|
HC WHFO OPPENHEIMER OT
|
Facility
|
OP
|
$560.00
|
|
|
Service Code
|
CPT L3931
|
| Hospital Charge Code |
901300800
|
|
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 OPPENHEIMER OT
|
Facility
|
IP
|
$560.00
|
|
|
Service Code
|
CPT L3931
|
| Hospital Charge Code |
901300800
|
|
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 OPPNHMR REVERSE KNUCKLE
|
Facility
|
OP
|
$244.00
|
|
|
Service Code
|
CPT L3931
|
| Hospital Charge Code |
905353952
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$58.56 |
| Max. Negotiated Rate |
$279.19 |
| Rate for Payer: Adventist Health Commercial |
$100.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$207.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$134.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$183.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$141.32
|
| Rate for Payer: Blue Shield of California Commercial |
$180.07
|
| Rate for Payer: Blue Shield of California EPN |
$118.58
|
| Rate for Payer: Cash Price |
$134.20
|
| Rate for Payer: Cash Price |
$134.20
|
| Rate for Payer: Cigna of CA HMO |
$170.80
|
| Rate for Payer: Cigna of CA PPO |
$170.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$207.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$207.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$207.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$97.60
|
| Rate for Payer: EPIC Health Plan Senior |
$97.60
|
| Rate for Payer: Galaxy Health WC |
$207.40
|
| Rate for Payer: Global Benefits Group Commercial |
$146.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$246.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$162.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$279.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$151.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$170.80
|
| Rate for Payer: Multiplan Commercial |
$195.20
|
| Rate for Payer: Networks By Design Commercial |
$122.00
|
| Rate for Payer: Prime Health Services Commercial |
$207.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$146.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$146.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$91.57
|
| Rate for Payer: United Healthcare All Other HMO |
$89.13
|
| Rate for Payer: United Healthcare HMO Rider |
$87.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$79.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$207.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$207.40
|
| Rate for Payer: Vantage Medical Group Senior |
$207.40
|
|
|
HC WHFO OPPNHMR REVERSE KNUCKLE
|
Facility
|
IP
|
$244.00
|
|
|
Service Code
|
CPT L3931
|
| Hospital Charge Code |
905353952
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$48.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$48.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$134.20
|
| Rate for Payer: Cash Price |
$134.20
|
| Rate for Payer: Cigna of CA HMO |
$170.80
|
| Rate for Payer: Cigna of CA PPO |
$170.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$97.60
|
| Rate for Payer: EPIC Health Plan Senior |
$97.60
|
| Rate for Payer: Galaxy Health WC |
$207.40
|
| Rate for Payer: Global Benefits Group Commercial |
$146.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$162.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$151.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.56
|
| Rate for Payer: Multiplan Commercial |
$195.20
|
| Rate for Payer: Networks By Design Commercial |
$122.00
|
| Rate for Payer: Prime Health Services Commercial |
$207.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$91.57
|
| Rate for Payer: United Healthcare All Other HMO |
$89.13
|
| Rate for Payer: United Healthcare HMO Rider |
$87.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$79.91
|
|
|
HC WHFO PALMER
|
Facility
|
IP
|
$147.00
|
|
|
Service Code
|
CPT L3931
|
| Hospital Charge Code |
905353936
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$29.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$29.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$80.85
|
| Rate for Payer: Cash Price |
$80.85
|
| Rate for Payer: Cigna of CA HMO |
$102.90
|
| Rate for Payer: Cigna of CA PPO |
$102.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.80
|
| Rate for Payer: EPIC Health Plan Senior |
$58.80
|
| Rate for Payer: Galaxy Health WC |
$124.95
|
| Rate for Payer: Global Benefits Group Commercial |
$88.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$98.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$56.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$90.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.28
|
| Rate for Payer: Multiplan Commercial |
$117.60
|
| Rate for Payer: Networks By Design Commercial |
$73.50
|
| Rate for Payer: Prime Health Services Commercial |
$124.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$55.17
|
| Rate for Payer: United Healthcare All Other HMO |
$53.70
|
| Rate for Payer: United Healthcare HMO Rider |
$52.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48.14
|
|
|
HC WHFO PALMER
|
Facility
|
OP
|
$147.00
|
|
|
Service Code
|
CPT L3931
|
| Hospital Charge Code |
905353936
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$35.28 |
| Max. Negotiated Rate |
$279.19 |
| Rate for Payer: Adventist Health Commercial |
$60.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$124.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$80.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$110.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$85.14
|
| Rate for Payer: Blue Shield of California Commercial |
$108.49
|
| Rate for Payer: Blue Shield of California EPN |
$71.44
|
| Rate for Payer: Cash Price |
$80.85
|
| Rate for Payer: Cash Price |
$80.85
|
| Rate for Payer: Cigna of CA HMO |
$102.90
|
| Rate for Payer: Cigna of CA PPO |
$102.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$124.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$124.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.80
|
| Rate for Payer: EPIC Health Plan Senior |
$58.80
|
| Rate for Payer: Galaxy Health WC |
$124.95
|
| Rate for Payer: Global Benefits Group Commercial |
$88.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$246.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$98.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$279.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$90.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$102.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$102.90
|
| Rate for Payer: Multiplan Commercial |
$117.60
|
| Rate for Payer: Networks By Design Commercial |
$73.50
|
| Rate for Payer: Prime Health Services Commercial |
