|
HC PACE MED ADVISA MRI A3SR01
|
Facility
|
OP
|
$10,638.00
|
|
|
Service Code
|
CPT C1786
|
| Hospital Charge Code |
906813754
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,127.60 |
| Max. Negotiated Rate |
$9,574.20 |
| Rate for Payer: Adventist Health Commercial |
$2,127.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,042.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,850.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,978.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,150.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,247.70
|
| Rate for Payer: Blue Shield of California Commercial |
$8,223.17
|
| Rate for Payer: Blue Shield of California EPN |
$5,361.55
|
| Rate for Payer: Cash Price |
$4,787.10
|
| Rate for Payer: Central Health Plan Commercial |
$8,510.40
|
| Rate for Payer: Cigna of CA HMO |
$7,446.60
|
| Rate for Payer: Cigna of CA PPO |
$7,446.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,042.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,042.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,042.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,255.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,255.20
|
| Rate for Payer: Galaxy Health WC |
$9,042.30
|
| Rate for Payer: Global Benefits Group Commercial |
$6,382.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,574.20
|
| Rate for Payer: InnovAge PACE Commercial |
$5,319.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,095.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,584.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,127.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,446.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,446.60
|
| Rate for Payer: Multiplan Commercial |
$7,978.50
|
| Rate for Payer: Networks By Design Commercial |
$5,319.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,042.30
|
| Rate for Payer: Riverside University Health System MISP |
$4,255.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,382.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,382.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,992.44
|
| Rate for Payer: United Healthcare All Other HMO |
$3,886.06
|
| Rate for Payer: United Healthcare HMO Rider |
$3,802.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,483.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,042.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,042.30
|
| Rate for Payer: Vantage Medical Group Senior |
$9,042.30
|
|
|
HC PACE MED ADVISA MRI A3SR01
|
Facility
|
IP
|
$10,638.00
|
|
|
Service Code
|
CPT C1786
|
| Hospital Charge Code |
906813754
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,127.60 |
| Max. Negotiated Rate |
$9,574.20 |
| Rate for Payer: Adventist Health Commercial |
$2,127.60
|
| Rate for Payer: Blue Shield of California Commercial |
$8,223.17
|
| Rate for Payer: Blue Shield of California EPN |
$5,361.55
|
| Rate for Payer: Cash Price |
$4,787.10
|
| Rate for Payer: Central Health Plan Commercial |
$8,510.40
|
| Rate for Payer: Cigna of CA HMO |
$7,446.60
|
| Rate for Payer: Cigna of CA PPO |
$7,446.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,255.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,255.20
|
| Rate for Payer: Galaxy Health WC |
$9,042.30
|
| Rate for Payer: Global Benefits Group Commercial |
$6,382.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,574.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,095.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,053.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,584.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,127.60
|
| Rate for Payer: Multiplan Commercial |
$7,978.50
|
| Rate for Payer: Networks By Design Commercial |
$5,319.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,042.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,992.44
|
| Rate for Payer: United Healthcare All Other HMO |
$3,886.06
|
| Rate for Payer: United Healthcare HMO Rider |
$3,802.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,483.95
|
|
|
HC PACE MED AZURA DR MRI W3DR01
|
Facility
|
OP
|
$11,000.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813814
|
|
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
|
|
|
HC PACE MED AZURA DR MRI W3DR01
|
Facility
|
IP
|
$11,000.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813814
|
|
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 AZURE S SR MRI W3SR01
|
Facility
|
IP
|
$10,938.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813822
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,187.60 |
| Max. Negotiated Rate |
$9,844.20 |
| Rate for Payer: Adventist Health Commercial |
$2,187.60
|
| Rate for Payer: Blue Shield of California Commercial |
$8,455.07
|
| Rate for Payer: Blue Shield of California EPN |
$5,512.75
|
| Rate for Payer: Cash Price |
$4,922.10
|
| Rate for Payer: Central Health Plan Commercial |
$8,750.40
|
| Rate for Payer: Cigna of CA HMO |
$7,656.60
|
| Rate for Payer: Cigna of CA PPO |
$7,656.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,375.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,375.20
|
| Rate for Payer: Galaxy Health WC |
$9,297.30
|
| Rate for Payer: Global Benefits Group Commercial |
$6,562.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,844.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,295.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,167.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,770.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,187.60
|
| Rate for Payer: Multiplan Commercial |
$8,203.50
|
| Rate for Payer: Networks By Design Commercial |
$5,469.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,297.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,105.03
