|
HC REPLACE G-J TUBE PERC
|
Facility
|
OP
|
$2,824.00
|
|
|
Service Code
|
CPT 49452
|
| Hospital Charge Code |
906749452
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$564.80 |
| Max. Negotiated Rate |
$6,716.00 |
| Rate for Payer: Adventist Health Commercial |
$564.80
|
| Rate for Payer: Adventist Health Commercial |
$1,144.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Cash Price |
$1,270.80
|
| Rate for Payer: Cash Price |
$1,270.80
|
| Rate for Payer: Cash Price |
$2,574.90
|
| Rate for Payer: Cash Price |
$2,574.90
|
| Rate for Payer: Cash Price |
$1,270.80
|
| Rate for Payer: Cash Price |
$2,574.90
|
| Rate for Payer: Cigna of CA HMO |
$3,662.08
|
| Rate for Payer: Cigna of CA HMO |
$1,807.36
|
| Rate for Payer: Cigna of CA PPO |
$2,089.76
|
| Rate for Payer: Cigna of CA PPO |
$4,234.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,283.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,283.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,166.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,166.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,005.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,976.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,924.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,924.77
|
| Rate for Payer: EPIC Health Plan Senior |
$1,283.18
|
| Rate for Payer: EPIC Health Plan Senior |
$1,283.18
|
| Rate for Payer: Galaxy Health WC |
$2,400.40
|
| Rate for Payer: Galaxy Health WC |
$4,863.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,433.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,694.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,913.11
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,913.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,793.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,633.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,573.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,573.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,254.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,254.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$677.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,373.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,469.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,469.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,563.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,563.15
|
| Rate for Payer: Multiplan Commercial |
$4,577.60
|
| Rate for Payer: Multiplan Commercial |
$2,259.20
|
| Rate for Payer: Multiplan WC |
$1,898.06
|
| Rate for Payer: Multiplan WC |
$1,898.06
|
| Rate for Payer: Networks By Design Commercial |
$3,719.30
|
| Rate for Payer: Networks By Design Commercial |
$1,835.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,400.40
|
| Rate for Payer: Prime Health Services Commercial |
$4,863.70
|
| Rate for Payer: Prime Health Services WC |
$1,878.70
|
| Rate for Payer: Prime Health Services WC |
$1,878.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,433.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,694.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,412.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,861.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,861.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,412.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,412.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,861.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,412.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,861.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,166.53
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,166.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,166.53
|
| Rate for Payer: Vantage Medical Group Senior |
$1,166.53
|
|
|
HC REPLACE G-J TUBE PERC
|
Facility
|
OP
|
$5,722.00
|
|
|
Service Code
|
CPT 49452
|
| Hospital Charge Code |
906749452
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,144.40 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,144.40
|
| Rate for Payer: Adventist Health Commercial |
$564.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,574.78
|
| Rate for Payer: Blue Shield of California Commercial |
$3,897.87
|
| Rate for Payer: Blue Shield of California Commercial |
$3,897.87
|
| Rate for Payer: Blue Shield of California Commercial |
$2,574.78
|
| Rate for Payer: Cash Price |
$1,270.80
|
| Rate for Payer: Cash Price |
$1,270.80
|
| Rate for Payer: Cash Price |
$2,574.90
|
| Rate for Payer: Cash Price |
$1,270.80
|
| Rate for Payer: Cash Price |
$2,574.90
|
| Rate for Payer: Cash Price |
$2,574.90
|
| Rate for Payer: Cigna of CA HMO |
$1,807.36
|
| Rate for Payer: Cigna of CA HMO |
$3,662.08
|
| Rate for Payer: Cigna of CA PPO |
$4,234.28
|
| Rate for Payer: Cigna of CA PPO |
$2,089.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,283.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,283.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,166.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,166.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,976.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,005.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,924.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,924.77
|
| Rate for Payer: EPIC Health Plan Senior |
$1,283.18
|
| Rate for Payer: EPIC Health Plan Senior |
$1,283.18
|
| Rate for Payer: Galaxy Health WC |
$4,863.70
|
| Rate for Payer: Galaxy Health WC |
$2,400.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,433.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,694.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,913.11
