|
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 |
$145.99
|
| 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 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 |
$145.99
|
| 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 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 |
$4,743.75
|
| 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
|
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 |
$5,263.50
|
| 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
|
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 |
$5,263.50
|
| 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
|
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 |
$4,743.75
|
| 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
|
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 |
$5,263.50
|
| 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 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 |
$5,263.50
|
| 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 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 |
$4,613.40
|
| 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 |
$4,613.40
|
| 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 |
$4,613.40
|
| 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 |
$4,613.40
|
| 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
|
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 |
$5,263.50
|
| 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 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 |
$5,263.50
|
| 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 |
$5,263.50
|
| 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 |
$5,263.50
|
| 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
|
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 |
$5,263.50
|
| 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 |
$5,263.50
|
| 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 |
$6,050.00
|
| 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 |
$6,050.00
|
| 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 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 |
$5,850.90
|
| 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 |
$5,850.90
|
| 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 |
$6,050.00
|
| 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 |
$6,050.00
|
| 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 |
$6,015.90
|
| 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
|
|