|
| Rate for Payer: United Healthcare All Other HMO |
$3,995.65
|
| Rate for Payer: United Healthcare HMO Rider |
$3,909.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,582.20
|
|
|
HC PACE MED AZURE S SR MRI W3SR01
|
Facility
|
OP
|
$10,938.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813822
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,187.60 |
| Max. Negotiated Rate |
$9,844.20 |
| Rate for Payer: Adventist Health Commercial |
$2,187.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,297.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,015.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,203.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,296.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,423.89
|
| Rate for Payer: Blue Shield of California Commercial |
$8,455.07
|
| Rate for Payer: Blue Shield of California EPN |
$5,512.75
|
| Rate for Payer: Cash Price |
$4,922.10
|
| Rate for Payer: Central Health Plan Commercial |
$8,750.40
|
| Rate for Payer: Cigna of CA HMO |
$7,656.60
|
| Rate for Payer: Cigna of CA PPO |
$7,656.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,297.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,297.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,297.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,375.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,375.20
|
| Rate for Payer: Galaxy Health WC |
$9,297.30
|
| Rate for Payer: Global Benefits Group Commercial |
$6,562.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,844.20
|
| Rate for Payer: InnovAge PACE Commercial |
$5,469.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,295.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,770.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,187.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,656.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,656.60
|
| Rate for Payer: Multiplan Commercial |
$8,203.50
|
| Rate for Payer: Networks By Design Commercial |
$5,469.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,297.30
|
| Rate for Payer: Riverside University Health System MISP |
$4,375.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,562.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,562.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,105.03
|
| Rate for Payer: United Healthcare All Other HMO |
$3,995.65
|
| Rate for Payer: United Healthcare HMO Rider |
$3,909.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,582.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,297.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,297.30
|
| Rate for Payer: Vantage Medical Group Senior |
$9,297.30
|
|
|
HC PACE MED CONSULTA C4TR01
|
Facility
|
OP
|
$18,208.00
|
|
|
Service Code
|
CPT C2621
|
| Hospital Charge Code |
906813646
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,641.60 |
| Max. Negotiated Rate |
$16,387.20 |
| Rate for Payer: Adventist Health Commercial |
$3,641.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15,476.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,014.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,656.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8,816.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,693.56
|
| Rate for Payer: Blue Shield of California Commercial |
$14,074.78
|
| Rate for Payer: Blue Shield of California EPN |
$9,176.83
|
| Rate for Payer: Cash Price |
$8,193.60
|
| Rate for Payer: Central Health Plan Commercial |
$14,566.40
|
| Rate for Payer: Cigna of CA HMO |
$12,745.60
|
| Rate for Payer: Cigna of CA PPO |
$12,745.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15,476.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,476.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15,476.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,283.20
|
| Rate for Payer: EPIC Health Plan Senior |
$7,283.20
|
| Rate for Payer: Galaxy Health WC |
$15,476.80
|
| Rate for Payer: Global Benefits Group Commercial |
$10,924.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$16,387.20
|
| Rate for Payer: InnovAge PACE Commercial |
$9,104.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,144.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,270.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,641.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12,745.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12,745.60
|
| Rate for Payer: Multiplan Commercial |
$13,656.00
|
| Rate for Payer: Networks By Design Commercial |
$9,104.00
|
| Rate for Payer: Prime Health Services Commercial |
$15,476.80
|
| Rate for Payer: Riverside University Health System MISP |
$7,283.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,924.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10,924.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,833.46
|
| Rate for Payer: United Healthcare All Other HMO |
$6,651.38
|
| Rate for Payer: United Healthcare HMO Rider |
$6,507.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,963.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15,476.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,476.80
|
| Rate for Payer: Vantage Medical Group Senior |
$15,476.80
|
|
|
HC PACE MED CONSULTA C4TR01
|
Facility
|
IP
|
$18,208.00
|
|
|
Service Code
|
CPT C2621
|
| Hospital Charge Code |
906813646
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,641.60 |
| Max. Negotiated Rate |
$16,387.20 |
| Rate for Payer: Adventist Health Commercial |
$3,641.60
|
| Rate for Payer: Blue Shield of California Commercial |
$14,074.78
|
| Rate for Payer: Blue Shield of California EPN |
$9,176.83
|
| Rate for Payer: Cash Price |
$8,193.60
|
| Rate for Payer: Central Health Plan Commercial |
$14,566.40
