|
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 |
$36.41
|
| Rate for Payer: Blue Shield of California Commercial |
$47.93
|
| 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: 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: InnovAge PACE Commercial |
$31.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$41.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$38.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.42
|
| 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 |
$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
|
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 |
$36.41
|
| Rate for Payer: Blue Shield of California Commercial |
$47.93
|
| 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: 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: InnovAge PACE Commercial |
$31.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$41.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$38.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.42
|
| 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 |
$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
|
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 |
$46.38
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$40.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$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
|
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 |
$35.24
|
| Rate for Payer: Blue Shield of California Commercial |
$46.38
|
| 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: 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: InnovAge PACE Commercial |
$30.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.60
|
| 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 |
$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 |
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 |
$46.38
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$40.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$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
|
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 |
$35.24
|
| Rate for Payer: Blue Shield of California Commercial |
$46.38
|
| 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: 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: InnovAge PACE Commercial |
$30.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.60
|
| 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 |
$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 |
$46.38
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$40.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$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 |
$35.24
|
| Rate for Payer: Blue Shield of California Commercial |
$46.38
|
| 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: 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: InnovAge PACE Commercial |
$30.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.60
|
| 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 |
$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 |
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 |
$46.38
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$40.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$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 |
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 |
$35.24
|
| Rate for Payer: Blue Shield of California Commercial |
$46.38
|
| 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: 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: InnovAge PACE Commercial |
$30.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.60
|
| 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 |
$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 INSRT CANN HEMO OTHR VN TO VN
|
Facility
|
IP
|
$12,186.00
|
|
|
Service Code
|
CPT 36800
|
| Hospital Charge Code |
909036800
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,437.20 |
| Max. Negotiated Rate |
$10,967.40 |
| Rate for Payer: Adventist Health Commercial |
$2,437.20
|
| Rate for Payer: Cash Price |
$5,483.70
|
| Rate for Payer: Central Health Plan Commercial |
$9,748.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,874.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,874.40
|
| Rate for Payer: Galaxy Health WC |
$10,358.10
|
| Rate for Payer: Global Benefits Group Commercial |
$7,311.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,967.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,128.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,642.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,543.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,437.20
|
| Rate for Payer: Multiplan Commercial |
$9,139.50
|
| Rate for Payer: Networks By Design Commercial |
$7,920.90
|
| Rate for Payer: Prime Health Services Commercial |
$10,358.10
|
|
|
HC INSRT CANN HEMO OTHR VN TO VN
|
Facility
|
OP
|
$12,186.00
|
|
|
Service Code
|
CPT 36800
|
| Hospital Charge Code |
909036800
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$217.72 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$2,437.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$6,868.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,555.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,868.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,764.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$10,943.70
|
| Rate for Payer: Blue Shield of California Commercial |
$4,851.77
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$5,483.70
|
| Rate for Payer: Cash Price |
$5,483.70
|
| Rate for Payer: Cash Price |
$5,483.70
|
| Rate for Payer: Central Health Plan Commercial |
$9,748.80
|
| Rate for Payer: Cigna of CA HMO |
$7,799.04
|
| Rate for Payer: Cigna of CA PPO |
$9,017.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,555.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,868.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,272.45
|
| Rate for Payer: EPIC Health Plan Senior |
$6,868.48
|
| Rate for Payer: Galaxy Health WC |
$10,358.10
|
| Rate for Payer: Global Benefits Group Commercial |
