|
HC INSOLE FELT SHOE ADD
|
Facility
|
OP
|
$62.00
|
|
|
Service Code
|
CPT L3520
|
| Hospital Charge Code |
905353520
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$15.96 |
| Max. Negotiated Rate |
$55.80 |
| 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 |
$34.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$30.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$36.63
|
| Rate for Payer: Blue Distinction Transplant |
$37.20
|
| Rate for Payer: Blue Shield of California Commercial |
$46.50
|
| Rate for Payer: Blue Shield of California EPN |
$33.73
|
| 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 Media |
$52.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$52.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$46.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21.70
|
| 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: LLUH Dept of Risk Management WC |
$25.42
|
| 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 |
$31.00
|
| Rate for Payer: United Healthcare All Other HMO |
$31.00
|
| Rate for Payer: United Healthcare HMO Rider |
$31.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52.70
|
| Rate for Payer: Vantage Medical Group Senior |
$52.70
|
|
|
HC INSOLE LEATHER SHOE ADD
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
CPT L3500
|
| Hospital Charge Code |
905353500
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$11.70 |
| Max. Negotiated Rate |
$54.00 |
| 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 |
$33.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$29.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35.45
|
| Rate for Payer: Blue Distinction Transplant |
$36.00
|
| Rate for Payer: Blue Shield of California Commercial |
$45.00
|
| Rate for Payer: Blue Shield of California EPN |
$32.64
|
| 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 Media |
$51.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$51.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$45.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21.00
|
| 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: LLUH Dept of Risk Management WC |
$24.60
|
| 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 |
$30.00
|
| Rate for Payer: United Healthcare All Other HMO |
$30.00
|
| Rate for Payer: United Healthcare HMO Rider |
$30.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30.00
|
| 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: Blue Shield of California EPN |
$32.04
|
| 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 Transplant |
$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: LLUH Dept of Risk Management WC |
$12.00
|
| 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: United Healthcare All Other Commercial |
$22.66
|
| Rate for Payer: United Healthcare All Other HMO |
$22.13
|
| Rate for Payer: United Healthcare HMO Rider |
$21.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.80
|
|
|
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: Blue Shield of California EPN |
$32.04
|
| 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 Transplant |
$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: LLUH Dept of Risk Management WC |
$12.00
|
| 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: United Healthcare All Other Commercial |
$22.66
|
| Rate for Payer: United Healthcare All Other HMO |
$22.13
|
| Rate for Payer: United Healthcare HMO Rider |
$21.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.80
|
|
|
HC INSOLE RUBBER SHOE ADD
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
CPT L3510
|
| Hospital Charge Code |
905353510
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$11.70 |
| Max. Negotiated Rate |
$54.00 |
| 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 |
$33.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$29.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35.45
|
| Rate for Payer: Blue Distinction Transplant |
$36.00
|
| Rate for Payer: Blue Shield of California Commercial |
$45.00
|
| Rate for Payer: Blue Shield of California EPN |
$32.64
|
| 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 Media |
$51.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$51.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$45.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21.00
|
| 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: LLUH Dept of Risk Management WC |
$24.60
|
| 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 |
$30.00
|
| Rate for Payer: United Healthcare All Other HMO |
$30.00
|
| Rate for Payer: United Healthcare HMO Rider |
$30.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30.00
|
| 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
|
$15,090.00
|
|
|
Service Code
|
CPT 36800
|
| Hospital Charge Code |
909036800
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,018.00 |
| Max. Negotiated Rate |
$13,581.00 |
| Rate for Payer: Cash Price |
$6,790.50
|
| Rate for Payer: Central Health Plan Commercial |
$12,072.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,036.00
|
| Rate for Payer: Galaxy Health WC |
$12,826.50
|
| Rate for Payer: Global Benefits Group Commercial |
$9,054.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,581.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,065.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,749.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,018.00
|
| Rate for Payer: Multiplan Commercial |
$11,317.50
|
| Rate for Payer: Networks By Design Commercial |
$9,808.50
|
| Rate for Payer: Prime Health Services Commercial |
$12,826.50
|
|
|
HC INSRT CANN HEMO OTHR VN TO VN