|
| Rate for Payer: Cigna of CA HMO |
$12,745.60
|
| Rate for Payer: Cigna of CA PPO |
$12,745.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,283.20
|
| Rate for Payer: EPIC Health Plan Senior |
$7,283.20
|
| Rate for Payer: Galaxy Health WC |
$15,476.80
|
| Rate for Payer: Global Benefits Group Commercial |
$10,924.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$16,387.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,144.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,937.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,270.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,641.60
|
| Rate for Payer: Multiplan Commercial |
$13,656.00
|
| Rate for Payer: Networks By Design Commercial |
$9,104.00
|
| Rate for Payer: Prime Health Services Commercial |
$15,476.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,833.46
|
| Rate for Payer: United Healthcare All Other HMO |
$6,651.38
|
| Rate for Payer: United Healthcare HMO Rider |
$6,507.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,963.12
|
|
|
HC PACE MED MICRA TC SYS MC1VRO1
|
Facility
|
IP
|
$25,000.00
|
|
|
Service Code
|
CPT C1786
|
| Hospital Charge Code |
906813823
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$5,000.00 |
| Max. Negotiated Rate |
$22,500.00 |
| Rate for Payer: Adventist Health Commercial |
$5,000.00
|
| Rate for Payer: Blue Shield of California Commercial |
$19,325.00
|
| Rate for Payer: Blue Shield of California EPN |
$12,600.00
|
| Rate for Payer: Cash Price |
$11,250.00
|
| Rate for Payer: Central Health Plan Commercial |
$20,000.00
|
| Rate for Payer: Cigna of CA HMO |
$17,500.00
|
| Rate for Payer: Cigna of CA PPO |
$17,500.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10,000.00
|
| Rate for Payer: Galaxy Health WC |
$21,250.00
|
| Rate for Payer: Global Benefits Group Commercial |
$15,000.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22,500.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,675.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,525.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,475.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,000.00
|
| Rate for Payer: Multiplan Commercial |
$18,750.00
|
| Rate for Payer: Networks By Design Commercial |
$12,500.00
|
| Rate for Payer: Prime Health Services Commercial |
$21,250.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,382.50
|
| Rate for Payer: United Healthcare All Other HMO |
$9,132.50
|
| Rate for Payer: United Healthcare HMO Rider |
$8,935.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,187.50
|
|
|
HC PACE MED MICRA TC SYS MC1VRO1
|
Facility
|
OP
|
$25,000.00
|
|
|
Service Code
|
CPT C1786
|
| Hospital Charge Code |
906813823
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$5,000.00 |
| Max. Negotiated Rate |
$22,500.00 |
| Rate for Payer: Adventist Health Commercial |
$5,000.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,250.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13,750.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18,750.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$12,105.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,682.50
|
| Rate for Payer: Blue Shield of California Commercial |
$19,325.00
|
| Rate for Payer: Blue Shield of California EPN |
$12,600.00
|
| Rate for Payer: Cash Price |
$11,250.00
|
| Rate for Payer: Central Health Plan Commercial |
$20,000.00
|
| Rate for Payer: Cigna of CA HMO |
$17,500.00
|
| Rate for Payer: Cigna of CA PPO |
$17,500.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,250.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$21,250.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21,250.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10,000.00
|
| Rate for Payer: Galaxy Health WC |
$21,250.00
|
| Rate for Payer: Global Benefits Group Commercial |
$15,000.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22,500.00
|
| Rate for Payer: InnovAge PACE Commercial |
$12,500.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,675.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,475.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,000.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,500.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17,500.00
|
| Rate for Payer: Multiplan Commercial |
$18,750.00
|
| Rate for Payer: Networks By Design Commercial |
$12,500.00
|
| Rate for Payer: Prime Health Services Commercial |
$21,250.00
|
| Rate for Payer: Riverside University Health System MISP |
$10,000.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15,000.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15,000.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,382.50
|
| Rate for Payer: United Healthcare All Other HMO |
$9,132.50
|
| Rate for Payer: United Healthcare HMO Rider |
$8,935.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,187.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,250.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21,250.00
|
| Rate for Payer: Vantage Medical Group Senior |
$21,250.00
|
|
|
HC PACE MED REVO MRI RVDR01
|
Facility
|
IP
|
$12,850.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813644
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,570.00 |
| Max. Negotiated Rate |
$11,565.00 |
| Rate for Payer: Adventist Health Commercial |
$2,570.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,933.05
|
| Rate for Payer: Blue Shield of California EPN |
$6,476.40
|
| Rate for Payer: Cash Price |
$5,782.50
|
| Rate for Payer: Central Health Plan Commercial |
$10,280.00
|
| Rate for Payer: Cigna of CA HMO |
$8,995.00
|
| Rate for Payer: Cigna of CA PPO |
$8,995.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,140.00
|
| Rate for Payer: Galaxy Health WC |
