|
HC WHFO DORSAL WRIST
|
Facility
|
OP
|
$231.00
|
|
|
Service Code
|
CPT L3931
|
| Hospital Charge Code |
905353938
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$55.44 |
| Max. Negotiated Rate |
$279.19 |
| Rate for Payer: Adventist Health Commercial |
$94.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$196.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$127.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$173.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133.80
|
| Rate for Payer: Blue Shield of California Commercial |
$170.48
|
| Rate for Payer: Blue Shield of California EPN |
$112.27
|
| Rate for Payer: Cash Price |
$127.05
|
| Rate for Payer: Cash Price |
$127.05
|
| Rate for Payer: Cigna of CA HMO |
$161.70
|
| Rate for Payer: Cigna of CA PPO |
$161.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$196.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$196.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$196.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.40
|
| Rate for Payer: EPIC Health Plan Senior |
$92.40
|
| Rate for Payer: Galaxy Health WC |
$196.35
|
| Rate for Payer: Global Benefits Group Commercial |
$138.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$246.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$154.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$279.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$142.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$161.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$161.70
|
| Rate for Payer: Multiplan Commercial |
$184.80
|
| Rate for Payer: Networks By Design Commercial |
$115.50
|
| Rate for Payer: Prime Health Services Commercial |
$196.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$138.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$138.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$86.69
|
| Rate for Payer: United Healthcare All Other HMO |
$84.38
|
| Rate for Payer: United Healthcare HMO Rider |
$82.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$75.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$196.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$196.35
|
| Rate for Payer: Vantage Medical Group Senior |
$196.35
|
|
|
HC WHFO DORSAL WRIST
|
Facility
|
IP
|
$231.00
|
|
|
Service Code
|
CPT L3931
|
| Hospital Charge Code |
905353938
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$46.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$46.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$127.05
|
| Rate for Payer: Cash Price |
$127.05
|
| Rate for Payer: Cigna of CA HMO |
$161.70
|
| Rate for Payer: Cigna of CA PPO |
$161.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.40
|
| Rate for Payer: EPIC Health Plan Senior |
$92.40
|
| Rate for Payer: Galaxy Health WC |
$196.35
|
| Rate for Payer: Global Benefits Group Commercial |
$138.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$154.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$88.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$142.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.44
|
| Rate for Payer: Multiplan Commercial |
$184.80
|
| Rate for Payer: Networks By Design Commercial |
$115.50
|
| Rate for Payer: Prime Health Services Commercial |
$196.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$86.69
|
| Rate for Payer: United Healthcare All Other HMO |
$84.38
|
| Rate for Payer: United Healthcare HMO Rider |
$82.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$75.65
|
|
|
HC WHFO DORSAL WRIST W/OUTRIGGER
|
Facility
|
OP
|
$182.00
|
|
|
Service Code
|
CPT L3931
|
| Hospital Charge Code |
905353940
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$43.68 |
| Max. Negotiated Rate |
$279.19 |
| Rate for Payer: Adventist Health Commercial |
$74.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$154.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$100.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$136.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$105.41
|
| Rate for Payer: Blue Shield of California Commercial |
$134.32
|
| Rate for Payer: Blue Shield of California EPN |
$88.45
|
| Rate for Payer: Cash Price |
$100.10
|
| Rate for Payer: Cash Price |
$100.10
|
| Rate for Payer: Cigna of CA HMO |
$127.40
|
| Rate for Payer: Cigna of CA PPO |
$127.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$154.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$154.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$154.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.80
|
| Rate for Payer: EPIC Health Plan Senior |
$72.80
|
| Rate for Payer: Galaxy Health WC |
$154.70
|
| Rate for Payer: Global Benefits Group Commercial |
$109.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$246.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$121.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$279.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$112.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$127.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$127.40
|
| Rate for Payer: Multiplan Commercial |
$145.60
|
| Rate for Payer: Networks By Design Commercial |
$91.00
|
| Rate for Payer: Prime Health Services Commercial |
$154.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$109.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$109.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$68.30
|
| Rate for Payer: United Healthcare All Other HMO |