|
Facility
|
OP
|
$15,090.00
|
|
|
Service Code
|
CPT 36800
|
| Hospital Charge Code |
909036800
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$240.50 |
| Max. Negotiated Rate |
$27,445.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$6,866.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,552.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,866.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Blue Distinction Transplant |
$9,054.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,710.35
|
| Rate for Payer: Blue Shield of California EPN |
$3,383.18
|
| Rate for Payer: Caremore Medicare Advantage |
$6,866.07
|
| Rate for Payer: Cash Price |
$6,790.50
|
| Rate for Payer: Cash Price |
$6,790.50
|
| Rate for Payer: Central Health Plan Commercial |
$12,072.00
|
| Rate for Payer: Cigna of CA PPO |
$11,166.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Dignity Health Media |
$6,866.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,552.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,269.19
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$6,866.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$6,866.07
|
| Rate for Payer: Galaxy Health WC |
$12,826.50
|
| Rate for Payer: Global Benefits Group Commercial |
$9,054.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,581.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$11,317.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,260.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$11,329.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,866.07
|
| Rate for Payer: InnovAge PACE Commercial |
$10,299.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,065.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$240.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,866.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,018.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,200.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,200.53
|
| Rate for Payer: Multiplan Commercial |
$11,317.50
|
| Rate for Payer: Networks By Design Commercial |
$9,808.50
|
| Rate for Payer: Prime Health Services Commercial |
$12,826.50
|
| Rate for Payer: Prime Health Services Medicare |
$7,278.03
|
| Rate for Payer: Riverside University Health System MISP |
$7,552.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,054.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$16,813.00
|
| Rate for Payer: United Healthcare All Other HMO |
$27,445.00
|
| Rate for Payer: United Healthcare HMO Rider |
$17,214.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,742.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,552.68
|
| Rate for Payer: Vantage Medical Group Senior |
$6,866.07
|
|
|
HC INSRTN PERITNL VENOUS SHUNT
|
Facility
|
OP
|
$10,915.00
|
|
|
Service Code
|
CPT 49425
|
| Hospital Charge Code |
909009425
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,121.89 |
| Max. Negotiated Rate |
$9,823.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,277.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,003.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,003.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$6,549.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Cash Price |
$4,911.75
|
| Rate for Payer: Cash Price |
$4,911.75
|
| Rate for Payer: Central Health Plan Commercial |
$8,732.00
|
| Rate for Payer: Cigna of CA PPO |
$8,077.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,277.75
|
| Rate for Payer: Dignity Health Media |
$9,277.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,277.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,366.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,366.00
|
| Rate for Payer: Galaxy Health WC |
$9,277.75
|
| Rate for Payer: Global Benefits Group Commercial |
$6,549.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,823.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8,186.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,820.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,280.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,121.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,183.00
|
| Rate for Payer: Multiplan Commercial |
$8,186.25
|
| Rate for Payer: Networks By Design Commercial |
$7,094.75
|
| Rate for Payer: Prime Health Services Commercial |
$9,277.75
|
| Rate for Payer: Riverside University Health System MISP |
$4,366.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,549.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,277.75
|
| Rate for Payer: Vantage Medical Group Senior |
$9,277.75
|
|
|
HC INSRTN PERITNL VENOUS SHUNT
|
Facility
|
IP
|
$10,915.00
|
|
|
Service Code
|
CPT 49425
|
| Hospital Charge Code |
909009425
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,183.00 |
| Max. Negotiated Rate |
$120,000.00 |
| Rate for Payer: Cash Price |
$4,911.75
|
| Rate for Payer: Cash Price |
$4,911.75
|
| Rate for Payer: Central Health Plan Commercial |
$8,732.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,366.00
|
| Rate for Payer: Galaxy Health WC |
$9,277.75
|
| Rate for Payer: Global Benefits Group Commercial |
$6,549.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,823.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,280.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,158.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,183.00
|
| Rate for Payer: Multiplan Commercial |
$8,186.25
|
| Rate for Payer: Networks By Design Commercial |
$120,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,277.75
|
|
|
HC INSRT TUN CNTRL VAD W SUB PORT GT 5YR
|
Facility
|
OP
|
