|
HC INSERT URINARY CATH COMPLICATED
|
Facility
|
IP
|
$1,081.00
|
|
|
Service Code
|
CPT 51703
|
| Hospital Charge Code |
902400104
|
|
Hospital Revenue Code
|
230
|
| Min. Negotiated Rate |
$216.20 |
| Max. Negotiated Rate |
$972.90 |
| Rate for Payer: Adventist Health Commercial |
$216.20
|
| Rate for Payer: Cash Price |
$486.45
|
| Rate for Payer: Central Health Plan Commercial |
$864.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$756.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$432.40
|
| Rate for Payer: EPIC Health Plan Senior |
$432.40
|
| Rate for Payer: Galaxy Health WC |
$918.85
|
| Rate for Payer: Global Benefits Group Commercial |
$648.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$972.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$686.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$637.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$216.20
|
| Rate for Payer: Multiplan Commercial |
$810.75
|
| Rate for Payer: Networks By Design Commercial |
$702.65
|
| Rate for Payer: Prime Health Services Commercial |
$918.85
|
|
|
HC INSERT URINARY CATH COMPLICATED
|
Facility
|
OP
|
$1,081.00
|
|
|
Service Code
|
CPT 51703
|
| Hospital Charge Code |
902400104
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.49 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$216.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$248.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$165.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$316.75
|
| Rate for Payer: Cash Price |
$486.45
|
| Rate for Payer: Cash Price |
$486.45
|
| Rate for Payer: Cash Price |
$486.45
|
| Rate for Payer: Cash Price |
$486.45
|
| Rate for Payer: Central Health Plan Commercial |
$864.80
|
| Rate for Payer: Cigna of CA HMO |
$691.84
|
| Rate for Payer: Cigna of CA PPO |
$799.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$248.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$182.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$165.49
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$756.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$273.06
|
| Rate for Payer: EPIC Health Plan Senior |
$182.04
|
| Rate for Payer: Galaxy Health WC |
$918.85
|
| Rate for Payer: Global Benefits Group Commercial |
$648.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$972.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$271.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$165.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$686.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$205.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$177.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$216.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$221.76
|
| Rate for Payer: Multiplan Commercial |
$810.75
|
| Rate for Payer: Multiplan WC |
$316.75
|
| Rate for Payer: Networks By Design Commercial |
$702.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$165.49
|
| Rate for Payer: Preferred Health Network WC |
$323.21
|
| Rate for Payer: Prime Health Services Commercial |
$918.85
|
| Rate for Payer: Prime Health Services Medicare |
$175.42
|
| Rate for Payer: Prime Health Services WC |
$313.51
|
| Rate for Payer: Riverside University Health System MISP |
$182.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$648.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$540.50
|
| Rate for Payer: United Healthcare All Other HMO |
$540.50
|
| Rate for Payer: United Healthcare HMO Rider |
$540.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$540.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$165.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$248.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Vantage Medical Group Senior |
$165.49
|
|
|
HC INSERT URINARY CATH COMPLICATED
|
Facility
|
IP
|
$1,081.00
|
|
|
Service Code
|
CPT 51703
|
| Hospital Charge Code |
902400104
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$216.20 |
| Max. Negotiated Rate |
$972.90 |
| Rate for Payer: Adventist Health Commercial |
$216.20
|
| Rate for Payer: Cash Price |
$486.45
|
| Rate for Payer: Central Health Plan Commercial |
$864.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$756.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$432.40
|
| Rate for Payer: EPIC Health Plan Senior |
$432.40
|
| Rate for Payer: Galaxy Health WC |
$918.85
|
| Rate for Payer: Global Benefits Group Commercial |
$648.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$972.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$686.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$637.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$216.20
|
| Rate for Payer: Multiplan Commercial |
$810.75
|
| Rate for Payer: Networks By Design Commercial |
$702.65
|
| Rate for Payer: Prime Health Services Commercial |
$918.85
|
|
|
HC INSERT VAD ARTERY ACCESS
|
Facility
|
OP
|
$12,136.00
|
|
|
Service Code
|
CPT 33990
|
| Hospital Charge Code |
906811429
