|
HC REPLACE PRETIBIAL SHELL
|
Facility
|
OP
|
$996.00
|
|
|
Service Code
|
CPT L4130
|
| Hospital Charge Code |
905354130
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$239.04 |
| Max. Negotiated Rate |
$846.60 |
| Rate for Payer: Adventist Health Commercial |
$408.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$846.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$547.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$747.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$576.88
|
| Rate for Payer: Blue Shield of California Commercial |
$735.05
|
| Rate for Payer: Blue Shield of California EPN |
$484.06
|
| Rate for Payer: Cash Price |
$448.20
|
| Rate for Payer: Cash Price |
$448.20
|
| Rate for Payer: Cigna of CA HMO |
$697.20
|
| Rate for Payer: Cigna of CA PPO |
$697.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$846.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$846.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$846.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$398.40
|
| Rate for Payer: EPIC Health Plan Senior |
$398.40
|
| Rate for Payer: Galaxy Health WC |
$846.60
|
| Rate for Payer: Global Benefits Group Commercial |
$597.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$546.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$664.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$618.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$616.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$239.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$697.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$697.20
|
| Rate for Payer: Multiplan Commercial |
$796.80
|
| Rate for Payer: Networks By Design Commercial |
$498.00
|
| Rate for Payer: Prime Health Services Commercial |
$846.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$597.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$597.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$373.80
|
| Rate for Payer: United Healthcare All Other HMO |
$363.84
|
| Rate for Payer: United Healthcare HMO Rider |
$355.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$326.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$846.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$846.60
|
| Rate for Payer: Vantage Medical Group Senior |
$846.60
|
|
|
HC REPLACE PROX/DIST UPRIGHT
|
Facility
|
IP
|
$576.00
|
|
|
Service Code
|
CPT L4070
|
| Hospital Charge Code |
905354070
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$115.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$115.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$259.20
|
| Rate for Payer: Cash Price |
$259.20
|
| Rate for Payer: Cigna of CA HMO |
$403.20
|
| Rate for Payer: Cigna of CA PPO |
$403.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$230.40
|
| Rate for Payer: EPIC Health Plan Senior |
$230.40
|
| Rate for Payer: Galaxy Health WC |
$489.60
|
| Rate for Payer: Global Benefits Group Commercial |
$345.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$384.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$219.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$356.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$138.24
|
| Rate for Payer: Multiplan Commercial |
$460.80
|
| Rate for Payer: Networks By Design Commercial |
$288.00
|
| Rate for Payer: Prime Health Services Commercial |
$489.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$216.17
|
| Rate for Payer: United Healthcare All Other HMO |
$210.41
|
| Rate for Payer: United Healthcare HMO Rider |
$205.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$188.64
|
|
|
HC REPLACE PROX/DIST UPRIGHT
|
Facility
|
IP
|
$576.00
|
|
|
Service Code
|
CPT L4070
|
| Hospital Charge Code |
915354070
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$115.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$115.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$259.20
|
| Rate for Payer: Cash Price |
$259.20
|
| Rate for Payer: Cigna of CA HMO |
$403.20
|
| Rate for Payer: Cigna of CA PPO |
$403.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$230.40
|
| Rate for Payer: EPIC Health Plan Senior |
$230.40
|
| Rate for Payer: Galaxy Health WC |
$489.60
|
| Rate for Payer: Global Benefits Group Commercial |
$345.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$384.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$219.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$356.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$138.24
|
| Rate for Payer: Multiplan Commercial |
$460.80
|
| Rate for Payer: Networks By Design Commercial |
$288.00
|
| Rate for Payer: Prime Health Services Commercial |
$489.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$216.17
|
| Rate for Payer: United Healthcare All Other HMO |
$210.41
|
| Rate for Payer: United Healthcare HMO Rider |
$205.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$188.64
|
|
|
HC REPLACE PROX/DIST UPRIGHT
|
Facility
|
OP
|
$576.00
|
|
|
Service Code
|
CPT L4070
|
| Hospital Charge Code |
905354070
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$138.24 |
| Max. Negotiated Rate |
$489.60 |
| Rate for Payer: Adventist Health Commercial |
$236.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$489.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$316.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$432.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$333.62
|
| Rate for Payer: Blue Shield of California Commercial |
$425.09
|
| Rate for Payer: Blue Shield of California EPN |
$279.94
|
| Rate for Payer: Cash Price |
$259.20
|
| Rate for Payer: Cash Price |
$259.20
|
| Rate for Payer: Cigna of CA HMO |
$403.20
|
| Rate for Payer: Cigna of CA PPO |
$403.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$489.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$489.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$489.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$230.40
|
| Rate for Payer: EPIC Health Plan Senior |