$13,903.00
|
|
|
Service Code
|
CPT 36561
|
| Hospital Charge Code |
909080012
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$494.00 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,982.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$8,341.80
|
| Rate for Payer: Blue Shield of California Commercial |
$6,621.66
|
| Rate for Payer: Blue Shield of California EPN |
$4,755.97
|
| Rate for Payer: Caremore Medicare Advantage |
$3,982.55
|
| Rate for Payer: Cash Price |
$6,256.35
|
| Rate for Payer: Cash Price |
$6,256.35
|
| Rate for Payer: Central Health Plan Commercial |
$11,122.40
|
| Rate for Payer: Cigna of CA PPO |
$10,288.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Media |
$3,982.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,376.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,982.55
|
| Rate for Payer: Galaxy Health WC |
$11,817.55
|
| Rate for Payer: Global Benefits Group Commercial |
$8,341.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,512.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$10,427.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,531.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,571.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,982.55
|
| Rate for Payer: InnovAge PACE Commercial |
$5,973.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,273.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$494.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,982.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,780.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,336.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,336.62
|
| Rate for Payer: Multiplan Commercial |
$10,427.25
|
| Rate for Payer: Networks By Design Commercial |
$9,036.95
|
| Rate for Payer: Prime Health Services Commercial |
$11,817.55
|
| Rate for Payer: Prime Health Services Medicare |
$4,221.50
|
| Rate for Payer: Riverside University Health System MISP |
$4,380.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,341.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC INSRT TUN CNTRL VAD W SUB PORT GT 5YR
|
Facility
|
IP
|
$13,903.00
|
|
|
Service Code
|
CPT 36561
|
| Hospital Charge Code |
909080012
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,780.60 |
| Max. Negotiated Rate |
$12,512.70 |
| Rate for Payer: Cash Price |
$6,256.35
|
| Rate for Payer: Central Health Plan Commercial |
$11,122.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,561.20
|
| Rate for Payer: Galaxy Health WC |
$11,817.55
|
| Rate for Payer: Global Benefits Group Commercial |
$8,341.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,512.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,273.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,297.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,780.60
|
| Rate for Payer: Multiplan Commercial |
$10,427.25
|
| Rate for Payer: Networks By Design Commercial |
$9,036.95
|
| Rate for Payer: Prime Health Services Commercial |
$11,817.55
|
|
|
HC INSRT TUN CNTRL VAD W/SUB PORT GT 5YR
|
Facility
|
OP
|
$13,903.00
|
|
|
Service Code
|
CPT 36561
|
| Hospital Charge Code |
900501569
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$12,512.70 |
| 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 |
$5,973.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$8,341.80
|
| Rate for Payer: Caremore Medicare Advantage |
$3,982.55
|
| Rate for Payer: Cash Price |
$6,256.35
|
| Rate for Payer: Cash Price |
$6,256.35
|
| Rate for Payer: Cash Price |
$6,256.35
|
| Rate for Payer: Cash Price |
$6,256.35
|
| Rate for Payer: Central Health Plan Commercial |
$11,122.40
|
| Rate for Payer: Cigna of CA PPO |
$10,288.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Media |
$3,982.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,376.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,982.55
|
| Rate for Payer: Galaxy Health WC |
$11,817.55
|
| Rate for Payer: Global Benefits Group Commercial |
$8,341.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,512.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$10,427.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,531.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,982.55
|
| Rate for Payer: InnovAge PACE Commercial |
$5,973.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,273.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$494.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,982.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,780.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,336.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,336.62
|
| Rate for Payer: Multiplan Commercial |
$10,427.25
|
| Rate for Payer: Networks By Design Commercial |
$9,036.95
|
| Rate for Payer: Prime Health Services Commercial |
$11,817.55
|
| Rate for Payer: Prime Health Services Medicare |
$4,221.50
|
| Rate for Payer: Riverside University Health System MISP |
$4,380.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,341.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,951.50
|
| Rate for Payer: United Healthcare All Other HMO |
$6,951.50
|
| Rate for Payer: United Healthcare HMO Rider |
$6,951.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,951.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC INSRT TUN CNTRL VAD W/SUB PORT GT 5YR
|
Facility
|
IP
|
$13,903.00
|
|
|
Service Code
|
CPT 36561
|
| Hospital Charge Code |
900501569
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,780.60 |
| Max. Negotiated Rate |
$12,512.70 |
| Rate for Payer: Cash Price |
$6,256.35
|
| Rate for Payer: Central Health Plan Commercial |