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,913.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,391.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,391.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,633.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,793.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,573.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,573.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,633.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,633.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,373.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$677.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,469.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,469.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,563.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,563.15
|
| Rate for Payer: Multiplan Commercial |
$2,259.20
|
| Rate for Payer: Multiplan Commercial |
$4,577.60
|
| Rate for Payer: Multiplan WC |
$1,898.06
|
| Rate for Payer: Multiplan WC |
$1,898.06
|
| Rate for Payer: Networks By Design Commercial |
$3,719.30
|
| Rate for Payer: Networks By Design Commercial |
$1,835.60
|
| Rate for Payer: Prime Health Services Commercial |
$4,863.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,400.40
|
| Rate for Payer: Prime Health Services WC |
$1,878.70
|
| Rate for Payer: Prime Health Services WC |
$1,878.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,433.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,694.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,861.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,412.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,166.53
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,166.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,166.53
|
| Rate for Payer: Vantage Medical Group Senior |
$1,166.53
|
|
|
HC REPLACE G-J TUBE PERC
|
Facility
|
IP
|
$5,722.00
|
|
|
Service Code
|
CPT 49452
|
| Hospital Charge Code |
906749452
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,144.40 |
| Max. Negotiated Rate |
$4,863.70 |
| Rate for Payer: Adventist Health Commercial |
$1,144.40
|
| Rate for Payer: Cash Price |
$2,574.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,005.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,288.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,288.80
|
| Rate for Payer: Galaxy Health WC |
$4,863.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,433.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,633.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,375.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,373.28
|
| Rate for Payer: Multiplan Commercial |
$4,577.60
|
| Rate for Payer: Networks By Design Commercial |
$3,719.30
|
| Rate for Payer: Prime Health Services Commercial |
$4,863.70
|
|
|
HC REPLACE G-J TUBE PERC
|
Facility
|
IP
|
$5,722.00
|
|
|
Service Code
|
CPT 49452
|
| Hospital Charge Code |
906749452
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,144.40 |
| Max. Negotiated Rate |
$4,863.70 |
| Rate for Payer: Adventist Health Commercial |
$1,144.40
|
| Rate for Payer: Cash Price |
$2,574.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,005.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,288.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,288.80
|
| Rate for Payer: Galaxy Health WC |
$4,863.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,433.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,633.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,375.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,373.28
|
| Rate for Payer: Multiplan Commercial |
$4,577.60
|
| Rate for Payer: Networks By Design Commercial |
$3,719.30
|
| Rate for Payer: Prime Health Services Commercial |
$4,863.70
|
|
|
HC REPLACE G-J TUBE PERC
|
Facility
|
IP
|
$5,722.00
|
|
|
Service Code
|
CPT 49452
|
| Hospital Charge Code |
906749452
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,144.40 |
| Max. Negotiated Rate |
$4,863.70 |
| Rate for Payer: Adventist Health Commercial |
$1,144.40
|
| Rate for Payer: Cash Price |
$2,574.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,005.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,288.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,288.80
|
| Rate for Payer: Galaxy Health WC |
$4,863.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,433.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,633.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,375.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,373.28
|
| Rate for Payer: Multiplan Commercial |
$4,577.60
|
| Rate for Payer: Networks By Design Commercial |
$3,719.30
|
| Rate for Payer: Prime Health Services Commercial |
$4,863.70
|
|
|
HC REPLACE G-J TUBE PERC
|
Facility
|
OP
|
$5,722.00
|
|
|
Service Code
|
CPT 49452
|
| Hospital Charge Code |
906749452
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,144.40 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,144.40
|
| Rate for Payer: Adventist Health Commercial |
$564.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,574.78
|
| Rate for Payer: Blue Shield of California Commercial |
$3,897.87
|
| Rate for Payer: Blue Shield of California Commercial |
$3,897.87
|
| Rate for Payer: Blue Shield of California Commercial |
$2,574.78
|
| Rate for Payer: Cash Price |
$1,270.80
|
| Rate for Payer: Cash Price |
$2,574.90
|
| Rate for Payer: Cash Price |
$2,574.90
|
| Rate for Payer: Cash Price |
$1,270.80
|
| Rate for Payer: Cash Price |
$1,270.80
|
| Rate for Payer: Cash Price |
$2,574.90
|
| Rate for Payer: Cigna of CA HMO |
$3,662.08
|
| Rate for Payer: Cigna of CA HMO |
$1,807.36
|
| Rate for Payer: Cigna of CA PPO |
$2,089.76
|
| Rate for Payer: Cigna of CA PPO |