$66.48
|
| Rate for Payer: United Healthcare HMO Rider |
$65.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$59.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$154.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$154.70
|
| Rate for Payer: Vantage Medical Group Senior |
$154.70
|
|
|
HC WHFO DORSAL WRIST W/OUTRIGGER
|
Facility
|
IP
|
$182.00
|
|
|
Service Code
|
CPT L3931
|
| Hospital Charge Code |
905353940
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$36.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$36.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$100.10
|
| Rate for Payer: Cash Price |
$100.10
|
| Rate for Payer: Cigna of CA HMO |
$127.40
|
| Rate for Payer: Cigna of CA PPO |
$127.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.80
|
| Rate for Payer: EPIC Health Plan Senior |
$72.80
|
| Rate for Payer: Galaxy Health WC |
$154.70
|
| Rate for Payer: Global Benefits Group Commercial |
$109.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$121.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$69.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$112.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.68
|
| Rate for Payer: Multiplan Commercial |
$145.60
|
| Rate for Payer: Networks By Design Commercial |
$91.00
|
| Rate for Payer: Prime Health Services Commercial |
$154.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$68.30
|
| Rate for Payer: United Healthcare All Other HMO |
$66.48
|
| Rate for Payer: United Healthcare HMO Rider |
$65.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$59.60
|
|
|
HC WHFO ELECTRIC POWERED
|
Facility
|
OP
|
$6,604.00
|
|
|
Service Code
|
CPT L3904
|
| Hospital Charge Code |
915353904
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,584.96 |
| Max. Negotiated Rate |
$5,613.40 |
| Rate for Payer: Adventist Health Commercial |
$2,707.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,613.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,632.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,953.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,825.04
|
| Rate for Payer: Blue Shield of California Commercial |
$4,873.75
|
| Rate for Payer: Blue Shield of California EPN |
$3,209.54
|
| Rate for Payer: Cash Price |
$3,632.20
|
| Rate for Payer: Cash Price |
$3,632.20
|
| Rate for Payer: Cigna of CA HMO |
$4,622.80
|
| Rate for Payer: Cigna of CA PPO |
$4,622.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,613.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,613.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,613.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,641.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,641.60
|
| Rate for Payer: Galaxy Health WC |
$5,613.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,962.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,443.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,404.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,894.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,087.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,584.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,622.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,622.80
|
| Rate for Payer: Multiplan Commercial |
$5,283.20
|
| Rate for Payer: Networks By Design Commercial |
$3,302.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,613.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,962.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,962.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,478.48
|
| Rate for Payer: United Healthcare All Other HMO |
$2,412.44
|
| Rate for Payer: United Healthcare HMO Rider |
$2,360.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,162.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,613.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,613.40
|
| Rate for Payer: Vantage Medical Group Senior |
$5,613.40
|
|
|
HC WHFO ELECTRIC POWERED
|
Facility
|
IP
|
$6,604.00
|
|
|
Service Code
|
CPT L3904
|
| Hospital Charge Code |
905353904
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,320.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,320.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$3,632.20
|
| Rate for Payer: Cash Price |
$3,632.20
|
| Rate for Payer: Cigna of CA HMO |
$4,622.80
|
| Rate for Payer: Cigna of CA PPO |
$4,622.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,641.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,641.60
|
| Rate for Payer: Galaxy Health WC |
$5,613.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,962.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,404.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,516.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,087.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,584.96
|
| Rate for Payer: Multiplan Commercial |
$5,283.20
|
| Rate for Payer: Networks By Design Commercial |
$3,302.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,613.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,478.48
|
| Rate for Payer: United Healthcare All Other HMO |
$2,412.44
|
| Rate for Payer: United Healthcare HMO Rider |
$2,360.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,162.81
|
|
|
HC WHFO ELECTRIC POWERED
|
Facility
|
IP
|
$6,604.00
|
|
|
Service Code
|
CPT L3904
|
| Hospital Charge Code |
915353904
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,320.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,320.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$3,632.20