$7,311.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,967.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,264.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$217.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,868.48
|
| Rate for Payer: InnovAge PACE Commercial |
$10,302.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,128.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$240.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,868.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,437.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,203.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,203.76
|
| Rate for Payer: Multiplan Commercial |
$9,139.50
|
| Rate for Payer: Multiplan WC |
$10,943.70
|
| Rate for Payer: Networks By Design Commercial |
$7,920.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$6,868.48
|
| Rate for Payer: Preferred Health Network WC |
$11,167.04
|
| Rate for Payer: Prime Health Services Commercial |
$10,358.10
|
| Rate for Payer: Prime Health Services Medicare |
$7,280.59
|
| Rate for Payer: Prime Health Services WC |
$10,832.03
|
| Rate for Payer: Riverside University Health System MISP |
$7,555.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,311.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,712.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$6,868.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,555.33
|
| Rate for Payer: Vantage Medical Group Senior |
$6,868.48
|
|
|
HC INSRTN PERITNL VENOUS SHUNT
|
Facility
|
IP
|
$14,435.00
|
|
|
Service Code
|
CPT 49425
|
| Hospital Charge Code |
909009425
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,887.00 |
| Max. Negotiated Rate |
$12,991.50 |
| Rate for Payer: Adventist Health Commercial |
$2,887.00
|
| Rate for Payer: Cash Price |
$6,495.75
|
| Rate for Payer: Central Health Plan Commercial |
$11,548.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,774.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,774.00
|
| Rate for Payer: Galaxy Health WC |
$12,269.75
|
| Rate for Payer: Global Benefits Group Commercial |
$8,661.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,991.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,628.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,499.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,935.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,887.00
|
| Rate for Payer: Multiplan Commercial |
$10,826.25
|
| Rate for Payer: Networks By Design Commercial |
$9,382.75
|
| Rate for Payer: Prime Health Services Commercial |
$12,269.75
|
|
|
HC INSRTN PERITNL VENOUS SHUNT
|
Facility
|
OP
|
$14,435.00
|
|
|
Service Code
|
CPT 49425
|
| Hospital Charge Code |
909009425
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,015.61 |
| Max. Negotiated Rate |
$12,991.50 |
| Rate for Payer: Adventist Health Commercial |
$2,887.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,269.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,939.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,826.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$6,495.75
|
| Rate for Payer: Cash Price |
$6,495.75
|
| Rate for Payer: Cash Price |
$6,495.75
|
| Rate for Payer: Central Health Plan Commercial |
$11,548.00
|
| Rate for Payer: Cigna of CA HMO |
$9,238.40
|
| Rate for Payer: Cigna of CA PPO |
$10,681.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,269.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$12,269.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12,269.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,774.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,774.00
|
| Rate for Payer: Galaxy Health WC |
$12,269.75
|
| Rate for Payer: Global Benefits Group Commercial |
$8,661.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,991.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,015.61
|
| Rate for Payer: InnovAge PACE Commercial |
$7,217.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,628.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,121.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,935.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,887.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,104.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,104.50
|
| Rate for Payer: Multiplan Commercial |
$10,826.25
|
| Rate for Payer: Networks By Design Commercial |
$9,382.75
|
| Rate for Payer: Prime Health Services Commercial |
$12,269.75
|
| Rate for Payer: Riverside University Health System MISP |
$5,774.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,661.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,269.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12,269.75
|
| Rate for Payer: Vantage Medical Group Senior |
$12,269.75
|
|
|
HC INSRT TUN CNTRL VAD W SUB PORT GT 5YR
|
Facility
|
OP
|
$15,189.00
|
|
|
Service Code
|
CPT 36561
|
| Hospital Charge Code |
909080012
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$446.98 |
| Max. Negotiated Rate |
$20,902.00 |
| Rate for Payer: Adventist Health Commercial |
$3,037.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$3,999.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,572.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,786.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,372.03
|
| Rate for Payer: Blue Shield of California Commercial |
$6,820.46
|
| Rate for Payer: Blue Shield of California EPN |
$4,450.12
|
| Rate for Payer: Cash Price |
$6,835.05
|
| Rate for Payer: Cash Price |
$6,835.05
|
| Rate for Payer: Cash Price |
$6,835.05
|
| Rate for Payer: Central Health Plan Commercial |
$12,151.20
|
| Rate for Payer: Cigna of CA HMO |
$9,720.96
|
| Rate for Payer: Cigna of CA PPO |
$11,239.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,398.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3,999.21
|
| Rate for Payer: Galaxy Health WC |
$12,910.65
|
| Rate for Payer: Global Benefits Group Commercial |
$9,113.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,670.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$446.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: InnovAge PACE Commercial |
