|
HC REPLACE LEATHER CUFF
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
CPT L4110
|
| Hospital Charge Code |
915354110
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$65.50 |
| Max. Negotiated Rate |
$180.00 |
| 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 |
$117.46
|
| Rate for Payer: Blue Shield of California Commercial |
$154.60
|
| Rate for Payer: Blue Shield of California EPN |
$100.80
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Central Health Plan Commercial |
$160.00
|
| Rate for Payer: Cigna of CA HMO |
$140.00
|
| Rate for Payer: Cigna of CA PPO |
$140.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$170.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$170.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.00
|
| Rate for Payer: EPIC Health Plan Senior |
$80.00
|
| Rate for Payer: Galaxy Health WC |
$170.00
|
| Rate for Payer: Global Benefits Group Commercial |
$120.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$180.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$98.54
|
| Rate for Payer: InnovAge PACE Commercial |
$100.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$133.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$108.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$123.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.00
|
| 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 |
$150.00
|
| Rate for Payer: Networks By Design Commercial |
$100.00
|
| Rate for Payer: Prime Health Services Commercial |
$170.00
|
| Rate for Payer: Riverside University Health System MISP |
$80.00
|
| 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 |
915354110
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Blue Shield of California Commercial |
$154.60
|
| Rate for Payer: Blue Shield of California EPN |
$100.80
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Central Health Plan Commercial |
$160.00
|
| Rate for Payer: Cigna of CA HMO |
$140.00
|
| Rate for Payer: Cigna of CA PPO |
$140.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.00
|
| Rate for Payer: EPIC Health Plan Senior |
$80.00
|
| Rate for Payer: Galaxy Health WC |
$170.00
|
| Rate for Payer: Global Benefits Group Commercial |
$120.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$180.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$133.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$76.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$123.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.00
|
| Rate for Payer: Multiplan Commercial |
$150.00
|
| 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 |
905354110
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Blue Shield of California Commercial |
$154.60
|
| Rate for Payer: Blue Shield of California EPN |
$100.80
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Central Health Plan Commercial |
$160.00
|
| Rate for Payer: Cigna of CA HMO |
$140.00
|
| Rate for Payer: Cigna of CA PPO |
$140.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.00
|
| Rate for Payer: EPIC Health Plan Senior |
$80.00
|
| Rate for Payer: Galaxy Health WC |
$170.00
|
| Rate for Payer: Global Benefits Group Commercial |
$120.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$180.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$133.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$76.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$123.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.00
|
| Rate for Payer: Multiplan Commercial |
$150.00
|
| 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 |
$65.50 |
| Max. Negotiated Rate |
$180.00 |
| 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 |
$117.46
|
| Rate for Payer: Blue Shield of California Commercial |
$154.60
|
| Rate for Payer: Blue Shield of California EPN |
$100.80
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Central Health Plan Commercial |
$160.00
|
| Rate for Payer: Cigna of CA HMO |
$140.00
|
| Rate for Payer: Cigna of CA PPO |
$140.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$170.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$170.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.00
|
| Rate for Payer: EPIC Health Plan Senior |
$80.00
|
| Rate for Payer: Galaxy Health WC |
$170.00
|
| Rate for Payer: Global Benefits Group Commercial |
$120.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$180.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$98.54
|
| Rate for Payer: InnovAge PACE Commercial |
$100.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$133.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$108.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$123.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.00
|
| 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 |
$150.00
|
| Rate for Payer: Networks By Design Commercial |
$100.00
|
| Rate for Payer: Prime Health Services Commercial |
$170.00
|
| Rate for Payer: Riverside University Health System MISP |
$80.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$120.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$120.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$75.06
|
| Rate for Payer: United Healthcare All Other HMO |
$73.06
|
| Rate for Payer: United Healthcare HMO Rider |
$71.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$65.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$170.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$170.00
