|
HC WHFO FLEXOR HINGE CABLE DRIVEN
|
Facility
|
IP
|
$1,588.00
|
|
|
Service Code
|
CPT L3901
|
| Hospital Charge Code |
905353901
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$317.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$317.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| 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: 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: Kaiser Permanente of CA Commercial/Self Funded |
$1,059.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$605.03
|
| 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: 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: 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
|
|
|
HC WHFO FLEXOR HINGE WRIST DRIVEN
|
Facility
|
OP
|
$2,500.00
|
|
|
Service Code
|
CPT L3900
|
| Hospital Charge Code |
915353900
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$600.00 |
| Max. Negotiated Rate |
$2,125.00 |
| Rate for Payer: Adventist Health Commercial |
$1,025.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,125.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,375.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,875.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,448.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,845.00
|
| Rate for Payer: Blue Shield of California EPN |
$1,215.00
|
| Rate for Payer: Cash Price |
$1,375.00
|
| Rate for Payer: Cash Price |
$1,375.00
|
| Rate for Payer: Cigna of CA HMO |
$1,750.00
|
| Rate for Payer: Cigna of CA PPO |
$1,750.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,125.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,125.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,125.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,000.00
|
| Rate for Payer: Galaxy Health WC |
$2,125.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,500.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,029.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,667.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,163.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,547.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$600.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,750.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,750.00
|
| Rate for Payer: Multiplan Commercial |
$2,000.00
|
| Rate for Payer: Networks By Design Commercial |
$1,250.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,125.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,500.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,500.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$938.25
|
| Rate for Payer: United Healthcare All Other HMO |
$913.25
|
| Rate for Payer: United Healthcare HMO Rider |
$893.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$818.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,125.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,125.00
|
| Rate for Payer: Vantage Medical Group Senior |
$2,125.00
|
|
|
HC WHFO FLEXOR HINGE WRIST DRIVEN
|
Facility
|
IP
|
$2,500.00
|
|
|
Service Code
|
CPT L3900
|
| Hospital Charge Code |
915353900
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$500.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$500.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,375.00
|
| Rate for Payer: Cash Price |
$1,375.00
|
| Rate for Payer: Cigna of CA HMO |
$1,750.00
|
| Rate for Payer: Cigna of CA PPO |
$1,750.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,000.00
|
| Rate for Payer: Galaxy Health WC |
$2,125.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,500.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,667.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$952.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,547.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$600.00
|
| Rate for Payer: Multiplan Commercial |
$2,000.00
|
| Rate for Payer: Networks By Design Commercial |
$1,250.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,125.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$938.25
|
| Rate for Payer: United Healthcare All Other HMO |
$913.25
|
| Rate for Payer: United Healthcare HMO Rider |
$893.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$818.75
|
|
|
HC WHFO FLEXOR HINGE WRIST DRIVEN
|
Facility
|
OP
|
$2,500.00
|
|
|
Service Code
|
CPT L3900
|
| Hospital Charge Code |
905353900
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$600.00 |
| Max. Negotiated Rate |
$2,125.00 |
| Rate for Payer: Adventist Health Commercial |
$1,025.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,125.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,375.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,875.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,448.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,845.00
|
| Rate for Payer: Blue Shield of California EPN |
$1,215.00
|
| Rate for Payer: Cash Price |
$1,375.00
|
| Rate for Payer: Cash Price |
$1,375.00
|
| Rate for Payer: Cigna of CA HMO |
$1,750.00
|
| Rate for Payer: Cigna of CA PPO |
$1,750.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,125.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,125.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,125.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,000.00
|
| Rate for Payer: Galaxy Health WC |
