|
HC INSJ PERM CCM DFIB SYS PG AND ELTRD
|
Facility
|
OP
|
$87,556.00
|
|
|
Service Code
|
CPT 0915T
|
| Hospital Charge Code |
906811503
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$570.02 |
| Max. Negotiated Rate |
$74,422.60 |
| Rate for Payer: Adventist Health Commercial |
$17,511.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,370.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$61,106.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$44,811.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$40,737.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$53,768.14
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$570.02
|
| Rate for Payer: Cash Price |
$48,155.80
|
| Rate for Payer: Cash Price |
$48,155.80
|
| Rate for Payer: Cash Price |
$48,155.80
|
| Rate for Payer: Cigna of CA HMO |
$56,035.84
|
| Rate for Payer: Cigna of CA PPO |
$64,791.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$61,106.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$44,811.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$40,737.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$54,995.54
|
| Rate for Payer: EPIC Health Plan Senior |
$40,737.44
|
| Rate for Payer: Galaxy Health WC |
$74,422.60
|
| Rate for Payer: Global Benefits Group Commercial |
$52,533.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$66,809.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$40,737.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$58,399.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33,358.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$40,737.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21,013.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$51,329.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$54,588.17
|
| Rate for Payer: Multiplan Commercial |
$70,044.80
|
| Rate for Payer: Networks By Design Commercial |
$56,911.40
|
| Rate for Payer: Prime Health Services Commercial |
$74,422.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$52,533.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$52,533.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$40,737.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$61,106.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$44,811.18
|
| Rate for Payer: Vantage Medical Group Senior |
$40,737.44
|
|
|
HC INSJ PERM CCM DFIB SYS PULSE GEN ONLY
|
Facility
|
IP
|
$61,298.00
|
|
|
Service Code
|
CPT 0916T
|
| Hospital Charge Code |
906811504
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$12,259.60 |
| Max. Negotiated Rate |
$52,103.30 |
| Rate for Payer: Adventist Health Commercial |
$12,259.60
|
| Rate for Payer: Cash Price |
$33,713.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$24,519.20
|
| Rate for Payer: EPIC Health Plan Senior |
$24,519.20
|
| Rate for Payer: Galaxy Health WC |
$52,103.30
|
| Rate for Payer: Global Benefits Group Commercial |
$36,778.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40,885.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23,354.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37,943.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14,711.52
|
| Rate for Payer: Multiplan Commercial |
$49,038.40
|
| Rate for Payer: Networks By Design Commercial |
$39,843.70
|
| Rate for Payer: Prime Health Services Commercial |
$52,103.30
|
|
|
HC INSJ PERM CCM DFIB SYS PULSE GEN ONLY
|
Facility
|
OP
|
$61,298.00
|
|
|
Service Code
|
CPT 0916T
|
| Hospital Charge Code |
906811504
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$570.02 |
| Max. Negotiated Rate |
$52,103.30 |
| Rate for Payer: Adventist Health Commercial |
$12,259.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$42,780.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$31,372.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28,520.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$37,643.10
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$570.02
|
| Rate for Payer: Cash Price |
$33,713.90
|
| Rate for Payer: Cash Price |
$33,713.90
|
| Rate for Payer: Cash Price |
$33,713.90
|
| Rate for Payer: Cigna of CA HMO |
$39,230.72
|
| Rate for Payer: Cigna of CA PPO |
$45,360.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$42,780.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$31,372.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$28,520.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$38,502.18
|
| Rate for Payer: EPIC Health Plan Senior |
$28,520.13
|
| Rate for Payer: Galaxy Health WC |
$52,103.30
|
| Rate for Payer: Global Benefits Group Commercial |
$36,778.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$46,773.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$28,520.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40,885.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23,354.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28,520.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14,711.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$35,935.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$38,216.97
|
| Rate for Payer: Multiplan Commercial |
$49,038.40
|
| Rate for Payer: Networks By Design Commercial |
$39,843.70
|
| Rate for Payer: Prime Health Services Commercial |
$52,103.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$36,778.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$36,778.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$28,520.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$42,780.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31,372.14