|
| Rate for Payer: Vantage Medical Group Senior |
$170.00
|
|
|
HC REPLACE MOLDED CALF LACER
|
Facility
|
IP
|
$1,068.00
|
|
|
Service Code
|
CPT L4050
|
| Hospital Charge Code |
915354050
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$213.60 |
| Max. Negotiated Rate |
$961.20 |
| Rate for Payer: Adventist Health Commercial |
$213.60
|
| Rate for Payer: Blue Shield of California Commercial |
$825.56
|
| Rate for Payer: Blue Shield of California EPN |
$538.27
|
| Rate for Payer: Cash Price |
$587.40
|
| Rate for Payer: Central Health Plan Commercial |
$854.40
|
| Rate for Payer: Cigna of CA HMO |
$747.60
|
| Rate for Payer: Cigna of CA PPO |
$747.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$427.20
|
| Rate for Payer: EPIC Health Plan Senior |
$427.20
|
| Rate for Payer: Galaxy Health WC |
$907.80
|
| Rate for Payer: Global Benefits Group Commercial |
$640.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$961.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$712.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$406.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$661.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$213.60
|
| Rate for Payer: Multiplan Commercial |
$801.00
|
| 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 |
$349.77 |
| Max. Negotiated Rate |
$961.20 |
| 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 |
$627.24
|
| Rate for Payer: Blue Shield of California Commercial |
$825.56
|
| Rate for Payer: Blue Shield of California EPN |
$538.27
|
| Rate for Payer: Cash Price |
$587.40
|
| Rate for Payer: Cash Price |
$587.40
|
| Rate for Payer: Central Health Plan Commercial |
$854.40
|
| Rate for Payer: Cigna of CA HMO |
$747.60
|
| Rate for Payer: Cigna of CA PPO |
$747.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$907.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$907.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$907.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$427.20
|
| Rate for Payer: EPIC Health Plan Senior |
$427.20
|
| Rate for Payer: Galaxy Health WC |
$907.80
|
| Rate for Payer: Global Benefits Group Commercial |
$640.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$961.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$570.16
|
| Rate for Payer: InnovAge PACE Commercial |
$534.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$712.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$629.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$661.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$437.88
|
| 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 |
$801.00
|
| Rate for Payer: Networks By Design Commercial |
$534.00
|
| Rate for Payer: Prime Health Services Commercial |
$907.80
|
| Rate for Payer: Riverside University Health System MISP |
$427.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$640.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$640.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$400.82
|
| Rate for Payer: United Healthcare All Other HMO |
$390.14
|
| Rate for Payer: United Healthcare HMO Rider |
$381.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$349.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$907.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$907.80
|
| Rate for Payer: Vantage Medical Group Senior |
$907.80
|
|
|
HC REPLACE MOLDED CALF LACER
|
Facility
|
IP
|
$1,068.00
|
|
|
Service Code
|
CPT L4050
|
| Hospital Charge Code |
905354050
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$213.60 |
| Max. Negotiated Rate |
$961.20 |
| Rate for Payer: Adventist Health Commercial |
$213.60
|
| Rate for Payer: Blue Shield of California Commercial |
$825.56
|
| Rate for Payer: Blue Shield of California EPN |
$538.27
|
| Rate for Payer: Cash Price |
$587.40
|
| Rate for Payer: Central Health Plan Commercial |
$854.40
|
| Rate for Payer: Cigna of CA HMO |
$747.60
|
| Rate for Payer: Cigna of CA PPO |
$747.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$427.20
|
| Rate for Payer: EPIC Health Plan Senior |
$427.20
|
| Rate for Payer: Galaxy Health WC |
$907.80
|
| Rate for Payer: Global Benefits Group Commercial |
$640.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$961.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$712.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$406.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$661.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$213.60
|
| Rate for Payer: Multiplan Commercial |
$801.00
|
| 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 |
$349.77 |
| Max. Negotiated Rate |
$961.20 |
| 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 |
$627.24
|
| Rate for Payer: Blue Shield of California Commercial |
$825.56
|
| Rate for Payer: Blue Shield of California EPN |
$538.27
|
| Rate for Payer: Cash Price |
$587.40
|
| Rate for Payer: Cash Price |
$587.40
|
| Rate for Payer: Central Health Plan Commercial |
$854.40
|
| Rate for Payer: Cigna of CA HMO |
$747.60
|
| Rate for Payer: Cigna of CA PPO |
$747.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$907.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$907.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$907.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$427.20
|
| Rate for Payer: EPIC Health Plan Senior |
$427.20
|
| Rate for Payer: Galaxy Health WC |
$907.80
|