$2,125.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,500.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,029.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,667.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,163.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,547.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$600.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,750.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,750.00
|
| Rate for Payer: Multiplan Commercial |
$2,000.00
|
| Rate for Payer: Networks By Design Commercial |
$1,250.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,125.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,500.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,500.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$938.25
|
| Rate for Payer: United Healthcare All Other HMO |
$913.25
|
| Rate for Payer: United Healthcare HMO Rider |
$893.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$818.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,125.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,125.00
|
| Rate for Payer: Vantage Medical Group Senior |
$2,125.00
|
|
|
HC WHFO FLEXOR HINGE WRIST DRIVEN
|
Facility
|
IP
|
$2,500.00
|
|
|
Service Code
|
CPT L3900
|
| Hospital Charge Code |
905353900
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$500.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$500.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,375.00
|
| Rate for Payer: Cash Price |
$1,375.00
|
| Rate for Payer: Cigna of CA HMO |
$1,750.00
|
| Rate for Payer: Cigna of CA PPO |
$1,750.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,000.00
|
| Rate for Payer: Galaxy Health WC |
$2,125.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,500.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,667.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$952.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,547.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$600.00
|
| Rate for Payer: Multiplan Commercial |
$2,000.00
|
| Rate for Payer: Networks By Design Commercial |
$1,250.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,125.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$938.25
|
| Rate for Payer: United Healthcare All Other HMO |
$913.25
|
| Rate for Payer: United Healthcare HMO Rider |
$893.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$818.75
|
|
|
HC WHFO KNUCKLE BENDER
|
Facility
|
OP
|
$339.00
|
|
|
Service Code
|
CPT L3929
|
| Hospital Charge Code |
905353918
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$81.36 |
| Max. Negotiated Rate |
$288.15 |
| Rate for Payer: Adventist Health Commercial |
$138.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$288.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$186.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$254.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$196.35
|
| Rate for Payer: Blue Shield of California Commercial |
$250.18
|
| Rate for Payer: Blue Shield of California EPN |
$164.75
|
| Rate for Payer: Cash Price |
$186.45
|
| Rate for Payer: Cash Price |
$186.45
|
| Rate for Payer: Cigna of CA HMO |
$237.30
|
| Rate for Payer: Cigna of CA PPO |
$237.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$288.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$288.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$288.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$135.60
|
| Rate for Payer: EPIC Health Plan Senior |
$135.60
|
| Rate for Payer: Galaxy Health WC |
$288.15
|
| Rate for Payer: Global Benefits Group Commercial |
$203.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$110.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$226.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$125.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$209.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$237.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$237.30
|
| Rate for Payer: Multiplan Commercial |
$271.20
|
| Rate for Payer: Networks By Design Commercial |
$169.50
|
| Rate for Payer: Prime Health Services Commercial |
$288.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$203.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$203.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$127.23
|
| Rate for Payer: United Healthcare All Other HMO |
$123.84
|
| Rate for Payer: United Healthcare HMO Rider |
$121.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$111.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$288.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$288.15
|
| Rate for Payer: Vantage Medical Group Senior |
$288.15
|
|
|
HC WHFO KNUCKLE BENDER
|
Facility
|
IP
|
$339.00
|
|
|
Service Code
|
CPT L3929
|
| Hospital Charge Code |
905353918
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$67.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$67.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$186.45
|
| Rate for Payer: Cash Price |
$186.45
|
| Rate for Payer: Cigna of CA HMO |
$237.30
|
| Rate for Payer: Cigna of CA PPO |
$237.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$135.60
|
| Rate for Payer: EPIC Health Plan Senior |
$135.60
|
| Rate for Payer: Galaxy Health WC |
$288.15
|
| Rate for Payer: Global Benefits Group Commercial |
$203.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$226.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$129.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$209.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.36