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$603.86 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$2,427.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,315.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,674.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,102.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,461.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,933.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,579.41
|
| Rate for Payer: Blue Shield of California EPN |
$6,020.76
|
| Rate for Payer: Cash Price |
$5,461.20
|
| Rate for Payer: Cash Price |
$5,461.20
|
| Rate for Payer: Cash Price |
$5,461.20
|
| Rate for Payer: Central Health Plan Commercial |
$9,708.80
|
| Rate for Payer: Cigna of CA HMO |
$7,767.04
|
| Rate for Payer: Cigna of CA PPO |
$8,980.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,315.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,315.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,315.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,495.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,854.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,854.40
|
| Rate for Payer: Galaxy Health WC |
$10,315.60
|
| Rate for Payer: Global Benefits Group Commercial |
$7,281.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,922.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$603.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,706.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$667.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,160.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,427.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8,495.20
|
| Rate for Payer: Multiplan Commercial |
$9,102.00
|
| Rate for Payer: Networks By Design Commercial |
$7,888.40
|
| Rate for Payer: Prime Health Services Commercial |
$10,315.60
|
| Rate for Payer: Riverside University Health System MISP |
$4,854.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,281.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,068.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,315.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,315.60
|
| Rate for Payer: Vantage Medical Group Senior |
$10,315.60
|
|
|
HC INSERT VAD ARTERY ACCESS
|
Facility
|
IP
|
$12,136.00
|
|
|
Service Code
|
CPT 33990
|
| Hospital Charge Code |
906811429
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,427.20 |
| Max. Negotiated Rate |
$10,922.40 |
| Rate for Payer: Adventist Health Commercial |
$2,427.20
|
| Rate for Payer: Cash Price |
$5,461.20
|
| Rate for Payer: Central Health Plan Commercial |
$9,708.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,495.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,854.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,854.40
|
| Rate for Payer: Galaxy Health WC |
$10,315.60
|
| Rate for Payer: Global Benefits Group Commercial |
$7,281.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,922.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,706.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,160.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,427.20
|
| Rate for Payer: Multiplan Commercial |
$9,102.00
|
| Rate for Payer: Networks By Design Commercial |
$7,888.40
|
| Rate for Payer: Prime Health Services Commercial |
$10,315.60
|
|
|
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 |
$20,340.90 |
| Rate for Payer: Adventist Health Commercial |
$4,520.20
|
| Rate for Payer: Cash Price |
$10,170.45
|
| Rate for Payer: Central Health Plan Commercial |
$18,080.80
|
| 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: Health Management Network EPO/PPO |
$20,340.90
|
| 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 |
$4,520.20
|
| Rate for Payer: Multiplan Commercial |
$16,950.75
|
| 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 |
$639.21 |
| Max. Negotiated Rate |
$20,340.90 |
| Rate for Payer: Adventist Health Commercial |
$4,520.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$10,643.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13,725.59
|
| 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 Exchange |
$11,461.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,933.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,017.03
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| 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: Central Health Plan Commercial |
$18,080.80
|
| 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: Health Management Network EPO/PPO |
$20,340.90
|
| 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 |
$4,520.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$14,262.33
|
| Rate for Payer: Multiplan Commercial |
$16,950.75
|
| Rate for Payer: Networks By Design Commercial |
$14,690.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$10,643.53
|
| Rate for Payer: Prime Health Services Commercial |
$19,210.85
|
| Rate for Payer: Prime Health Services Medicare |
$11,282.14
|
| Rate for Payer: Riverside University Health System MISP |
$11,707.88
|
| 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
|