|
| Rate for Payer: Vantage Medical Group Senior |
$28,520.13
|
|
|
HC INSJ PERM CCM DFIB SYS SINGLE LEAD
|
Facility
|
IP
|
$22,601.00
|
|
|
Service Code
|
CPT 0917T
|
| Hospital Charge Code |
906811505
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$4,520.20 |
| Max. Negotiated Rate |
$19,210.85 |
| Rate for Payer: Adventist Health Commercial |
$4,520.20
|
| Rate for Payer: Cash Price |
$12,430.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,040.40
|
| Rate for Payer: EPIC Health Plan Senior |
$9,040.40
|
| Rate for Payer: Galaxy Health WC |
$19,210.85
|
| Rate for Payer: Global Benefits Group Commercial |
$13,560.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15,074.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,610.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,990.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,424.24
|
| Rate for Payer: Multiplan Commercial |
$18,080.80
|
| Rate for Payer: Networks By Design Commercial |
$14,690.65
|
| Rate for Payer: Prime Health Services Commercial |
$19,210.85
|
|
|
HC INSJ PERM CCM DFIB SYS SINGLE LEAD
|
Facility
|
OP
|
$22,601.00
|
|
|
Service Code
|
CPT 0917T
|
| Hospital Charge Code |
906811505
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$570.02 |
| Max. Negotiated Rate |
$19,210.85 |
| Rate for Payer: Adventist Health Commercial |
$4,520.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15,773.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11,567.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,515.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,879.27
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$570.02
|
| Rate for Payer: Cash Price |
$12,430.55
|
| Rate for Payer: Cash Price |
$12,430.55
|
| Rate for Payer: Cash Price |
$12,430.55
|
| Rate for Payer: Cigna of CA HMO |
$14,464.64
|
| Rate for Payer: Cigna of CA PPO |
$16,724.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15,773.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,567.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,515.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,195.87
|
| Rate for Payer: EPIC Health Plan Senior |
$10,515.46
|
| Rate for Payer: Galaxy Health WC |
$19,210.85
|
| Rate for Payer: Global Benefits Group Commercial |
$13,560.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$17,245.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10,515.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15,074.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,610.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,515.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,424.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13,249.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14,090.72
|
| Rate for Payer: Multiplan Commercial |
$18,080.80
|
| Rate for Payer: Networks By Design Commercial |
$14,690.65
|
| Rate for Payer: Prime Health Services Commercial |
$19,210.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13,560.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13,560.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$10,515.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15,773.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,567.01
|
| Rate for Payer: Vantage Medical Group Senior |
$10,515.46
|
|
|
HC INSOLE FELT SHOE ADD
|
Facility
|
OP
|
$62.00
|
|
|
Service Code
|
CPT L3520
|
| Hospital Charge Code |
915353520
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$14.11 |
| Max. Negotiated Rate |
$52.70 |
| Rate for Payer: Adventist Health Commercial |
$25.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$46.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35.91
|
| Rate for Payer: Blue Shield of California Commercial |
$45.76
|
| Rate for Payer: Blue Shield of California EPN |
$30.13
|
| Rate for Payer: Cash Price |
$34.10
|
| Rate for Payer: Cash Price |
$34.10
|
| Rate for Payer: Cigna of CA HMO |
$43.40
|
| Rate for Payer: Cigna of CA PPO |
$43.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$52.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$52.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.80
|
| Rate for Payer: EPIC Health Plan Senior |
$24.80
|
| Rate for Payer: Galaxy Health WC |
$52.70
|
| Rate for Payer: Global Benefits Group Commercial |
$37.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$41.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$38.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$43.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$43.40
|
| Rate for Payer: Multiplan Commercial |
$49.60
|
| Rate for Payer: Networks By Design Commercial |
$31.00
|
| Rate for Payer: Prime Health Services Commercial |
$52.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$37.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$37.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$23.27
|
| Rate for Payer: United Healthcare All Other HMO |
$22.65
|
| Rate for Payer: United Healthcare HMO Rider |
$22.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52.70
|
| Rate for Payer: Vantage Medical Group Senior |
$52.70
|
|
|
HC INSOLE FELT SHOE ADD
|
Facility
|
IP
|
$62.00
|
|
|
Service Code
|
CPT L3520
|
| Hospital Charge Code |
905353520
