|
HC REPLACE MOLDED THIGH LACER
|
Facility
|
IP
|
$1,068.00
|
|
|
Service Code
|
CPT L4040
|
| Hospital Charge Code |
915354040
|
|
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
|
OP
|
$1,068.00
|
|
|
Service Code
|
CPT L4040
|
| Hospital Charge Code |
905354040
|
|
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 |
$550.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$712.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$622.74
|
| 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 THIGH LACER
|
Facility
|
OP
|
$1,068.00
|
|
|
Service Code
|
CPT L4040
|
| Hospital Charge Code |
915354040
|
|
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 |
$550.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$712.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$622.74
|
| 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 NON-MOLDED LACER
|
Facility
|
IP
|
$616.00
|
|
|
Service Code
|
CPT L4045
|
| Hospital Charge Code |
905354045
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$123.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$123.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$338.80
|
| Rate for Payer: Cash Price |
$338.80
|
| Rate for Payer: Cigna of CA HMO |
$431.20
|
| Rate for Payer: Cigna of CA PPO |
$431.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$246.40
|
| Rate for Payer: EPIC Health Plan Senior |
$246.40
|
| Rate for Payer: Galaxy Health WC |
$523.60
|
| Rate for Payer: Global Benefits Group Commercial |
$369.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$410.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$234.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$381.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$147.84
|
| Rate for Payer: Multiplan Commercial |
$492.80
|
| Rate for Payer: Networks By Design Commercial |
$308.00
|
| Rate for Payer: Prime Health Services Commercial |
$523.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$231.18
|
| Rate for Payer: United Healthcare All Other HMO |
$225.02
|
| Rate for Payer: United Healthcare HMO Rider |
$220.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$201.74
|
|
|
HC REPLACE NON-MOLDED LACER
|
Facility
|
IP
|
$616.00
|
|
|
Service Code
|
CPT L4045
|
| Hospital Charge Code |
915354045
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$123.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Networks By Design Commercial |
$308.00
|
| Rate for Payer: Adventist Health Commercial |
$123.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$338.80
|
| Rate for Payer: Cash Price |
$338.80
|
| Rate for Payer: Cigna of CA HMO |
$431.20
|
| Rate for Payer: Cigna of CA PPO |
$431.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$246.40
|
| Rate for Payer: EPIC Health Plan Senior |
$246.40
|
| Rate for Payer: Galaxy Health WC |
$523.60
|
| Rate for Payer: Global Benefits Group Commercial |
$369.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$410.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$234.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$381.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$147.84
|
| Rate for Payer: Multiplan Commercial |
$492.80
|
| Rate for Payer: Prime Health Services Commercial |
$523.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$231.18
|
| Rate for Payer: United Healthcare All Other HMO |
$225.02
|
| Rate for Payer: United Healthcare HMO Rider |
$220.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$201.74
|
|
|
HC REPLACE NON-MOLDED LACER
|
Facility
|
OP
|
$616.00
|
|
|
Service Code
|
CPT L4045
|
| Hospital Charge Code |
915354045
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$147.84 |
| Max. Negotiated Rate |
$523.60 |
| Rate for Payer: Adventist Health Commercial |
$252.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$523.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$338.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$462.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$356.79
|
| Rate for Payer: Blue Shield of California Commercial |
$454.61
|
| Rate for Payer: Blue Shield of California EPN |
$299.38
|
| Rate for Payer: Cash Price |
$338.80
|
| Rate for Payer: Cash Price |
$338.80
|
| Rate for Payer: Cigna of CA HMO |
$431.20
|
| Rate for Payer: Cigna of CA PPO |
$431.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$523.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$523.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$523.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$246.40
|
| Rate for Payer: EPIC Health Plan Senior |
$246.40
|
| Rate for Payer: Galaxy Health WC |
$523.60
|
| Rate for Payer: Global Benefits Group Commercial |
$369.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$422.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$410.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$477.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$381.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$147.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$431.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$431.20
|
| Rate for Payer: Multiplan Commercial |
$492.80
|
| Rate for Payer: Networks By Design Commercial |
$308.00
|