$4,234.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,283.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,283.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,166.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,166.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,005.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,976.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,924.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,924.77
|
| Rate for Payer: EPIC Health Plan Senior |
$1,283.18
|
| Rate for Payer: EPIC Health Plan Senior |
$1,283.18
|
| Rate for Payer: Galaxy Health WC |
$4,863.70
|
| Rate for Payer: Galaxy Health WC |
$2,400.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,694.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,433.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,913.11
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,913.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,391.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,391.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,633.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,793.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,573.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,573.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,633.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,633.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$677.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,373.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,469.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,469.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,563.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,563.15
|
| Rate for Payer: Multiplan Commercial |
$2,259.20
|
| Rate for Payer: Multiplan Commercial |
$4,577.60
|
| Rate for Payer: Networks By Design Commercial |
$3,719.30
|
| Rate for Payer: Networks By Design Commercial |
$1,835.60
|
| Rate for Payer: Prime Health Services Commercial |
$4,863.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,400.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,433.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,694.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,399.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,399.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,412.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,861.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,166.53
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,166.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,166.53
|
| Rate for Payer: Vantage Medical Group Senior |
$1,166.53
|
|
|
HC REPLACE HIGH ROLL CUFF
|
Facility
|
OP
|
$503.00
|
|
|
Service Code
|
CPT L4060
|
| Hospital Charge Code |
915354060
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$120.72 |
| Max. Negotiated Rate |
$446.42 |
| Rate for Payer: Adventist Health Commercial |
$206.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$427.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$276.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$377.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$304.47
|
| Rate for Payer: Blue Shield of California Commercial |
$386.81
|
| Rate for Payer: Blue Shield of California Commercial |
$255.02
|
| Rate for Payer: Cash Price |
$226.35
|
| Rate for Payer: Cash Price |
$226.35
|
| Rate for Payer: Cigna of CA HMO |
$352.10
|
| Rate for Payer: Cigna of CA PPO |
$352.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$427.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$427.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$427.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$352.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$201.20
|
| Rate for Payer: EPIC Health Plan Senior |
$201.20
|
| Rate for Payer: Galaxy Health WC |
$427.55
|
| Rate for Payer: Global Benefits Group Commercial |
$301.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$394.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$319.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$446.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$296.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$352.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$352.10
|
| Rate for Payer: Multiplan Commercial |
$402.40
|
| Rate for Payer: Networks By Design Commercial |
$251.50
|
| Rate for Payer: Prime Health Services Commercial |
$427.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$301.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$301.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$188.78
|
| Rate for Payer: United Healthcare All Other HMO |
$183.75
|
| Rate for Payer: United Healthcare HMO Rider |
$179.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$164.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$427.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$427.55
|
| Rate for Payer: Vantage Medical Group Senior |
$427.55
|
|
|
HC REPLACE HIGH ROLL CUFF
|
Facility
|
IP
|
$503.00
|
|
|
Service Code
|
CPT L4060
|
| Hospital Charge Code |
915354060
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$100.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$100.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$226.35
|
| Rate for Payer: Cash Price |
$226.35
|
| Rate for Payer: Cigna of CA HMO |
$352.10
|
| Rate for Payer: Cigna of CA PPO |
$352.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$352.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$201.20
|
| Rate for Payer: EPIC Health Plan Senior |
$201.20
|
| Rate for Payer: Galaxy Health WC |
$427.55
|
| Rate for Payer: Global Benefits Group Commercial |
$301.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$319.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$296.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.72
|
| Rate for Payer: Multiplan Commercial |
$402.40
|
| Rate for Payer: Networks By Design Commercial |
$326.95
|
| Rate for Payer: Prime Health Services Commercial |