| Rate for Payer: Global Benefits Group Commercial |
$640.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$961.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$570.16
|
| Rate for Payer: InnovAge PACE Commercial |
$534.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$712.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$629.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$661.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$437.88
|
| 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 |
$801.00
|
| Rate for Payer: Networks By Design Commercial |
$534.00
|
| Rate for Payer: Prime Health Services Commercial |
$907.80
|
| Rate for Payer: Riverside University Health System MISP |
$427.20
|
| 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 |
$961.20 |
| Rate for Payer: Adventist Health Commercial |
$213.60
|
| Rate for Payer: Blue Shield of California Commercial |
$825.56
|
| Rate for Payer: Blue Shield of California EPN |
$538.27
|
| Rate for Payer: Cash Price |
$587.40
|
| Rate for Payer: Central Health Plan Commercial |
$854.40
|
| Rate for Payer: Cigna of CA HMO |
$747.60
|
| Rate for Payer: Cigna of CA PPO |
$747.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$427.20
|
| Rate for Payer: EPIC Health Plan Senior |
$427.20
|
| Rate for Payer: Galaxy Health WC |
$907.80
|
| Rate for Payer: Global Benefits Group Commercial |
$640.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$961.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$712.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$406.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$661.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$213.60
|
| Rate for Payer: Multiplan Commercial |
$801.00
|
| 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 |
905354040
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$349.77 |
| Max. Negotiated Rate |
$961.20 |
| 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 |
$627.24
|
| Rate for Payer: Blue Shield of California Commercial |
$825.56
|
| Rate for Payer: Blue Shield of California EPN |
$538.27
|
| Rate for Payer: Cash Price |
$587.40
|
| Rate for Payer: Cash Price |
$587.40
|
| Rate for Payer: Central Health Plan Commercial |
$854.40
|
| Rate for Payer: Cigna of CA HMO |
$747.60
|
| Rate for Payer: Cigna of CA PPO |
$747.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$907.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$907.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$907.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$427.20
|
| Rate for Payer: EPIC Health Plan Senior |
$427.20
|
| Rate for Payer: Galaxy Health WC |
$907.80
|
| Rate for Payer: Global Benefits Group Commercial |
$640.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$961.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$563.75
|
| Rate for Payer: InnovAge PACE Commercial |
$534.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$712.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$622.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$661.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$437.88
|
| 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 |
$801.00
|
| Rate for Payer: Networks By Design Commercial |
$534.00
|
| Rate for Payer: Prime Health Services Commercial |
$907.80
|
| Rate for Payer: Riverside University Health System MISP |
$427.20
|
| 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 |
915354040
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$213.60 |
| Max. Negotiated Rate |
$961.20 |
| Rate for Payer: Adventist Health Commercial |
$213.60
|
| Rate for Payer: Blue Shield of California Commercial |
$825.56
|
| Rate for Payer: Blue Shield of California EPN |
$538.27
|
| Rate for Payer: Cash Price |
$587.40
|
| Rate for Payer: Central Health Plan Commercial |
$854.40
|
| Rate for Payer: Cigna of CA HMO |
$747.60
|
| Rate for Payer: Cigna of CA PPO |
$747.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$427.20
|
| Rate for Payer: EPIC Health Plan Senior |
$427.20
|
| Rate for Payer: Galaxy Health WC |
$907.80
|
| Rate for Payer: Global Benefits Group Commercial |
$640.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$961.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$712.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$406.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$661.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$213.60
|
| Rate for Payer: Multiplan Commercial |
$801.00
|
| 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 |
$349.77 |
| Max. Negotiated Rate |
$961.20 |
| 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 |
$627.24
|
| Rate for Payer: Blue Shield of California Commercial |
$825.56
|
| Rate for Payer: Blue Shield of California EPN |
$538.27
|
| Rate for Payer: Cash Price |
$587.40
|
| Rate for Payer: Cash Price |
$587.40
|
| Rate for Payer: Central Health Plan Commercial |
$854.40
|
| Rate for Payer: Cigna of CA HMO |
$747.60
|
| Rate for Payer: Cigna of CA PPO |
$747.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$907.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$907.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$907.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$427.20
|
| Rate for Payer: EPIC Health Plan Senior |
$427.20
|
| Rate for Payer: Galaxy Health WC |
$907.80
|
| Rate for Payer: Global Benefits Group Commercial |