$230.40
|
| Rate for Payer: Galaxy Health WC |
$489.60
|
| Rate for Payer: Global Benefits Group Commercial |
$345.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$379.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$384.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$429.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$356.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$138.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$403.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$403.20
|
| Rate for Payer: Multiplan Commercial |
$460.80
|
| Rate for Payer: Networks By Design Commercial |
$288.00
|
| Rate for Payer: Prime Health Services Commercial |
$489.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$345.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$345.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$216.17
|
| Rate for Payer: United Healthcare All Other HMO |
$210.41
|
| Rate for Payer: United Healthcare HMO Rider |
$205.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$188.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$489.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$489.60
|
| Rate for Payer: Vantage Medical Group Senior |
$489.60
|
|
|
HC REPLACE PROX/DIST UPRIGHT
|
Facility
|
OP
|
$576.00
|
|
|
Service Code
|
CPT L4070
|
| Hospital Charge Code |
915354070
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$138.24 |
| Max. Negotiated Rate |
$489.60 |
| Rate for Payer: Adventist Health Commercial |
$236.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$489.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$316.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$432.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$333.62
|
| Rate for Payer: Blue Shield of California Commercial |
$425.09
|
| Rate for Payer: Blue Shield of California EPN |
$279.94
|
| Rate for Payer: Cash Price |
$259.20
|
| Rate for Payer: Cash Price |
$259.20
|
| Rate for Payer: Cigna of CA HMO |
$403.20
|
| Rate for Payer: Cigna of CA PPO |
$403.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$489.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$489.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$489.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$230.40
|
| Rate for Payer: EPIC Health Plan Senior |
$230.40
|
| Rate for Payer: Galaxy Health WC |
$489.60
|
| Rate for Payer: Global Benefits Group Commercial |
$345.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$379.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$384.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$429.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$356.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$138.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$403.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$403.20
|
| Rate for Payer: Multiplan Commercial |
$460.80
|
| Rate for Payer: Networks By Design Commercial |
$288.00
|
| Rate for Payer: Prime Health Services Commercial |
$489.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$345.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$345.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$216.17
|
| Rate for Payer: United Healthcare All Other HMO |
$210.41
|
| Rate for Payer: United Healthcare HMO Rider |
$205.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$188.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$489.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$489.60
|
| Rate for Payer: Vantage Medical Group Senior |
$489.60
|
|
|
HC REPLACE PROX THIGH BAND
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
CPT L4080
|
| Hospital Charge Code |
905354080
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$38.40 |
| Max. Negotiated Rate |
$136.00 |
| Rate for Payer: Adventist Health Commercial |
$65.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$136.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$88.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$120.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$92.67
|
| Rate for Payer: Blue Shield of California Commercial |
$118.08
|
| Rate for Payer: Blue Shield of California EPN |
$77.76
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna of CA HMO |
$112.00
|
| Rate for Payer: Cigna of CA PPO |
$112.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$136.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$136.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$136.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.00
|
| Rate for Payer: EPIC Health Plan Senior |
$64.00
|
| Rate for Payer: Galaxy Health WC |
$136.00
|
| Rate for Payer: Global Benefits Group Commercial |
$96.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$78.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$106.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$99.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$112.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$112.00
|
| Rate for Payer: Multiplan Commercial |
$128.00
|
| Rate for Payer: Networks By Design Commercial |
$80.00
|
| Rate for Payer: Prime Health Services Commercial |
$136.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$96.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$96.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$60.05
|
| Rate for Payer: United Healthcare All Other HMO |
$58.45
|
| Rate for Payer: United Healthcare HMO Rider |
$57.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$52.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$136.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$136.00
|
| Rate for Payer: Vantage Medical Group Senior |
$136.00
|
|
|
HC REPLACE PROX THIGH BAND
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
CPT L4080
|
| Hospital Charge Code |
915354080
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$32.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$32.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna of CA HMO |
$112.00
|