|
| Rate for Payer: Multiplan Commercial |
$271.20
|
| Rate for Payer: Networks By Design Commercial |
$169.50
|
| Rate for Payer: Prime Health Services Commercial |
$288.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$127.23
|
| Rate for Payer: United Healthcare All Other HMO |
$123.84
|
| Rate for Payer: United Healthcare HMO Rider |
$121.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$111.02
|
|
|
HC WHFO KNUCKLE BENDER 2 SEG
|
Facility
|
OP
|
$420.00
|
|
|
Service Code
|
CPT L3925
|
| Hospital Charge Code |
905353922
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$67.62 |
| Max. Negotiated Rate |
$357.00 |
| Rate for Payer: Adventist Health Commercial |
$172.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$357.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$231.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$315.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$243.26
|
| Rate for Payer: Blue Shield of California Commercial |
$309.96
|
| Rate for Payer: Blue Shield of California EPN |
$204.12
|
| Rate for Payer: Cash Price |
$231.00
|
| Rate for Payer: Cash Price |
$231.00
|
| Rate for Payer: Cigna of CA HMO |
$294.00
|
| Rate for Payer: Cigna of CA PPO |
$294.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$357.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$357.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$357.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$168.00
|
| Rate for Payer: EPIC Health Plan Senior |
$168.00
|
| Rate for Payer: Galaxy Health WC |
$357.00
|
| Rate for Payer: Global Benefits Group Commercial |
$252.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$67.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$280.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$76.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$259.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$294.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$294.00
|
| Rate for Payer: Multiplan Commercial |
$336.00
|
| Rate for Payer: Networks By Design Commercial |
$210.00
|
| Rate for Payer: Prime Health Services Commercial |
$357.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$252.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$252.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$157.63
|
| Rate for Payer: United Healthcare All Other HMO |
$153.43
|
| Rate for Payer: United Healthcare HMO Rider |
$150.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$137.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$357.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$357.00
|
| Rate for Payer: Vantage Medical Group Senior |
$357.00
|
|
|
HC WHFO KNUCKLE BENDER 2 SEG
|
Facility
|
IP
|
$420.00
|
|
|
Service Code
|
CPT L3925
|
| Hospital Charge Code |
905353922
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$84.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$231.00
|
| Rate for Payer: Cash Price |
$231.00
|
| Rate for Payer: Cigna of CA HMO |
$294.00
|
| Rate for Payer: Cigna of CA PPO |
$294.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$168.00
|
| Rate for Payer: EPIC Health Plan Senior |
$168.00
|
| Rate for Payer: Galaxy Health WC |
$357.00
|
| Rate for Payer: Global Benefits Group Commercial |
$252.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$280.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$160.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$259.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.80
|
| Rate for Payer: Multiplan Commercial |
$336.00
|
| Rate for Payer: Networks By Design Commercial |
$210.00
|
| Rate for Payer: Prime Health Services Commercial |
$357.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$157.63
|
| Rate for Payer: United Healthcare All Other HMO |
$153.43
|
| Rate for Payer: United Healthcare HMO Rider |
$150.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$137.55
|
|
|
HC WHFO KNUCKLE BENDER 2 SEG
|
Facility
|
OP
|
$420.00
|
|
|
Service Code
|
CPT L3925
|
| Hospital Charge Code |
915353922
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$67.62 |
| Max. Negotiated Rate |
$357.00 |
| Rate for Payer: Adventist Health Commercial |
$172.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$357.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$231.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$315.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$243.26
|
| Rate for Payer: Blue Shield of California Commercial |
$309.96
|
| Rate for Payer: Blue Shield of California EPN |
$204.12
|
| Rate for Payer: Cash Price |
$231.00
|
| Rate for Payer: Cash Price |
$231.00
|
| Rate for Payer: Cigna of CA HMO |
$294.00
|
| Rate for Payer: Cigna of CA PPO |
$294.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$357.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$357.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$357.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$168.00
|
| Rate for Payer: EPIC Health Plan Senior |
$168.00
|
| Rate for Payer: Galaxy Health WC |
$357.00
|
| Rate for Payer: Global Benefits Group Commercial |
$252.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$67.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$280.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$76.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$259.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$294.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$294.00