|
| Rate for Payer: Cash Price |
$3,632.20
|
| Rate for Payer: Cigna of CA HMO |
$4,622.80
|
| Rate for Payer: Cigna of CA PPO |
$4,622.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,641.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,641.60
|
| Rate for Payer: Galaxy Health WC |
$5,613.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,962.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,404.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,516.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,087.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,584.96
|
| Rate for Payer: Multiplan Commercial |
$5,283.20
|
| Rate for Payer: Networks By Design Commercial |
$3,302.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,613.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,478.48
|
| Rate for Payer: United Healthcare All Other HMO |
$2,412.44
|
| Rate for Payer: United Healthcare HMO Rider |
$2,360.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,162.81
|
|
|
HC WHFO ELECTRIC POWERED
|
Facility
|
OP
|
$6,604.00
|
|
|
Service Code
|
CPT L3904
|
| Hospital Charge Code |
905353904
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,584.96 |
| Max. Negotiated Rate |
$5,613.40 |
| Rate for Payer: Adventist Health Commercial |
$2,707.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,613.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,632.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,953.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,825.04
|
| Rate for Payer: Blue Shield of California Commercial |
$4,873.75
|
| Rate for Payer: Blue Shield of California EPN |
$3,209.54
|
| Rate for Payer: Cash Price |
$3,632.20
|
| Rate for Payer: Cash Price |
$3,632.20
|
| Rate for Payer: Cigna of CA HMO |
$4,622.80
|
| Rate for Payer: Cigna of CA PPO |
$4,622.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,613.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,613.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,613.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,641.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,641.60
|
| Rate for Payer: Galaxy Health WC |
$5,613.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,962.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,443.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,404.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,894.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,087.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,584.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,622.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,622.80
|
| Rate for Payer: Multiplan Commercial |
$5,283.20
|
| Rate for Payer: Networks By Design Commercial |
$3,302.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,613.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,962.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,962.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,478.48
|
| Rate for Payer: United Healthcare All Other HMO |
$2,412.44
|
| Rate for Payer: United Healthcare HMO Rider |
$2,360.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,162.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,613.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,613.40
|
| Rate for Payer: Vantage Medical Group Senior |
$5,613.40
|
|
|
HC WHFO FINGER EXTENSION
|
Facility
|
OP
|
$157.00
|
|
|
Service Code
|
CPT L3929
|
| Hospital Charge Code |
905353928
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$37.68 |
| Max. Negotiated Rate |
$133.45 |
| Rate for Payer: Adventist Health Commercial |
$64.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$133.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$86.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$117.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$90.93
|
| Rate for Payer: Blue Shield of California Commercial |
$115.87
|
| Rate for Payer: Blue Shield of California EPN |
$76.30
|
| Rate for Payer: Cash Price |
$86.35
|
| Rate for Payer: Cash Price |
$86.35
|
| Rate for Payer: Cigna of CA HMO |
$109.90
|
| Rate for Payer: Cigna of CA PPO |
$109.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$133.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$133.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$133.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.80
|
| Rate for Payer: EPIC Health Plan Senior |
$62.80
|
| Rate for Payer: Galaxy Health WC |
$133.45
|
| Rate for Payer: Global Benefits Group Commercial |
$94.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$110.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$104.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$125.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$97.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$109.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$109.90
|
| Rate for Payer: Multiplan Commercial |
$125.60
|
| Rate for Payer: Networks By Design Commercial |
$78.50
|
| Rate for Payer: Prime Health Services Commercial |
$133.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$94.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$94.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$58.92
|
| Rate for Payer: United Healthcare All Other HMO |
$57.35
|
| Rate for Payer: United Healthcare HMO Rider |