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 |
$78,800.40 |
| Rate for Payer: Adventist Health Commercial |
$17,511.20
|
| Rate for Payer: Cash Price |
$39,400.20
|
| Rate for Payer: Central Health Plan Commercial |
$70,044.80
|
| 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: Health Management Network EPO/PPO |
$78,800.40
|
| 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 |
$17,511.20
|
| Rate for Payer: Multiplan Commercial |
$65,667.00
|
| 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 PG AND ELTRD
|
Facility
|
OP
|
$87,556.00
|
|
|
Service Code
|
CPT 0915T
|
| Hospital Charge Code |
906811503
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$639.21 |
| Max. Negotiated Rate |
$78,800.40 |
| Rate for Payer: Adventist Health Commercial |
$17,511.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$40,371.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$53,172.76
|
| 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 Exchange |
$11,461.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,933.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,017.03
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| 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: Central Health Plan Commercial |
$70,044.80
|
| 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 |
$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: Health Management Network EPO/PPO |
$78,800.40
|
| 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 |
$17,511.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$54,097.57
|
| Rate for Payer: Multiplan Commercial |
$65,667.00
|
| Rate for Payer: Networks By Design Commercial |
$56,911.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$40,371.32
|
| Rate for Payer: Prime Health Services Commercial |
$74,422.60
|
| Rate for Payer: Prime Health Services Medicare |
$42,793.60
|
| Rate for Payer: Riverside University Health System MISP |
$44,408.45
|
| 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 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 |
$55,168.20 |
| Rate for Payer: Adventist Health Commercial |
$12,259.60
|
| Rate for Payer: Cash Price |
$27,584.10
|
| Rate for Payer: Central Health Plan Commercial |
$49,038.40
|
| 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: Health Management Network EPO/PPO |
$55,168.20
|
| 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 |
$12,259.60
|
| Rate for Payer: Multiplan Commercial |
$45,973.50
|
| 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 |
$639.21 |
| Max. Negotiated Rate |
$55,168.20 |
| Rate for Payer: Adventist Health Commercial |
$12,259.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$28,608.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$37,226.28
|
| 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 Exchange |
$11,461.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,933.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,017.03
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| 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: Central Health Plan Commercial |
$49,038.40
|
| 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: Health Management Network EPO/PPO |
$55,168.20
|
| 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 |
$12,259.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$38,336.01
|
| Rate for Payer: Multiplan Commercial |
$45,973.50
|
| Rate for Payer: Networks By Design Commercial |
$39,843.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$28,608.96
|
| Rate for Payer: Prime Health Services Commercial |
$52,103.30
|
| Rate for Payer: Prime Health Services Medicare |
$30,325.50
|
| Rate for Payer: Riverside University Health System MISP |
$31,469.86
|
| 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 SINGLE LEAD
|
Facility
|
OP
|
$22,601.00
|
|
|
Service Code
|
CPT 0917T
|
| Hospital Charge Code |
906811505
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$639.21 |
| Max. Negotiated Rate |
$20,340.90 |
| Rate for Payer: Adventist Health Commercial |
$4,520.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$10,643.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13,725.59
|
| 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 Exchange |
$11,461.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,933.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,017.03
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| 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: Central Health Plan Commercial |
$18,080.80
|
| 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: Health Management Network EPO/PPO |
$20,340.90
|
| 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 |
$4,520.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$14,262.33
|
| Rate for Payer: Multiplan Commercial |
$16,950.75
|
| Rate for Payer: Networks By Design Commercial |
$14,690.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$10,643.53
|
| Rate for Payer: Prime Health Services Commercial |
$19,210.85
|
| Rate for Payer: Prime Health Services Medicare |
$11,282.14
|