$5,998.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,131.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$493.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,037.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,358.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,358.94
|
| Rate for Payer: Multiplan Commercial |
$11,391.75
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: Networks By Design Commercial |
$9,872.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Preferred Health Network WC |
$6,502.07
|
| Rate for Payer: Prime Health Services Commercial |
$12,910.65
|
| Rate for Payer: Prime Health Services Medicare |
$4,239.16
|
| Rate for Payer: Prime Health Services WC |
$6,307.01
|
| Rate for Payer: Riverside University Health System MISP |
$4,399.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,113.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,999.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC INSRT TUN CNTRL VAD W SUB PORT GT 5YR
|
Facility
|
IP
|
$15,189.00
|
|
|
Service Code
|
CPT 36561
|
| Hospital Charge Code |
909080012
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,037.80 |
| Max. Negotiated Rate |
$13,670.10 |
| Rate for Payer: Adventist Health Commercial |
$3,037.80
|
| Rate for Payer: Cash Price |
$6,835.05
|
| Rate for Payer: Central Health Plan Commercial |
$12,151.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,075.60
|
| Rate for Payer: EPIC Health Plan Senior |
$6,075.60
|
| Rate for Payer: Galaxy Health WC |
$12,910.65
|
| Rate for Payer: Global Benefits Group Commercial |
$9,113.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,670.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,131.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,787.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,401.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,037.80
|
| Rate for Payer: Multiplan Commercial |
$11,391.75
|
| Rate for Payer: Networks By Design Commercial |
$9,872.85
|
| Rate for Payer: Prime Health Services Commercial |
$12,910.65
|
|
|
HC INSRT TUN CNTRL VAD W/SUB PORT GT 5YR
|
Facility
|
OP
|
$15,189.00
|
|
|
Service Code
|
CPT 36561
|
| Hospital Charge Code |
900501569
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$13,670.10 |
| Rate for Payer: Adventist Health Commercial |
$3,037.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,572.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,786.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,372.03
|
| Rate for Payer: Cash Price |
$6,835.05
|
| Rate for Payer: Cash Price |
$6,835.05
|
| Rate for Payer: Cash Price |
$6,835.05
|
| Rate for Payer: Cash Price |
$6,835.05
|
| Rate for Payer: Central Health Plan Commercial |
$12,151.20
|
| Rate for Payer: Cigna of CA HMO |
$9,720.96
|
| Rate for Payer: Cigna of CA PPO |
$11,239.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,398.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3,999.21
|
| Rate for Payer: Galaxy Health WC |
$12,910.65
|
| Rate for Payer: Global Benefits Group Commercial |
$9,113.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,670.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: InnovAge PACE Commercial |
$5,998.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,131.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$493.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,037.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,358.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,358.94
|
| Rate for Payer: Multiplan Commercial |
$11,391.75
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: Networks By Design Commercial |
$9,872.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Preferred Health Network WC |
$6,502.07
|
| Rate for Payer: Prime Health Services Commercial |
$12,910.65
|
| Rate for Payer: Prime Health Services Medicare |
$4,239.16
|
| Rate for Payer: Prime Health Services WC |
$6,307.01
|
| Rate for Payer: Riverside University Health System MISP |
$4,399.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,113.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,594.50
|
| Rate for Payer: United Healthcare All Other HMO |
$7,594.50
|
| Rate for Payer: United Healthcare HMO Rider |
$7,594.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,594.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,999.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC INSRT TUN CNTRL VAD W/SUB PORT GT 5YR
|
Facility
|
IP
|
$15,189.00
|
|
|
Service Code
|
CPT 36561
|
| Hospital Charge Code |
900501569
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,037.80 |
| Max. Negotiated Rate |
$13,670.10 |
| Rate for Payer: Adventist Health Commercial |
$3,037.80
|
| Rate for Payer: Cash Price |
$6,835.05
|
| Rate for Payer: Central Health Plan Commercial |
$12,151.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,075.60
|
| Rate for Payer: EPIC Health Plan Senior |
$6,075.60
|
| Rate for Payer: Galaxy Health WC |
$12,910.65
|
| Rate for Payer: Global Benefits Group Commercial |
$9,113.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,670.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,131.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,787.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,401.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,037.80
|
| Rate for Payer: Multiplan Commercial |
$11,391.75
|
| Rate for Payer: Networks By Design Commercial |
$9,872.85
|
| Rate for Payer: Prime Health Services Commercial |
$12,910.65
|
|
|
HC INS SUBQ CAR RHYTHM MTR W PRGM
|
Facility
|
OP
|
$14,325.00
|
|
|
Service Code
|
CPT 33285
|
| Hospital Charge Code |
906813406
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,865.00 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$2,865.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$10,515.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15,773.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11,567.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,515.46
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,581.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$16,754.51
|
| Rate for Payer: Blue Shield of California Commercial |
$5,999.40
|
| Rate for Payer: Blue Shield of California EPN |