|
| Rate for Payer: Multiplan Commercial |
$336.00
|
| Rate for Payer: Networks By Design Commercial |
$210.00
|
| Rate for Payer: Prime Health Services Commercial |
$357.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$252.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$252.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$157.63
|
| Rate for Payer: United Healthcare All Other HMO |
$153.43
|
| Rate for Payer: United Healthcare HMO Rider |
$150.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$137.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$357.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$357.00
|
| Rate for Payer: Vantage Medical Group Senior |
$357.00
|
|
|
HC WHFO KNUCKLE BENDER 2 SEG
|
Facility
|
IP
|
$420.00
|
|
|
Service Code
|
CPT L3925
|
| Hospital Charge Code |
915353922
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$84.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$231.00
|
| Rate for Payer: Cash Price |
$231.00
|
| Rate for Payer: Cigna of CA HMO |
$294.00
|
| Rate for Payer: Cigna of CA PPO |
$294.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$168.00
|
| Rate for Payer: EPIC Health Plan Senior |
$168.00
|
| Rate for Payer: Galaxy Health WC |
$357.00
|
| Rate for Payer: Global Benefits Group Commercial |
$252.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$280.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$160.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$259.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.80
|
| Rate for Payer: Multiplan Commercial |
$336.00
|
| Rate for Payer: Networks By Design Commercial |
$210.00
|
| Rate for Payer: Prime Health Services Commercial |
$357.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$157.63
|
| Rate for Payer: United Healthcare All Other HMO |
$153.43
|
| Rate for Payer: United Healthcare HMO Rider |
$150.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$137.55
|
|
|
HC WHFO KNUCKLE BENDER OUTRIGGER
|
Facility
|
OP
|
$424.00
|
|
|
Service Code
|
CPT L3929
|
| Hospital Charge Code |
905353920
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$101.76 |
| Max. Negotiated Rate |
$360.40 |
| Rate for Payer: Adventist Health Commercial |
$173.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$360.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$233.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$318.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$245.58
|
| Rate for Payer: Blue Shield of California Commercial |
$312.91
|
| Rate for Payer: Blue Shield of California EPN |
$206.06
|
| Rate for Payer: Cash Price |
$233.20
|
| Rate for Payer: Cash Price |
$233.20
|
| Rate for Payer: Cigna of CA HMO |
$296.80
|
| Rate for Payer: Cigna of CA PPO |
$296.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$360.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$360.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$360.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$169.60
|
| Rate for Payer: EPIC Health Plan Senior |
$169.60
|
| Rate for Payer: Galaxy Health WC |
$360.40
|
| Rate for Payer: Global Benefits Group Commercial |
$254.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$110.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$282.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$125.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$262.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$101.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$296.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$296.80
|
| Rate for Payer: Multiplan Commercial |
$339.20
|
| Rate for Payer: Networks By Design Commercial |
$212.00
|
| Rate for Payer: Prime Health Services Commercial |
$360.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$254.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$254.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$159.13
|
| Rate for Payer: United Healthcare All Other HMO |
$154.89
|
| Rate for Payer: United Healthcare HMO Rider |
$151.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$138.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$360.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$360.40
|
| Rate for Payer: Vantage Medical Group Senior |
$360.40
|
|
|
HC WHFO KNUCKLE BENDER OUTRIGGER
|
Facility
|
IP
|
$424.00
|
|
|
Service Code
|
CPT L3929
|
| Hospital Charge Code |
905353920
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$84.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$84.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$233.20
|
| Rate for Payer: Cash Price |
$233.20
|
| Rate for Payer: Cigna of CA HMO |
$296.80
|
| Rate for Payer: Cigna of CA PPO |
$296.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$169.60
|
| Rate for Payer: EPIC Health Plan Senior |
$169.60
|
| Rate for Payer: Galaxy Health WC |
$360.40
|
| Rate for Payer: Global Benefits Group Commercial |
$254.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$282.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$161.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$262.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$101.76
|
| Rate for Payer: Multiplan Commercial |
$339.20
|
| Rate for Payer: Networks By Design Commercial |
$212.00
|
| Rate for Payer: Prime Health Services Commercial |