$11,122.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,561.20
|
| Rate for Payer: Galaxy Health WC |
$11,817.55
|
| Rate for Payer: Global Benefits Group Commercial |
$8,341.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,512.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,273.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,297.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,780.60
|
| Rate for Payer: Multiplan Commercial |
$10,427.25
|
| Rate for Payer: Networks By Design Commercial |
$9,036.95
|
| Rate for Payer: Prime Health Services Commercial |
$11,817.55
|
|
|
HC INS SUBQ CAR RHYTHM MTR W PRGM
|
Facility
|
OP
|
$17,740.00
|
|
|
Service Code
|
CPT 33285
|
| Hospital Charge Code |
906820138
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,901.00 |
| Max. Negotiated Rate |
$48,045.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$10,614.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15,922.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11,676.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,614.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$14,511.92
|
| Rate for Payer: Blue Distinction Transplant |
$10,644.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,824.53
|
| Rate for Payer: Blue Shield of California EPN |
$4,183.44
|
| Rate for Payer: Caremore Medicare Advantage |
$10,614.79
|
| Rate for Payer: Cash Price |
$7,983.00
|
| Rate for Payer: Cash Price |
$7,983.00
|
| Rate for Payer: Central Health Plan Commercial |
$14,192.00
|
| Rate for Payer: Cigna of CA PPO |
$13,127.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15,922.18
|
| Rate for Payer: Dignity Health Media |
$10,614.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,676.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,329.97
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$10,614.79
|
| Rate for Payer: EPIC Health Plan Transplant |
$10,614.79
|
| Rate for Payer: Galaxy Health WC |
$15,079.00
|
| Rate for Payer: Global Benefits Group Commercial |
$10,644.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,966.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$13,305.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$17,408.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$17,514.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10,614.79
|
| Rate for Payer: InnovAge PACE Commercial |
$15,922.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,832.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,190.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,614.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,548.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14,223.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14,223.82
|
| Rate for Payer: Multiplan Commercial |
$13,305.00
|
| Rate for Payer: Multiplan WC |
$14,511.92
|
| Rate for Payer: Networks By Design Commercial |
$11,531.00
|
| Rate for Payer: Preferred Health Network WC |
$14,808.08
|
| Rate for Payer: Prime Health Services Commercial |
$15,079.00
|
| Rate for Payer: Prime Health Services Medicare |
$11,251.68
|
| Rate for Payer: Prime Health Services WC |
$14,363.84
|
| Rate for Payer: Riverside University Health System MISP |
$11,676.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,644.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$29,673.00
|
| Rate for Payer: United Healthcare All Other HMO |
$48,045.00
|
| Rate for Payer: United Healthcare HMO Rider |
$31,101.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28,895.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15,922.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,676.27
|
| Rate for Payer: Vantage Medical Group Senior |
$10,614.79
|
|
|
HC INS SUBQ CAR RHYTHM MTR W PRGM
|
Facility
|
IP
|
$17,740.00
|
|
|
Service Code
|
CPT 33285
|
| Hospital Charge Code |
906820138
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,548.00 |
| Max. Negotiated Rate |
$15,966.00 |
| Rate for Payer: Cash Price |
$7,983.00
|
| Rate for Payer: Central Health Plan Commercial |
$14,192.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,096.00
|
| Rate for Payer: Galaxy Health WC |
$15,079.00
|
| Rate for Payer: Global Benefits Group Commercial |
$10,644.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,966.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,832.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,758.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,548.00
|
| Rate for Payer: Multiplan Commercial |
$13,305.00
|
| Rate for Payer: Networks By Design Commercial |
$11,531.00
|
| Rate for Payer: Prime Health Services Commercial |
$15,079.00
|
|
|
HC INS SUBQ CAR RHYTHM MTR W PRGM
|
Facility
|
IP
|
$17,740.00
|
|
|
Service Code
|
CPT 33285
|
| Hospital Charge Code |
906813406
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,548.00 |
| Max. Negotiated Rate |
$15,966.00 |
| Rate for Payer: Cash Price |
$7,983.00
|
| Rate for Payer: Central Health Plan Commercial |
$14,192.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,096.00
|
| Rate for Payer: Galaxy Health WC |
$15,079.00
|
| Rate for Payer: Global Benefits Group Commercial |
$10,644.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,966.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,832.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,758.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,548.00
|
| Rate for Payer: Multiplan Commercial |
$13,305.00
|
| Rate for Payer: Networks By Design Commercial |
$11,531.00
|
| Rate for Payer: Prime Health Services Commercial |
$15,079.00
|
|
|
HC INS SUBQ CAR RHYTHM MTR W PRGM