| Rate for Payer: Cigna of CA PPO |
$112.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.00
|
| Rate for Payer: EPIC Health Plan Senior |
$64.00
|
| Rate for Payer: Galaxy Health WC |
$136.00
|
| Rate for Payer: Global Benefits Group Commercial |
$96.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$106.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$99.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.40
|
| Rate for Payer: Multiplan Commercial |
$128.00
|
| Rate for Payer: Networks By Design Commercial |
$80.00
|
| Rate for Payer: Prime Health Services Commercial |
$136.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$60.05
|
| Rate for Payer: United Healthcare All Other HMO |
$58.45
|
| Rate for Payer: United Healthcare HMO Rider |
$57.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$52.40
|
|
|
HC REPLACE PROX THIGH BAND
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
CPT L4080
|
| Hospital Charge Code |
915354080
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$38.40 |
| Max. Negotiated Rate |
$136.00 |
| Rate for Payer: Adventist Health Commercial |
$65.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$136.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$88.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$120.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$92.67
|
| Rate for Payer: Blue Shield of California Commercial |
$118.08
|
| Rate for Payer: Blue Shield of California EPN |
$77.76
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna of CA HMO |
$112.00
|
| Rate for Payer: Cigna of CA PPO |
$112.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$136.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$136.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$136.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.00
|
| Rate for Payer: EPIC Health Plan Senior |
$64.00
|
| Rate for Payer: Galaxy Health WC |
$136.00
|
| Rate for Payer: Global Benefits Group Commercial |
$96.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$78.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$106.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$99.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$112.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$112.00
|
| Rate for Payer: Multiplan Commercial |
$128.00
|
| Rate for Payer: Networks By Design Commercial |
$80.00
|
| Rate for Payer: Prime Health Services Commercial |
$136.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$96.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$96.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$60.05
|
| Rate for Payer: United Healthcare All Other HMO |
$58.45
|
| Rate for Payer: United Healthcare HMO Rider |
$57.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$52.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$136.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$136.00
|
| Rate for Payer: Vantage Medical Group Senior |
$136.00
|
|
|
HC REPLACE PROX THIGH BAND
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
CPT L4080
|
| Hospital Charge Code |
905354080
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$32.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$32.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna of CA HMO |
$112.00
|
| Rate for Payer: Cigna of CA PPO |
$112.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.00
|
| Rate for Payer: EPIC Health Plan Senior |
$64.00
|
| Rate for Payer: Galaxy Health WC |
$136.00
|
| Rate for Payer: Global Benefits Group Commercial |
$96.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$106.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$99.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.40
|
| Rate for Payer: Multiplan Commercial |
$128.00
|
| Rate for Payer: Networks By Design Commercial |
$80.00
|
| Rate for Payer: Prime Health Services Commercial |
$136.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$60.05
|
| Rate for Payer: United Healthcare All Other HMO |
$58.45
|
| Rate for Payer: United Healthcare HMO Rider |
$57.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$52.40
|
|
|
HC REPLACE QUAD SOCKET BRIM
|
Facility
|
IP
|
$1,412.00
|
|
|
Service Code
|
CPT L4030
|
| Hospital Charge Code |
905354030
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$282.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$282.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$635.40
|
| Rate for Payer: Cash Price |
$635.40
|
| Rate for Payer: Cigna of CA HMO |
$988.40
|
| Rate for Payer: Cigna of CA PPO |
$988.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$564.80
|
| Rate for Payer: EPIC Health Plan Senior |
$564.80
|
| Rate for Payer: Galaxy Health WC |
$1,200.20
|
| Rate for Payer: Global Benefits Group Commercial |
$847.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$941.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$537.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$874.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$338.88
|
| Rate for Payer: Multiplan Commercial |
$1,129.60
|
| Rate for Payer: Networks By Design Commercial |
$706.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,200.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$529.92
|
| Rate for Payer: United Healthcare All Other HMO |
$515.80
|
| Rate for Payer: United Healthcare HMO Rider |
$504.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$462.43
|
|
|
HC REPLACE QUAD SOCKET BRIM
|
Facility
|
OP
|
$1,412.00
|
|
|
Service Code
|
CPT L4030
|
| Hospital Charge Code |
905354030
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$338.88 |
| Max. Negotiated Rate |
$1,200.20 |
| Rate for Payer: Adventist Health Commercial |
$578.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,200.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$776.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,059.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$817.83
|
| Rate for Payer: Blue Shield of California Commercial |
$1,042.06
