|
HC REPLACE GIRDLE MILWAUKEE
|
Facility
|
OP
|
$1,971.00
|
|
|
Service Code
|
CPT L4000
|
| Hospital Charge Code |
905354000
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$473.04 |
| Max. Negotiated Rate |
$1,675.35 |
| Rate for Payer: Adventist Health Commercial |
$808.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,675.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,084.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,478.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,141.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,454.60
|
| Rate for Payer: Blue Shield of California EPN |
$957.91
|
| Rate for Payer: Cash Price |
$1,084.05
|
| Rate for Payer: Cash Price |
$1,084.05
|
| Rate for Payer: Cigna of CA HMO |
$1,379.70
|
| Rate for Payer: Cigna of CA PPO |
$1,379.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,675.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,675.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,675.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$788.40
|
| Rate for Payer: EPIC Health Plan Senior |
$788.40
|
| Rate for Payer: Galaxy Health WC |
$1,675.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,182.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$662.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,314.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$748.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,220.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$473.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,379.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,379.70
|
| Rate for Payer: Multiplan Commercial |
$1,576.80
|
| Rate for Payer: Networks By Design Commercial |
$985.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,675.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,182.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,182.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$739.72
|
| Rate for Payer: United Healthcare All Other HMO |
$720.01
|
| Rate for Payer: United Healthcare HMO Rider |
$704.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$645.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,675.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,675.35
|
| Rate for Payer: Vantage Medical Group Senior |
$1,675.35
|
|
|
HC REPLACE GIRDLE MILWAUKEE
|
Facility
|
IP
|
$1,971.00
|
|
|
Service Code
|
CPT L4000
|
| Hospital Charge Code |
915354000
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$394.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$394.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,084.05
|
| Rate for Payer: Cash Price |
$1,084.05
|
| Rate for Payer: Cigna of CA HMO |
$1,379.70
|
| Rate for Payer: Cigna of CA PPO |
$1,379.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$788.40
|
| Rate for Payer: EPIC Health Plan Senior |
$788.40
|
| Rate for Payer: Galaxy Health WC |
$1,675.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,182.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,314.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$750.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,220.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$473.04
|
| Rate for Payer: Multiplan Commercial |
$1,576.80
|
| Rate for Payer: Networks By Design Commercial |
$985.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,675.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$739.72
|
| Rate for Payer: United Healthcare All Other HMO |
$720.01
|
| Rate for Payer: United Healthcare HMO Rider |
$704.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$645.50
|
|
|
HC REPLACE G-J TUBE PERC
|
Facility
|
OP
|
$5,722.00
|
|
|
Service Code
|
CPT 49452
|
| Hospital Charge Code |
906749452
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$973.00 |
| Max. Negotiated Rate |
$6,427.00 |
| Rate for Payer: Adventist Health Commercial |
$1,144.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,191.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Cash Price |
$3,147.10
|
| Rate for Payer: Cash Price |
$3,147.10
|
| Rate for Payer: Cash Price |
$3,147.10
|
| Rate for Payer: Cigna of CA HMO |
$3,662.08
|
| Rate for Payer: Cigna of CA PPO |
$4,234.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,310.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,191.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,608.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,191.26
|
| Rate for Payer: Galaxy Health WC |
$4,863.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,433.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,953.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,191.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,816.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,573.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,191.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,373.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,500.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,596.29
|
| Rate for Payer: Multiplan Commercial |
$4,577.60
|
| Rate for Payer: Multiplan WC |
$1,898.06
|
| Rate for Payer: Networks By Design Commercial |
$3,719.30
|
| Rate for Payer: Prime Health Services Commercial |
$4,863.70
|
| Rate for Payer: Prime Health Services WC |
$1,878.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,433.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,861.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,861.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,861.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,861.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,191.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Vantage Medical Group Senior |
$1,191.26
|
|
|
HC REPLACE G-J TUBE PERC
|
Facility
|
OP
|
$5,722.00
|
|
|
Service Code
|
CPT 49452
|
| Hospital Charge Code |