|
Facility
|
OP
|
$17,740.00
|
|
|
Service Code
|
CPT 33285
|
| Hospital Charge Code |
906813406
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,901.00 |
| Max. Negotiated Rate |
$48,045.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$10,614.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15,922.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11,676.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,614.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$14,511.92
|
| Rate for Payer: Blue Distinction Transplant |
$10,644.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,824.53
|
| Rate for Payer: Blue Shield of California EPN |
$4,183.44
|
| Rate for Payer: Caremore Medicare Advantage |
$10,614.79
|
| Rate for Payer: Cash Price |
$7,983.00
|
| Rate for Payer: Cash Price |
$7,983.00
|
| Rate for Payer: Central Health Plan Commercial |
$14,192.00
|
| Rate for Payer: Cigna of CA PPO |
$13,127.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15,922.18
|
| Rate for Payer: Dignity Health Media |
$10,614.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,676.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,329.97
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$10,614.79
|
| Rate for Payer: EPIC Health Plan Transplant |
$10,614.79
|
| Rate for Payer: Galaxy Health WC |
$15,079.00
|
| Rate for Payer: Global Benefits Group Commercial |
$10,644.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,966.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$13,305.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$17,408.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$17,514.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10,614.79
|
| Rate for Payer: InnovAge PACE Commercial |
$15,922.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,832.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,190.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,614.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,548.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14,223.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14,223.82
|
| Rate for Payer: Multiplan Commercial |
$13,305.00
|
| Rate for Payer: Multiplan WC |
$14,511.92
|
| Rate for Payer: Networks By Design Commercial |
$11,531.00
|
| Rate for Payer: Preferred Health Network WC |
$14,808.08
|
| Rate for Payer: Prime Health Services Commercial |
$15,079.00
|
| Rate for Payer: Prime Health Services Medicare |
$11,251.68
|
| Rate for Payer: Prime Health Services WC |
$14,363.84
|
| Rate for Payer: Riverside University Health System MISP |
$11,676.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,644.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$29,673.00
|
| Rate for Payer: United Healthcare All Other HMO |
$48,045.00
|
| Rate for Payer: United Healthcare HMO Rider |
$31,101.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28,895.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15,922.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,676.27
|
| Rate for Payer: Vantage Medical Group Senior |
$10,614.79
|
|
|
HC INSTILL RX AGENT VIA NEPH TUBE
|
Facility
|
IP
|
$791.00
|
|
|
Service Code
|
CPT 50391
|
| Hospital Charge Code |
907201118
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$158.20 |
| Max. Negotiated Rate |
$711.90 |
| Rate for Payer: Cash Price |
$355.95
|
| Rate for Payer: Central Health Plan Commercial |
$632.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$316.40
|
| Rate for Payer: Galaxy Health WC |
$672.35
|
| Rate for Payer: Global Benefits Group Commercial |
$474.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$711.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$527.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$301.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$158.20
|
| Rate for Payer: Multiplan Commercial |
$593.25
|
| Rate for Payer: Networks By Design Commercial |
$514.15
|
| Rate for Payer: Prime Health Services Commercial |
$672.35
|
|
|
HC INSTILL RX AGENT VIA NEPH TUBE
|
Facility
|
OP
|
$791.00
|
|
|
Service Code
|
CPT 50391
|
| Hospital Charge Code |
907201118
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$158.20 |
| Max. Negotiated Rate |
$4,846.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$308.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$463.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$339.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$308.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$474.60
|
| Rate for Payer: Blue Shield of California Commercial |
$951.13
|
| Rate for Payer: Blue Shield of California EPN |
$683.14
|
| Rate for Payer: Caremore Medicare Advantage |
$308.79
|
| Rate for Payer: Cash Price |
$355.95
|
| Rate for Payer: Cash Price |
$355.95
|
| Rate for Payer: Central Health Plan Commercial |
$632.80
|
| Rate for Payer: Cigna of CA PPO |
$585.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$463.18
|
| Rate for Payer: Dignity Health Media |
$308.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$339.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$416.87
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$308.79
|
| Rate for Payer: EPIC Health Plan Transplant |
$308.79
|
| Rate for Payer: Galaxy Health WC |
$672.35
|
| Rate for Payer: Global Benefits Group Commercial |
$474.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$711.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$593.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$506.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$509.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$308.79