| Rate for Payer: Prime Health Services Commercial |
$523.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$369.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$369.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$231.18
|
| Rate for Payer: United Healthcare All Other HMO |
$225.02
|
| Rate for Payer: United Healthcare HMO Rider |
$220.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$201.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$523.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$523.60
|
| Rate for Payer: Vantage Medical Group Senior |
$523.60
|
|
|
HC REPLACE NON-MOLDED LACER
|
Facility
|
OP
|
$526.00
|
|
|
Service Code
|
CPT L4055
|
| Hospital Charge Code |
915354055
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$126.24 |
| Max. Negotiated Rate |
$447.10 |
| Rate for Payer: Adventist Health Commercial |
$215.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$447.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$289.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$394.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$304.66
|
| Rate for Payer: Blue Shield of California Commercial |
$388.19
|
| Rate for Payer: Blue Shield of California EPN |
$255.64
|
| Rate for Payer: Cash Price |
$289.30
|
| Rate for Payer: Cash Price |
$289.30
|
| Rate for Payer: Cigna of CA HMO |
$368.20
|
| Rate for Payer: Cigna of CA PPO |
$368.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$447.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$447.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$447.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$210.40
|
| Rate for Payer: EPIC Health Plan Senior |
$210.40
|
| Rate for Payer: Galaxy Health WC |
$447.10
|
| Rate for Payer: Global Benefits Group Commercial |
$315.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$360.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$350.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$407.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$325.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$368.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$368.20
|
| Rate for Payer: Multiplan Commercial |
$420.80
|
| Rate for Payer: Networks By Design Commercial |
$263.00
|
| Rate for Payer: Prime Health Services Commercial |
$447.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$315.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$315.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$197.41
|
| Rate for Payer: United Healthcare All Other HMO |
$192.15
|
| Rate for Payer: United Healthcare HMO Rider |
$187.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$172.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$447.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$447.10
|
| Rate for Payer: Vantage Medical Group Senior |
$447.10
|
|
|
HC REPLACE NON-MOLDED LACER
|
Facility
|
IP
|
$526.00
|
|
|
Service Code
|
CPT L4055
|
| Hospital Charge Code |
915354055
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$105.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$105.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$289.30
|
| Rate for Payer: Cash Price |
$289.30
|
| Rate for Payer: Cigna of CA HMO |
$368.20
|
| Rate for Payer: Cigna of CA PPO |
$368.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$210.40
|
| Rate for Payer: EPIC Health Plan Senior |
$210.40
|
| Rate for Payer: Galaxy Health WC |
$447.10
|
| Rate for Payer: Global Benefits Group Commercial |
$315.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$350.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$200.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$325.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.24
|
| Rate for Payer: Multiplan Commercial |
$420.80
|
| Rate for Payer: Networks By Design Commercial |
$263.00
|
| Rate for Payer: Prime Health Services Commercial |
$447.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$197.41
|
| Rate for Payer: United Healthcare All Other HMO |
$192.15
|
| Rate for Payer: United Healthcare HMO Rider |
$187.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$172.26
|
|
|
HC REPLACE NON-MOLDED LACER
|
Facility
|
OP
|
$616.00
|
|
|
Service Code
|
CPT L4045
|
| Hospital Charge Code |
905354045
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$147.84 |
| Max. Negotiated Rate |
$523.60 |
| Rate for Payer: Adventist Health Commercial |
$252.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$523.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$338.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$462.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$356.79
|
| Rate for Payer: Blue Shield of California Commercial |
$454.61
|
| Rate for Payer: Blue Shield of California EPN |
$299.38
|
| Rate for Payer: Cash Price |
$338.80
|
| Rate for Payer: Cash Price |
$338.80
|
| Rate for Payer: Cigna of CA HMO |
$431.20
|
| Rate for Payer: Cigna of CA PPO |
$431.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$523.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$523.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$523.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$246.40
|
| Rate for Payer: EPIC Health Plan Senior |
