00
|
| Rate for Payer: InnovAge PACE Commercial |
$4,785.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,383.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,923.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,914.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,699.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,699.00
|
| Rate for Payer: Multiplan Commercial |
$7,177.50
|
| Rate for Payer: Networks By Design Commercial |
$4,785.00
|
| Rate for Payer: Prime Health Services Commercial |
$8,134.50
|
| Rate for Payer: Riverside University Health System MISP |
$3,828.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,742.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,742.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,591.62
|
| Rate for Payer: United Healthcare All Other HMO |
$3,495.92
|
| Rate for Payer: United Healthcare HMO Rider |
$3,420.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,134.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,134.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,134.50
|
| Rate for Payer: Vantage Medical Group Senior |
$8,134.50
|
|
|
HC PACE MED ADAPTA S ADDRS1
|
Facility
|
IP
|
$9,570.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813583
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,914.00 |
| Max. Negotiated Rate |
$8,613.00 |
| Rate for Payer: Adventist Health Commercial |
$1,914.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,397.61
|
| Rate for Payer: Blue Shield of California EPN |
$4,823.28
|
| Rate for Payer: Cash Price |
$4,306.50
|
| Rate for Payer: Central Health Plan Commercial |
$7,656.00
|
| Rate for Payer: Cigna of CA HMO |
$6,699.00
|
| Rate for Payer: Cigna of CA PPO |
$6,699.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,828.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,828.00
|
| Rate for Payer: Galaxy Health WC |
$8,134.50
|
| Rate for Payer: Global Benefits Group Commercial |
$5,742.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,613.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,383.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,646.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,923.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,914.00
|
| Rate for Payer: Multiplan Commercial |
$7,177.50
|
| Rate for Payer: Networks By Design Commercial |
$4,785.00
|
| Rate for Payer: Prime Health Services Commercial |
$8,134.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,591.62
|
| Rate for Payer: United Healthcare All Other HMO |
$3,495.92
|
| Rate for Payer: United Healthcare HMO Rider |
$3,420.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,134.18
|
|
|
HC PACE MED ADVISA DR MRI A2DR01
|
Facility
|
IP
|
$11,000.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813694
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,200.00 |
| Max. Negotiated Rate |
$9,900.00 |
| Rate for Payer: Adventist Health Commercial |
$2,200.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,503.00
|
| Rate for Payer: Blue Shield of California EPN |
$5,544.00
|
| Rate for Payer: Cash Price |
$4,950.00
|
| Rate for Payer: Central Health Plan Commercial |
$8,800.00
|
| Rate for Payer: Cigna of CA HMO |
$7,700.00
|
| Rate for Payer: Cigna of CA PPO |
$7,700.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,400.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,400.00
|
| Rate for Payer: Galaxy Health WC |
$9,350.00
|
| Rate for Payer: Global Benefits Group Commercial |
$6,600.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,900.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,337.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,191.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,809.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,200.00
|
| Rate for Payer: Multiplan Commercial |
$8,250.00
|
| Rate for Payer: Networks By Design Commercial |
$5,500.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,350.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,128.30
|
| Rate for Payer: United Healthcare All Other HMO |
$4,018.30
|
| Rate for Payer: United Healthcare HMO Rider |
$3,931.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,602.50
|
|
|
HC PACE MED ADVISA DR MRI A2DR01
|
Facility
|
OP
|
$11,000.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813694
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,200.00 |
| Max. Negotiated Rate |
$9,900.00 |
| Rate for Payer: Adventist Health Commercial |
$2,200.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,350.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,050.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,250.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,326.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,460.30
|
| Rate for Payer: Blue Shield of California Commercial |
$8,503.00
|
| Rate for Payer: Blue Shield of California EPN |
$5,544.00
|
| Rate for Payer: Cash Price |
$4,950.00
|
| Rate for Payer: Central Health Plan Commercial |
$8,800.00
|
| Rate for Payer: Cigna of CA HMO |
$7,700.00
|
| Rate for Payer: Cigna of CA PPO |
$7,700.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,350.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,350.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,350.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,400.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,400.00
|
| Rate for Payer: Galaxy Health WC |
$9,350.00
|
| Rate for Payer: Global Benefits Group Commercial |
$6,600.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,900.00
|
| Rate for Payer: InnovAge PACE Commercial |
$5,500.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,337.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,809.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,200.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,700.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,700.00
|
| Rate for Payer: Multiplan Commercial |
$8,250.00
|
| Rate for Payer: Networks By Design Commercial |
$5,500.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,350.00
|
| Rate for Payer: Riverside University Health System MISP |
$4,400.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,600.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,600.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,128.30
|
| Rate for Payer: United Healthcare All Other HMO |
$4,018.30
|
| Rate for Payer: United Healthcare HMO Rider |
$3,931.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,602.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,350.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,350.00
|
| Rate for Payer: Vantage Medical Group Senior |
$9,350.00
|
|