$360.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$159.13
|
| Rate for Payer: United Healthcare All Other HMO |
$154.89
|
| Rate for Payer: United Healthcare HMO Rider |
$151.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$138.86
|
|
|
HC WHFO KNUCKLE BENDER OUTRIGGER
|
Facility
|
OP
|
$424.00
|
|
|
Service Code
|
CPT L3929
|
| Hospital Charge Code |
915353920
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$101.76 |
| Max. Negotiated Rate |
$360.40 |
| Rate for Payer: Adventist Health Commercial |
$173.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$360.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$233.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$318.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$245.58
|
| Rate for Payer: Blue Shield of California Commercial |
$312.91
|
| Rate for Payer: Blue Shield of California EPN |
$206.06
|
| Rate for Payer: Cash Price |
$233.20
|
| Rate for Payer: Cash Price |
$233.20
|
| Rate for Payer: Cigna of CA HMO |
$296.80
|
| Rate for Payer: Cigna of CA PPO |
$296.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$360.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$360.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$360.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$169.60
|
| Rate for Payer: EPIC Health Plan Senior |
$169.60
|
| Rate for Payer: Galaxy Health WC |
$360.40
|
| Rate for Payer: Global Benefits Group Commercial |
$254.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$110.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$282.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$125.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$262.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$101.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$296.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$296.80
|
| Rate for Payer: Multiplan Commercial |
$339.20
|
| Rate for Payer: Networks By Design Commercial |
$212.00
|
| Rate for Payer: Prime Health Services Commercial |
$360.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$254.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$254.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$159.13
|
| Rate for Payer: United Healthcare All Other HMO |
$154.89
|
| Rate for Payer: United Healthcare HMO Rider |
$151.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$138.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$360.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$360.40
|
| Rate for Payer: Vantage Medical Group Senior |
$360.40
|
|
|
HC WHFO KNUCKLE BENDER OUTRIGGER
|
Facility
|
IP
|
$424.00
|
|
|
Service Code
|
CPT L3929
|
| Hospital Charge Code |
915353920
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$84.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$84.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$233.20
|
| Rate for Payer: Cash Price |
$233.20
|
| Rate for Payer: Cigna of CA HMO |
$296.80
|
| Rate for Payer: Cigna of CA PPO |
$296.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$169.60
|
| Rate for Payer: EPIC Health Plan Senior |
$169.60
|
| Rate for Payer: Galaxy Health WC |
$360.40
|
| Rate for Payer: Global Benefits Group Commercial |
$254.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$282.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$161.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$262.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$101.76
|
| Rate for Payer: Multiplan Commercial |
$339.20
|
| Rate for Payer: Networks By Design Commercial |
$212.00
|
| Rate for Payer: Prime Health Services Commercial |
$360.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$159.13
|
| Rate for Payer: United Healthcare All Other HMO |
$154.89
|
| Rate for Payer: United Healthcare HMO Rider |
$151.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$138.86
|
|
|
HC WHFO LONG OPPONENS
|
Facility
|
IP
|
$549.00
|
|
|
Service Code
|
CPT L3808
|
| Hospital Charge Code |
905353805
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$109.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$109.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$301.95
|
| Rate for Payer: Cash Price |
$301.95
|
| Rate for Payer: Cigna of CA HMO |
$384.30
|
| Rate for Payer: Cigna of CA PPO |
$384.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$219.60
|
| Rate for Payer: EPIC Health Plan Senior |
$219.60
|
| Rate for Payer: Galaxy Health WC |
$466.65
|
| Rate for Payer: Global Benefits Group Commercial |
$329.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$366.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$209.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$339.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$131.76
|
| Rate for Payer: Multiplan Commercial |
$439.20
|
| Rate for Payer: Networks By Design Commercial |
$274.50
|
| Rate for Payer: Prime Health Services Commercial |
$466.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$206.04
|
| Rate for Payer: United Healthcare All Other HMO |
$200.55
|
| Rate for Payer: United Healthcare HMO Rider |
$196.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$179.80
|
|
|
HC WHFO LONG OPPONENS
|
Facility
|
OP
|
$549.00
|
|
|
Service Code
|
CPT L3808
|
| Hospital Charge Code |
905353805
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$131.76 |
| Max. Negotiated Rate |
$466.65 |
| Rate for Payer: Adventist Health Commercial |