906749452
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,144.40 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$1,144.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,191.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,470.08
|
| Rate for Payer: Cash Price |
$3,147.10
|
| Rate for Payer: Cash Price |
$3,147.10
|
| Rate for Payer: Cash Price |
$3,147.10
|
| Rate for Payer: Cigna of CA HMO |
$3,662.08
|
| Rate for Payer: Cigna of CA PPO |
$4,234.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,310.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,191.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,608.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,191.26
|
| Rate for Payer: Galaxy Health WC |
$4,863.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,433.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,953.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,391.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,191.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,816.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,573.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,191.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,373.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,500.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,596.29
|
| Rate for Payer: Multiplan Commercial |
$4,577.60
|
| Rate for Payer: Networks By Design Commercial |
$3,719.30
|
| Rate for Payer: Prime Health Services Commercial |
$4,863.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,433.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,429.51
|
| 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: Upland Medical Group Pediatric |
$1,191.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Vantage Medical Group Senior |
$1,191.26
|
|
|
HC REPLACE G-J TUBE PERC
|
Facility
|
IP
|
$5,722.00
|
|
|
Service Code
|
CPT 49452
|
| Hospital Charge Code |
906749452
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,144.40 |
| Max. Negotiated Rate |
$4,863.70 |
| Rate for Payer: Adventist Health Commercial |
$1,144.40
|
| Rate for Payer: Cash Price |
$3,147.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,288.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,288.80
|
| Rate for Payer: Galaxy Health WC |
$4,863.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,433.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,816.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,180.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,541.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,373.28
|
| Rate for Payer: Multiplan Commercial |
$4,577.60
|
| Rate for Payer: Networks By Design Commercial |
$3,719.30
|
| Rate for Payer: Prime Health Services Commercial |
$4,863.70
|
|
|
HC REPLACE G-J TUBE PERC
|
Facility
|
IP
|
$5,722.00
|
|
|
Service Code
|
CPT 49452
|
| Hospital Charge Code |
906749452
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,144.40 |
| Max. Negotiated Rate |
$4,863.70 |
| Rate for Payer: Adventist Health Commercial |
$1,144.40
|
| Rate for Payer: Cash Price |
$3,147.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,288.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,288.80
|
| Rate for Payer: Galaxy Health WC |
$4,863.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,433.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,816.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,180.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,541.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,373.28
|
| Rate for Payer: Multiplan Commercial |
$4,577.60
|
| Rate for Payer: Networks By Design Commercial |
$3,719.30
|
| Rate for Payer: Prime Health Services Commercial |
$4,863.70
|
|
|
HC REPLACE G-J TUBE PERC
|
Facility
|
IP
|
$5,722.00
|
|
|
Service Code
|
CPT 49452
|
| Hospital Charge Code |
906749452
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,144.40 |
| Max. Negotiated Rate |
$4,863.70 |
| Rate for Payer: Adventist Health Commercial |
$1,144.40
|
| Rate for Payer: Cash Price |
$3,147.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,288.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,288.80
|
| Rate for Payer: Galaxy Health WC |
$4,863.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,433.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,816.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,180.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,541.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,373.28
|
| Rate for Payer: Multiplan Commercial |
$4,577.60
|
| Rate for Payer: Networks By Design Commercial |
$3,719.30
|
| Rate for Payer: Prime Health Services Commercial |
$4,863.70
|
|
|
HC REPLACE G-J TUBE PERC
|
Facility
|
OP
|
$5,722.00
|
|
|
Service Code
|
CPT 49452
|
| Hospital Charge Code |
906749452
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,144.40 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$1,144.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,191.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,470.08
|
| Rate for Payer: Cash Price |
$3,147.10
|
| Rate for Payer: Cash Price |
$3,147.10
|
| Rate for Payer: Cash Price |
$3,147.10
|
| Rate for Payer: Cigna of CA HMO |
$3,662.08
|
| Rate for Payer: Cigna of CA PPO |
$4,234.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,310.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,191.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,608.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,191.26
|
| Rate for Payer: Galaxy Health WC |