$56.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$51.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$133.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$133.45
|
| Rate for Payer: Vantage Medical Group Senior |
$133.45
|
|
|
HC WHFO FINGER EXTENSION
|
Facility
|
IP
|
$157.00
|
|
|
Service Code
|
CPT L3929
|
| Hospital Charge Code |
905363928
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$31.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$31.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$86.35
|
| Rate for Payer: Cash Price |
$86.35
|
| Rate for Payer: Cigna of CA HMO |
$109.90
|
| Rate for Payer: Cigna of CA PPO |
$109.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.80
|
| Rate for Payer: EPIC Health Plan Senior |
$62.80
|
| Rate for Payer: Galaxy Health WC |
$133.45
|
| Rate for Payer: Global Benefits Group Commercial |
$94.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$104.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$97.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.68
|
| Rate for Payer: Multiplan Commercial |
$125.60
|
| Rate for Payer: Networks By Design Commercial |
$78.50
|
| Rate for Payer: Prime Health Services Commercial |
$133.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$58.92
|
| Rate for Payer: United Healthcare All Other HMO |
$57.35
|
| Rate for Payer: United Healthcare HMO Rider |
$56.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$51.42
|
|
|
HC WHFO FINGER EXTENSION
|
Facility
|
IP
|
$157.00
|
|
|
Service Code
|
CPT L3929
|
| Hospital Charge Code |
905353928
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$31.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$31.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$86.35
|
| Rate for Payer: Cash Price |
$86.35
|
| Rate for Payer: Cigna of CA HMO |
$109.90
|
| Rate for Payer: Cigna of CA PPO |
$109.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.80
|
| Rate for Payer: EPIC Health Plan Senior |
$62.80
|
| Rate for Payer: Galaxy Health WC |
$133.45
|
| Rate for Payer: Global Benefits Group Commercial |
$94.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$104.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$97.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.68
|
| Rate for Payer: Multiplan Commercial |
$125.60
|
| Rate for Payer: Networks By Design Commercial |
$78.50
|
| Rate for Payer: Prime Health Services Commercial |
$133.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$58.92
|
| Rate for Payer: United Healthcare All Other HMO |
$57.35
|
| Rate for Payer: United Healthcare HMO Rider |
$56.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$51.42
|
|
|
HC WHFO FINGER EXTENSION
|
Facility
|
OP
|
$157.00
|
|
|
Service Code
|
CPT L3929
|
| Hospital Charge Code |
905363928
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$37.68 |
| Max. Negotiated Rate |
$133.45 |
| Rate for Payer: Adventist Health Commercial |
$64.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$133.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$86.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$117.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$90.93
|
| Rate for Payer: Blue Shield of California Commercial |
$115.87
|
| Rate for Payer: Blue Shield of California EPN |
$76.30
|
| Rate for Payer: Cash Price |
$86.35
|
| Rate for Payer: Cash Price |
$86.35
|
| Rate for Payer: Cigna of CA HMO |
$109.90
|
| Rate for Payer: Cigna of CA PPO |
$109.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$133.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$133.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$133.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.80
|
| Rate for Payer: EPIC Health Plan Senior |
$62.80
|
| Rate for Payer: Galaxy Health WC |
$133.45
|
| Rate for Payer: Global Benefits Group Commercial |
$94.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$110.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$104.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$125.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$97.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$109.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$109.90
|
| Rate for Payer: Multiplan Commercial |
$125.60
|
| Rate for Payer: Networks By Design Commercial |
$78.50
|
| Rate for Payer: Prime Health Services Commercial |
$133.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$94.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$94.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$58.92
|
| Rate for Payer: United Healthcare All Other HMO |
$57.35
|
| Rate for Payer: United Healthcare HMO Rider |
$56.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$51.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$133.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$133.45
|
| Rate for Payer: Vantage Medical Group Senior |
$133.45
|
|
|
HC WHFO FINGER KNUCKLE BENDER
|
Facility
|
IP
|
$54.00
|
|
|
Service Code
|
CPT L3929
|
| Hospital Charge Code |
905353948
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$10.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$10.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Cigna of CA HMO |
$37.80
|
| Rate for Payer: Cigna of CA PPO |
$37.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.60
|
| Rate for Payer: EPIC Health Plan Senior |
$21.60
|
| Rate for Payer: Galaxy Health WC |
$45.90
|
| Rate for Payer: Global Benefits Group Commercial |