$10,922.50
|
| Rate for Payer: Global Benefits Group Commercial |
$7,710.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,565.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,570.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,895.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,954.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,570.00
|
| Rate for Payer: Multiplan Commercial |
$9,637.50
|
| Rate for Payer: Networks By Design Commercial |
$6,425.00
|
| Rate for Payer: Prime Health Services Commercial |
$10,922.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,822.60
|
| Rate for Payer: United Healthcare All Other HMO |
$4,694.10
|
| Rate for Payer: United Healthcare HMO Rider |
$4,592.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,208.38
|
|
|
HC PACE MED REVO MRI RVDR01
|
Facility
|
OP
|
$12,850.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813644
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,570.00 |
| Max. Negotiated Rate |
$11,565.00 |
| Rate for Payer: Adventist Health Commercial |
$2,570.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,922.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,067.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,637.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,221.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,546.81
|
| Rate for Payer: Blue Shield of California Commercial |
$9,933.05
|
| Rate for Payer: Blue Shield of California EPN |
$6,476.40
|
| Rate for Payer: Cash Price |
$5,782.50
|
| Rate for Payer: Central Health Plan Commercial |
$10,280.00
|
| Rate for Payer: Cigna of CA HMO |
$8,995.00
|
| Rate for Payer: Cigna of CA PPO |
$8,995.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,922.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,922.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,922.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,140.00
|
| Rate for Payer: Galaxy Health WC |
$10,922.50
|
| Rate for Payer: Global Benefits Group Commercial |
$7,710.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,565.00
|
| Rate for Payer: InnovAge PACE Commercial |
$6,425.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,570.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,954.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,570.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,995.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,995.00
|
| Rate for Payer: Multiplan Commercial |
$9,637.50
|
| Rate for Payer: Networks By Design Commercial |
$6,425.00
|
| Rate for Payer: Prime Health Services Commercial |
$10,922.50
|
| Rate for Payer: Riverside University Health System MISP |
$5,140.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,710.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,710.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,822.60
|
| Rate for Payer: United Healthcare All Other HMO |
$4,694.10
|
| Rate for Payer: United Healthcare HMO Rider |
$4,592.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,208.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,922.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,922.50
|
| Rate for Payer: Vantage Medical Group Senior |
$10,922.50
|
|
|
HC PACE MED SENSIA DR SEDR01
|
Facility
|
IP
|
$7,635.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813580
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,527.00 |
| Max. Negotiated Rate |
$6,871.50 |
| Rate for Payer: Adventist Health Commercial |
$1,527.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,901.85
|
| Rate for Payer: Blue Shield of California EPN |
$3,848.04
|
| Rate for Payer: Cash Price |
$3,435.75
|
| Rate for Payer: Central Health Plan Commercial |
$6,108.00
|
| Rate for Payer: Cigna of CA HMO |
$5,344.50
|
| Rate for Payer: Cigna of CA PPO |
$5,344.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,054.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,054.00
|
| Rate for Payer: Galaxy Health WC |
$6,489.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4,581.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,871.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,092.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,908.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,726.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,527.00
|
| Rate for Payer: Multiplan Commercial |
$5,726.25
|
| Rate for Payer: Networks By Design Commercial |
$3,817.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,489.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,865.42
|
| Rate for Payer: United Healthcare All Other HMO |
$2,789.07
|
| Rate for Payer: United Healthcare HMO Rider |
$2,728.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,500.46
|
|
|
HC PACE MED SENSIA DR SEDR01
|
Facility
|
OP
|
$7,635.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813580
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,527.00 |
| Max. Negotiated Rate |
$6,871.50 |
| Rate for Payer: Adventist Health Commercial |
$1,527.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,489.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,199.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,726.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,696.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,484.04
|
| Rate for Payer: Blue Shield of California Commercial |
$5,901.85
|
| Rate for Payer: Blue Shield of California EPN |
$3,848.04
|
| Rate for Payer: Cash Price |
$3,435.75
|
| Rate for Payer: Central Health Plan Commercial |
$6,108.00
|
| Rate for Payer: Cigna of CA HMO |
$5,344.50
|
| Rate for Payer: Cigna of CA PPO |