$225.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$466.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$301.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$411.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$317.98
|
| Rate for Payer: Blue Shield of California Commercial |
$405.16
|
| Rate for Payer: Blue Shield of California EPN |
$266.81
|
| Rate for Payer: Cash Price |
$301.95
|
| Rate for Payer: Cash Price |
$301.95
|
| Rate for Payer: Cigna of CA HMO |
$384.30
|
| Rate for Payer: Cigna of CA PPO |
$384.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$466.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$466.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$466.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$219.60
|
| Rate for Payer: EPIC Health Plan Senior |
$219.60
|
| Rate for Payer: Galaxy Health WC |
$466.65
|
| Rate for Payer: Global Benefits Group Commercial |
$329.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$282.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$366.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$319.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$339.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$131.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$384.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$384.30
|
| Rate for Payer: Multiplan Commercial |
$439.20
|
| Rate for Payer: Networks By Design Commercial |
$274.50
|
| Rate for Payer: Prime Health Services Commercial |
$466.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$329.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$329.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$206.04
|
| Rate for Payer: United Healthcare All Other HMO |
$200.55
|
| Rate for Payer: United Healthcare HMO Rider |
$196.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$179.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$466.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$466.65
|
| Rate for Payer: Vantage Medical Group Senior |
$466.65
|
|
|
HC WHFO NONTORSION JOINT(S) PREFA
|
Facility
|
OP
|
$459.00
|
|
|
Service Code
|
CPT L3931
|
| Hospital Charge Code |
905353931
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$110.16 |
| Max. Negotiated Rate |
$390.15 |
| Rate for Payer: Adventist Health Commercial |
$188.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$390.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$252.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$344.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$265.85
|
| Rate for Payer: Blue Shield of California Commercial |
$338.74
|
| Rate for Payer: Blue Shield of California EPN |
$223.07
|
| Rate for Payer: Cash Price |
$252.45
|
| Rate for Payer: Cash Price |
$252.45
|
| Rate for Payer: Cigna of CA HMO |
$321.30
|
| Rate for Payer: Cigna of CA PPO |
$321.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$390.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$390.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$390.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$183.60
|
| Rate for Payer: EPIC Health Plan Senior |
$183.60
|
| Rate for Payer: Galaxy Health WC |
$390.15
|
| Rate for Payer: Global Benefits Group Commercial |
$275.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$246.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$306.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$279.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$284.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$110.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$321.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$321.30
|
| Rate for Payer: Multiplan Commercial |
$367.20
|
| Rate for Payer: Networks By Design Commercial |
$229.50
|
| Rate for Payer: Prime Health Services Commercial |
$390.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$275.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$275.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$172.26
|
| Rate for Payer: United Healthcare All Other HMO |
$167.67
|
| Rate for Payer: United Healthcare HMO Rider |
$164.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$150.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$390.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$390.15
|
| Rate for Payer: Vantage Medical Group Senior |
$390.15
|
|
|
HC WHFO NONTORSION JOINT(S) PREFA
|
Facility
|
IP
|
$459.00
|
|
|
Service Code
|
CPT L3931
|
| Hospital Charge Code |
905353931
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$91.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$91.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$252.45
|
| Rate for Payer: Cash Price |
$252.45
|
| Rate for Payer: Cigna of CA HMO |
$321.30
|
| Rate for Payer: Cigna of CA PPO |
$321.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$183.60
|
| Rate for Payer: EPIC Health Plan Senior |
$183.60
|
| Rate for Payer: Galaxy Health WC |
$390.15
|
| Rate for Payer: Global Benefits Group Commercial |
$275.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$306.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$174.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$284.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$110.16
|
| Rate for Payer: Multiplan Commercial |
$367.20
|
| Rate for Payer: Networks By Design Commercial |
$229.50
|
| Rate for Payer: Prime Health Services Commercial |