$32.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.96
|
| Rate for Payer: Multiplan Commercial |
$43.20
|
| Rate for Payer: Networks By Design Commercial |
$27.00
|
| Rate for Payer: Prime Health Services Commercial |
$45.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.27
|
| Rate for Payer: United Healthcare All Other HMO |
$19.73
|
| Rate for Payer: United Healthcare HMO Rider |
$19.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.68
|
|
|
HC WHFO FINGER KNUCKLE BENDER
|
Facility
|
OP
|
$54.00
|
|
|
Service Code
|
CPT L3929
|
| Hospital Charge Code |
905353948
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$12.96 |
| Max. Negotiated Rate |
$125.00 |
| Rate for Payer: Adventist Health Commercial |
$22.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$45.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$40.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$31.28
|
| Rate for Payer: Blue Shield of California Commercial |
$39.85
|
| Rate for Payer: Blue Shield of California EPN |
$26.24
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Cigna of CA HMO |
$37.80
|
| Rate for Payer: Cigna of CA PPO |
$37.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$45.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$45.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$45.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.60
|
| Rate for Payer: EPIC Health Plan Senior |
$21.60
|
| Rate for Payer: Galaxy Health WC |
$45.90
|
| Rate for Payer: Global Benefits Group Commercial |
$32.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$110.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$125.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$37.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$37.80
|
| Rate for Payer: Multiplan Commercial |
$43.20
|
| Rate for Payer: Networks By Design Commercial |
$27.00
|
| Rate for Payer: Prime Health Services Commercial |
$45.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.27
|
| Rate for Payer: United Healthcare All Other HMO |
$19.73
|
| Rate for Payer: United Healthcare HMO Rider |
$19.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$45.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45.90
|
| Rate for Payer: Vantage Medical Group Senior |
$45.90
|
|
|
HC WHFO FING EXT WRIST SUPPORT
|
Facility
|
IP
|
$560.00
|
|
|
Service Code
|
CPT L3931
|
| Hospital Charge Code |
901300801
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$112.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$112.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$308.00
|
| Rate for Payer: Cash Price |
$308.00
|
| Rate for Payer: Cigna of CA HMO |
$392.00
|
| Rate for Payer: Cigna of CA PPO |
$392.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$224.00
|
| Rate for Payer: EPIC Health Plan Senior |
$224.00
|
| Rate for Payer: Galaxy Health WC |
$476.00
|
| Rate for Payer: Global Benefits Group Commercial |
$336.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$373.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$213.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$346.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$134.40
|
| Rate for Payer: Multiplan Commercial |
$448.00
|
| Rate for Payer: Networks By Design Commercial |
$280.00
|
| Rate for Payer: Prime Health Services Commercial |
$476.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$210.17
|
| Rate for Payer: United Healthcare All Other HMO |
$204.57
|
| Rate for Payer: United Healthcare HMO Rider |
$200.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$183.40
|
|
|
HC WHFO FING EXT WRIST SUPPORT
|
Facility
|
OP
|
$560.00
|
|
|
Service Code
|
CPT L3931
|
| Hospital Charge Code |
901300801
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$476.00 |
| Rate for Payer: Adventist Health Commercial |
$229.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$476.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$308.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$420.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$324.35
|
| Rate for Payer: Blue Shield of California Commercial |
$413.28
|
| Rate for Payer: Blue Shield of California EPN |
$272.16
|
| Rate for Payer: Cash Price |
$308.00
|
| Rate for Payer: Cash Price |
$308.00
|
| Rate for Payer: Cigna of CA HMO |
$392.00
|
| Rate for Payer: Cigna of CA PPO |
$392.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$476.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$476.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$476.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$224.00
|
| Rate for Payer: EPIC Health Plan Senior |
$224.00
|
| Rate for Payer: Galaxy Health WC |
$476.00
|
| Rate for Payer: Global Benefits Group Commercial |
$336.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$246.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$373.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$279.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$346.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$134.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$392.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$392.00
|
| Rate for Payer: Multiplan Commercial |
$448.00
|
| Rate for Payer: Networks By Design Commercial |
$280.00
|
| Rate for Payer: Prime Health Services Commercial |
$476.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$336.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$336.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$210.17