$5,344.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,489.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,489.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,489.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,054.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,054.00
|
| Rate for Payer: Galaxy Health WC |
$6,489.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4,581.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,871.50
|
| Rate for Payer: InnovAge PACE Commercial |
$3,817.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,092.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,726.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,527.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,344.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,344.50
|
| Rate for Payer: Multiplan Commercial |
$5,726.25
|
| Rate for Payer: Networks By Design Commercial |
$3,817.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,489.75
|
| Rate for Payer: Riverside University Health System MISP |
$3,054.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,581.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,581.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,865.42
|
| Rate for Payer: United Healthcare All Other HMO |
$2,789.07
|
| Rate for Payer: United Healthcare HMO Rider |
$2,728.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,500.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,489.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,489.75
|
| Rate for Payer: Vantage Medical Group Senior |
$6,489.75
|
|
|
HC PACE MED SENSIA SR SESR01
|
Facility
|
IP
|
$7,130.00
|
|
|
Service Code
|
CPT C1786
|
| Hospital Charge Code |
906813590
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,426.00 |
| Max. Negotiated Rate |
$6,417.00 |
| Rate for Payer: Adventist Health Commercial |
$1,426.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,511.49
|
| Rate for Payer: Blue Shield of California EPN |
$3,593.52
|
| Rate for Payer: Cash Price |
$3,208.50
|
| Rate for Payer: Central Health Plan Commercial |
$5,704.00
|
| Rate for Payer: Cigna of CA HMO |
$4,991.00
|
| Rate for Payer: Cigna of CA PPO |
$4,991.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,852.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,852.00
|
| Rate for Payer: Galaxy Health WC |
$6,060.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,278.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,417.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,755.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,716.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,413.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,426.00
|
| Rate for Payer: Multiplan Commercial |
$5,347.50
|
| Rate for Payer: Networks By Design Commercial |
$3,565.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,060.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,675.89
|
| Rate for Payer: United Healthcare All Other HMO |
$2,604.59
|
| Rate for Payer: United Healthcare HMO Rider |
$2,548.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,335.07
|
|
|
HC PACE MED SENSIA SR SESR01
|
Facility
|
OP
|
$7,130.00
|
|
|
Service Code
|
CPT C1786
|
| Hospital Charge Code |
906813590
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,426.00 |
| Max. Negotiated Rate |
$6,417.00 |
| Rate for Payer: Adventist Health Commercial |
$1,426.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,060.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,921.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,347.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,452.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,187.45
|
| Rate for Payer: Blue Shield of California Commercial |
$5,511.49
|
| Rate for Payer: Blue Shield of California EPN |
$3,593.52
|
| Rate for Payer: Cash Price |
$3,208.50
|
| Rate for Payer: Central Health Plan Commercial |
$5,704.00
|
| Rate for Payer: Cigna of CA HMO |
$4,991.00
|
| Rate for Payer: Cigna of CA PPO |
$4,991.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,060.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,060.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,060.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,852.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,852.00
|
| Rate for Payer: Galaxy Health WC |
$6,060.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,278.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,417.00
|
| Rate for Payer: InnovAge PACE Commercial |
$3,565.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,755.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,413.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,426.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,991.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,991.00
|
| Rate for Payer: Multiplan Commercial |
$5,347.50
|
| Rate for Payer: Networks By Design Commercial |
$3,565.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,060.50
|
| Rate for Payer: Riverside University Health System MISP |
$2,852.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,278.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,278.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,675.89
|
| Rate for Payer: United Healthcare All Other HMO |
$2,604.59
|
| Rate for Payer: United Healthcare HMO Rider |
$2,548.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,335.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,060.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,060.50
|
| Rate for Payer: Vantage Medical Group Senior |
$6,060.50
|
|
|
HC PACE MED SOLARA W1TR03
|
Facility
|
IP
|
$23,750.00
|
|
|
Service Code
|
CPT C2621
|
| Hospital Charge Code |
906813813
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$4,750.00 |
| Max. Negotiated Rate |
$21,375.00 |