$640.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$961.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$563.75
|
| Rate for Payer: InnovAge PACE Commercial |
$534.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$712.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$622.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$661.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$437.88
|
| 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 |
$801.00
|
| Rate for Payer: Networks By Design Commercial |
$534.00
|
| Rate for Payer: Prime Health Services Commercial |
$907.80
|
| Rate for Payer: Riverside University Health System MISP |
$427.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$640.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$640.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$400.82
|
| Rate for Payer: United Healthcare All Other HMO |
$390.14
|
| Rate for Payer: United Healthcare HMO Rider |
$381.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$349.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$907.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$907.80
|
| Rate for Payer: Vantage Medical Group Senior |
$907.80
|
|
|
HC REPLACE NON-MOLDED LACER
|
Facility
|
IP
|
$526.00
|
|
|
Service Code
|
CPT L4055
|
| Hospital Charge Code |
915354055
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$105.20 |
| Max. Negotiated Rate |
$473.40 |
| Rate for Payer: Adventist Health Commercial |
$105.20
|
| Rate for Payer: Blue Shield of California Commercial |
$406.60
|
| Rate for Payer: Blue Shield of California EPN |
$265.10
|
| Rate for Payer: Cash Price |
$289.30
|
| Rate for Payer: Central Health Plan Commercial |
$420.80
|
| Rate for Payer: Cigna of CA HMO |
$368.20
|
| Rate for Payer: Cigna of CA PPO |
$368.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$210.40
|
| Rate for Payer: EPIC Health Plan Senior |
$210.40
|
| Rate for Payer: Galaxy Health WC |
$447.10
|
| Rate for Payer: Global Benefits Group Commercial |
$315.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$473.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$350.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$200.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$325.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.20
|
| Rate for Payer: Multiplan Commercial |
$394.50
|
| 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 |
915354045
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$123.20 |
| Max. Negotiated Rate |
$554.40 |
| Rate for Payer: Adventist Health Commercial |
$123.20
|
| Rate for Payer: Blue Shield of California Commercial |
$476.17
|
| Rate for Payer: Blue Shield of California EPN |
$310.46
|
| Rate for Payer: Cash Price |
$338.80
|
| Rate for Payer: Central Health Plan Commercial |
$492.80
|
| Rate for Payer: Cigna of CA HMO |
$431.20
|
| Rate for Payer: Cigna of CA PPO |
$431.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$246.40
|
| Rate for Payer: EPIC Health Plan Senior |
$246.40
|
| Rate for Payer: Galaxy Health WC |
$523.60
|
| Rate for Payer: Global Benefits Group Commercial |
$369.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$554.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$410.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$234.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$381.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$123.20
|
| Rate for Payer: Multiplan Commercial |
$462.00
|
| 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
|
$526.00
|
|
|
Service Code
|
CPT L4055
|
| Hospital Charge Code |
905354055
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$172.26 |
| Max. Negotiated Rate |
$473.40 |
| 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 |
$308.92
|
| Rate for Payer: Blue Shield of California Commercial |
$406.60
|
| Rate for Payer: Blue Shield of California EPN |
$265.10
|
| Rate for Payer: Cash Price |
$289.30
|
| Rate for Payer: Cash Price |
$289.30
|
| Rate for Payer: Central Health Plan Commercial |
$420.80
|
| Rate for Payer: Cigna of CA HMO |
$368.20
|
| Rate for Payer: Cigna of CA PPO |
$368.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$447.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$447.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$447.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$210.40
|
| Rate for Payer: EPIC Health Plan Senior |
$210.40
|
| Rate for Payer: Galaxy Health WC |
$447.10
|
| Rate for Payer: Global Benefits Group Commercial |
$315.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$473.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$369.20
|
| Rate for Payer: InnovAge PACE Commercial |
$263.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$350.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$407.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$325.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$215.66
|
| 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 |
$394.50
|
| Rate for Payer: Networks By Design Commercial |
$263.00
|
| Rate for Payer: Prime Health Services Commercial |
$447.10
|
| Rate for Payer: Riverside University Health System MISP |
$210.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$315.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$315.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$197.41
|
| Rate for Payer: United Healthcare All Other HMO |
$192.15
|