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$12.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$12.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$34.10
|
| Rate for Payer: Cash Price |
$34.10
|
| Rate for Payer: Cigna of CA HMO |
$43.40
|
| Rate for Payer: Cigna of CA PPO |
$43.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.80
|
| Rate for Payer: EPIC Health Plan Senior |
$24.80
|
| Rate for Payer: Galaxy Health WC |
$52.70
|
| Rate for Payer: Global Benefits Group Commercial |
$37.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$41.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$38.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.88
|
| Rate for Payer: Multiplan Commercial |
$49.60
|
| Rate for Payer: Networks By Design Commercial |
$31.00
|
| Rate for Payer: Prime Health Services Commercial |
$52.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$23.27
|
| Rate for Payer: United Healthcare All Other HMO |
$22.65
|
| Rate for Payer: United Healthcare HMO Rider |
$22.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.30
|
|
|
HC INSOLE FELT SHOE ADD
|
Facility
|
OP
|
$62.00
|
|
|
Service Code
|
CPT L3520
|
| Hospital Charge Code |
905353520
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$14.11 |
| Max. Negotiated Rate |
$52.70 |
| Rate for Payer: Adventist Health Commercial |
$25.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$46.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35.91
|
| Rate for Payer: Blue Shield of California Commercial |
$45.76
|
| Rate for Payer: Blue Shield of California EPN |
$30.13
|
| Rate for Payer: Cash Price |
$34.10
|
| Rate for Payer: Cash Price |
$34.10
|
| Rate for Payer: Cigna of CA HMO |
$43.40
|
| Rate for Payer: Cigna of CA PPO |
$43.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$52.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$52.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.80
|
| Rate for Payer: EPIC Health Plan Senior |
$24.80
|
| Rate for Payer: Galaxy Health WC |
$52.70
|
| Rate for Payer: Global Benefits Group Commercial |
$37.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$41.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$38.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$43.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$43.40
|
| Rate for Payer: Multiplan Commercial |
$49.60
|
| Rate for Payer: Networks By Design Commercial |
$31.00
|
| Rate for Payer: Prime Health Services Commercial |
$52.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$37.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$37.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$23.27
|
| Rate for Payer: United Healthcare All Other HMO |
$22.65
|
| Rate for Payer: United Healthcare HMO Rider |
$22.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52.70
|
| Rate for Payer: Vantage Medical Group Senior |
$52.70
|
|
|
HC INSOLE FELT SHOE ADD
|
Facility
|
IP
|
$62.00
|
|
|
Service Code
|
CPT L3520
|
| Hospital Charge Code |
915353520
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$12.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$12.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$34.10
|
| Rate for Payer: Cash Price |
$34.10
|
| Rate for Payer: Cigna of CA HMO |
$43.40
|
| Rate for Payer: Cigna of CA PPO |
$43.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.80
|
| Rate for Payer: EPIC Health Plan Senior |
$24.80
|
| Rate for Payer: Galaxy Health WC |
$52.70
|
| Rate for Payer: Global Benefits Group Commercial |
$37.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$41.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$38.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.88
|
| Rate for Payer: Multiplan Commercial |
$49.60
|
| Rate for Payer: Networks By Design Commercial |
$31.00
|
| Rate for Payer: Prime Health Services Commercial |
$52.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$23.27
|
| Rate for Payer: United Healthcare All Other HMO |
$22.65
|
| Rate for Payer: United Healthcare HMO Rider |
$22.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.30
|
|
|
HC INSOLE LEATHER SHOE ADD
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
CPT L3500
|
| Hospital Charge Code |
905353500
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$12.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna of CA HMO |
$42.00
|
| Rate for Payer: Cigna of CA PPO |
$42.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.00
|
| Rate for Payer: EPIC Health Plan Senior |
$24.00
|
| Rate for Payer: Galaxy Health WC |
$51.00
|
| Rate for Payer: Global Benefits Group Commercial |
$36.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.40
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: Networks By Design Commercial |
$30.00
|
| Rate for Payer: Prime Health Services Commercial |
$51.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.52
|
| Rate for Payer: United Healthcare All Other HMO |
$21.92
|
| Rate for Payer: United Healthcare HMO Rider |
$21.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.65
|
|
|
HC INSOLE LEATHER SHOE ADD
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
CPT L3500
|
| Hospital Charge Code |
915353500
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$12.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna of CA HMO |
$42.00
|
| Rate for Payer: Cigna of CA PPO |
$42.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.00
|