| Rate for Payer: Adventist Health Commercial |
$4,750.00
|
| Rate for Payer: Blue Shield of California Commercial |
$18,358.75
|
| Rate for Payer: Blue Shield of California EPN |
$11,970.00
|
| Rate for Payer: Cash Price |
$10,687.50
|
| Rate for Payer: Central Health Plan Commercial |
$19,000.00
|
| Rate for Payer: Cigna of CA HMO |
$16,625.00
|
| Rate for Payer: Cigna of CA PPO |
$16,625.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,500.00
|
| Rate for Payer: EPIC Health Plan Senior |
$9,500.00
|
| Rate for Payer: Galaxy Health WC |
$20,187.50
|
| Rate for Payer: Global Benefits Group Commercial |
$14,250.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$21,375.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15,841.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,048.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,701.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,750.00
|
| Rate for Payer: Multiplan Commercial |
$17,812.50
|
| Rate for Payer: Networks By Design Commercial |
$11,875.00
|
| Rate for Payer: Prime Health Services Commercial |
$20,187.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,913.38
|
| Rate for Payer: United Healthcare All Other HMO |
$8,675.88
|
| Rate for Payer: United Healthcare HMO Rider |
$8,488.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,778.12
|
|
|
HC PACE MED SOLARA W1TR03
|
Facility
|
OP
|
$23,750.00
|
|
|
Service Code
|
CPT C2621
|
| Hospital Charge Code |
906813813
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$4,750.00 |
| Max. Negotiated Rate |
$21,375.00 |
| Rate for Payer: Adventist Health Commercial |
$4,750.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20,187.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13,062.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17,812.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,499.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,948.38
|
| Rate for Payer: Blue Shield of California Commercial |
$18,358.75
|
| Rate for Payer: Blue Shield of California EPN |
$11,970.00
|
| Rate for Payer: Cash Price |
$10,687.50
|
| Rate for Payer: Central Health Plan Commercial |
$19,000.00
|
| Rate for Payer: Cigna of CA HMO |
$16,625.00
|
| Rate for Payer: Cigna of CA PPO |
$16,625.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20,187.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$20,187.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20,187.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,500.00
|
| Rate for Payer: EPIC Health Plan Senior |
$9,500.00
|
| Rate for Payer: Galaxy Health WC |
$20,187.50
|
| Rate for Payer: Global Benefits Group Commercial |
$14,250.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$21,375.00
|
| Rate for Payer: InnovAge PACE Commercial |
$11,875.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15,841.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,701.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,750.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16,625.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16,625.00
|
| Rate for Payer: Multiplan Commercial |
$17,812.50
|
| Rate for Payer: Networks By Design Commercial |
$11,875.00
|
| Rate for Payer: Prime Health Services Commercial |
$20,187.50
|
| Rate for Payer: Riverside University Health System MISP |
$9,500.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14,250.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14,250.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,913.38
|
| Rate for Payer: United Healthcare All Other HMO |
$8,675.88
|
| Rate for Payer: United Healthcare HMO Rider |
$8,488.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,778.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20,187.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20,187.50
|
| Rate for Payer: Vantage Medical Group Senior |
$20,187.50
|
|
|
HC PACE MED SOLARA W4TR03
|
Facility
|
OP
|
$23,750.00
|
|
|
Service Code
|
CPT C2621
|
| Hospital Charge Code |
906813800
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$4,750.00 |
| Max. Negotiated Rate |
$21,375.00 |
| Rate for Payer: Adventist Health Commercial |
$4,750.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20,187.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13,062.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17,812.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,499.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,948.38
|
| Rate for Payer: Blue Shield of California Commercial |
$18,358.75
|
| Rate for Payer: Blue Shield of California EPN |
$11,970.00
|
| Rate for Payer: Cash Price |
$10,687.50
|
| Rate for Payer: Central Health Plan Commercial |
$19,000.00
|
| Rate for Payer: Cigna of CA HMO |
$16,625.00
|
| Rate for Payer: Cigna of CA PPO |
$16,625.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20,187.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$20,187.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20,187.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,500.00
|
| Rate for Payer: EPIC Health Plan Senior |
$9,500.00
|
| Rate for Payer: Galaxy Health WC |
$20,187.50
|
| Rate for Payer: Global Benefits Group Commercial |
$14,250.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$21,375.00
|
| Rate for Payer: InnovAge PACE Commercial |
$11,875.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15,841.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,701.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,750.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16,625.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16,625.00
|
| Rate for Payer: Multiplan Commercial |
$17,812.50
|
| Rate for Payer: Networks By Design Commercial |