$427.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$188.78
|
| Rate for Payer: United Healthcare All Other HMO |
$183.75
|
| Rate for Payer: United Healthcare HMO Rider |
$179.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$164.73
|
|
|
HC REPLACE HIGH ROLL CUFF
|
Facility
|
OP
|
$503.00
|
|
|
Service Code
|
CPT L4060
|
| Hospital Charge Code |
905354060
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$120.72 |
| Max. Negotiated Rate |
$446.42 |
| Rate for Payer: Adventist Health Commercial |
$206.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$427.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$276.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$377.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$304.47
|
| Rate for Payer: Blue Shield of California Commercial |
$386.81
|
| Rate for Payer: Blue Shield of California Commercial |
$255.02
|
| Rate for Payer: Cash Price |
$226.35
|
| Rate for Payer: Cash Price |
$226.35
|
| Rate for Payer: Cigna of CA HMO |
$352.10
|
| Rate for Payer: Cigna of CA PPO |
$352.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$427.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$427.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$427.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$352.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$201.20
|
| Rate for Payer: EPIC Health Plan Senior |
$201.20
|
| Rate for Payer: Galaxy Health WC |
$427.55
|
| Rate for Payer: Global Benefits Group Commercial |
$301.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$394.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$319.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$446.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$296.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$352.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$352.10
|
| Rate for Payer: Multiplan Commercial |
$402.40
|
| Rate for Payer: Networks By Design Commercial |
$251.50
|
| Rate for Payer: Prime Health Services Commercial |
$427.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$301.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$301.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$188.78
|
| Rate for Payer: United Healthcare All Other HMO |
$183.75
|
| Rate for Payer: United Healthcare HMO Rider |
$179.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$164.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$427.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$427.55
|
| Rate for Payer: Vantage Medical Group Senior |
$427.55
|
|
|
HC REPLACE HIGH ROLL CUFF
|
Facility
|
IP
|
$503.00
|
|
|
Service Code
|
CPT L4060
|
| Hospital Charge Code |
905354060
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$100.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$100.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$226.35
|
| Rate for Payer: Cash Price |
$226.35
|
| Rate for Payer: Cigna of CA HMO |
$352.10
|
| Rate for Payer: Cigna of CA PPO |
$352.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$352.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$201.20
|
| Rate for Payer: EPIC Health Plan Senior |
$201.20
|
| Rate for Payer: Galaxy Health WC |
$427.55
|
| Rate for Payer: Global Benefits Group Commercial |
$301.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$319.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$296.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.72
|
| Rate for Payer: Multiplan Commercial |
$402.40
|
| Rate for Payer: Networks By Design Commercial |
$326.95
|
| Rate for Payer: Prime Health Services Commercial |
$427.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$188.78
|
| Rate for Payer: United Healthcare All Other HMO |
$183.75
|
| Rate for Payer: United Healthcare HMO Rider |
$179.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$164.73
|
|
|
HC REPLACE KAFO BAND
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
CPT L4090
|
| Hospital Charge Code |
905354090
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$48.00 |
| Max. Negotiated Rate |
$170.00 |
| Rate for Payer: Adventist Health Commercial |
$82.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$170.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$110.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$150.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$121.06
|
| Rate for Payer: Blue Shield of California Commercial |
$153.80
|
| Rate for Payer: Blue Shield of California Commercial |
$101.40
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna of CA HMO |
$140.00
|
| Rate for Payer: Cigna of CA PPO |
$140.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$170.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$170.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$140.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.00
|
| Rate for Payer: EPIC Health Plan Senior |
$80.00
|
| Rate for Payer: Galaxy Health WC |
$170.00
|
| Rate for Payer: Global Benefits Group Commercial |
$120.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$74.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$127.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$84.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$118.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$140.00
|
| Rate for Payer: Multiplan Commercial |
$160.00
|
| Rate for Payer: Networks By Design Commercial |
$100.00
|
| Rate for Payer: Prime Health Services Commercial |
$170.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$120.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$120.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$75.06
|
| Rate for Payer: United Healthcare All Other HMO |
$73.06
|
| Rate for Payer: United Healthcare HMO Rider |
$71.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$65.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$170.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$170.00