$4,863.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,433.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,953.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,391.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,191.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,816.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,573.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,191.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,373.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,500.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,596.29
|
| Rate for Payer: Multiplan Commercial |
$4,577.60
|
| Rate for Payer: Multiplan WC |
$1,898.06
|
| Rate for Payer: Networks By Design Commercial |
$3,719.30
|
| Rate for Payer: Prime Health Services Commercial |
$4,863.70
|
| Rate for Payer: Prime Health Services WC |
$1,878.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,433.20
|
| 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: Upland Medical Group Pediatric |
$1,191.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Vantage Medical Group Senior |
$1,191.26
|
|
|
HC REPLACE HIGH ROLL CUFF
|
Facility
|
OP
|
$503.00
|
|
|
Service Code
|
CPT L4060
|
| Hospital Charge Code |
915354060
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$120.72 |
| Max. Negotiated Rate |
$446.42 |
| Rate for Payer: Adventist Health Commercial |
$206.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$427.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$276.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$377.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$291.34
|
| Rate for Payer: Blue Shield of California Commercial |
$371.21
|
| Rate for Payer: Blue Shield of California EPN |
$244.46
|
| Rate for Payer: Cash Price |
$276.65
|
| Rate for Payer: Cash Price |
$276.65
|
| Rate for Payer: Cigna of CA HMO |
$352.10
|
| Rate for Payer: Cigna of CA PPO |
$352.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$427.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$427.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$427.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$201.20
|
| Rate for Payer: EPIC Health Plan Senior |
$201.20
|
| Rate for Payer: Galaxy Health WC |
$427.55
|
| Rate for Payer: Global Benefits Group Commercial |
$301.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$394.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$335.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$446.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$311.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$352.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$352.10
|
| Rate for Payer: Multiplan Commercial |
$402.40
|
| Rate for Payer: Networks By Design Commercial |
$251.50
|
| Rate for Payer: Prime Health Services Commercial |
$427.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$301.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$301.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$188.78
|
| Rate for Payer: United Healthcare All Other HMO |
$183.75
|
| Rate for Payer: United Healthcare HMO Rider |
$179.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$164.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$427.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$427.55
|
| Rate for Payer: Vantage Medical Group Senior |
$427.55
|
|
|
HC REPLACE HIGH ROLL CUFF
|
Facility
|
IP
|
$503.00
|
|
|
Service Code
|
CPT L4060
|
| Hospital Charge Code |
905354060
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$100.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$100.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$276.65
|
| Rate for Payer: Cash Price |
$276.65
|
| Rate for Payer: Cigna of CA HMO |
$352.10
|
| Rate for Payer: Cigna of CA PPO |
$352.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$201.20
|
| Rate for Payer: EPIC Health Plan Senior |
$201.20
|
| Rate for Payer: Galaxy Health WC |
$427.55
|
| Rate for Payer: Global Benefits Group Commercial |
$301.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$335.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$191.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$311.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.72
|
| Rate for Payer: Multiplan Commercial |
$402.40
|
| Rate for Payer: Networks By Design Commercial |
$251.50
|
| Rate for Payer: Prime Health Services Commercial |
$427.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$188.78
|
| Rate for Payer: United Healthcare All Other HMO |
$183.75
|
| Rate for Payer: United Healthcare HMO Rider |
$179.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$164.73
|
|
|
HC REPLACE HIGH ROLL CUFF
|
Facility
|
IP
|
$503.00
|
|
|
Service Code
|
CPT L4060
|
| Hospital Charge Code |
915354060
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$100.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$100.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$276.65
|
| Rate for Payer: Cash Price |
$276.65
|
| Rate for Payer: Cigna of CA HMO |
$352.10
|
| Rate for Payer: Cigna of CA PPO |
$352.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$201.20
|
| Rate for Payer: EPIC Health Plan Senior |
$201.20
|
| Rate for Payer: Galaxy Health WC |
$427.55
|
| Rate for Payer: Global Benefits Group Commercial |
$301.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$335.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$191.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$311.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.72
|
| Rate for Payer: Multiplan Commercial |
$402.40
|
| Rate for Payer: Networks By Design Commercial |
$251.50
|
| Rate for Payer: Prime Health Services Commercial |
$427.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$188.78
|
| Rate for Payer: United Healthcare All Other HMO |
$183.75
|
| Rate for Payer: United Healthcare HMO Rider |
$179.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$164.73
|
|
|
HC REPLACE HIGH ROLL CUFF
|
Facility
|
OP
|
$503.00
|
|
|
Service Code
|
CPT L4060
|
| Hospital Charge Code |
905354060
