|
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 |
$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 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$123.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$277.20
|
| Rate for Payer: Cash Price |
$277.20
|
| Rate for Payer: Cigna of CA HMO |
$431.20
|
| Rate for Payer: Cigna of CA PPO |
$431.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$391.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$363.44
|
| 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 |
$400.40
|
| 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
|
$526.00
|
|
|
Service Code
|
CPT L4055
|
| Hospital Charge Code |
905354055
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$105.20 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$105.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$236.70
|
| Rate for Payer: Cash Price |
$236.70
|
| Rate for Payer: Cigna of CA HMO |
$368.20
|
| Rate for Payer: Cigna of CA PPO |
$368.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$334.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$310.34
|
| 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 |
$341.90
|
| 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
|
IP
|
$616.00
|
|
|
Service Code
|
CPT L4045
|
| Hospital Charge Code |
905354045
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$123.20 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$123.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$277.20
|
| Rate for Payer: Cash Price |
$277.20
|
| Rate for Payer: Cigna of CA HMO |
$431.20
|
| Rate for Payer: Cigna of CA PPO |
$431.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$391.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$363.44
|
| 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 |
$400.40
|
| 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 |
$372.86
|
| Rate for Payer: Blue Shield of California Commercial |
$473.70
|
| Rate for Payer: Blue Shield of California Commercial |
$312.31
|
| Rate for Payer: Cash Price |
$277.20
|
| Rate for Payer: Cash Price |
$277.20
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$422.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$391.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$477.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$363.44
|
| 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
|
$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 |
$372.86
|
| Rate for Payer: Blue Shield of California Commercial |
$473.70
|
| Rate for Payer: Blue Shield of California Commercial |
$312.31
|
| Rate for Payer: Cash Price |
$277.20
|
| Rate for Payer: Cash Price |
$277.20
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$422.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$391.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$477.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$363.44
|
| 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: Vantage Medical Group Senior |
$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 |
$318.39
|
| Rate for Payer: Blue Shield of California Commercial |
$404.49
|
| Rate for Payer: Blue Shield of California Commercial |
$266.68
|
| Rate for Payer: Cash Price |
$236.70
|
| Rate for Payer: Cash Price |
$236.70
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$360.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$334.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$407.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$310.34
|
| 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
|
|
|
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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$105.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$236.70
|
| Rate for Payer: Cash Price |
$236.70
|
| Rate for Payer: Cigna of CA HMO |
$368.20
|
| Rate for Payer: Cigna of CA PPO |
$368.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$334.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$310.34
|
| 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 |
$341.90
|
| 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
|
$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 |
$318.39
|
| Rate for Payer: Blue Shield of California Commercial |
$404.49
|
| Rate for Payer: Blue Shield of California Commercial |
$266.68
|
| Rate for Payer: Cash Price |
$236.70
|
| Rate for Payer: Cash Price |
$236.70
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$360.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$334.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$407.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$310.34
|
| 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 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 |
$5,442.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,465.80
|
| 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 Foundation Hospitals Commercial/Self Funded |
$7,679.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,135.46
|
| 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 |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$2,418.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,061.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Cash Price |
$5,442.30
|
| Rate for Payer: Cash Price |
$5,442.30
|
| Rate for Payer: Cash Price |
$5,442.30
|
| 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 |
$6,091.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,467.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,061.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,465.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,700.73
|
| Rate for Payer: EPIC Health Plan Senior |
$4,467.15
|
| 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/Senior |
$6,660.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$701.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,679.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$793.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,685.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,902.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,116.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,441.81
|
| 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 |
$6,047.00
|
| 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 |
$4,061.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Vantage Medical Group Senior |
$4,061.05
|
|
|
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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$199.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$448.20
|
| Rate for Payer: Cash Price |
$448.20
|
| Rate for Payer: Cigna of CA HMO |
$697.20
|
| Rate for Payer: Cigna of CA PPO |
$697.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$632.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$587.64
|
| 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 |
$647.40
|
| 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$199.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$448.20
|
| Rate for Payer: Cash Price |
$448.20
|
| Rate for Payer: Cigna of CA HMO |
$697.20
|
| Rate for Payer: Cigna of CA PPO |
$697.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$632.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$587.64
|
| 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 |
$647.40
|
| 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 |
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 |
$602.88
|
| Rate for Payer: Blue Shield of California Commercial |
$765.92
|
| Rate for Payer: Blue Shield of California Commercial |
$504.97
|
| Rate for Payer: Cash Price |
$448.20
|
| Rate for Payer: Cash Price |
$448.20
|
| Rate for Payer: Cigna of CA HMO |
$697.20
|
| Rate for Payer: Cigna of CA PPO |
$697.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$846.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$846.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$846.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$546.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$632.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$618.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$587.64
|
| 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
|
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: Vantage Medical Group Senior |
$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 |
$602.88
|
| Rate for Payer: Blue Shield of California Commercial |
$765.92
|
| Rate for Payer: Blue Shield of California Commercial |
$504.97
|
| Rate for Payer: Cash Price |
$448.20
|
| Rate for Payer: Cash Price |
$448.20
|
| Rate for Payer: Cigna of CA HMO |
$697.20
|
| Rate for Payer: Cigna of CA PPO |
$697.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$846.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$846.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$846.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$546.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$632.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$618.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$587.64