|
| Rate for Payer: United Healthcare All Other HMO |
$204.57
|
| Rate for Payer: United Healthcare HMO Rider |
$200.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$183.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$476.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$476.00
|
| Rate for Payer: Vantage Medical Group Senior |
$476.00
|
|
|
HC WHFO FING EXT WRIST SUPPORT
|
Facility
|
OP
|
$264.00
|
|
|
Service Code
|
CPT L3931
|
| Hospital Charge Code |
905353930
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$63.36 |
| Max. Negotiated Rate |
$279.19 |
| Rate for Payer: Adventist Health Commercial |
$108.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$224.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$145.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$152.91
|
| Rate for Payer: Blue Shield of California Commercial |
$194.83
|
| Rate for Payer: Blue Shield of California EPN |
$128.30
|
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Cigna of CA HMO |
$184.80
|
| Rate for Payer: Cigna of CA PPO |
$184.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$224.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$224.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$224.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$105.60
|
| Rate for Payer: EPIC Health Plan Senior |
$105.60
|
| Rate for Payer: Galaxy Health WC |
$224.40
|
| Rate for Payer: Global Benefits Group Commercial |
$158.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$246.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$176.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$279.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$184.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.80
|
| Rate for Payer: Multiplan Commercial |
$211.20
|
| Rate for Payer: Networks By Design Commercial |
$132.00
|
| Rate for Payer: Prime Health Services Commercial |
$224.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$158.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$158.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$99.08
|
| Rate for Payer: United Healthcare All Other HMO |
$96.44
|
| Rate for Payer: United Healthcare HMO Rider |
$94.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$86.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$224.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$224.40
|
| Rate for Payer: Vantage Medical Group Senior |
$224.40
|
|
|
HC WHFO FING EXT WRIST SUPPORT
|
Facility
|
IP
|
$264.00
|
|
|
Service Code
|
CPT L3931
|
| Hospital Charge Code |
905353930
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$52.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$52.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Cigna of CA HMO |
$184.80
|
| Rate for Payer: Cigna of CA PPO |
$184.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$105.60
|
| Rate for Payer: EPIC Health Plan Senior |
$105.60
|
| Rate for Payer: Galaxy Health WC |
$224.40
|
| Rate for Payer: Global Benefits Group Commercial |
$158.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$176.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.36
|
| Rate for Payer: Multiplan Commercial |
$211.20
|
| Rate for Payer: Networks By Design Commercial |
$132.00
|
| Rate for Payer: Prime Health Services Commercial |
$224.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$99.08
|
| Rate for Payer: United Healthcare All Other HMO |
$96.44
|
| Rate for Payer: United Healthcare HMO Rider |
$94.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$86.46
|
|
|
HC WHFO FLEXION GLOVE
|
Facility
|
OP
|
$212.00
|
|
|
Service Code
|
CPT L3912
|
| Hospital Charge Code |
905353912
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$50.88 |
| Max. Negotiated Rate |
$180.20 |
| Rate for Payer: Adventist Health Commercial |
$86.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$180.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$116.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$159.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$122.79
|
| Rate for Payer: Blue Shield of California Commercial |
$156.46
|
| Rate for Payer: Blue Shield of California EPN |
$103.03
|
| Rate for Payer: Cash Price |
$116.60
|
| Rate for Payer: Cash Price |
$116.60
|
| Rate for Payer: Cigna of CA HMO |
$148.40
|
| Rate for Payer: Cigna of CA PPO |
$148.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$180.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$180.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.80
|
| Rate for Payer: EPIC Health Plan Senior |
$84.80
|
| Rate for Payer: Galaxy Health WC |
$180.20
|
| Rate for Payer: Global Benefits Group Commercial |
$127.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$105.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$141.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$119.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$131.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$148.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$148.40
|
| Rate for Payer: Multiplan Commercial |
$169.60
|
| Rate for Payer: Networks By Design Commercial |
$106.00
|
| Rate for Payer: Prime Health Services Commercial |
$180.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$127.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$127.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$79.56
|
| Rate for Payer: United Healthcare All Other HMO |