$3,914.40
|
| Rate for Payer: Cash Price |
$6,446.25
|
| Rate for Payer: Cash Price |
$6,446.25
|
| Rate for Payer: Cash Price |
$6,446.25
|
| Rate for Payer: Central Health Plan Commercial |
$11,460.00
|
| Rate for Payer: Cigna of CA HMO |
$9,168.00
|
| Rate for Payer: Cigna of CA PPO |
$10,600.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15,773.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,567.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,515.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,195.87
|
| Rate for Payer: EPIC Health Plan Senior |
$10,515.46
|
| Rate for Payer: Galaxy Health WC |
$12,176.25
|
| Rate for Payer: Global Benefits Group Commercial |
$8,595.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,892.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$17,245.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8,319.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10,515.46
|
| Rate for Payer: InnovAge PACE Commercial |
$15,773.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,554.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,190.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,515.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,865.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14,090.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14,090.72
|
| Rate for Payer: Multiplan Commercial |
$10,743.75
|
| Rate for Payer: Multiplan WC |
$16,754.51
|
| Rate for Payer: Networks By Design Commercial |
$9,311.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$10,515.46
|
| Rate for Payer: Preferred Health Network WC |
$17,096.44
|
| Rate for Payer: Prime Health Services Commercial |
$12,176.25
|
| Rate for Payer: Prime Health Services Medicare |
$11,146.39
|
| Rate for Payer: Prime Health Services WC |
$16,583.55
|
| Rate for Payer: Riverside University Health System MISP |
$11,567.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,595.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$31,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$10,515.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15,773.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,567.01
|
| Rate for Payer: Vantage Medical Group Senior |
$10,515.46
|
|
|
HC INS SUBQ CAR RHYTHM MTR W PRGM
|
Facility
|
IP
|
$16,853.00
|
|
|
Service Code
|
CPT 33285
|
| Hospital Charge Code |
906820138
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,370.60 |
| Max. Negotiated Rate |
$15,167.70 |
| Rate for Payer: Adventist Health Commercial |
$3,370.60
|
| Rate for Payer: Cash Price |
$7,583.85
|
| Rate for Payer: Central Health Plan Commercial |
$13,482.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,741.20
|
| Rate for Payer: EPIC Health Plan Senior |
$6,741.20
|
| Rate for Payer: Galaxy Health WC |
$14,325.05
|
| Rate for Payer: Global Benefits Group Commercial |
$10,111.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,167.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,240.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,420.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,432.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,370.60
|
| Rate for Payer: Multiplan Commercial |
$12,639.75
|
| Rate for Payer: Networks By Design Commercial |
$10,954.45
|
| Rate for Payer: Prime Health Services Commercial |
$14,325.05
|
|
|
HC INS SUBQ CAR RHYTHM MTR W PRGM
|
Facility
|
IP
|
$14,325.00
|
|
|
Service Code
|
CPT 33285
|
| Hospital Charge Code |
906813406
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,865.00 |
| Max. Negotiated Rate |
$12,892.50 |
| Rate for Payer: Adventist Health Commercial |
$2,865.00
|
| Rate for Payer: Cash Price |
$6,446.25
|
| Rate for Payer: Central Health Plan Commercial |
$11,460.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,730.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,730.00
|
| Rate for Payer: Galaxy Health WC |
$12,176.25
|
| Rate for Payer: Global Benefits Group Commercial |
$8,595.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,892.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,554.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,457.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,867.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,865.00
|
| Rate for Payer: Multiplan Commercial |
$10,743.75
|
| Rate for Payer: Networks By Design Commercial |
$9,311.25
|
| Rate for Payer: Prime Health Services Commercial |
$12,176.25
|
|
|
HC INS SUBQ CAR RHYTHM MTR W PRGM
|
Facility
|
OP
|
$16,853.00
|
|
|
Service Code
|
CPT 33285
|
| Hospital Charge Code |
906820138
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,901.00 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$3,370.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$10,515.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15,773.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11,567.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,515.46
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,581.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$16,754.51
|
| Rate for Payer: Blue Shield of California Commercial |
$5,999.40
|
| Rate for Payer: Blue Shield of California EPN |
$3,914.40
|
| Rate for Payer: Cash Price |
$7,583.85
|
| Rate for Payer: Cash Price |
$7,583.85
|
| Rate for Payer: Cash Price |
$7,583.85
|
| Rate for Payer: Central Health Plan Commercial |
$13,482.40
|
| Rate for Payer: Cigna of CA HMO |
$10,785.92
|
| Rate for Payer: Cigna of CA PPO |
$12,471.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15,773.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,567.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,515.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,195.87
|
| Rate for Payer: EPIC Health Plan Senior |
$10,515.46
|
| Rate for Payer: Galaxy Health WC |
$14,325.05
|
| Rate for Payer: Global Benefits Group Commercial |
$10,111.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,167.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$17,245.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8,319.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10,515.46