| Rate for Payer: EPIC Health Plan Senior |
$24.00
|
| Rate for Payer: Galaxy Health WC |
$51.00
|
| Rate for Payer: Global Benefits Group Commercial |
$36.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.40
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: Networks By Design Commercial |
$30.00
|
| Rate for Payer: Prime Health Services Commercial |
$51.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.52
|
| Rate for Payer: United Healthcare All Other HMO |
$21.92
|
| Rate for Payer: United Healthcare HMO Rider |
$21.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.65
|
|
|
HC INSOLE LEATHER SHOE ADD
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
CPT L3500
|
| Hospital Charge Code |
905353500
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$10.35 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Adventist Health Commercial |
$24.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$51.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$33.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$45.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.75
|
| Rate for Payer: Blue Shield of California Commercial |
$44.28
|
| Rate for Payer: Blue Shield of California EPN |
$29.16
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna of CA HMO |
$42.00
|
| Rate for Payer: Cigna of CA PPO |
$42.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$51.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$51.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$51.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.00
|
| Rate for Payer: EPIC Health Plan Senior |
$24.00
|
| Rate for Payer: Galaxy Health WC |
$51.00
|
| Rate for Payer: Global Benefits Group Commercial |
$36.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$42.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$42.00
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: Networks By Design Commercial |
$30.00
|
| Rate for Payer: Prime Health Services Commercial |
$51.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$36.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$36.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.52
|
| Rate for Payer: United Healthcare All Other HMO |
$21.92
|
| Rate for Payer: United Healthcare HMO Rider |
$21.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$51.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$51.00
|
| Rate for Payer: Vantage Medical Group Senior |
$51.00
|
|
|
HC INSOLE LEATHER SHOE ADD
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
CPT L3500
|
| Hospital Charge Code |
915353500
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$10.35 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Adventist Health Commercial |
$24.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$51.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$33.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$45.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.75
|
| Rate for Payer: Blue Shield of California Commercial |
$44.28
|
| Rate for Payer: Blue Shield of California EPN |
$29.16
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna of CA HMO |
$42.00
|
| Rate for Payer: Cigna of CA PPO |
$42.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$51.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$51.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$51.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.00
|
| Rate for Payer: EPIC Health Plan Senior |
$24.00
|
| Rate for Payer: Galaxy Health WC |
$51.00
|
| Rate for Payer: Global Benefits Group Commercial |
$36.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$42.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$42.00
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: Networks By Design Commercial |
$30.00
|
| Rate for Payer: Prime Health Services Commercial |
$51.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$36.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$36.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.52
|
| Rate for Payer: United Healthcare All Other HMO |
$21.92
|
| Rate for Payer: United Healthcare HMO Rider |
$21.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$51.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$51.00
|
| Rate for Payer: Vantage Medical Group Senior |
$51.00
|
|
|
HC INSOLE RUBBER SHOE ADD
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
CPT L3510
|
| Hospital Charge Code |
915353510
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$10.35 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Adventist Health Commercial |
$24.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$51.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$33.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$45.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.75
|
| Rate for Payer: Blue Shield of California Commercial |
$44.28
|
| Rate for Payer: Blue Shield of California EPN |
$29.16
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna of CA HMO |
$42.00
|
| Rate for Payer: Cigna of CA PPO |
$42.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$51.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$51.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$51.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.00
|
| Rate for Payer: EPIC Health Plan Senior |
$24.00
|
| Rate for Payer: Galaxy Health WC |
$51.00
|
| Rate for Payer: Global Benefits Group Commercial |