$77.44
|
| Rate for Payer: United Healthcare HMO Rider |
$75.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$69.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$180.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.20
|
| Rate for Payer: Vantage Medical Group Senior |
$180.20
|
|
|
HC WHFO FLEXION GLOVE
|
Facility
|
OP
|
$212.00
|
|
|
Service Code
|
CPT L3912
|
| Hospital Charge Code |
915353912
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$50.88 |
| Max. Negotiated Rate |
$180.20 |
| Rate for Payer: Adventist Health Commercial |
$86.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$180.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$116.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$159.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$122.79
|
| Rate for Payer: Blue Shield of California Commercial |
$156.46
|
| Rate for Payer: Blue Shield of California EPN |
$103.03
|
| Rate for Payer: Cash Price |
$116.60
|
| Rate for Payer: Cash Price |
$116.60
|
| Rate for Payer: Cigna of CA HMO |
$148.40
|
| Rate for Payer: Cigna of CA PPO |
$148.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$180.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$180.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.80
|
| Rate for Payer: EPIC Health Plan Senior |
$84.80
|
| Rate for Payer: Galaxy Health WC |
$180.20
|
| Rate for Payer: Global Benefits Group Commercial |
$127.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$105.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$141.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$119.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$131.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$148.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$148.40
|
| Rate for Payer: Multiplan Commercial |
$169.60
|
| Rate for Payer: Networks By Design Commercial |
$106.00
|
| Rate for Payer: Prime Health Services Commercial |
$180.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$127.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$127.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$79.56
|
| Rate for Payer: United Healthcare All Other HMO |
$77.44
|
| Rate for Payer: United Healthcare HMO Rider |
$75.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$69.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$180.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.20
|
| Rate for Payer: Vantage Medical Group Senior |
$180.20
|
|
|
HC WHFO FLEXION GLOVE
|
Facility
|
IP
|
$212.00
|
|
|
Service Code
|
CPT L3912
|
| Hospital Charge Code |
905353912
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$42.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$42.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$116.60
|
| Rate for Payer: Cash Price |
$116.60
|
| Rate for Payer: Cigna of CA HMO |
$148.40
|
| Rate for Payer: Cigna of CA PPO |
$148.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.80
|
| Rate for Payer: EPIC Health Plan Senior |
$84.80
|
| Rate for Payer: Galaxy Health WC |
$180.20
|
| Rate for Payer: Global Benefits Group Commercial |
$127.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$141.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$131.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.88
|
| Rate for Payer: Multiplan Commercial |
$169.60
|
| Rate for Payer: Networks By Design Commercial |
$106.00
|
| Rate for Payer: Prime Health Services Commercial |
$180.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$79.56
|
| Rate for Payer: United Healthcare All Other HMO |
$77.44
|
| Rate for Payer: United Healthcare HMO Rider |
$75.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$69.43
|
|
|
HC WHFO FLEXION GLOVE
|
Facility
|
IP
|
$212.00
|
|
|
Service Code
|
CPT L3912
|
| Hospital Charge Code |
915353912
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$42.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$42.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$116.60
|
| Rate for Payer: Cash Price |
$116.60
|
| Rate for Payer: Cigna of CA HMO |
$148.40
|
| Rate for Payer: Cigna of CA PPO |
$148.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.80
|
| Rate for Payer: EPIC Health Plan Senior |
$84.80
|
| Rate for Payer: Galaxy Health WC |
$180.20
|
| Rate for Payer: Global Benefits Group Commercial |
$127.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$141.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$131.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.88
|
| Rate for Payer: Multiplan Commercial |
$169.60
|
| Rate for Payer: Networks By Design Commercial |
$106.00
|
| Rate for Payer: Prime Health Services Commercial |
$180.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$79.56
|
| Rate for Payer: United Healthcare All Other HMO |
$77.44
|
| Rate for Payer: United Healthcare HMO Rider |
$75.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$69.43
|
|
|
HC WHFO FLEXOR HINGE CABLE DRIVEN
|
Facility
|
OP
|
$3,330.00
|
|
|
Service Code
|
CPT L3901
|
| Hospital Charge Code |
915353901
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$799.20 |
| Max. Negotiated Rate |
$2,830.50 |
| Rate for Payer: Adventist Health Commercial |
$1,365.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,830.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,831.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,497.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,928.74
|