|
| Rate for Payer: InnovAge PACE Commercial |
$15,773.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,240.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,190.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,515.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,370.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14,090.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14,090.72
|
| Rate for Payer: Multiplan Commercial |
$12,639.75
|
| Rate for Payer: Multiplan WC |
$16,754.51
|
| Rate for Payer: Networks By Design Commercial |
$10,954.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$10,515.46
|
| Rate for Payer: Preferred Health Network WC |
$17,096.44
|
| Rate for Payer: Prime Health Services Commercial |
$14,325.05
|
| Rate for Payer: Prime Health Services Medicare |
$11,146.39
|
| Rate for Payer: Prime Health Services WC |
$16,583.55
|
| Rate for Payer: Riverside University Health System MISP |
$11,567.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,111.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$31,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$10,515.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15,773.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,567.01
|
| Rate for Payer: Vantage Medical Group Senior |
$10,515.46
|
|
|
HC INST ANTINEOPLSTC PHRM/BIOLGC AGT RNL PLVS
|
Facility
|
OP
|
$7,149.00
|
|
|
Service Code
|
CPT C9789
|
| Hospital Charge Code |
910100789
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,429.80 |
| Max. Negotiated Rate |
$6,434.10 |
| Rate for Payer: Adventist Health Commercial |
$1,429.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,859.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,289.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,145.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,859.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$3,217.05
|
| Rate for Payer: Cash Price |
$3,217.05
|
| Rate for Payer: Cash Price |
$3,217.05
|
| Rate for Payer: Central Health Plan Commercial |
$5,719.20
|
| Rate for Payer: Cigna of CA HMO |
$4,575.36
|
| Rate for Payer: Cigna of CA PPO |
$5,290.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,289.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,145.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,859.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,860.31
|
| Rate for Payer: EPIC Health Plan Senior |
$2,859.49
|
| Rate for Payer: Galaxy Health WC |
$6,076.65
|
| Rate for Payer: Global Benefits Group Commercial |
$4,289.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,434.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,689.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,859.49
|
| Rate for Payer: InnovAge PACE Commercial |
$4,289.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,768.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,859.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,429.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,831.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,831.72
|
| Rate for Payer: Multiplan Commercial |
$5,361.75
|
| Rate for Payer: Networks By Design Commercial |
$4,646.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,859.49
|
| Rate for Payer: Prime Health Services Commercial |
$6,076.65
|
| Rate for Payer: Prime Health Services Medicare |
$3,031.06
|
| Rate for Payer: Riverside University Health System MISP |
$3,145.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,289.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,574.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,574.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,574.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,574.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,859.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,289.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,145.44
|
| Rate for Payer: Vantage Medical Group Senior |
$2,859.49
|
|
|
HC INST ANTINEOPLSTC PHRM/BIOLGC AGT RNL PLVS
|
Facility
|
IP
|
$7,149.00
|
|
|
Service Code
|
CPT C9789
|
| Hospital Charge Code |
910100789
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,429.80 |
| Max. Negotiated Rate |
$6,434.10 |
| Rate for Payer: Adventist Health Commercial |
$1,429.80
|
| Rate for Payer: Cash Price |
$3,217.05
|
| Rate for Payer: Central Health Plan Commercial |
$5,719.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,859.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,859.60
|
| Rate for Payer: Galaxy Health WC |
$6,076.65
|
| Rate for Payer: Global Benefits Group Commercial |
$4,289.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,434.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,768.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,723.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,425.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,429.80
|
| Rate for Payer: Multiplan Commercial |
$5,361.75
|
| Rate for Payer: Networks By Design Commercial |
$4,646.85
|
| Rate for Payer: Prime Health Services Commercial |
$6,076.65
|
|
|
HC INSTILL RX AGENT VIA NEPH TUBE
|
Facility
|
IP
|
$1,046.00
|
|
|
Service Code
|
CPT 50391
|
| Hospital Charge Code |
907201118
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$209.20 |
| Max. Negotiated Rate |
$941.40 |
| Rate for Payer: Adventist Health Commercial |
$209.20
|
| Rate for Payer: Cash Price |
$470.70
|
| Rate for Payer: Central Health Plan Commercial |
$836.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$418.40
|
| Rate for Payer: EPIC Health Plan Senior |
$418.40
|
| Rate for Payer: Galaxy Health WC |
$889.10
|
| Rate for Payer: Global Benefits Group Commercial |
$627.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$941.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$697.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$398.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$647.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$209.20
|
| Rate for Payer: Multiplan Commercial |
$784.50
|
| Rate for Payer: Networks By Design Commercial |
$679.90
|
| Rate for Payer: Prime Health Services Commercial |
$889.10
|
|