$36.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$42.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$42.00
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: Networks By Design Commercial |
$30.00
|
| Rate for Payer: Prime Health Services Commercial |
$51.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$36.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$36.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.52
|
| Rate for Payer: United Healthcare All Other HMO |
$21.92
|
| Rate for Payer: United Healthcare HMO Rider |
$21.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$51.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$51.00
|
| Rate for Payer: Vantage Medical Group Senior |
$51.00
|
|
|
HC INSOLE RUBBER SHOE ADD
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
CPT L3510
|
| Hospital Charge Code |
905353510
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$10.35 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Adventist Health Commercial |
$24.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$51.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$33.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$45.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.75
|
| Rate for Payer: Blue Shield of California Commercial |
$44.28
|
| Rate for Payer: Blue Shield of California EPN |
$29.16
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna of CA HMO |
$42.00
|
| Rate for Payer: Cigna of CA PPO |
$42.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$51.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$51.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$51.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.00
|
| Rate for Payer: EPIC Health Plan Senior |
$24.00
|
| Rate for Payer: Galaxy Health WC |
$51.00
|
| Rate for Payer: Global Benefits Group Commercial |
$36.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$42.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$42.00
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: Networks By Design Commercial |
$30.00
|
| Rate for Payer: Prime Health Services Commercial |
$51.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$36.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$36.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.52
|
| Rate for Payer: United Healthcare All Other HMO |
$21.92
|
| Rate for Payer: United Healthcare HMO Rider |
$21.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$51.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$51.00
|
| Rate for Payer: Vantage Medical Group Senior |
$51.00
|
|
|
HC INSOLE RUBBER SHOE ADD
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
CPT L3510
|
| Hospital Charge Code |
905353510
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$12.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna of CA HMO |
$42.00
|
| Rate for Payer: Cigna of CA PPO |
$42.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.00
|
| Rate for Payer: EPIC Health Plan Senior |
$24.00
|
| Rate for Payer: Galaxy Health WC |
$51.00
|
| Rate for Payer: Global Benefits Group Commercial |
$36.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.40
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: Networks By Design Commercial |
$30.00
|
| Rate for Payer: Prime Health Services Commercial |
$51.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.52
|
| Rate for Payer: United Healthcare All Other HMO |
$21.92
|
| Rate for Payer: United Healthcare HMO Rider |
$21.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.65
|
|
|
HC INSOLE RUBBER SHOE ADD
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
CPT L3510
|
| Hospital Charge Code |
915353510
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$12.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna of CA HMO |
$42.00
|
| Rate for Payer: Cigna of CA PPO |
$42.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.00
|
| Rate for Payer: EPIC Health Plan Senior |
$24.00
|
| Rate for Payer: Galaxy Health WC |
$51.00
|
| Rate for Payer: Global Benefits Group Commercial |
$36.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.40
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: Networks By Design Commercial |
$30.00
|
| Rate for Payer: Prime Health Services Commercial |
$51.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.52
|
| Rate for Payer: United Healthcare All Other HMO |
$21.92
|
| Rate for Payer: United Healthcare HMO Rider |
$21.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.65
|
|
|
HC INSRT CANN HEMO OTHR VN TO VN
|
Facility
|
IP
|
$14,750.00
|
|
|
Service Code
|
CPT 36800
|
| Hospital Charge Code |
909036800
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,950.00 |
| Max. Negotiated Rate |
$12,537.50 |
| Rate for Payer: Adventist Health Commercial |
$2,950.00
|
| Rate for Payer: Cash Price |
$8,112.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,900.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,900.00
|
| Rate for Payer: Galaxy Health WC |
$12,537.50
|
| Rate for Payer: Global Benefits Group Commercial |
$8,850.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,838.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,619.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,130.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,540.00
|
| Rate for Payer: Multiplan Commercial |
$11,800.00
|