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$120.72 |
| Max. Negotiated Rate |
$446.42 |
| Rate for Payer: Adventist Health Commercial |
$206.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$427.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$276.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$377.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$291.34
|
| Rate for Payer: Blue Shield of California Commercial |
$371.21
|
| Rate for Payer: Blue Shield of California EPN |
$244.46
|
| Rate for Payer: Cash Price |
$276.65
|
| Rate for Payer: Cash Price |
$276.65
|
| Rate for Payer: Cigna of CA HMO |
$352.10
|
| Rate for Payer: Cigna of CA PPO |
$352.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$427.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$427.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$427.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$201.20
|
| Rate for Payer: EPIC Health Plan Senior |
$201.20
|
| Rate for Payer: Galaxy Health WC |
$427.55
|
| Rate for Payer: Global Benefits Group Commercial |
$301.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$394.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$335.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$446.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$311.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$352.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$352.10
|
| Rate for Payer: Multiplan Commercial |
$402.40
|
| Rate for Payer: Networks By Design Commercial |
$251.50
|
| Rate for Payer: Prime Health Services Commercial |
$427.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$301.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$301.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$188.78
|
| Rate for Payer: United Healthcare All Other HMO |
$183.75
|
| Rate for Payer: United Healthcare HMO Rider |
$179.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$164.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$427.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$427.55
|
| Rate for Payer: Vantage Medical Group Senior |
$427.55
|
|
|
HC REPLACE KAFO BAND
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
CPT L4090
|
| Hospital Charge Code |
915354090
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$48.00 |
| Max. Negotiated Rate |
$170.00 |
| Rate for Payer: Adventist Health Commercial |
$82.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$170.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$110.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$150.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$115.84
|
| Rate for Payer: Blue Shield of California Commercial |
$147.60
|
| Rate for Payer: Blue Shield of California EPN |
$97.20
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cigna of CA HMO |
$140.00
|
| Rate for Payer: Cigna of CA PPO |
$140.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$170.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$170.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.00
|
| Rate for Payer: EPIC Health Plan Senior |
$80.00
|
| Rate for Payer: Galaxy Health WC |
$170.00
|
| Rate for Payer: Global Benefits Group Commercial |
$120.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$74.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$133.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$84.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$123.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$140.00
|
| Rate for Payer: Multiplan Commercial |
$160.00
|
| Rate for Payer: Networks By Design Commercial |
$100.00
|
| Rate for Payer: Prime Health Services Commercial |
$170.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$120.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$120.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$75.06
|
| Rate for Payer: United Healthcare All Other HMO |
$73.06
|
| Rate for Payer: United Healthcare HMO Rider |
$71.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$65.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$170.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$170.00
|
| Rate for Payer: Vantage Medical Group Senior |
$170.00
|
|
|
HC REPLACE KAFO BAND
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
CPT L4090
|
| Hospital Charge Code |
905354090
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$48.00 |
| Max. Negotiated Rate |
$170.00 |
| Rate for Payer: Adventist Health Commercial |
$82.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$170.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$110.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$150.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$115.84
|
| Rate for Payer: Blue Shield of California Commercial |
$147.60
|
| Rate for Payer: Blue Shield of California EPN |
$97.20
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cigna of CA HMO |
$140.00
|
| Rate for Payer: Cigna of CA PPO |
$140.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$170.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$170.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.00
|
| Rate for Payer: EPIC Health Plan Senior |
$80.00
|
| Rate for Payer: Galaxy Health WC |
$170.00
|
| Rate for Payer: Global Benefits Group Commercial |
$120.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$74.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$133.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$84.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$123.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$140.00
|
| Rate for Payer: Multiplan Commercial |
$160.00
|
| Rate for Payer: Networks By Design Commercial |
$100.00
|
| Rate for Payer: Prime Health Services Commercial |
$170.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$120.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$120.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$75.06