| Rate for Payer: United Healthcare HMO Rider |
$187.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$172.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$447.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$447.10
|
| Rate for Payer: Vantage Medical Group Senior |
$447.10
|
|
|
HC REPLACE NON-MOLDED LACER
|
Facility
|
OP
|
$616.00
|
|
|
Service Code
|
CPT L4045
|
| Hospital Charge Code |
905354045
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$201.74 |
| Max. Negotiated Rate |
$554.40 |
| 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 |
$361.78
|
| Rate for Payer: Blue Shield of California Commercial |
$476.17
|
| Rate for Payer: Blue Shield of California EPN |
$310.46
|
| Rate for Payer: Cash Price |
$338.80
|
| Rate for Payer: Cash Price |
$338.80
|
| Rate for Payer: Central Health Plan Commercial |
$492.80
|
| Rate for Payer: Cigna of CA HMO |
$431.20
|
| Rate for Payer: Cigna of CA PPO |
$431.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$523.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$523.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$523.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$246.40
|
| Rate for Payer: EPIC Health Plan Senior |
$246.40
|
| Rate for Payer: Galaxy Health WC |
$523.60
|
| Rate for Payer: Global Benefits Group Commercial |
$369.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$554.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$432.24
|
| Rate for Payer: InnovAge PACE Commercial |
$308.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$410.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$477.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$381.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$252.56
|
| 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 |
$462.00
|
| Rate for Payer: Networks By Design Commercial |
$308.00
|
| Rate for Payer: Prime Health Services Commercial |
$523.60
|
| Rate for Payer: Riverside University Health System MISP |
$246.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$369.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$369.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$231.18
|
| Rate for Payer: United Healthcare All Other HMO |
$225.02
|
| Rate for Payer: United Healthcare HMO Rider |
$220.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$201.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$523.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$523.60
|
| Rate for Payer: Vantage Medical Group Senior |
$523.60
|
|
|
HC REPLACE NON-MOLDED LACER
|
Facility
|
OP
|
$526.00
|
|
|
Service Code
|
CPT L4055
|
| Hospital Charge Code |
915354055
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$172.26 |
| Max. Negotiated Rate |
$473.40 |
| 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 |
$308.92
|
| Rate for Payer: Blue Shield of California Commercial |
$406.60
|
| Rate for Payer: Blue Shield of California EPN |
$265.10
|
| Rate for Payer: Cash Price |
$289.30
|
| Rate for Payer: Cash Price |
$289.30
|
| Rate for Payer: Central Health Plan Commercial |
$420.80
|
| Rate for Payer: Cigna of CA HMO |
$368.20
|
| Rate for Payer: Cigna of CA PPO |
$368.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$447.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$447.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$447.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$210.40
|
| Rate for Payer: EPIC Health Plan Senior |
$210.40
|
| Rate for Payer: Galaxy Health WC |
$447.10
|
| Rate for Payer: Global Benefits Group Commercial |
$315.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$473.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$369.20
|
| Rate for Payer: InnovAge PACE Commercial |
$263.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$350.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$407.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$325.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$215.66
|
| 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 |
$394.50
|
| Rate for Payer: Networks By Design Commercial |
$263.00
|
| Rate for Payer: Prime Health Services Commercial |
$447.10
|
| Rate for Payer: Riverside University Health System MISP |
$210.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$315.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$315.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$197.41
|
| Rate for Payer: United Healthcare All Other HMO |
$192.15
|
| Rate for Payer: United Healthcare HMO Rider |
$187.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$172.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$447.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$447.10
|
| Rate for Payer: Vantage Medical Group Senior |
$447.10
|
|
|
HC REPLACE NON-MOLDED LACER
|
Facility
|
IP
|
$526.00
|
|
|
Service Code
|
CPT L4055
|
| Hospital Charge Code |
905354055
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$105.20 |
| Max. Negotiated Rate |
$473.40 |
| Rate for Payer: Adventist Health Commercial |
$105.20
|
| Rate for Payer: Blue Shield of California Commercial |
$406.60
|
| Rate for Payer: Blue Shield of California EPN |
$265.10
|
| Rate for Payer: Cash Price |
$289.30
|
| Rate for Payer: Central Health Plan Commercial |
$420.80
|
| Rate for Payer: Cigna of CA HMO |
$368.20
|
| Rate for Payer: Cigna of CA PPO |
$368.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$210.40
|