|
| Rate for Payer: Blue Shield of California EPN |
$686.23
|
| Rate for Payer: Cash Price |
$635.40
|
| Rate for Payer: Cash Price |
$635.40
|
| Rate for Payer: Cigna of CA HMO |
$988.40
|
| Rate for Payer: Cigna of CA PPO |
$988.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,200.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,200.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,200.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$564.80
|
| Rate for Payer: EPIC Health Plan Senior |
$564.80
|
| Rate for Payer: Galaxy Health WC |
$1,200.20
|
| Rate for Payer: Global Benefits Group Commercial |
$847.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$526.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$941.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$595.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$874.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$338.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$988.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$988.40
|
| Rate for Payer: Multiplan Commercial |
$1,129.60
|
| Rate for Payer: Networks By Design Commercial |
$706.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,200.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$847.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$847.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$529.92
|
| Rate for Payer: United Healthcare All Other HMO |
$515.80
|
| Rate for Payer: United Healthcare HMO Rider |
$504.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$462.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,200.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,200.20
|
| Rate for Payer: Vantage Medical Group Senior |
$1,200.20
|
|
|
HC REPLACE QUAD SOCKET BRIM
|
Facility
|
IP
|
$1,412.00
|
|
|
Service Code
|
CPT L4030
|
| Hospital Charge Code |
915354030
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$282.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$282.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$635.40
|
| Rate for Payer: Cash Price |
$635.40
|
| Rate for Payer: Cigna of CA HMO |
$988.40
|
| Rate for Payer: Cigna of CA PPO |
$988.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$564.80
|
| Rate for Payer: EPIC Health Plan Senior |
$564.80
|
| Rate for Payer: Galaxy Health WC |
$1,200.20
|
| Rate for Payer: Global Benefits Group Commercial |
$847.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$941.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$537.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$874.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$338.88
|
| Rate for Payer: Multiplan Commercial |
$1,129.60
|
| Rate for Payer: Networks By Design Commercial |
$706.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,200.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$529.92
|
| Rate for Payer: United Healthcare All Other HMO |
$515.80
|
| Rate for Payer: United Healthcare HMO Rider |
$504.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$462.43
|
|
|
HC REPLACE QUAD SOCKET BRIM
|
Facility
|
OP
|
$1,412.00
|
|
|
Service Code
|
CPT L4030
|
| Hospital Charge Code |
915354030
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$338.88 |
| Max. Negotiated Rate |
$1,200.20 |
| Rate for Payer: Adventist Health Commercial |
$578.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,200.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$776.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,059.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$817.83
|
| Rate for Payer: Blue Shield of California Commercial |
$1,042.06
|
| Rate for Payer: Blue Shield of California EPN |
$686.23
|
| Rate for Payer: Cash Price |
$635.40
|
| Rate for Payer: Cash Price |
$635.40
|
| Rate for Payer: Cigna of CA HMO |
$988.40
|
| Rate for Payer: Cigna of CA PPO |
$988.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,200.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,200.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,200.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$564.80
|
| Rate for Payer: EPIC Health Plan Senior |
$564.80
|
| Rate for Payer: Galaxy Health WC |
$1,200.20
|
| Rate for Payer: Global Benefits Group Commercial |
$847.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$526.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$941.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$595.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$874.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$338.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$988.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$988.40
|
| Rate for Payer: Multiplan Commercial |
$1,129.60
|
| Rate for Payer: Networks By Design Commercial |
$706.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,200.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$847.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$847.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$529.92
|
| Rate for Payer: United Healthcare All Other HMO |
$515.80
|
| Rate for Payer: United Healthcare HMO Rider |
$504.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$462.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,200.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,200.20
|
| Rate for Payer: Vantage Medical Group Senior |
$1,200.20
|
|
|
HC REPLACE QUAD SOCKET CUSTOM
|
Facility
|
OP
|
$1,958.00
|
|
|
Service Code
|
CPT L4020
|
| Hospital Charge Code |
915354020
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$469.92 |
| Max. Negotiated Rate |
$1,664.30 |
| Rate for Payer: Adventist Health Commercial |
$802.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,664.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,076.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,468.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,134.07
|
| Rate for Payer: Blue Shield of California Commercial |
$1,445.00
|
| Rate for Payer: Blue Shield of California EPN |
$951.59