| Rate for Payer: Blue Shield of California Commercial |
$2,457.54
|
| Rate for Payer: Blue Shield of California EPN |
$1,618.38
|
| Rate for Payer: Cash Price |
$1,831.50
|
| Rate for Payer: Cash Price |
$1,831.50
|
| Rate for Payer: Cigna of CA HMO |
$2,331.00
|
| Rate for Payer: Cigna of CA PPO |
$2,331.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,830.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,830.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,830.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,332.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,332.00
|
| Rate for Payer: Galaxy Health WC |
$2,830.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,998.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,370.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,221.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,549.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,061.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$799.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,331.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,331.00
|
| Rate for Payer: Multiplan Commercial |
$2,664.00
|
| Rate for Payer: Networks By Design Commercial |
$1,665.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,830.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,998.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,998.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,249.75
|
| Rate for Payer: United Healthcare All Other HMO |
$1,216.45
|
| Rate for Payer: United Healthcare HMO Rider |
$1,190.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,090.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,830.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,830.50
|
| Rate for Payer: Vantage Medical Group Senior |
$2,830.50
|
|
|
HC WHFO FLEXOR HINGE CABLE DRIVEN
|
Facility
|
OP
|
$1,588.00
|
|
|
Service Code
|
CPT L3901
|
| Hospital Charge Code |
905353901
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$381.12 |
| Max. Negotiated Rate |
$1,549.41 |
| Rate for Payer: Adventist Health Commercial |
$651.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,349.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$873.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,191.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$919.77
|
| Rate for Payer: Blue Shield of California Commercial |
$1,171.94
|
| Rate for Payer: Blue Shield of California EPN |
$771.77
|
| Rate for Payer: Cash Price |
$873.40
|
| Rate for Payer: Cash Price |
$873.40
|
| Rate for Payer: Cigna of CA HMO |
$1,111.60
|
| Rate for Payer: Cigna of CA PPO |
$1,111.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,349.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,349.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,349.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$635.20
|
| Rate for Payer: EPIC Health Plan Senior |
$635.20
|
| Rate for Payer: Galaxy Health WC |
$1,349.80
|
| Rate for Payer: Global Benefits Group Commercial |
$952.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,370.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,059.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,549.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$982.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$381.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,111.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,111.60
|
| Rate for Payer: Multiplan Commercial |
$1,270.40
|
| Rate for Payer: Networks By Design Commercial |
$794.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,349.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$952.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$952.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$595.98
|
| Rate for Payer: United Healthcare All Other HMO |
$580.10
|
| Rate for Payer: United Healthcare HMO Rider |
$567.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$520.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,349.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,349.80
|
| Rate for Payer: Vantage Medical Group Senior |
$1,349.80
|
|
|
HC WHFO FLEXOR HINGE CABLE DRIVEN
|
Facility
|
IP
|
$3,330.00
|
|
|
Service Code
|
CPT L3901
|
| Hospital Charge Code |
915353901
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$666.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$666.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,831.50
|
| Rate for Payer: Cash Price |
$1,831.50
|
| Rate for Payer: Cigna of CA HMO |
$2,331.00
|
| Rate for Payer: Cigna of CA PPO |
$2,331.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,332.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,332.00
|
| Rate for Payer: Galaxy Health WC |
$2,830.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,998.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,221.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,268.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,061.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$799.20
|
| Rate for Payer: Multiplan Commercial |
$2,664.00
|
| Rate for Payer: Networks By Design Commercial |
$1,665.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,830.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,249.75
|
| Rate for Payer: United Healthcare All Other HMO |
$1,216.45
|
| Rate for Payer: United Healthcare HMO Rider |
$1,190.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,090.58
|
|