| Rate for Payer: Riverside University Health System MISP |
$11,707.88
|
| 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 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 |
$20,340.90 |
| Rate for Payer: Adventist Health Commercial |
$4,520.20
|
| Rate for Payer: Cash Price |
$10,170.45
|
| Rate for Payer: Central Health Plan Commercial |
$18,080.80
|
| 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: Health Management Network EPO/PPO |
$20,340.90
|
| 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 |
$4,520.20
|
| Rate for Payer: Multiplan Commercial |
$16,950.75
|
| Rate for Payer: Networks By Design Commercial |
$14,690.65
|
| Rate for Payer: Prime Health Services Commercial |
$19,210.85
|
|
|
HC INSOLE FELT SHOE ADD
|
Facility
|
OP
|
$62.00
|
|
|
Service Code
|
CPT L3520
|
| Hospital Charge Code |
915353520
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$14.45 |
| Max. Negotiated Rate |
$55.80 |
| 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 |
$36.07
|
| Rate for Payer: Blue Shield of California Commercial |
$49.72
|
| Rate for Payer: Blue Shield of California EPN |
$31.25
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Central Health Plan Commercial |
$49.60
|
| 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: Health Management Network EPO/PPO |
$55.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.45
|
| 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 |
$25.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$43.40
|
| Rate for Payer: Multiplan Commercial |
$46.50
|
| Rate for Payer: Networks By Design Commercial |
$31.00
|
| Rate for Payer: Prime Health Services Commercial |
$52.70
|
| Rate for Payer: Riverside University Health System MISP |
$24.80
|
| 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 |
$55.80 |
| Rate for Payer: Adventist Health Commercial |
$12.40
|
| Rate for Payer: Blue Shield of California Commercial |
$49.72
|
| Rate for Payer: Blue Shield of California EPN |
$31.25
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Central Health Plan Commercial |
$49.60
|
| 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: Health Management Network EPO/PPO |
$55.80
|
| 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 |
$12.40
|
| Rate for Payer: Multiplan Commercial |
$46.50
|
| 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 |
905353520
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$12.40 |
| Max. Negotiated Rate |
$55.80 |
| Rate for Payer: Adventist Health Commercial |
$12.40
|
| Rate for Payer: Blue Shield of California Commercial |
$49.72
|
| Rate for Payer: Blue Shield of California EPN |
$31.25
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Central Health Plan Commercial |
$49.60
|
| 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: Health Management Network EPO/PPO |
$55.80
|
| 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 |
$12.40
|
| Rate for Payer: Multiplan Commercial |
$46.50
|
| 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 |
905353520
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$14.45 |
| Max. Negotiated Rate |
$55.80 |
| 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 |
$36.07
|
| Rate for Payer: Blue Shield of California Commercial |
$49.72
|
| Rate for Payer: Blue Shield of California EPN |
$31.25
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Central Health Plan Commercial |
$49.60
|
| 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: Health Management Network EPO/PPO |
$55.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.45
|
| 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 |
$25.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$43.40
|
| Rate for Payer: Multiplan Commercial |
$46.50
|
| Rate for Payer: Networks By Design Commercial |
$31.00
|
| Rate for Payer: Prime Health Services Commercial |
$52.70
|
| Rate for Payer: Riverside University Health System MISP |
$24.80
|
| 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 |
915353500
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$10.60 |
| Max. Negotiated Rate |
$54.00 |
| 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 |
$34.90
|
| Rate for Payer: Blue Shield of California Commercial |
$48.12
|
| Rate for Payer: Blue Shield of California EPN |
$30.24
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Central Health Plan Commercial |
$48.00
|
| 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: Health Management Network EPO/PPO |
$54.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$10.60
|
| 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 |
$24.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$42.00
|
| Rate for Payer: Multiplan Commercial |
$45.00
|
| Rate for Payer: Networks By Design Commercial |
$30.00
|
| Rate for Payer: Prime Health Services Commercial |
$51.00
|
| Rate for Payer: Riverside University Health System MISP |
$24.00
|
| 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 |
905353500
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$10.60 |
| Max. Negotiated Rate |
$54.00 |