|
| Rate for Payer: Cash Price |
$881.10
|
| Rate for Payer: Cash Price |
$881.10
|
| Rate for Payer: Cigna of CA HMO |
$1,370.60
|
| Rate for Payer: Cigna of CA PPO |
$1,370.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,664.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,664.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,664.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$783.20
|
| Rate for Payer: EPIC Health Plan Senior |
$783.20
|
| Rate for Payer: Galaxy Health WC |
$1,664.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,174.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$819.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,305.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$927.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,212.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$469.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,370.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,370.60
|
| Rate for Payer: Multiplan Commercial |
$1,566.40
|
| Rate for Payer: Networks By Design Commercial |
$979.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,664.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,174.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,174.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$734.84
|
| Rate for Payer: United Healthcare All Other HMO |
$715.26
|
| Rate for Payer: United Healthcare HMO Rider |
$699.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$641.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,664.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,664.30
|
| Rate for Payer: Vantage Medical Group Senior |
$1,664.30
|
|
|
HC REPLACE QUAD SOCKET CUSTOM
|
Facility
|
IP
|
$1,958.00
|
|
|
Service Code
|
CPT L4020
|
| Hospital Charge Code |
915354020
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$391.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$391.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$881.10
|
| Rate for Payer: Cash Price |
$881.10
|
| Rate for Payer: Cigna of CA HMO |
$1,370.60
|
| Rate for Payer: Cigna of CA PPO |
$1,370.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$783.20
|
| Rate for Payer: EPIC Health Plan Senior |
$783.20
|
| Rate for Payer: Galaxy Health WC |
$1,664.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,174.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,305.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$746.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,212.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$469.92
|
| Rate for Payer: Multiplan Commercial |
$1,566.40
|
| Rate for Payer: Networks By Design Commercial |
$979.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,664.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$734.84
|
| Rate for Payer: United Healthcare All Other HMO |
$715.26
|
| Rate for Payer: United Healthcare HMO Rider |
$699.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$641.25
|
|
|
HC REPLACE QUAD SOCKET CUSTOM
|
Facility
|
OP
|
$1,958.00
|
|
|
Service Code
|
CPT L4020
|
| Hospital Charge Code |
905354020
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$469.92 |
| Max. Negotiated Rate |
$1,664.30 |
| Rate for Payer: Adventist Health Commercial |
$802.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,664.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,076.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,468.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,134.07
|
| Rate for Payer: Blue Shield of California Commercial |
$1,445.00
|
| Rate for Payer: Blue Shield of California EPN |
$951.59
|
| Rate for Payer: Cash Price |
$881.10
|
| Rate for Payer: Cash Price |
$881.10
|
| Rate for Payer: Cigna of CA HMO |
$1,370.60
|
| Rate for Payer: Cigna of CA PPO |
$1,370.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,664.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,664.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,664.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$783.20
|
| Rate for Payer: EPIC Health Plan Senior |
$783.20
|
| Rate for Payer: Galaxy Health WC |
$1,664.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,174.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$819.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,305.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$927.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,212.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$469.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,370.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,370.60
|
| Rate for Payer: Multiplan Commercial |
$1,566.40
|
| Rate for Payer: Networks By Design Commercial |
$979.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,664.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,174.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,174.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$734.84
|
| Rate for Payer: United Healthcare All Other HMO |
$715.26
|
| Rate for Payer: United Healthcare HMO Rider |
$699.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$641.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,664.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,664.30
|
| Rate for Payer: Vantage Medical Group Senior |
$1,664.30
|
|
|
HC REPLACE QUAD SOCKET CUSTOM
|
Facility
|
IP
|
$1,958.00
|
|
|
Service Code
|
CPT L4020
|
| Hospital Charge Code |
905354020
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$391.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$391.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$881.10
|
| Rate for Payer: Cash Price |
$881.10
|
| Rate for Payer: Cigna of CA HMO |
$1,370.60
|
| Rate for Payer: Cigna of CA PPO |
$1,370.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$783.20
|
| Rate for Payer: EPIC Health Plan Senior |
$783.20
|
| Rate for Payer: Galaxy Health WC |