|
| Rate for Payer: Vantage Medical Group Senior |
$170.00
|
|
|
HC REPLACE KAFO BAND
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
CPT L4090
|
| Hospital Charge Code |
915354090
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna of CA HMO |
$140.00
|
| Rate for Payer: Cigna of CA PPO |
$140.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$140.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.00
|
| Rate for Payer: EPIC Health Plan Senior |
$80.00
|
| Rate for Payer: Galaxy Health WC |
$170.00
|
| Rate for Payer: Global Benefits Group Commercial |
$120.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$127.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$118.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.00
|
| Rate for Payer: Multiplan Commercial |
$160.00
|
| Rate for Payer: Networks By Design Commercial |
$130.00
|
| Rate for Payer: Prime Health Services Commercial |
$170.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$75.06
|
| Rate for Payer: United Healthcare All Other HMO |
$73.06
|
| Rate for Payer: United Healthcare HMO Rider |
$71.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$65.50
|
|
|
HC REPLACE KAFO BAND
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
CPT L4090
|
| Hospital Charge Code |
915354090
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$48.00 |
| Max. Negotiated Rate |
$170.00 |
| Rate for Payer: Adventist Health Commercial |
$82.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$170.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$110.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$150.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$121.06
|
| Rate for Payer: Blue Shield of California Commercial |
$153.80
|
| Rate for Payer: Blue Shield of California Commercial |
$101.40
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna of CA HMO |
$140.00
|
| Rate for Payer: Cigna of CA PPO |
$140.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$170.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$170.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$140.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.00
|
| Rate for Payer: EPIC Health Plan Senior |
$80.00
|
| Rate for Payer: Galaxy Health WC |
$170.00
|
| Rate for Payer: Global Benefits Group Commercial |
$120.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$74.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$127.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$84.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$118.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$140.00
|
| Rate for Payer: Multiplan Commercial |
$160.00
|
| Rate for Payer: Networks By Design Commercial |
$100.00
|
| Rate for Payer: Prime Health Services Commercial |
$170.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$120.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$120.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$75.06
|
| Rate for Payer: United Healthcare All Other HMO |
$73.06
|
| Rate for Payer: United Healthcare HMO Rider |
$71.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$65.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$170.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$170.00
|
| Rate for Payer: Vantage Medical Group Senior |
$170.00
|
|
|
HC REPLACE KAFO BAND
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
CPT L4090
|
| Hospital Charge Code |
905354090
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna of CA HMO |
$140.00
|
| Rate for Payer: Cigna of CA PPO |
$140.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$140.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.00
|
| Rate for Payer: EPIC Health Plan Senior |
$80.00
|
| Rate for Payer: Galaxy Health WC |
$170.00
|
| Rate for Payer: Global Benefits Group Commercial |
$120.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$127.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$118.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.00
|
| Rate for Payer: Multiplan Commercial |
$160.00
|
| Rate for Payer: Networks By Design Commercial |
$130.00
|
| Rate for Payer: Prime Health Services Commercial |
$170.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$75.06
|
| Rate for Payer: United Healthcare All Other HMO |
$73.06
|
| Rate for Payer: United Healthcare HMO Rider |
$71.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$65.50
|
|
|
HC REPLACE LEATHER CUFF
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
CPT L4110
|
| Hospital Charge Code |
905354110
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$48.00 |
| Max. Negotiated Rate |
$170.00 |
| Rate for Payer: Adventist Health Commercial |
$82.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$170.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$110.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$150.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$121.06
|
| Rate for Payer: Blue Shield of California Commercial |
$153.80
|
| Rate for Payer: Blue Shield of California Commercial |
$101.40
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna of CA HMO |
$140.00
|
| Rate for Payer: Cigna of CA PPO |
$140.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$170.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$170.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$140.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.00
|
| Rate for Payer: EPIC Health Plan Senior |
$80.00
|
| Rate for Payer: Galaxy Health WC |
$170.00
|
| Rate for Payer: Global Benefits Group Commercial |
$120.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$96.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$127.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$108.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$118.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$140.00