|
| Rate for Payer: United Healthcare All Other HMO |
$73.06
|
| Rate for Payer: United Healthcare HMO Rider |
$71.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$65.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$170.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$170.00
|
| Rate for Payer: Vantage Medical Group Senior |
$170.00
|
|
|
HC REPLACE KAFO BAND
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
CPT L4090
|
| Hospital Charge Code |
905354090
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cigna of CA HMO |
$140.00
|
| Rate for Payer: Cigna of CA PPO |
$140.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.00
|
| Rate for Payer: EPIC Health Plan Senior |
$80.00
|
| Rate for Payer: Galaxy Health WC |
$170.00
|
| Rate for Payer: Global Benefits Group Commercial |
$120.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$133.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$76.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$123.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.00
|
| Rate for Payer: Multiplan Commercial |
$160.00
|
| Rate for Payer: Networks By Design Commercial |
$100.00
|
| Rate for Payer: Prime Health Services Commercial |
$170.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$75.06
|
| Rate for Payer: United Healthcare All Other HMO |
$73.06
|
| Rate for Payer: United Healthcare HMO Rider |
$71.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$65.50
|
|
|
HC REPLACE KAFO BAND
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
CPT L4090
|
| Hospital Charge Code |
915354090
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cigna of CA HMO |
$140.00
|
| Rate for Payer: Cigna of CA PPO |
$140.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.00
|
| Rate for Payer: EPIC Health Plan Senior |
$80.00
|
| Rate for Payer: Galaxy Health WC |
$170.00
|
| Rate for Payer: Global Benefits Group Commercial |
$120.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$133.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$76.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$123.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.00
|
| Rate for Payer: Multiplan Commercial |
$160.00
|
| Rate for Payer: Networks By Design Commercial |
$100.00
|
| Rate for Payer: Prime Health Services Commercial |
$170.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$75.06
|
| Rate for Payer: United Healthcare All Other HMO |
$73.06
|
| Rate for Payer: United Healthcare HMO Rider |
$71.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$65.50
|
|
|
HC REPLACE LEATHER CUFF
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
CPT L4110
|
| Hospital Charge Code |
915354110
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cigna of CA HMO |
$140.00
|
| Rate for Payer: Cigna of CA PPO |
$140.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.00
|
| Rate for Payer: EPIC Health Plan Senior |
$80.00
|
| Rate for Payer: Galaxy Health WC |
$170.00
|
| Rate for Payer: Global Benefits Group Commercial |
$120.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$133.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$76.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$123.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.00
|
| Rate for Payer: Multiplan Commercial |
$160.00
|
| Rate for Payer: Networks By Design Commercial |
$100.00
|
| Rate for Payer: Prime Health Services Commercial |
$170.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$75.06
|
| Rate for Payer: United Healthcare All Other HMO |
$73.06
|
| Rate for Payer: United Healthcare HMO Rider |
$71.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$65.50
|
|
|
HC REPLACE LEATHER CUFF
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
CPT L4110
|
| Hospital Charge Code |
905354110
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$48.00 |
| Max. Negotiated Rate |
$170.00 |
| Rate for Payer: Adventist Health Commercial |
$82.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$170.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$110.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$150.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$115.84
|
| Rate for Payer: Blue Shield of California Commercial |
$147.60
|
| Rate for Payer: Blue Shield of California EPN |
$97.20
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cigna of CA HMO |
$140.00
|
| Rate for Payer: Cigna of CA PPO |
$140.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$170.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$170.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.00
|
| Rate for Payer: EPIC Health Plan Senior |
$80.00
|
| Rate for Payer: Galaxy Health WC |
$170.00
|
| Rate for Payer: Global Benefits Group Commercial |
$120.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$96.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$133.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$108.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$123.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$140.00
|
| Rate for Payer: Multiplan Commercial |
$160.00
|
| Rate for Payer: Networks By Design Commercial |
$100.00
|
| Rate for Payer: Prime Health Services Commercial |
$170.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$120.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$120.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$75.06
|
| Rate for Payer: United Healthcare All Other HMO |
$73.06
|
| Rate for Payer: United Healthcare HMO Rider |
$71.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$65.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$170.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$170.00
|
| Rate for Payer: Vantage Medical Group Senior |
$170.00
|
|
|
HC REPLACE LEATHER CUFF