| Rate for Payer: Networks By Design Commercial |
$9,587.50
|
| Rate for Payer: Prime Health Services Commercial |
$12,537.50
|
|
|
HC INSRT CANN HEMO OTHR VN TO VN
|
Facility
|
OP
|
$14,750.00
|
|
|
Service Code
|
CPT 36800
|
| Hospital Charge Code |
909036800
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$212.65 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$2,950.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,555.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,868.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,822.94
|
| Rate for Payer: Cash Price |
$8,112.50
|
| Rate for Payer: Cash Price |
$8,112.50
|
| Rate for Payer: Cash Price |
$8,112.50
|
| Rate for Payer: Cigna of CA HMO |
$9,440.00
|
| Rate for Payer: Cigna of CA PPO |
$10,915.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,555.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,868.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,272.45
|
| Rate for Payer: EPIC Health Plan Senior |
$6,868.48
|
| Rate for Payer: Galaxy Health WC |
$12,537.50
|
| Rate for Payer: Global Benefits Group Commercial |
$8,850.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,264.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$212.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,868.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,838.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$240.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,868.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,540.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,654.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,203.76
|
| Rate for Payer: Multiplan Commercial |
$11,800.00
|
| Rate for Payer: Multiplan WC |
$10,943.70
|
| Rate for Payer: Networks By Design Commercial |
$9,587.50
|
| Rate for Payer: Prime Health Services Commercial |
$12,537.50
|
| Rate for Payer: Prime Health Services WC |
$10,832.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,850.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,712.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$6,868.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,555.33
|
| Rate for Payer: Vantage Medical Group Senior |
$6,868.48
|
|
|
HC INSRT TUN CNTRL VAD W SUB PORT GT 5YR
|
Facility
|
IP
|
$15,628.00
|
|
|
Service Code
|
CPT 36561
|
| Hospital Charge Code |
909080012
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,125.60 |
| Max. Negotiated Rate |
$13,283.80 |
| Rate for Payer: Adventist Health Commercial |
$3,125.60
|
| Rate for Payer: Cash Price |
$8,595.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,251.20
|
| Rate for Payer: EPIC Health Plan Senior |
$6,251.20
|
| Rate for Payer: Galaxy Health WC |
$13,283.80
|
| Rate for Payer: Global Benefits Group Commercial |
$9,376.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,423.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,954.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,673.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,750.72
|
| Rate for Payer: Multiplan Commercial |
$12,502.40
|
| Rate for Payer: Networks By Design Commercial |
$10,158.20
|
| Rate for Payer: Prime Health Services Commercial |
$13,283.80
|
|
|
HC INSRT TUN CNTRL VAD W SUB PORT GT 5YR
|
Facility
|
OP
|
$15,628.00
|
|
|
Service Code
|
CPT 36561
|
| Hospital Charge Code |
909080012
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$436.58 |
| Max. Negotiated Rate |
$20,902.00 |
| Rate for Payer: Adventist Health Commercial |
$3,125.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$3,968.41
|
| Rate for Payer: Cash Price |
$8,595.40
|
| Rate for Payer: Cash Price |
$8,595.40
|
| Rate for Payer: Cash Price |
$8,595.40
|
| Rate for Payer: Cigna of CA HMO |
$10,001.92
|
| Rate for Payer: Cigna of CA PPO |
$11,564.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,398.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3,999.21
|
| Rate for Payer: Galaxy Health WC |
$13,283.80
|
| Rate for Payer: Global Benefits Group Commercial |
$9,376.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$436.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,423.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$493.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,750.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,039.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,358.94
|
| Rate for Payer: Multiplan Commercial |
$12,502.40
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: Networks By Design Commercial |
$10,158.20
|
| Rate for Payer: Prime Health Services Commercial |
$13,283.80
|
| Rate for Payer: Prime Health Services WC |
$6,307.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,376.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,999.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC INSRT TUN CNTRL VAD W/SUB PORT GT 5YR
|
Facility
|
IP
|
$13,590.00
|
|
|
Service Code
|
CPT 36561
|
| Hospital Charge Code |
900501569
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,718.00 |
| Max. Negotiated Rate |
$11,551.50 |
| Rate for Payer: Adventist Health Commercial |
$2,718.00
|
| Rate for Payer: Cash Price |
$7,474.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,436.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,436.00
|
| Rate for Payer: Galaxy Health WC |
$11,551.50
|
| Rate for Payer: Global Benefits Group Commercial |