$390.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$172.26
|
| Rate for Payer: United Healthcare All Other HMO |
$167.67
|
| Rate for Payer: United Healthcare HMO Rider |
$164.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$150.32
|
|
|
HC WHFO OPPENHEIMER
|
Facility
|
OP
|
$427.00
|
|
|
Service Code
|
CPT L3931
|
| Hospital Charge Code |
905353924
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$102.48 |
| Max. Negotiated Rate |
$362.95 |
| Rate for Payer: Adventist Health Commercial |
$175.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$362.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$234.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$320.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$247.32
|
| Rate for Payer: Blue Shield of California Commercial |
$315.13
|
| Rate for Payer: Blue Shield of California EPN |
$207.52
|
| Rate for Payer: Cash Price |
$234.85
|
| Rate for Payer: Cash Price |
$234.85
|
| Rate for Payer: Cigna of CA HMO |
$298.90
|
| Rate for Payer: Cigna of CA PPO |
$298.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$362.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$362.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$362.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$170.80
|
| Rate for Payer: EPIC Health Plan Senior |
$170.80
|
| Rate for Payer: Galaxy Health WC |
$362.95
|
| Rate for Payer: Global Benefits Group Commercial |
$256.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$246.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$284.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$279.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$264.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$298.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$298.90
|
| Rate for Payer: Multiplan Commercial |
$341.60
|
| Rate for Payer: Networks By Design Commercial |
$213.50
|
| Rate for Payer: Prime Health Services Commercial |
$362.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$256.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$256.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$160.25
|
| Rate for Payer: United Healthcare All Other HMO |
$155.98
|
| Rate for Payer: United Healthcare HMO Rider |
$152.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$139.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$362.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$362.95
|
| Rate for Payer: Vantage Medical Group Senior |
$362.95
|
|
|
HC WHFO OPPENHEIMER
|
Facility
|
IP
|
$427.00
|
|
|
Service Code
|
CPT L3931
|
| Hospital Charge Code |
915353924
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$85.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$85.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$234.85
|
| Rate for Payer: Cash Price |
$234.85
|
| Rate for Payer: Cigna of CA HMO |
$298.90
|
| Rate for Payer: Cigna of CA PPO |
$298.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$170.80
|
| Rate for Payer: EPIC Health Plan Senior |
$170.80
|
| Rate for Payer: Galaxy Health WC |
$362.95
|
| Rate for Payer: Global Benefits Group Commercial |
$256.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$284.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$162.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$264.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.48
|
| Rate for Payer: Multiplan Commercial |
$341.60
|
| Rate for Payer: Networks By Design Commercial |
$213.50
|
| Rate for Payer: Prime Health Services Commercial |
$362.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$160.25
|
| Rate for Payer: United Healthcare All Other HMO |
$155.98
|
| Rate for Payer: United Healthcare HMO Rider |
$152.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$139.84
|
|
|
HC WHFO OPPENHEIMER
|
Facility
|
OP
|
$427.00
|
|
|
Service Code
|
CPT L3931
|
| Hospital Charge Code |
915353924
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$102.48 |
| Max. Negotiated Rate |
$362.95 |
| Rate for Payer: Adventist Health Commercial |
$175.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$362.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$234.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$320.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$247.32
|
| Rate for Payer: Blue Shield of California Commercial |
$315.13
|
| Rate for Payer: Blue Shield of California EPN |
$207.52
|
| Rate for Payer: Cash Price |
$234.85
|
| Rate for Payer: Cash Price |
$234.85
|
| Rate for Payer: Cigna of CA HMO |
$298.90
|
| Rate for Payer: Cigna of CA PPO |
$298.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$362.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$362.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$362.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$170.80
|
| Rate for Payer: EPIC Health Plan Senior |
$170.80
|
| Rate for Payer: Galaxy Health WC |
$362.95
|
| Rate for Payer: Global Benefits Group Commercial |
$256.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$246.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$284.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$279.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$264.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$298.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$298.90
|
| Rate for Payer: Multiplan Commercial |
$341.60
|
| Rate for Payer: Networks By Design Commercial |