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
CPT L4110
|
| Hospital Charge Code |
905354110
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cigna of CA HMO |
$140.00
|
| Rate for Payer: Cigna of CA PPO |
$140.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.00
|
| Rate for Payer: EPIC Health Plan Senior |
$80.00
|
| Rate for Payer: Galaxy Health WC |
$170.00
|
| Rate for Payer: Global Benefits Group Commercial |
$120.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$133.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$76.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$123.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.00
|
| Rate for Payer: Multiplan Commercial |
$160.00
|
| Rate for Payer: Networks By Design Commercial |
$100.00
|
| Rate for Payer: Prime Health Services Commercial |
$170.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$75.06
|
| Rate for Payer: United Healthcare All Other HMO |
$73.06
|
| Rate for Payer: United Healthcare HMO Rider |
$71.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$65.50
|
|
|
HC REPLACE LEATHER CUFF
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
CPT L4110
|
| Hospital Charge Code |
915354110
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$48.00 |
| Max. Negotiated Rate |
$170.00 |
| Rate for Payer: Adventist Health Commercial |
$82.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$170.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$110.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$150.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$115.84
|
| Rate for Payer: Blue Shield of California Commercial |
$147.60
|
| Rate for Payer: Blue Shield of California EPN |
$97.20
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cigna of CA HMO |
$140.00
|
| Rate for Payer: Cigna of CA PPO |
$140.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$170.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$170.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.00
|
| Rate for Payer: EPIC Health Plan Senior |
$80.00
|
| Rate for Payer: Galaxy Health WC |
$170.00
|
| Rate for Payer: Global Benefits Group Commercial |
$120.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$96.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$133.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$108.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$123.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$140.00
|
| Rate for Payer: Multiplan Commercial |
$160.00
|
| Rate for Payer: Networks By Design Commercial |
$100.00
|
| Rate for Payer: Prime Health Services Commercial |
$170.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$120.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$120.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$75.06
|
| Rate for Payer: United Healthcare All Other HMO |
$73.06
|
| Rate for Payer: United Healthcare HMO Rider |
$71.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$65.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$170.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$170.00
|
| Rate for Payer: Vantage Medical Group Senior |
$170.00
|
|
|
HC REPLACE MOLDED CALF LACER
|
Facility
|
IP
|
$1,068.00
|
|
|
Service Code
|
CPT L4050
|
| Hospital Charge Code |
915354050
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$213.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$213.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$587.40
|
| Rate for Payer: Cash Price |
$587.40
|
| Rate for Payer: Cigna of CA HMO |
$747.60
|
| Rate for Payer: Cigna of CA PPO |
$747.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$427.20
|
| Rate for Payer: EPIC Health Plan Senior |
$427.20
|
| Rate for Payer: Galaxy Health WC |
$907.80
|
| Rate for Payer: Global Benefits Group Commercial |
$640.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$712.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$406.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$661.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$256.32
|
| Rate for Payer: Multiplan Commercial |
$854.40
|
| Rate for Payer: Networks By Design Commercial |
$534.00
|
| Rate for Payer: Prime Health Services Commercial |
$907.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$400.82
|
| Rate for Payer: United Healthcare All Other HMO |
$390.14
|
| Rate for Payer: United Healthcare HMO Rider |
$381.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$349.77
|
|
|
HC REPLACE MOLDED CALF LACER
|
Facility
|
OP
|
$1,068.00
|
|
|
Service Code
|
CPT L4050
|
| Hospital Charge Code |
905354050
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$256.32 |
| Max. Negotiated Rate |
$907.80 |
| Rate for Payer: Adventist Health Commercial |
$437.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$907.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$587.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$801.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$618.59
|
| Rate for Payer: Blue Shield of California Commercial |
$788.18
|
| Rate for Payer: Blue Shield of California EPN |
$519.05
|
| Rate for Payer: Cash Price |
$587.40
|
| Rate for Payer: Cash Price |
$587.40
|
| Rate for Payer: Cigna of CA HMO |
$747.60
|
| Rate for Payer: Cigna of CA PPO |
$747.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$907.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$907.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$907.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$427.20
|
| Rate for Payer: EPIC Health Plan Senior |
$427.20
|
| Rate for Payer: Galaxy Health WC |
$907.80
|
| Rate for Payer: Global Benefits Group Commercial |