|
| Rate for Payer: InnovAge PACE Commercial |
$463.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$527.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$226.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$308.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$158.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$413.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$413.78
|
| Rate for Payer: Multiplan Commercial |
$593.25
|
| Rate for Payer: Networks By Design Commercial |
$514.15
|
| Rate for Payer: Prime Health Services Commercial |
$672.35
|
| Rate for Payer: Prime Health Services Medicare |
$327.32
|
| Rate for Payer: Riverside University Health System MISP |
$339.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$474.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$463.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$339.67
|
| Rate for Payer: Vantage Medical Group Senior |
$308.79
|
|
|
HC INST WAVE FREE RATIO WO STRESS AGENT
|
Facility
|
OP
|
$9,375.00
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
906820291
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$195.17 |
| Max. Negotiated Rate |
$8,437.50 |
| Rate for Payer: Adventist Health Medi-Cal |
$195.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5,693.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$195.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,539.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,538.75
|
| Rate for Payer: Blue Distinction Transplant |
$5,625.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Caremore Medicare Advantage |
$195.17
|
| Rate for Payer: Cash Price |
$4,218.75
|
| Rate for Payer: Cash Price |
$4,218.75
|
| Rate for Payer: Cash Price |
$4,218.75
|
| Rate for Payer: Central Health Plan Commercial |
$7,500.00
|
| Rate for Payer: Cigna of CA HMO |
$6,000.00
|
| Rate for Payer: Cigna of CA PPO |
$6,937.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$292.76
|
| Rate for Payer: Dignity Health Media |
$195.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$214.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$263.48
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$195.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$195.17
|
| Rate for Payer: Galaxy Health WC |
$7,968.75
|
| Rate for Payer: Global Benefits Group Commercial |
$5,625.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,437.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7,031.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$320.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$322.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$195.17
|
| Rate for Payer: InnovAge PACE Commercial |
$292.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,253.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$195.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,875.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$261.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$261.53
|
| Rate for Payer: Multiplan Commercial |
$7,031.25
|
| Rate for Payer: Networks By Design Commercial |
$6,093.75
|
| Rate for Payer: Prime Health Services Commercial |
$7,968.75
|
| Rate for Payer: Prime Health Services Medicare |
$206.88
|
| Rate for Payer: Riverside University Health System MISP |
$214.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,625.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,625.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,078.00
|
| Rate for Payer: United Healthcare All Other HMO |
$827.00
|
| Rate for Payer: United Healthcare HMO Rider |
$702.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$643.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: Vantage Medical Group Senior |
$195.17
|
|
|
HC INST WAVE FREE RATIO WO STRESS AGENT
|
Facility
|
OP
|
$9,375.00
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
906803801
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$195.17 |
| Max. Negotiated Rate |
$8,437.50 |
| Rate for Payer: Adventist Health Medi-Cal |
$195.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5,693.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$195.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,539.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,538.75
|
| Rate for Payer: Blue Distinction Transplant |
$5,625.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Caremore Medicare Advantage |
$195.17
|
| Rate for Payer: Cash Price |
$4,218.75
|
| Rate for Payer: Cash Price |
$4,218.75
|
| Rate for Payer: Cash Price |
$4,218.75
|
| Rate for Payer: Central Health Plan Commercial |
$7,500.00
|
| Rate for Payer: Cigna of CA HMO |
$6,000.00
|
| Rate for Payer: Cigna of CA PPO |
$6,937.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$292.76
|
| Rate for Payer: Dignity Health Media |
$195.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$214.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$263.48
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$195.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$195.17
|
| Rate for Payer: Galaxy Health WC |
$7,968.75
|
| Rate for Payer: Global Benefits Group Commercial |
$5,625.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,437.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7,031.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$320.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$322.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$195.17
|
| Rate for Payer: InnovAge PACE Commercial |