| Rate for Payer: EPIC Health Plan Senior |
$210.40
|
| Rate for Payer: Galaxy Health WC |
$447.10
|
| Rate for Payer: Global Benefits Group Commercial |
$315.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$473.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$350.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$200.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$325.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.20
|
| Rate for Payer: Multiplan Commercial |
$394.50
|
| 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 |
$554.40 |
| Rate for Payer: Adventist Health Commercial |
$123.20
|
| Rate for Payer: Blue Shield of California Commercial |
$476.17
|
| Rate for Payer: Blue Shield of California EPN |
$310.46
|
| Rate for Payer: Cash Price |
$338.80
|
| Rate for Payer: Central Health Plan Commercial |
$492.80
|
| Rate for Payer: Cigna of CA HMO |
$431.20
|
| Rate for Payer: Cigna of CA PPO |
$431.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$246.40
|
| Rate for Payer: EPIC Health Plan Senior |
$246.40
|
| Rate for Payer: Galaxy Health WC |
$523.60
|
| Rate for Payer: Global Benefits Group Commercial |
$369.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$554.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$410.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$234.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$381.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$123.20
|
| Rate for Payer: Multiplan Commercial |
$462.00
|
| 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 |
$201.74 |
| Max. Negotiated Rate |
$554.40 |
| 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 |
$361.78
|
| Rate for Payer: Blue Shield of California Commercial |
$476.17
|
| Rate for Payer: Blue Shield of California EPN |
$310.46
|
| Rate for Payer: Cash Price |
$338.80
|
| Rate for Payer: Cash Price |
$338.80
|
| Rate for Payer: Central Health Plan Commercial |
$492.80
|
| Rate for Payer: Cigna of CA HMO |
$431.20
|
| Rate for Payer: Cigna of CA PPO |
$431.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$523.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$523.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$523.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$246.40
|
| Rate for Payer: EPIC Health Plan Senior |
$246.40
|
| Rate for Payer: Galaxy Health WC |
$523.60
|
| Rate for Payer: Global Benefits Group Commercial |
$369.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$554.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$432.24
|
| Rate for Payer: InnovAge PACE Commercial |
$308.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$410.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$477.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$381.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$252.56
|
| 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 |
$462.00
|
| Rate for Payer: Networks By Design Commercial |
$308.00
|
| Rate for Payer: Prime Health Services Commercial |
$523.60
|
| Rate for Payer: Riverside University Health System MISP |
$246.40
|
| 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 PORT THRU SAME ACCESS
|
Facility
|
IP
|
$11,754.00
|
|
|
Service Code
|
CPT 36585
|
| Hospital Charge Code |
909020012
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,350.80 |
| Max. Negotiated Rate |
$10,578.60 |
| Rate for Payer: Adventist Health Commercial |
$2,350.80
|
| Rate for Payer: Cash Price |
$6,464.70
|
| Rate for Payer: Central Health Plan Commercial |
$9,403.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,701.60
|
| Rate for Payer: EPIC Health Plan Senior |
$4,701.60
|
| Rate for Payer: Galaxy Health WC |
$9,990.90
|
| Rate for Payer: Global Benefits Group Commercial |
$7,052.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,578.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,839.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,478.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,275.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,350.80
|
| Rate for Payer: Multiplan Commercial |
$8,815.50
|
| Rate for Payer: Networks By Design Commercial |
$7,640.10
|
| Rate for Payer: Prime Health Services Commercial |
$9,990.90
|
|
|
HC REPLACE PORT THRU SAME ACCESS
|
Facility
|
OP
|
$11,754.00
|
|
|
Service Code
|
CPT 36585
|
| Hospital Charge Code |
909020012
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$718.48 |
| Max. Negotiated Rate |
$20,902.00 |
| Rate for Payer: Adventist Health Commercial |
$2,350.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$3,999.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,372.03
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$6,464.70
|
| Rate for Payer: Cash Price |
$6,464.70
|
| Rate for Payer: Cash Price |
$6,464.70
|
| Rate for Payer: Central Health Plan Commercial |
$9,403.20
|
| Rate for Payer: Cigna of CA HMO |
$7,522.56
|
| Rate for Payer: Cigna of CA PPO |
$8,697.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,398.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3,999.21
|
| Rate for Payer: Galaxy Health WC |
$9,990.90
|
| Rate for Payer: Global Benefits Group Commercial |
$7,052.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,578.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$718.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: InnovAge PACE Commercial |