$640.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$556.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$712.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$629.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$661.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$256.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$747.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$747.60
|
| Rate for Payer: Multiplan Commercial |
$854.40
|
| Rate for Payer: Networks By Design Commercial |
$534.00
|
| Rate for Payer: Prime Health Services Commercial |
$907.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$640.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$640.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$400.82
|
| Rate for Payer: United Healthcare All Other HMO |
$390.14
|
| Rate for Payer: United Healthcare HMO Rider |
$381.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$349.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$907.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$907.80
|
| Rate for Payer: Vantage Medical Group Senior |
$907.80
|
|
|
HC REPLACE MOLDED CALF LACER
|
Facility
|
OP
|
$1,068.00
|
|
|
Service Code
|
CPT L4050
|
| Hospital Charge Code |
915354050
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$256.32 |
| Max. Negotiated Rate |
$907.80 |
| Rate for Payer: Adventist Health Commercial |
$437.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$907.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$587.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$801.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$618.59
|
| Rate for Payer: Blue Shield of California Commercial |
$788.18
|
| Rate for Payer: Blue Shield of California EPN |
$519.05
|
| Rate for Payer: Cash Price |
$587.40
|
| Rate for Payer: Cash Price |
$587.40
|
| Rate for Payer: Cigna of CA HMO |
$747.60
|
| Rate for Payer: Cigna of CA PPO |
$747.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$907.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$907.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$907.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$427.20
|
| Rate for Payer: EPIC Health Plan Senior |
$427.20
|
| Rate for Payer: Galaxy Health WC |
$907.80
|
| Rate for Payer: Global Benefits Group Commercial |
$640.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$556.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$712.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$629.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$661.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$256.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$747.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$747.60
|
| Rate for Payer: Multiplan Commercial |
$854.40
|
| Rate for Payer: Networks By Design Commercial |
$534.00
|
| Rate for Payer: Prime Health Services Commercial |
$907.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$640.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$640.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$400.82
|
| Rate for Payer: United Healthcare All Other HMO |
$390.14
|
| Rate for Payer: United Healthcare HMO Rider |
$381.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$349.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$907.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$907.80
|
| Rate for Payer: Vantage Medical Group Senior |
$907.80
|
|
|
HC REPLACE MOLDED CALF LACER
|
Facility
|
IP
|
$1,068.00
|
|
|
Service Code
|
CPT L4050
|
| Hospital Charge Code |
905354050
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$213.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$213.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$587.40
|
| Rate for Payer: Cash Price |
$587.40
|
| Rate for Payer: Cigna of CA HMO |
$747.60
|
| Rate for Payer: Cigna of CA PPO |
$747.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$427.20
|
| Rate for Payer: EPIC Health Plan Senior |
$427.20
|
| Rate for Payer: Galaxy Health WC |
$907.80
|
| Rate for Payer: Global Benefits Group Commercial |
$640.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$712.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$406.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$661.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$256.32
|
| Rate for Payer: Multiplan Commercial |
$854.40
|
| Rate for Payer: Networks By Design Commercial |
$534.00
|
| Rate for Payer: Prime Health Services Commercial |
$907.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$400.82
|
| Rate for Payer: United Healthcare All Other HMO |
$390.14
|
| Rate for Payer: United Healthcare HMO Rider |
$381.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$349.77
|
|
|
HC REPLACE MOLDED THIGH LACER
|
Facility
|
IP
|
$1,068.00
|
|
|
Service Code
|
CPT L4040
|
| Hospital Charge Code |
905354040
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$213.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$213.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$587.40
|
| Rate for Payer: Cash Price |
$587.40
|
| Rate for Payer: Cigna of CA HMO |
$747.60
|
| Rate for Payer: Cigna of CA PPO |
$747.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$427.20
|
| Rate for Payer: EPIC Health Plan Senior |
$427.20
|
| Rate for Payer: Galaxy Health WC |
$907.80
|
| Rate for Payer: Global Benefits Group Commercial |
$640.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$712.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$406.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$661.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$256.32
|
| Rate for Payer: Multiplan Commercial |
$854.40
|
| Rate for Payer: Networks By Design Commercial |
$534.00
|
| Rate for Payer: Prime Health Services Commercial |
$907.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$400.82
|
| Rate for Payer: United Healthcare All Other HMO |
$390.14
|
| Rate for Payer: United Healthcare HMO Rider |
$381.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$349.77
|
|