$292.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,253.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$195.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,875.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$261.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$261.53
|
| Rate for Payer: Multiplan Commercial |
$7,031.25
|
| Rate for Payer: Networks By Design Commercial |
$6,093.75
|
| Rate for Payer: Prime Health Services Commercial |
$7,968.75
|
| Rate for Payer: Prime Health Services Medicare |
$206.88
|
| Rate for Payer: Riverside University Health System MISP |
$214.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,625.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,625.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,078.00
|
| Rate for Payer: United Healthcare All Other HMO |
$827.00
|
| Rate for Payer: United Healthcare HMO Rider |
$702.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$643.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: Vantage Medical Group Senior |
$195.17
|
|
|
HC INST WAVE FREE RATIO WO STRESS AGENT
|
Facility
|
IP
|
$9,375.00
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
906803801
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,875.00 |
| Max. Negotiated Rate |
$8,437.50 |
| Rate for Payer: Cash Price |
$4,218.75
|
| Rate for Payer: Central Health Plan Commercial |
$7,500.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,750.00
|
| Rate for Payer: Galaxy Health WC |
$7,968.75
|
| Rate for Payer: Global Benefits Group Commercial |
$5,625.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,437.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,253.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,571.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,875.00
|
| Rate for Payer: Multiplan Commercial |
$7,031.25
|
| Rate for Payer: Networks By Design Commercial |
$6,093.75
|
| Rate for Payer: Prime Health Services Commercial |
$7,968.75
|
|
|
HC INST WAVE FREE RATIO WO STRESS AGENT
|
Facility
|
IP
|
$9,375.00
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
906820291
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,875.00 |
| Max. Negotiated Rate |
$8,437.50 |
| Rate for Payer: Cash Price |
$4,218.75
|
| Rate for Payer: Central Health Plan Commercial |
$7,500.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,750.00
|
| Rate for Payer: Galaxy Health WC |
$7,968.75
|
| Rate for Payer: Global Benefits Group Commercial |
$5,625.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,437.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,253.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,571.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,875.00
|
| Rate for Payer: Multiplan Commercial |
$7,031.25
|
| Rate for Payer: Networks By Design Commercial |
$6,093.75
|
| Rate for Payer: Prime Health Services Commercial |
$7,968.75
|
|
|
HC INSULIN
|
Facility
|
IP
|
$162.00
|
|
|
Service Code
|
CPT 83525
|
| Hospital Charge Code |
900912130
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.40 |
| Max. Negotiated Rate |
$145.80 |
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Central Health Plan Commercial |
$129.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.80
|
| Rate for Payer: Galaxy Health WC |
$137.70
|
| Rate for Payer: Global Benefits Group Commercial |
$97.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$145.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$108.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.40
|
| Rate for Payer: Multiplan Commercial |
$121.50
|
| Rate for Payer: Networks By Design Commercial |
$105.30
|
| Rate for Payer: Prime Health Services Commercial |
$137.70
|
|
|
HC INSULIN
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
CPT 83525
|
| Hospital Charge Code |
900912130
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$101.44 |
| Rate for Payer: Adventist Health Medi-Cal |
$11.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$83.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.43
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$83.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$101.44
|
| Rate for Payer: Blue Distinction Transplant |
$23.40
|
| Rate for Payer: Blue Shield of California Commercial |
$24.10
|
| Rate for Payer: Blue Shield of California EPN |
$18.95
|
| Rate for Payer: Caremore Medicare Advantage |
$11.43
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Central Health Plan Commercial |
$31.20
|
| Rate for Payer: Cigna of CA HMO |
$24.96
|
| Rate for Payer: Cigna of CA PPO |
$28.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.14
|
| Rate for Payer: Dignity Health Media |
$11.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.43
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$11.43
|
| Rate for Payer: EPIC Health Plan Transplant |
$11.43
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$29.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$18.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$18.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.43
|
| Rate for Payer: InnovAge PACE Commercial |
$17.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.32
|
| Rate for Payer: Multiplan Commercial |
$29.25
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
| Rate for Payer: Prime Health Services Medicare |
$12.12
|
| Rate for Payer: Riverside University Health System MISP |
$12.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.26
|
| Rate for Payer: United Healthcare All Other HMO |
$9.26
|
| Rate for Payer: United Healthcare HMO Rider |
$9.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.57
|
| Rate for Payer: Vantage Medical Group Senior |
$11.43
|
|