$246.40
|
| Rate for Payer: Galaxy Health WC |
$523.60
|
| Rate for Payer: Global Benefits Group Commercial |
$369.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$422.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$410.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$477.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$381.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$147.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$431.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$431.20
|
| Rate for Payer: Multiplan Commercial |
$492.80
|
| Rate for Payer: Networks By Design Commercial |
$308.00
|
| Rate for Payer: Prime Health Services Commercial |
$523.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$369.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$369.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$231.18
|
| Rate for Payer: United Healthcare All Other HMO |
$225.02
|
| Rate for Payer: United Healthcare HMO Rider |
$220.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$201.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$523.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$523.60
|
| Rate for Payer: Vantage Medical Group Senior |
$523.60
|
|
|
HC REPLACE NON-MOLDED LACER
|
Facility
|
OP
|
$526.00
|
|
|
Service Code
|
CPT L4055
|
| Hospital Charge Code |
905354055
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$126.24 |
| Max. Negotiated Rate |
$447.10 |
| Rate for Payer: Adventist Health Commercial |
$215.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$447.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$289.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$394.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$304.66
|
| Rate for Payer: Blue Shield of California Commercial |
$388.19
|
| Rate for Payer: Blue Shield of California EPN |
$255.64
|
| Rate for Payer: Cash Price |
$289.30
|
| Rate for Payer: Cash Price |
$289.30
|
| Rate for Payer: Cigna of CA HMO |
$368.20
|
| Rate for Payer: Cigna of CA PPO |
$368.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$447.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$447.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$447.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$210.40
|
| Rate for Payer: EPIC Health Plan Senior |
$210.40
|
| Rate for Payer: Galaxy Health WC |
$447.10
|
| Rate for Payer: Global Benefits Group Commercial |
$315.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$360.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$350.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$407.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$325.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$368.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$368.20
|
| Rate for Payer: Multiplan Commercial |
$420.80
|
| Rate for Payer: Networks By Design Commercial |
$263.00
|
| Rate for Payer: Prime Health Services Commercial |
$447.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$315.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$315.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$197.41
|
| Rate for Payer: United Healthcare All Other HMO |
$192.15
|
| Rate for Payer: United Healthcare HMO Rider |
$187.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$172.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$447.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$447.10
|
| Rate for Payer: Vantage Medical Group Senior |
$447.10
|
|
|
HC REPLACE NON-MOLDED LACER
|
Facility
|
IP
|
$526.00
|
|
|
Service Code
|
CPT L4055
|
| Hospital Charge Code |
905354055
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$105.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$105.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$289.30
|
| Rate for Payer: Cash Price |
$289.30
|
| Rate for Payer: Cigna of CA HMO |
$368.20
|
| Rate for Payer: Cigna of CA PPO |
$368.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$210.40
|
| Rate for Payer: EPIC Health Plan Senior |
$210.40
|
| Rate for Payer: Galaxy Health WC |
$447.10
|
| Rate for Payer: Global Benefits Group Commercial |
$315.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$350.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$200.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$325.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.24
|
| Rate for Payer: Multiplan Commercial |
$420.80
|
| Rate for Payer: Networks By Design Commercial |
$263.00
|
| Rate for Payer: Prime Health Services Commercial |
$447.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$197.41
|
| Rate for Payer: United Healthcare All Other HMO |
$192.15
|
| Rate for Payer: United Healthcare HMO Rider |
$187.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$172.26
|
|
|
HC REPLACE PORT THRU SAME ACCESS
|
Facility
|
IP
|
$12,094.00
|
|
|
Service Code
|
CPT 36585
|
| Hospital Charge Code |
909020012
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,418.80 |
| Max. Negotiated Rate |
$10,279.90 |
| Rate for Payer: Adventist Health Commercial |
$2,418.80
|
| Rate for Payer: Cash Price |
$6,651.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,837.60
|