$213.50
|
| Rate for Payer: Prime Health Services Commercial |
$362.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$256.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$256.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$160.25
|
| Rate for Payer: United Healthcare All Other HMO |
$155.98
|
| Rate for Payer: United Healthcare HMO Rider |
$152.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$139.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$362.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$362.95
|
| Rate for Payer: Vantage Medical Group Senior |
$362.95
|
|
|
HC WHFO OPPENHEIMER
|
Facility
|
IP
|
$427.00
|
|
|
Service Code
|
CPT L3931
|
| Hospital Charge Code |
905353924
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$85.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$85.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$234.85
|
| Rate for Payer: Cash Price |
$234.85
|
| Rate for Payer: Cigna of CA HMO |
$298.90
|
| Rate for Payer: Cigna of CA PPO |
$298.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$170.80
|
| Rate for Payer: EPIC Health Plan Senior |
$170.80
|
| Rate for Payer: Galaxy Health WC |
$362.95
|
| Rate for Payer: Global Benefits Group Commercial |
$256.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$284.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$162.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$264.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.48
|
| Rate for Payer: Multiplan Commercial |
$341.60
|
| Rate for Payer: Networks By Design Commercial |
$213.50
|
| Rate for Payer: Prime Health Services Commercial |
$362.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$160.25
|
| Rate for Payer: United Healthcare All Other HMO |
$155.98
|
| Rate for Payer: United Healthcare HMO Rider |
$152.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$139.84
|
|
|
HC WHFO OPPENHEIMER KNUCKLE
|
Facility
|
OP
|
$251.00
|
|
|
Service Code
|
CPT L3925
|
| Hospital Charge Code |
905353950
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$60.24 |
| Max. Negotiated Rate |
$213.35 |
| Rate for Payer: Adventist Health Commercial |
$102.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$213.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$138.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$188.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$145.38
|
| Rate for Payer: Blue Shield of California Commercial |
$185.24
|
| Rate for Payer: Blue Shield of California EPN |
$121.99
|
| Rate for Payer: Cash Price |
$138.05
|
| Rate for Payer: Cash Price |
$138.05
|
| Rate for Payer: Cigna of CA HMO |
$175.70
|
| Rate for Payer: Cigna of CA PPO |
$175.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$213.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$213.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$213.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.40
|
| Rate for Payer: EPIC Health Plan Senior |
$100.40
|
| Rate for Payer: Galaxy Health WC |
$213.35
|
| Rate for Payer: Global Benefits Group Commercial |
$150.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$67.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$167.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$76.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$155.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$175.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$175.70
|
| Rate for Payer: Multiplan Commercial |
$200.80
|
| Rate for Payer: Networks By Design Commercial |
$125.50
|
| Rate for Payer: Prime Health Services Commercial |
$213.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$150.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$150.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$94.20
|
| Rate for Payer: United Healthcare All Other HMO |
$91.69
|
| Rate for Payer: United Healthcare HMO Rider |
$89.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$82.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$213.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$213.35
|
| Rate for Payer: Vantage Medical Group Senior |
$213.35
|
|
|
HC WHFO OPPENHEIMER KNUCKLE
|
Facility
|
IP
|
$251.00
|
|
|
Service Code
|
CPT L3925
|
| Hospital Charge Code |
905353950
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$50.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$50.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$138.05
|
| Rate for Payer: Cash Price |
$138.05
|
| Rate for Payer: Cigna of CA HMO |
$175.70
|
| Rate for Payer: Cigna of CA PPO |
$175.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.40
|
| Rate for Payer: EPIC Health Plan Senior |
$100.40
|
| Rate for Payer: Galaxy Health WC |
$213.35
|
| Rate for Payer: Global Benefits Group Commercial |
$150.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$167.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$95.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$155.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.24
|
| Rate for Payer: Multiplan Commercial |
$200.80
|
| Rate for Payer: Networks By Design Commercial |
$125.50
|
| Rate for Payer: Prime Health Services Commercial |
$213.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$94.20
|
| Rate for Payer: United Healthcare All Other HMO |
$91.69
|
| Rate for Payer: United Healthcare HMO Rider |
$89.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$82.20
|
|