$11,875.00
|
| Rate for Payer: Prime Health Services Commercial |
$20,187.50
|
| Rate for Payer: Riverside University Health System MISP |
$9,500.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14,250.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14,250.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,913.38
|
| Rate for Payer: United Healthcare All Other HMO |
$8,675.88
|
| Rate for Payer: United Healthcare HMO Rider |
$8,488.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,778.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20,187.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20,187.50
|
| Rate for Payer: Vantage Medical Group Senior |
$20,187.50
|
|
|
HC PACE MED SOLARA W4TR03
|
Facility
|
IP
|
$23,750.00
|
|
|
Service Code
|
CPT C2621
|
| Hospital Charge Code |
906813800
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$4,750.00 |
| Max. Negotiated Rate |
$21,375.00 |
| Rate for Payer: Adventist Health Commercial |
$4,750.00
|
| Rate for Payer: Blue Shield of California Commercial |
$18,358.75
|
| Rate for Payer: Blue Shield of California EPN |
$11,970.00
|
| Rate for Payer: Cash Price |
$10,687.50
|
| Rate for Payer: Central Health Plan Commercial |
$19,000.00
|
| Rate for Payer: Cigna of CA HMO |
$16,625.00
|
| Rate for Payer: Cigna of CA PPO |
$16,625.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,500.00
|
| Rate for Payer: EPIC Health Plan Senior |
$9,500.00
|
| Rate for Payer: Galaxy Health WC |
$20,187.50
|
| Rate for Payer: Global Benefits Group Commercial |
$14,250.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$21,375.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15,841.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,048.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,701.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,750.00
|
| Rate for Payer: Multiplan Commercial |
$17,812.50
|
| Rate for Payer: Networks By Design Commercial |
$11,875.00
|
| Rate for Payer: Prime Health Services Commercial |
$20,187.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,913.38
|
| Rate for Payer: United Healthcare All Other HMO |
$8,675.88
|
| Rate for Payer: United Healthcare HMO Rider |
$8,488.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,778.12
|
|
|
HC PACE MED SYNCRA C2TR01
|
Facility
|
IP
|
$18,208.00
|
|
|
Service Code
|
CPT C2621
|
| Hospital Charge Code |
906813647
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,641.60 |
| Max. Negotiated Rate |
$16,387.20 |
| Rate for Payer: Adventist Health Commercial |
$3,641.60
|
| Rate for Payer: Blue Shield of California Commercial |
$14,074.78
|
| Rate for Payer: Blue Shield of California EPN |
$9,176.83
|
| Rate for Payer: Cash Price |
$8,193.60
|
| Rate for Payer: Central Health Plan Commercial |
$14,566.40
|
| Rate for Payer: Cigna of CA HMO |
$12,745.60
|
| Rate for Payer: Cigna of CA PPO |
$12,745.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,283.20
|
| Rate for Payer: EPIC Health Plan Senior |
$7,283.20
|
| Rate for Payer: Galaxy Health WC |
$15,476.80
|
| Rate for Payer: Global Benefits Group Commercial |
$10,924.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$16,387.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,144.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,937.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,270.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,641.60
|
| Rate for Payer: Multiplan Commercial |
$13,656.00
|
| Rate for Payer: Networks By Design Commercial |
$9,104.00
|
| Rate for Payer: Prime Health Services Commercial |
$15,476.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,833.46
|
| Rate for Payer: United Healthcare All Other HMO |
$6,651.38
|
| Rate for Payer: United Healthcare HMO Rider |
$6,507.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,963.12
|
|
|
HC PACE MED SYNCRA C2TR01
|
Facility
|
OP
|
$18,208.00
|
|
|
Service Code
|
CPT C2621
|
| Hospital Charge Code |
906813647
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,641.60 |
| Max. Negotiated Rate |
$16,387.20 |
| Rate for Payer: Adventist Health Commercial |
$3,641.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15,476.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,014.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,656.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8,816.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,693.56
|
| Rate for Payer: Blue Shield of California Commercial |
$14,074.78
|
| Rate for Payer: Blue Shield of California EPN |
$9,176.83
|
| Rate for Payer: Cash Price |
$8,193.60
|
| Rate for Payer: Central Health Plan Commercial |
$14,566.40
|
| Rate for Payer: Cigna of CA HMO |
$12,745.60
|
| Rate for Payer: Cigna of CA PPO |
$12,745.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15,476.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,476.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15,476.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,283.20
|
| Rate for Payer: EPIC Health Plan Senior |
$7,283.20
|
| Rate for Payer: Galaxy Health WC |
$15,476.80
|
| Rate for Payer: Global Benefits Group Commercial |
$10,924.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$16,387.20
|
| Rate for Payer: InnovAge PACE Commercial |
$9,104.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,144.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,270.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,641.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12,745.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12,745.60
|
| Rate for Payer: Multiplan Commercial |
$13,656.00
|
| Rate for Payer: Networks By Design Commercial |
$9,104.00
|
| Rate for Payer: Prime Health Services Commercial |
$15,476.80
