|
HC INSJ PERM CCM DFIB SYS DUAL LEADS
|
Facility
|
IP
|
$22,601.00
|
|
|
Service Code
|
CPT 0918T
|
| Hospital Charge Code |
906811506
|
|
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 |
$10,170.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15,820.70
|
| 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 Foundation Hospitals Commercial/Self Funded |
$14,351.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13,334.59
|
| 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 DUAL LEADS
|
Facility
|
OP
|
$22,601.00
|
|
|
Service Code
|
CPT 0918T
|
| Hospital Charge Code |
906811506
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$594.18 |
| Max. Negotiated Rate |
$19,210.85 |
| Rate for Payer: Adventist Health Commercial |
$4,520.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14,824.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15,965.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11,707.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,643.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16,261.00
|
| Rate for Payer: Blue Shield of California Commercial |
$594.18
|
| Rate for Payer: Blue Shield of California Commercial |
$899.51
|
| Rate for Payer: Cash Price |
$10,170.45
|
| Rate for Payer: Cash Price |
$10,170.45
|
| Rate for Payer: Cash Price |
$10,170.45
|
| Rate for Payer: Cash Price |
$10,170.45
|
| 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 |
$15,965.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,707.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,643.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15,820.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$17,561.82
|
| Rate for Payer: EPIC Health Plan Senior |
$11,707.88
|
| 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/Senior |
$17,455.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10,643.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14,351.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8,204.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14,900.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,424.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13,410.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14,262.33
|
| 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 |
$10,643.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15,965.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,707.88
|
| Rate for Payer: Vantage Medical Group Senior |
$10,643.53
|
|
|
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 |
$594.18 |
| Max. Negotiated Rate |
$74,422.60 |
| Rate for Payer: Adventist Health Commercial |
$17,511.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$57,427.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$60,556.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$44,408.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$40,371.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16,261.00
|
| Rate for Payer: Blue Shield of California Commercial |
$594.18
|
| Rate for Payer: Blue Shield of California Commercial |
$899.51
|
| Rate for Payer: Cash Price |
$39,400.20
|
| Rate for Payer: Cash Price |
$39,400.20
|
| Rate for Payer: Cash Price |
$39,400.20
|
| Rate for Payer: Cash Price |
$39,400.20
|
| 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 |
$60,556.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$44,408.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$40,371.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$61,289.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$66,612.68
|
| Rate for Payer: EPIC Health Plan Senior |
$44,408.45
|
| 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/Senior |
$66,208.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$40,371.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$55,598.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31,782.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$56,519.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21,013.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$50,867.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$54,097.57
|
| 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 |
$40,371.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$60,556.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$44,408.45
|
| Rate for Payer: Vantage Medical Group Senior |
$40,371.32
|
|
|
HC INSJ PERM CCM DFIB SYS PG AND ELTRD
|
Facility
|
IP
|
$87,556.00
|
|
|
Service Code
|
CPT 0915T
|
| Hospital Charge Code |
906811503
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$17,511.20 |
| Max. Negotiated Rate |
$74,422.60 |
| Rate for Payer: Adventist Health Commercial |
$17,511.20
|
| Rate for Payer: Cash Price |
$39,400.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$61,289.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$35,022.40
|
| Rate for Payer: EPIC Health Plan Senior |
$35,022.40
|
| Rate for Payer: Galaxy Health WC |
$74,422.60
|
| Rate for Payer: Global Benefits Group Commercial |
$52,533.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$55,598.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$51,658.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21,013.44
|
| 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
|
|
|
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 |
$594.18 |
| Max. Negotiated Rate |
$52,103.30 |
| Rate for Payer: Adventist Health Commercial |
$12,259.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$40,205.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$42,913.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$31,469.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28,608.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16,261.00
|
| Rate for Payer: Blue Shield of California Commercial |
$594.18
|
| Rate for Payer: Blue Shield of California Commercial |
$899.51
|
| Rate for Payer: Cash Price |
$27,584.10
|
| Rate for Payer: Cash Price |
$27,584.10
|
| Rate for Payer: Cash Price |
$27,584.10
|
| Rate for Payer: Cash Price |
$27,584.10
|
| 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 |
$42,913.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$31,469.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$28,608.96
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$42,908.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$47,204.78
|
| Rate for Payer: EPIC Health Plan Senior |
$31,469.86
|
| 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/Senior |
$46,918.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$28,608.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$38,924.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22,251.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$40,052.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14,711.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$36,047.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$38,336.01
|
| 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 |
$28,608.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$42,913.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31,469.86
|
| Rate for Payer: Vantage Medical Group Senior |
$28,608.96
|
|
|
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 |
$27,584.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$42,908.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$38,924.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$36,165.82
|
| 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 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 |
$10,170.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15,820.70
|
| 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 Foundation Hospitals Commercial/Self Funded |
$14,351.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13,334.59
|
| 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 |
$594.18 |
| Max. Negotiated Rate |
$19,210.85 |
| Rate for Payer: Adventist Health Commercial |
$4,520.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14,824.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15,965.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11,707.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,643.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16,261.00
|
| Rate for Payer: Blue Shield of California Commercial |
$594.18
|
| Rate for Payer: Blue Shield of California Commercial |
$899.51
|
| Rate for Payer: Cash Price |
$10,170.45
|
| Rate for Payer: Cash Price |
$10,170.45
|
| Rate for Payer: Cash Price |
$10,170.45
|
| Rate for Payer: Cash Price |
$10,170.45
|
| 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 |
$15,965.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,707.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,643.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15,820.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$17,561.82
|
| Rate for Payer: EPIC Health Plan Senior |
$11,707.88
|
| 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/Senior |
$17,455.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10,643.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14,351.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8,204.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14,900.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,424.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13,410.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14,262.33
|
| 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 |
$10,643.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15,965.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,707.88
|
| Rate for Payer: Vantage Medical Group Senior |
$10,643.53
|
|
|
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 |
$37.53
|
| Rate for Payer: Blue Shield of California Commercial |
$47.68
|
| Rate for Payer: Blue Shield of California Commercial |
$31.43
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cash Price |
$27.90
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$39.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$36.58