|
| Rate for Payer: Multiplan Commercial |
$160.00
|
| Rate for Payer: Networks By Design Commercial |
$100.00
|
| Rate for Payer: Prime Health Services Commercial |
$170.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$120.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$120.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$75.06
|
| Rate for Payer: United Healthcare All Other HMO |
$73.06
|
| Rate for Payer: United Healthcare HMO Rider |
$71.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$65.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$170.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$170.00
|
| Rate for Payer: Vantage Medical Group Senior |
$170.00
|
|
|
HC REPLACE LEATHER CUFF
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
CPT L4110
|
| Hospital Charge Code |
905354110
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna of CA HMO |
$140.00
|
| Rate for Payer: Cigna of CA PPO |
$140.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$140.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.00
|
| Rate for Payer: EPIC Health Plan Senior |
$80.00
|
| Rate for Payer: Galaxy Health WC |
$170.00
|
| Rate for Payer: Global Benefits Group Commercial |
$120.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$127.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$118.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.00
|
| Rate for Payer: Multiplan Commercial |
$160.00
|
| Rate for Payer: Networks By Design Commercial |
$130.00
|
| Rate for Payer: Prime Health Services Commercial |
$170.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$75.06
|
| Rate for Payer: United Healthcare All Other HMO |
$73.06
|
| Rate for Payer: United Healthcare HMO Rider |
$71.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$65.50
|
|
|
HC REPLACE LEATHER CUFF
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
CPT L4110
|
| Hospital Charge Code |
915354110
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna of CA HMO |
$140.00
|
| Rate for Payer: Cigna of CA PPO |
$140.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$140.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.00
|
| Rate for Payer: EPIC Health Plan Senior |
$80.00
|
| Rate for Payer: Galaxy Health WC |
$170.00
|
| Rate for Payer: Global Benefits Group Commercial |
$120.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$127.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$118.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.00
|
| Rate for Payer: Multiplan Commercial |
$160.00
|
| Rate for Payer: Networks By Design Commercial |
$130.00
|
| Rate for Payer: Prime Health Services Commercial |
$170.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$75.06
|
| Rate for Payer: United Healthcare All Other HMO |
$73.06
|
| Rate for Payer: United Healthcare HMO Rider |
$71.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$65.50
|
|
|
HC REPLACE LEATHER CUFF
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
CPT L4110
|
| Hospital Charge Code |
915354110
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$48.00 |
| Max. Negotiated Rate |
$170.00 |
| Rate for Payer: Adventist Health Commercial |
$82.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$170.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$110.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$150.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$121.06
|
| Rate for Payer: Blue Shield of California Commercial |
$153.80
|
| Rate for Payer: Blue Shield of California Commercial |
$101.40
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna of CA HMO |
$140.00
|
| Rate for Payer: Cigna of CA PPO |
$140.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$170.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$170.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$140.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.00
|
| Rate for Payer: EPIC Health Plan Senior |
$80.00
|
| Rate for Payer: Galaxy Health WC |
$170.00
|
| Rate for Payer: Global Benefits Group Commercial |
$120.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$96.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$127.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$108.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$118.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$140.00
|
| Rate for Payer: Multiplan Commercial |
$160.00
|
| Rate for Payer: Networks By Design Commercial |
$100.00
|
| Rate for Payer: Prime Health Services Commercial |
$170.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$120.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$120.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$75.06
|
| Rate for Payer: United Healthcare All Other HMO |
$73.06
|
| Rate for Payer: United Healthcare HMO Rider |
$71.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$65.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$170.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$170.00
|
| Rate for Payer: Vantage Medical Group Senior |
$170.00
|
|
|
HC REPLACE MOLDED CALF LACER
|
Facility
|
IP
|
$1,068.00
|
|
|
Service Code
|
CPT L4050
|
| Hospital Charge Code |
905354050
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$213.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$213.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$480.60
|
| Rate for Payer: Cash Price |
$480.60
|
| Rate for Payer: Cigna of CA HMO |
$747.60
|
| Rate for Payer: Cigna of CA PPO |
$747.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$678.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$630.12
|
| 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 |
$694.20
|
| Rate for Payer: Prime Health Services Commercial |