$5,998.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,839.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$793.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,350.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,358.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,358.94
|
| Rate for Payer: Multiplan Commercial |
$8,815.50
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: Networks By Design Commercial |
$7,640.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Preferred Health Network WC |
$6,502.07
|
| Rate for Payer: Prime Health Services Commercial |
$9,990.90
|
| Rate for Payer: Prime Health Services Medicare |
$4,239.16
|
| Rate for Payer: Prime Health Services WC |
$6,307.01
|
| Rate for Payer: Riverside University Health System MISP |
$4,399.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,052.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,999.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC REPLACE PRETIBIAL SHELL
|
Facility
|
IP
|
$996.00
|
|
|
Service Code
|
CPT L4130
|
| Hospital Charge Code |
905354130
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$199.20 |
| Max. Negotiated Rate |
$896.40 |
| Rate for Payer: Adventist Health Commercial |
$199.20
|
| Rate for Payer: Blue Shield of California Commercial |
$769.91
|
| Rate for Payer: Blue Shield of California EPN |
$501.98
|
| Rate for Payer: Cash Price |
$547.80
|
| Rate for Payer: Central Health Plan Commercial |
$796.80
|
| Rate for Payer: Cigna of CA HMO |
$697.20
|
| Rate for Payer: Cigna of CA PPO |
$697.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$398.40
|
| Rate for Payer: EPIC Health Plan Senior |
$398.40
|
| Rate for Payer: Galaxy Health WC |
$846.60
|
| Rate for Payer: Global Benefits Group Commercial |
$597.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$896.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$664.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$379.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$616.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$199.20
|
| Rate for Payer: Multiplan Commercial |
$747.00
|
| 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 |
915354130
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$326.19 |
| Max. Negotiated Rate |
$896.40 |
| 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 |
$584.95
|
| Rate for Payer: Blue Shield of California Commercial |
$769.91
|
| Rate for Payer: Blue Shield of California EPN |
$501.98
|
| Rate for Payer: Cash Price |
$547.80
|
| Rate for Payer: Cash Price |
$547.80
|
| Rate for Payer: Central Health Plan Commercial |
$796.80
|
| Rate for Payer: Cigna of CA HMO |
$697.20
|
| Rate for Payer: Cigna of CA PPO |
$697.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$846.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$846.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$846.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$398.40
|
| Rate for Payer: EPIC Health Plan Senior |
$398.40
|
| Rate for Payer: Galaxy Health WC |
$846.60
|
| Rate for Payer: Global Benefits Group Commercial |
$597.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$896.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$559.62
|
| Rate for Payer: InnovAge PACE Commercial |
$498.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$664.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$618.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$616.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$408.36
|
| 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 |
$747.00
|
| Rate for Payer: Networks By Design Commercial |
$498.00
|
| Rate for Payer: Prime Health Services Commercial |
$846.60
|
| Rate for Payer: Riverside University Health System MISP |
$398.40
|
| 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 |
905354130
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$326.19 |
| Max. Negotiated Rate |
$896.40 |
| 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 |
$584.95
|
| Rate for Payer: Blue Shield of California Commercial |
$769.91
|
| Rate for Payer: Blue Shield of California EPN |
$501.98
|
| Rate for Payer: Cash Price |
$547.80
|
| Rate for Payer: Cash Price |
$547.80
|
| Rate for Payer: Central Health Plan Commercial |
$796.80
|
| Rate for Payer: Cigna of CA HMO |
$697.20
|
| Rate for Payer: Cigna of CA PPO |
$697.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$846.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$846.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$846.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$398.40
|
| Rate for Payer: EPIC Health Plan Senior |
$398.40
|
| Rate for Payer: Galaxy Health WC |
$846.60
|
| Rate for Payer: Global Benefits Group Commercial |
$597.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$896.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$559.62
|
| Rate for Payer: InnovAge PACE Commercial |
$498.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$664.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$618.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$616.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$408.36
|
| 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 |
$747.00
|
| Rate for Payer: Networks By Design Commercial |
$498.00
|
| Rate for Payer: Prime Health Services Commercial |
$846.60
|
| Rate for Payer: Riverside University Health System MISP |
$398.40
|
| 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
|
|