$1,664.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,174.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,305.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$746.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,212.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$469.92
|
| Rate for Payer: Multiplan Commercial |
$1,566.40
|
| Rate for Payer: Networks By Design Commercial |
$979.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,664.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$734.84
|
| Rate for Payer: United Healthcare All Other HMO |
$715.26
|
| Rate for Payer: United Healthcare HMO Rider |
$699.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$641.25
|
|
|
HC REPLACE/REVISION/SHUNT SYSTEM
|
Facility
|
IP
|
$11,217.00
|
|
|
Service Code
|
CPT 62230
|
| Hospital Charge Code |
900501521
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,243.40 |
| Max. Negotiated Rate |
$9,534.45 |
| Rate for Payer: Adventist Health Commercial |
$2,243.40
|
| Rate for Payer: Cash Price |
$5,047.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,486.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4,486.80
|
| Rate for Payer: Galaxy Health WC |
$9,534.45
|
| Rate for Payer: Global Benefits Group Commercial |
$6,730.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,481.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,273.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,943.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,692.08
|
| Rate for Payer: Multiplan Commercial |
$8,973.60
|
| Rate for Payer: Networks By Design Commercial |
$7,291.05
|
| Rate for Payer: Prime Health Services Commercial |
$9,534.45
|
|
|
HC REPLACE/REVISION/SHUNT SYSTEM
|
Facility
|
OP
|
$11,217.00
|
|
|
Service Code
|
CPT 62230
|
| Hospital Charge Code |
900501521
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$973.00 |
| Max. Negotiated Rate |
$13,344.70 |
| Rate for Payer: Adventist Health Commercial |
$2,243.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,205.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,950.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,137.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Cash Price |
$5,047.65
|
| Rate for Payer: Cash Price |
$5,047.65
|
| Rate for Payer: Cash Price |
$5,047.65
|
| Rate for Payer: Cigna of CA HMO |
$7,178.88
|
| Rate for Payer: Cigna of CA PPO |
$8,300.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,205.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,950.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,137.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,984.96
|
| Rate for Payer: EPIC Health Plan Senior |
$8,137.01
|
| Rate for Payer: Galaxy Health WC |
$9,534.45
|
| Rate for Payer: Global Benefits Group Commercial |
$6,730.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$13,344.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8,137.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,481.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,414.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,137.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,692.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,252.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,903.59
|
| Rate for Payer: Multiplan Commercial |
$8,973.60
|
| Rate for Payer: Multiplan WC |
$12,964.88
|
| Rate for Payer: Networks By Design Commercial |
$7,291.05
|
| Rate for Payer: Prime Health Services Commercial |
$9,534.45
|
| Rate for Payer: Prime Health Services WC |
$12,832.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,730.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,608.50
|
| Rate for Payer: United Healthcare All Other HMO |
$5,608.50
|
| Rate for Payer: United Healthcare HMO Rider |
$5,608.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,608.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$8,137.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,205.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,950.71
|
| Rate for Payer: Vantage Medical Group Senior |
$8,137.01
|
|
|
HC REPLACE SOFT INTERFACE, HELMET
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
CPT A8004
|
| Hospital Charge Code |
915368004
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$89.25 |
| Rate for Payer: Adventist Health Commercial |
$21.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$68.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$89.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$57.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$78.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$64.48
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: Cigna of CA HMO |
$67.20
|
| Rate for Payer: Cigna of CA PPO |
$77.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$89.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$89.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$89.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.00
|
| Rate for Payer: EPIC Health Plan Senior |
$42.00
|
| Rate for Payer: Galaxy Health WC |
$89.25
|
| Rate for Payer: Global Benefits Group Commercial |
$63.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$70.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$65.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$73.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$73.50
|
| Rate for Payer: Multiplan Commercial |
$84.00
|
| Rate for Payer: Networks By Design Commercial |
$68.25
|
| Rate for Payer: Prime Health Services Commercial |
$89.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$63.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$63.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$52.50
|
| Rate for Payer: United Healthcare All Other HMO |
$52.50
|
| Rate for Payer: United Healthcare HMO Rider |
$52.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$52.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$89.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$89.25
|
| Rate for Payer: Vantage Medical Group Senior |
$89.25
|
|
|
HC REPLACE SOFT INTERFACE, HELMET