$8,154.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,064.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,177.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,412.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,261.60
|
| Rate for Payer: Multiplan Commercial |
$10,872.00
|
| Rate for Payer: Networks By Design Commercial |
$8,833.50
|
| Rate for Payer: Prime Health Services Commercial |
$11,551.50
|
|
|
HC INSRT TUN CNTRL VAD W/SUB PORT GT 5YR
|
Facility
|
OP
|
$13,590.00
|
|
|
Service Code
|
CPT 36561
|
| Hospital Charge Code |
900501569
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$493.75 |
| Max. Negotiated Rate |
$11,551.50 |
| Rate for Payer: Adventist Health Commercial |
$2,718.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Cash Price |
$7,474.50
|
| Rate for Payer: Cash Price |
$7,474.50
|
| Rate for Payer: Cash Price |
$7,474.50
|
| Rate for Payer: Cigna of CA HMO |
$8,697.60
|
| Rate for Payer: Cigna of CA PPO |
$10,056.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,398.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3,999.21
|
| Rate for Payer: Galaxy Health WC |
$11,551.50
|
| Rate for Payer: Global Benefits Group Commercial |
$8,154.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,064.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$493.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,261.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,039.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,358.94
|
| Rate for Payer: Multiplan Commercial |
$10,872.00
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: Networks By Design Commercial |
$8,833.50
|
| Rate for Payer: Prime Health Services Commercial |
$11,551.50
|
| Rate for Payer: Prime Health Services WC |
$6,307.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,154.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,795.00
|
| Rate for Payer: United Healthcare All Other HMO |
$6,795.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6,795.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,795.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,999.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC INS SUBQ CAR RHYTHM MTR W PRGM
|
Facility
|
IP
|
$16,853.00
|
|
|
Service Code
|
CPT 33285
|
| Hospital Charge Code |
906820138
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,370.60 |
| Max. Negotiated Rate |
$14,325.05 |
| Rate for Payer: Adventist Health Commercial |
$3,370.60
|
| Rate for Payer: Cash Price |
$9,269.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,741.20
|
| Rate for Payer: EPIC Health Plan Senior |
$6,741.20
|
| Rate for Payer: Galaxy Health WC |
$14,325.05
|
| Rate for Payer: Global Benefits Group Commercial |
$10,111.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,240.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,420.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,432.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,044.72
|
| Rate for Payer: Multiplan Commercial |
$13,482.40
|
| Rate for Payer: Networks By Design Commercial |
$10,954.45
|
| Rate for Payer: Prime Health Services Commercial |
$14,325.05
|
|
|
HC INS SUBQ CAR RHYTHM MTR W PRGM
|
Facility
|
OP
|
$16,853.00
|
|
|
Service Code
|
CPT 33285
|
| Hospital Charge Code |
906820138
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,370.60 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$3,370.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15,773.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11,567.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,515.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$3,490.94
|
| Rate for Payer: Cash Price |
$9,269.15
|
| Rate for Payer: Cash Price |
$9,269.15
|
| Rate for Payer: Cash Price |
$9,269.15
|
| Rate for Payer: Cigna of CA HMO |
$10,785.92
|
| Rate for Payer: Cigna of CA PPO |
$12,471.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15,773.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,567.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,515.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,195.87
|
| Rate for Payer: EPIC Health Plan Senior |
$10,515.46
|
| Rate for Payer: Galaxy Health WC |
$14,325.05
|
| Rate for Payer: Global Benefits Group Commercial |
$10,111.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$17,245.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8,126.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10,515.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,240.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,190.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,515.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,044.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13,249.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14,090.72
|
| Rate for Payer: Multiplan Commercial |
$13,482.40
|
| Rate for Payer: Multiplan WC |
$16,754.51
|
| Rate for Payer: Networks By Design Commercial |
$10,954.45
|
| Rate for Payer: Prime Health Services Commercial |
$14,325.05
|
| Rate for Payer: Prime Health Services WC |
$16,583.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,111.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$31,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$10,515.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15,773.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,567.01
|
| Rate for Payer: Vantage Medical Group Senior |
$10,515.46
|
|