|
| Rate for Payer: Riverside University Health System MISP |
$7,283.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,924.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10,924.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,833.46
|
| Rate for Payer: United Healthcare All Other HMO |
$6,651.38
|
| Rate for Payer: United Healthcare HMO Rider |
$6,507.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,963.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15,476.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,476.80
|
| Rate for Payer: Vantage Medical Group Senior |
$15,476.80
|
|
|
HC PACE MED VERSA VEDR01
|
Facility
|
IP
|
$8,538.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813581
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,707.60 |
| Max. Negotiated Rate |
$7,684.20 |
| Rate for Payer: Adventist Health Commercial |
$1,707.60
|
| Rate for Payer: Blue Shield of California Commercial |
$6,599.87
|
| Rate for Payer: Blue Shield of California EPN |
$4,303.15
|
| Rate for Payer: Cash Price |
$3,842.10
|
| Rate for Payer: Central Health Plan Commercial |
$6,830.40
|
| Rate for Payer: Cigna of CA HMO |
$5,976.60
|
| Rate for Payer: Cigna of CA PPO |
$5,976.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,415.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,415.20
|
| Rate for Payer: Galaxy Health WC |
$7,257.30
|
| Rate for Payer: Global Benefits Group Commercial |
$5,122.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,684.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,694.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,252.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,285.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,707.60
|
| Rate for Payer: Multiplan Commercial |
$6,403.50
|
| Rate for Payer: Networks By Design Commercial |
$4,269.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,257.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,204.31
|
| Rate for Payer: United Healthcare All Other HMO |
$3,118.93
|
| Rate for Payer: United Healthcare HMO Rider |
$3,051.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,796.20
|
|
|
HC PACE MED VERSA VEDR01
|
Facility
|
OP
|
$8,538.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813581
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,707.60 |
| Max. Negotiated Rate |
$7,684.20 |
| Rate for Payer: Adventist Health Commercial |
$1,707.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,257.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,695.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,403.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,134.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,014.37
|
| Rate for Payer: Blue Shield of California Commercial |
$6,599.87
|
| Rate for Payer: Blue Shield of California EPN |
$4,303.15
|
| Rate for Payer: Cash Price |
$3,842.10
|
| Rate for Payer: Central Health Plan Commercial |
$6,830.40
|
| Rate for Payer: Cigna of CA HMO |
$5,976.60
|
| Rate for Payer: Cigna of CA PPO |
$5,976.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,257.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,257.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,257.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,415.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,415.20
|
| Rate for Payer: Galaxy Health WC |
$7,257.30
|
| Rate for Payer: Global Benefits Group Commercial |
$5,122.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,684.20
|
| Rate for Payer: InnovAge PACE Commercial |
$4,269.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,694.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,285.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,707.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,976.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,976.60
|
| Rate for Payer: Multiplan Commercial |
$6,403.50
|
| Rate for Payer: Networks By Design Commercial |
$4,269.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,257.30
|
| Rate for Payer: Riverside University Health System MISP |
$3,415.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,122.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,122.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,204.31
|
| Rate for Payer: United Healthcare All Other HMO |
$3,118.93
|
| Rate for Payer: United Healthcare HMO Rider |
$3,051.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,796.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,257.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,257.30
|
| Rate for Payer: Vantage Medical Group Senior |
$7,257.30
|
|
|
HC PACE REMV REPL EX DUAL LEADS
|
Facility
|
IP
|
$26,271.00
|
|
|
Service Code
|
CPT 33228
|
| Hospital Charge Code |
906820213
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,254.20 |
| Max. Negotiated Rate |
$23,643.90 |
| Rate for Payer: Adventist Health Commercial |
$5,254.20
|
| Rate for Payer: Cash Price |
$11,821.95
|
| Rate for Payer: Central Health Plan Commercial |
$21,016.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,508.40
|
| Rate for Payer: EPIC Health Plan Senior |
$10,508.40
|
| Rate for Payer: Galaxy Health WC |
$22,330.35
|
| Rate for Payer: Global Benefits Group Commercial |
$15,762.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$23,643.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17,522.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,009.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,261.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,254.20
|
| Rate for Payer: Multiplan Commercial |
$19,703.25
|
| Rate for Payer: Networks By Design Commercial |
$17,076.15
|
| Rate for Payer: Prime Health Services Commercial |
$22,330.35
|
|