| 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 |
$34.90
|
| Rate for Payer: Blue Shield of California Commercial |
$48.12
|
| Rate for Payer: Blue Shield of California EPN |
$30.24
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Central Health Plan Commercial |
$48.00
|
| 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: Health Management Network EPO/PPO |
$54.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$10.60
|
| 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 |
$24.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$42.00
|
| Rate for Payer: Multiplan Commercial |
$45.00
|
| Rate for Payer: Networks By Design Commercial |
$30.00
|
| Rate for Payer: Prime Health Services Commercial |
$51.00
|
| Rate for Payer: Riverside University Health System MISP |
$24.00
|
| 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 |
$54.00 |
| Rate for Payer: Adventist Health Commercial |
$12.00
|
| Rate for Payer: Blue Shield of California Commercial |
$48.12
|
| Rate for Payer: Blue Shield of California EPN |
$30.24
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Central Health Plan Commercial |
$48.00
|
| 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: Health Management Network EPO/PPO |
$54.00
|
| 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 |
$12.00
|
| Rate for Payer: Multiplan Commercial |
$45.00
|
| 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
|
IP
|
$60.00
|
|
|
Service Code
|
CPT L3500
|
| Hospital Charge Code |
915353500
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$54.00 |
| Rate for Payer: Adventist Health Commercial |
$12.00
|
| Rate for Payer: Blue Shield of California Commercial |
$48.12
|
| Rate for Payer: Blue Shield of California EPN |
$30.24
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Central Health Plan Commercial |
$48.00
|
| 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: Health Management Network EPO/PPO |
$54.00
|
| 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 |
$12.00
|
| Rate for Payer: Multiplan Commercial |
$45.00
|
| 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 |
$54.00 |
| Rate for Payer: Adventist Health Commercial |
$12.00
|
| Rate for Payer: Blue Shield of California Commercial |
$48.12
|
| Rate for Payer: Blue Shield of California EPN |
$30.24
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Central Health Plan Commercial |
$48.00
|
| 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: Health Management Network EPO/PPO |
$54.00
|
| 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 |
$12.00
|
| Rate for Payer: Multiplan Commercial |
$45.00
|
| 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 |
$10.60 |
| Max. Negotiated Rate |
$54.00 |
| 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 |
$34.90
|
| Rate for Payer: Blue Shield of California Commercial |
$48.12
|
| Rate for Payer: Blue Shield of California EPN |
$30.24
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Central Health Plan Commercial |
$48.00
|
| 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: Health Management Network EPO/PPO |
$54.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$10.60
|
| 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 |
$24.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$42.00
|
| Rate for Payer: Multiplan Commercial |
$45.00
|
| Rate for Payer: Networks By Design Commercial |
$30.00
|
| Rate for Payer: Prime Health Services Commercial |
$51.00
|
| Rate for Payer: Riverside University Health System MISP |
$24.00
|
| 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 |
$10.60 |
| Max. Negotiated Rate |
$54.00 |
| 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 |
$34.90
|
| Rate for Payer: Blue Shield of California Commercial |
$48.12
|
| Rate for Payer: Blue Shield of California EPN |
$30.24
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Central Health Plan Commercial |
$48.00
|
| 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: Health Management Network EPO/PPO |
$54.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$10.60
|
| 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 |
$24.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$42.00
|
| Rate for Payer: Multiplan Commercial |
$45.00
|
| Rate for Payer: Networks By Design Commercial |
$30.00
|
| Rate for Payer: Prime Health Services Commercial |
$51.00
|
| Rate for Payer: Riverside University Health System MISP |
$24.00
|
| 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 |
$54.00 |
| Rate for Payer: Adventist Health Commercial |
$12.00
|
| Rate for Payer: Blue Shield of California Commercial |
$48.12
|
| Rate for Payer: Blue Shield of California EPN |
$30.24
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Central Health Plan Commercial |
$48.00
|
| 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: Health Management Network EPO/PPO |
$54.00
|
| 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 |
$12.00
|
| Rate for Payer: Multiplan Commercial |
$45.00
|
| 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
|
|