| Rate for Payer: EPIC Health Plan Senior |
$4,837.60
|
| Rate for Payer: Galaxy Health WC |
$10,279.90
|
| Rate for Payer: Global Benefits Group Commercial |
$7,256.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,066.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,607.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,486.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,902.56
|
| Rate for Payer: Multiplan Commercial |
$9,675.20
|
| Rate for Payer: Networks By Design Commercial |
$7,861.10
|
| Rate for Payer: Prime Health Services Commercial |
$10,279.90
|
|
|
HC REPLACE PORT THRU SAME ACCESS
|
Facility
|
OP
|
$12,094.00
|
|
|
Service Code
|
CPT 36585
|
| Hospital Charge Code |
909020012
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$701.77 |
| Max. Negotiated Rate |
$20,902.00 |
| Rate for Payer: Adventist Health Commercial |
$2,418.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$6,651.70
|
| Rate for Payer: Cash Price |
$6,651.70
|
| Rate for Payer: Cash Price |
$6,651.70
|
| Rate for Payer: Cigna of CA HMO |
$7,740.16
|
| Rate for Payer: Cigna of CA PPO |
$8,949.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,398.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3,999.21
|
| Rate for Payer: Galaxy Health WC |
$10,279.90
|
| Rate for Payer: Global Benefits Group Commercial |
$7,256.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$701.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,066.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$793.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,902.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,039.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,358.94
|
| Rate for Payer: Multiplan Commercial |
$9,675.20
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: Networks By Design Commercial |
$7,861.10
|
| Rate for Payer: Prime Health Services Commercial |
$10,279.90
|
| Rate for Payer: Prime Health Services WC |
$6,307.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,256.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,999.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC 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 |
$547.80
|
| Rate for Payer: Cash Price |
$547.80
|
| 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 PRETIBIAL SHELL
|
Facility
|
IP
|
$996.00
|
|
|
Service Code
|
CPT L4130
|
| Hospital Charge Code |
905354130
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$199.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$199.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$547.80
|
| Rate for Payer: Cash Price |
$547.80
|
| Rate for Payer: Cigna of CA HMO |
$697.20
|
| Rate for Payer: Cigna of CA PPO |
$697.20
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$664.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$379.48
|
| 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: 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: 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
|
|
|
HC REPLACE PRETIBIAL SHELL
|
Facility
|
IP
|
$996.00
|
|
|
Service Code
|
CPT L4130
|
| Hospital Charge Code |
915354130
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$199.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$199.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$547.80
|
| Rate for Payer: Cash Price |
$547.80
|
| Rate for Payer: Cigna of CA HMO |
$697.20
|
| Rate for Payer: Cigna of CA PPO |
$697.20
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$664.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$379.48
|
| 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: 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: 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
|
|
|
HC REPLACE PRETIBIAL SHELL
|
Facility
|
OP
|
$996.00
|
|
|
Service Code
|
CPT L4130
|
| Hospital Charge Code |
915354130
|
|
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 |
$547.80
|
| Rate for Payer: Cash Price |
$547.80
|
| 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 |
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 |
$316.80
|
| Rate for Payer: Cash Price |
$316.80
|
| 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 |
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 |
$316.80
|
| Rate for Payer: Cash Price |
$316.80
|
| 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 |
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 |
$316.80
|
| Rate for Payer: Cash Price |
$316.80
|
| 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 |
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 |
$316.80
|
| Rate for Payer: Cash Price |
$316.80
|
| 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
|
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 |
$88.00
|
| Rate for Payer: Cash Price |
$88.00
|
| 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 |
$88.00
|
| Rate for Payer: Cash Price |
$88.00
|
| 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 |
$88.00
|
| Rate for Payer: Cash Price |
$88.00
|
| 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 |
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 |
$88.00
|
| Rate for Payer: Cash Price |
$88.00
|
| 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
|
|