|
| 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$12.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cigna of CA HMO |
$43.40
|
| Rate for Payer: Cigna of CA PPO |
$43.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$39.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$36.58
|
| 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 |
$40.30
|
| 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
|
IP
|
$62.00
|
|
|
Service Code
|
CPT L3520
|
| Hospital Charge Code |
915353520
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$12.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$12.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cigna of CA HMO |
$43.40
|
| Rate for Payer: Cigna of CA PPO |
$43.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$39.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$36.58
|
| 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 |
$40.30
|
| 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 |
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 |
$37.53
|
| Rate for Payer: Blue Shield of California Commercial |
$47.68
|
| Rate for Payer: Blue Shield of California Commercial |
$31.43
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cash Price |
$27.90
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$39.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$36.58
|
| 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 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 |
$36.32
|
| Rate for Payer: Blue Shield of California Commercial |
$46.14
|
| Rate for Payer: Blue Shield of California Commercial |
$30.42
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$10.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$38.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.40
|
| 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
|
IP
|
$60.00
|
|
|
Service Code
|
CPT L3500
|
| Hospital Charge Code |
905353500
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$12.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cigna of CA HMO |
$42.00
|
| Rate for Payer: Cigna of CA PPO |
$42.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$38.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.40
|
| 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 |
$39.00
|
| 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 |
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 |
$36.32
|
| Rate for Payer: Blue Shield of California Commercial |
$46.14
|
| Rate for Payer: Blue Shield of California Commercial |
$30.42
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$10.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$38.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.40
|
| 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
|
IP
|
$60.00
|
|
|
Service Code
|
CPT L3500
|
| Hospital Charge Code |
915353500
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$12.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cigna of CA HMO |
$42.00
|
| Rate for Payer: Cigna of CA PPO |
$42.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$38.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.40
|
| 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 |
$39.00
|
| 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$12.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cigna of CA HMO |
$42.00
|
| Rate for Payer: Cigna of CA PPO |
$42.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$38.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.40
|
| 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 |
$39.00
|
| 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
|
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 |
$36.32
|
| Rate for Payer: Blue Shield of California Commercial |
$46.14
|
| Rate for Payer: Blue Shield of California Commercial |
$30.42
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$10.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$38.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.40
|
| 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 |
$14,109.00 |
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Adventist Health Commercial |
$12.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cigna of CA HMO |
$42.00
|
| Rate for Payer: Cigna of CA PPO |
$42.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$38.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.40
|
| 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 |
$39.00
|
| 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
|
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 |
$36.32
|
| Rate for Payer: Blue Shield of California Commercial |
$46.14
|
| Rate for Payer: Blue Shield of California Commercial |
$30.42
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$10.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$38.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.40
|
| 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 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 |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$2,950.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,735.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,872.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,156.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,942.61
|
| Rate for Payer: Blue Shield of California Commercial |
$4,454.70
|
| Rate for Payer: Cash Price |
$6,637.50
|
| Rate for Payer: Cash Price |
$6,637.50
|
| Rate for Payer: Cash Price |
$6,637.50
|
| 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 |
$10,735.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,872.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,156.86
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,325.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,808.82
|
| Rate for Payer: EPIC Health Plan Senior |
$7,872.55
|
| 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/Senior |
$11,737.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$212.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,156.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9,366.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$240.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,019.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,540.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,017.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,590.19
|
| 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 |
$7,375.00
|
| 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 |
$7,156.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,735.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,872.55
|
| Rate for Payer: Vantage Medical Group Senior |
$7,156.86
|
|
|
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 |
$6,637.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,325.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$9,366.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,702.50
|
| 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 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 |
$7,032.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,939.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$9,923.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9,220.52
|
| 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 |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$3,125.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,061.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,136.63
|
| Rate for Payer: Blue Shield of California Commercial |
$6,262.29
|
| Rate for Payer: Cash Price |
$7,032.60
|
| Rate for Payer: Cash Price |
$7,032.60
|
| Rate for Payer: Cash Price |
$7,032.60
|
| 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 |
$6,091.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,467.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,061.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,939.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,700.73
|
| Rate for Payer: EPIC Health Plan Senior |
$4,467.15
|
| 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/Senior |
$6,660.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$436.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9,923.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$493.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,685.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,750.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,116.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,441.81
|
| 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 |
$7,814.00
|
| 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 |
$4,061.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Vantage Medical Group Senior |
$4,061.05
|
|
|
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 |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,061.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Cash Price |
$6,115.50
|
| Rate for Payer: Cash Price |
$6,115.50
|
| Rate for Payer: Cash Price |
$6,115.50
|
| 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 |
$6,091.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,467.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,061.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,513.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,700.73
|
| Rate for Payer: EPIC Health Plan Senior |
$4,467.15
|
| 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/Senior |
$6,660.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,629.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$493.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,365.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,261.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,116.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,441.81
|
| 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 |
$4,061.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Vantage Medical Group Senior |
$4,061.05
|
|