$907.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$400.82
|
| Rate for Payer: United Healthcare All Other HMO |
$390.14
|
| Rate for Payer: United Healthcare HMO Rider |
$381.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$349.77
|
|
|
HC REPLACE MOLDED CALF LACER
|
Facility
|
OP
|
$1,068.00
|
|
|
Service Code
|
CPT L4050
|
| Hospital Charge Code |
915354050
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$256.32 |
| Max. Negotiated Rate |
$907.80 |
| Rate for Payer: Adventist Health Commercial |
$437.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$907.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$587.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$801.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$646.46
|
| Rate for Payer: Blue Shield of California Commercial |
$821.29
|
| Rate for Payer: Blue Shield of California Commercial |
$541.48
|
| Rate for Payer: Cash Price |
$480.60
|
| Rate for Payer: Cash Price |
$480.60
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$556.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$678.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$629.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$630.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$256.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$747.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$747.60
|
| Rate for Payer: Multiplan Commercial |
$854.40
|
| Rate for Payer: Networks By Design Commercial |
$534.00
|
| Rate for Payer: Prime Health Services Commercial |
$907.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$640.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$640.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$400.82
|
| Rate for Payer: United Healthcare All Other HMO |
$390.14
|
| Rate for Payer: United Healthcare HMO Rider |
$381.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$349.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$907.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$907.80
|
| Rate for Payer: Vantage Medical Group Senior |
$907.80
|
|
|
HC REPLACE MOLDED CALF LACER
|
Facility
|
IP
|
$1,068.00
|
|
|
Service Code
|
CPT L4050
|
| Hospital Charge Code |
915354050
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$213.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$213.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$480.60
|
| Rate for Payer: Cash Price |
$480.60
|
| Rate for Payer: Cigna of CA HMO |
$747.60
|
| Rate for Payer: Cigna of CA PPO |
$747.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$678.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$630.12
|
| 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 |
$694.20
|
| Rate for Payer: Prime Health Services Commercial |
$907.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$400.82
|
| Rate for Payer: United Healthcare All Other HMO |
$390.14
|
| Rate for Payer: United Healthcare HMO Rider |
$381.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$349.77
|
|
|
HC REPLACE MOLDED CALF LACER
|
Facility
|
OP
|
$1,068.00
|
|
|
Service Code
|
CPT L4050
|
| Hospital Charge Code |
905354050
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$256.32 |
| Max. Negotiated Rate |
$907.80 |
| Rate for Payer: Adventist Health Commercial |
$437.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$907.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$587.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$801.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$646.46
|
| Rate for Payer: Blue Shield of California Commercial |
$821.29
|
| Rate for Payer: Blue Shield of California Commercial |
$541.48
|
| Rate for Payer: Cash Price |
$480.60
|
| Rate for Payer: Cash Price |
$480.60
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$556.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$678.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$629.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$630.12
|
| 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 |
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 |
$646.46
|
| Rate for Payer: Blue Shield of California Commercial |
$821.29
|
| Rate for Payer: Blue Shield of California Commercial |
$541.48
|
| Rate for Payer: Cash Price |
$480.60
|
| Rate for Payer: Cash Price |
$480.60
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$550.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$678.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$622.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$630.12
|
| 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
|
IP
|
$1,068.00
|
|
|
Service Code
|
CPT L4040
|
| Hospital Charge Code |
905354040
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$213.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Cash Price |
$480.60
|
| Rate for Payer: Adventist Health Commercial |
$213.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$480.60
|
| Rate for Payer: Cigna of CA HMO |
$747.60
|
| Rate for Payer: Cigna of CA PPO |
$747.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$678.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$630.12
|
| 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 |
$694.20
|
| 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 |
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 |
$646.46
|
| Rate for Payer: Blue Shield of California Commercial |
$821.29
|
| Rate for Payer: Blue Shield of California Commercial |
$541.48
|
| Rate for Payer: Cash Price |
$480.60
|
| Rate for Payer: Cash Price |
$480.60
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$550.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$678.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$622.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$630.12
|
| 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
|
|