|
| 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
|
|
|
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 |
$348.65
|
| Rate for Payer: Blue Shield of California Commercial |
$442.94
|
| Rate for Payer: Blue Shield of California Commercial |
$292.03
|
| Rate for Payer: Cash Price |
$259.20
|
| Rate for Payer: Cash Price |
$259.20
|
| Rate for Payer: Cigna of CA HMO |
$403.20
|
| Rate for Payer: Cigna of CA PPO |
$403.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$489.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$489.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$489.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$379.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$365.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$429.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$339.84
|
| 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
|
IP
|
$576.00
|
|
|
Service Code
|
CPT L4070
|
| Hospital Charge Code |
915354070
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$115.20 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$115.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$259.20
|
| Rate for Payer: Cash Price |
$259.20
|
| Rate for Payer: Cigna of CA HMO |
$403.20
|
| Rate for Payer: Cigna of CA PPO |
$403.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$365.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$339.84
|
| 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 |
$374.40
|
| 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 |
$348.65
|
| Rate for Payer: Blue Shield of California Commercial |
$442.94
|
| Rate for Payer: Blue Shield of California Commercial |
$292.03
|
| Rate for Payer: Cash Price |
$259.20
|
| Rate for Payer: Cash Price |
$259.20
|
| Rate for Payer: Cigna of CA HMO |
$403.20
|
| Rate for Payer: Cigna of CA PPO |
$403.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$489.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$489.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$489.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$379.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$365.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$429.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$339.84
|
| 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
|
IP
|
$576.00
|
|
|
Service Code
|
CPT L4070
|
| Hospital Charge Code |
905354070
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$115.20 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$115.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$259.20
|
| Rate for Payer: Cash Price |
$259.20
|
| Rate for Payer: Cigna of CA HMO |
$403.20
|
| Rate for Payer: Cigna of CA PPO |
$403.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$365.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$339.84
|
| 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 |
$374.40
|
| 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 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 |
$96.85
|
| Rate for Payer: Blue Shield of California Commercial |
$81.12
|
| Rate for Payer: Blue Shield of California Commercial |
$123.04
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna of CA HMO |
$112.00
|
| Rate for Payer: Cigna of CA PPO |
$112.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$136.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$136.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$136.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$78.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$101.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$89.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$94.40
|
| 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$32.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna of CA HMO |
$112.00
|
| Rate for Payer: Cigna of CA PPO |
$112.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$101.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$94.40
|
| 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 |
$104.00
|
| 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
|
IP
|
$160.00
|
|
|
Service Code
|
CPT L4080
|
| Hospital Charge Code |
915354080
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$32.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$32.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna of CA HMO |
$112.00
|
| Rate for Payer: Cigna of CA PPO |
$112.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$101.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$94.40
|
| 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 |
$104.00
|
| 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 |
$96.85
|
| Rate for Payer: Blue Shield of California Commercial |
$81.12
|
| Rate for Payer: Blue Shield of California Commercial |
$123.04
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna of CA HMO |
$112.00
|
| Rate for Payer: Cigna of CA PPO |
$112.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$136.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$136.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$136.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$78.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$101.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$89.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$94.40
|
| 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 QUAD SOCKET BRIM
|
Facility
|
OP
|
$1,412.00
|
|
|
Service Code
|
CPT L4030
|
| Hospital Charge Code |
915354030
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$338.88 |
| Max. Negotiated Rate |
$1,200.20 |
| Rate for Payer: Adventist Health Commercial |
$578.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,200.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$776.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,059.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$854.68
|
| Rate for Payer: Blue Shield of California Commercial |
$715.88
|
| Rate for Payer: Blue Shield of California Commercial |
$1,085.83
|
| Rate for Payer: Cash Price |
$635.40
|
| Rate for Payer: Cash Price |
$635.40
|
| Rate for Payer: Cigna of CA HMO |
$988.40
|
| Rate for Payer: Cigna of CA PPO |
$988.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,200.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,200.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,200.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$988.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$564.80
|
| Rate for Payer: EPIC Health Plan Senior |
$564.80
|
| Rate for Payer: Galaxy Health WC |
$1,200.20
|
| Rate for Payer: Global Benefits Group Commercial |
$847.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$526.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$896.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$595.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$833.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$338.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$988.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$988.40
|
| Rate for Payer: Multiplan Commercial |
$1,129.60
|
| Rate for Payer: Networks By Design Commercial |
$706.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,200.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$847.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$847.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$529.92
|
| Rate for Payer: United Healthcare All Other HMO |
$515.80
|
| Rate for Payer: United Healthcare HMO Rider |
$504.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$462.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,200.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,200.20
|
| Rate for Payer: Vantage Medical Group Senior |
$1,200.20
|
|
|
HC REPLACE QUAD SOCKET BRIM
|
Facility
|
IP
|
$1,412.00
|
|
|
Service Code
|
CPT L4030
|
| Hospital Charge Code |
915354030
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$282.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$282.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$635.40
|
| Rate for Payer: Cash Price |
$635.40
|
| Rate for Payer: Cigna of CA HMO |
$988.40
|
| Rate for Payer: Cigna of CA PPO |
$988.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$988.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$564.80
|
| Rate for Payer: EPIC Health Plan Senior |
$564.80
|
| Rate for Payer: Galaxy Health WC |
$1,200.20
|
| Rate for Payer: Global Benefits Group Commercial |
$847.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$896.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$833.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$338.88
|
| Rate for Payer: Multiplan Commercial |
$1,129.60
|
| Rate for Payer: Networks By Design Commercial |
$917.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,200.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$529.92
|
| Rate for Payer: United Healthcare All Other HMO |
$515.80
|
| Rate for Payer: United Healthcare HMO Rider |
$504.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$462.43
|
|