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
CPT A8004
|
| Hospital Charge Code |
905368004
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$89.25 |
| Rate for Payer: Adventist Health Commercial |
$21.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$68.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$89.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$57.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$78.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$64.48
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: Cigna of CA HMO |
$67.20
|
| Rate for Payer: Cigna of CA PPO |
$77.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$89.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$89.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$89.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.00
|
| Rate for Payer: EPIC Health Plan Senior |
$42.00
|
| Rate for Payer: Galaxy Health WC |
$89.25
|
| Rate for Payer: Global Benefits Group Commercial |
$63.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$70.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$65.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$73.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$73.50
|
| Rate for Payer: Multiplan Commercial |
$84.00
|
| Rate for Payer: Networks By Design Commercial |
$68.25
|
| Rate for Payer: Prime Health Services Commercial |
$89.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$63.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$63.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$52.50
|
| Rate for Payer: United Healthcare All Other HMO |
$52.50
|
| Rate for Payer: United Healthcare HMO Rider |
$52.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$52.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$89.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$89.25
|
| Rate for Payer: Vantage Medical Group Senior |
$89.25
|
|
|
HC REPLACE SOFT INTERFACE, HELMET
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
CPT A8004
|
| Hospital Charge Code |
905368004
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$89.25 |
| Rate for Payer: Adventist Health Commercial |
$21.00
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.00
|
| Rate for Payer: EPIC Health Plan Senior |
$42.00
|
| Rate for Payer: Galaxy Health WC |
$89.25
|
| Rate for Payer: Global Benefits Group Commercial |
$63.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$70.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$65.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.20
|
| Rate for Payer: Multiplan Commercial |
$84.00
|
| Rate for Payer: Networks By Design Commercial |
$68.25
|
| Rate for Payer: Prime Health Services Commercial |
$89.25
|
|
|
HC REPLACE SOFT INTERFACE, HELMET
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
CPT A8004
|
| Hospital Charge Code |
915368004
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$89.25 |
| Rate for Payer: Adventist Health Commercial |
$21.00
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.00
|
| Rate for Payer: EPIC Health Plan Senior |
$42.00
|
| Rate for Payer: Galaxy Health WC |
$89.25
|
| Rate for Payer: Global Benefits Group Commercial |
$63.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$70.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$65.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.20
|
| Rate for Payer: Multiplan Commercial |
$84.00
|
| Rate for Payer: Networks By Design Commercial |
$68.25
|
| Rate for Payer: Prime Health Services Commercial |
$89.25
|
|
|
HC REPLACE STRAP ANY ORTHOSIS
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
CPT L4002
|
| Hospital Charge Code |
905354002
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$4.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$4.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$10.35
|
| Rate for Payer: Cash Price |
$10.35
|
| Rate for Payer: Cigna of CA HMO |
$16.10
|
| Rate for Payer: Cigna of CA PPO |
$16.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.20
|
| Rate for Payer: EPIC Health Plan Senior |
$9.20
|
| Rate for Payer: Galaxy Health WC |
$19.55
|
| Rate for Payer: Global Benefits Group Commercial |
$13.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.52
|
| Rate for Payer: Multiplan Commercial |
$18.40
|
| Rate for Payer: Networks By Design Commercial |
$11.50
|
| Rate for Payer: Prime Health Services Commercial |
$19.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.63
|
| Rate for Payer: United Healthcare All Other HMO |
$8.40
|
| Rate for Payer: United Healthcare HMO Rider |
$8.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.53
|
|
|
HC REPLACE STRAP ANY ORTHOSIS
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
CPT L4002
|
| Hospital Charge Code |
915354002
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$5.52 |
| Max. Negotiated Rate |
$19.55 |
| Rate for Payer: Adventist Health Commercial |
$9.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.32
|
| Rate for Payer: Blue Shield of California Commercial |
$16.97
|
| Rate for Payer: Blue Shield of California EPN |
$11.18
|
| Rate for Payer: Cash Price |
$10.35
|
| Rate for Payer: Cash Price |
$10.35
|
| Rate for Payer: Cigna of CA HMO |
$16.10
|
| Rate for Payer: Cigna of CA PPO |
$16.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.20
|
| Rate for Payer: EPIC Health Plan Senior |
$9.20
|
| Rate for Payer: Galaxy Health WC |
$19.55
|
| Rate for Payer: Global Benefits Group Commercial |
$13.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.10
|
| Rate for Payer: Multiplan Commercial |
$18.40
|
| Rate for Payer: Networks By Design Commercial |
$11.50
|
| Rate for Payer: Prime Health Services Commercial |
$19.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.63
|
| Rate for Payer: United Healthcare All Other HMO |
$8.40
|
| Rate for Payer: United Healthcare HMO Rider |
$8.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.55
|
| Rate for Payer: Vantage Medical Group Senior |
$19.55
|
|