$124.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$88.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$88.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$55.17
|
| Rate for Payer: United Healthcare All Other HMO |
$53.70
|
| Rate for Payer: United Healthcare HMO Rider |
$52.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$124.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.95
|
| Rate for Payer: Vantage Medical Group Senior |
$124.95
|
|
|
HC WHFO REVERSE KNUCKLE BENDER
|
Facility
|
IP
|
$198.00
|
|
|
Service Code
|
CPT L3929
|
| Hospital Charge Code |
905353942
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$39.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$39.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cigna of CA HMO |
$138.60
|
| Rate for Payer: Cigna of CA PPO |
$138.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.20
|
| Rate for Payer: EPIC Health Plan Senior |
$79.20
|
| Rate for Payer: Galaxy Health WC |
$168.30
|
| Rate for Payer: Global Benefits Group Commercial |
$118.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$132.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$75.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$122.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.52
|
| Rate for Payer: Multiplan Commercial |
$158.40
|
| Rate for Payer: Networks By Design Commercial |
$99.00
|
| Rate for Payer: Prime Health Services Commercial |
$168.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$74.31
|
| Rate for Payer: United Healthcare All Other HMO |
$72.33
|
| Rate for Payer: United Healthcare HMO Rider |
$70.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$64.84
|
|
|
HC WHFO REVERSE KNUCKLE BENDER
|
Facility
|
OP
|
$198.00
|
|
|
Service Code
|
CPT L3929
|
| Hospital Charge Code |
905353942
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$47.52 |
| Max. Negotiated Rate |
$168.30 |
| Rate for Payer: Adventist Health Commercial |
$81.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$168.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$108.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$148.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$114.68
|
| Rate for Payer: Blue Shield of California Commercial |
$146.12
|
| Rate for Payer: Blue Shield of California EPN |
$96.23
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cigna of CA HMO |
$138.60
|
| Rate for Payer: Cigna of CA PPO |
$138.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$168.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$168.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$168.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.20
|
| Rate for Payer: EPIC Health Plan Senior |
$79.20
|
| Rate for Payer: Galaxy Health WC |
$168.30
|
| Rate for Payer: Global Benefits Group Commercial |
$118.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$110.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$132.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$125.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$122.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$138.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$138.60
|
| Rate for Payer: Multiplan Commercial |
$158.40
|
| Rate for Payer: Networks By Design Commercial |
$99.00
|
| Rate for Payer: Prime Health Services Commercial |
$168.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$118.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$118.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$74.31
|
| Rate for Payer: United Healthcare All Other HMO |
$72.33
|
| Rate for Payer: United Healthcare HMO Rider |
$70.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$64.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$168.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$168.30
|
| Rate for Payer: Vantage Medical Group Senior |
$168.30
|
|
|
HC WHFO REV KNUCK BNDR OUTRIGGER
|
Facility
|
IP
|
$227.00
|
|
|
Service Code
|
CPT L3929
|
| Hospital Charge Code |
905353944
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$45.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$45.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$124.85
|
| Rate for Payer: Cash Price |
$124.85
|
| Rate for Payer: Cigna of CA HMO |
$158.90
|
| Rate for Payer: Cigna of CA PPO |
$158.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$90.80
|
| Rate for Payer: EPIC Health Plan Senior |
$90.80
|
| Rate for Payer: Galaxy Health WC |
$192.95
|
| Rate for Payer: Global Benefits Group Commercial |
$136.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$151.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$140.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.48
|
| Rate for Payer: Multiplan Commercial |
$181.60
|
| Rate for Payer: Networks By Design Commercial |
$113.50
|
| Rate for Payer: Prime Health Services Commercial |
$192.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$85.19
|
| Rate for Payer: United Healthcare All Other HMO |
$82.92
|
| Rate for Payer: United Healthcare HMO Rider |
$81.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$74.34
|
|
|
HC WHFO REV KNUCK BNDR OUTRIGGER
|
Facility
|
OP
|
$227.00
|
|
|
Service Code
|
CPT L3929
|
| Hospital Charge Code |
905353944
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$192.95 |
| Rate for Payer: Adventist Health Commercial |
$93.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$192.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$124.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$170.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$131.48
|
| Rate for Payer: Blue Shield of California Commercial |
$167.53
|
| Rate for Payer: Blue Shield of California EPN |
$110.32
|
| Rate for Payer: Cash Price |
$124.85
|
| Rate for Payer: Cash Price |
$124.85
|
| Rate for Payer: Cigna of CA HMO |
$158.90
|
| Rate for Payer: Cigna of CA PPO |
$158.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$192.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$192.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$192.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$90.80
|
| Rate for Payer: EPIC Health Plan Senior |
$90.80
|
| Rate for Payer: Galaxy Health WC |
$192.95
|
| Rate for Payer: Global Benefits Group Commercial |
$136.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$110.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$151.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$125.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$140.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$158.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$158.90
|
| Rate for Payer: Multiplan Commercial |
$181.60
|
| Rate for Payer: Networks By Design Commercial |
$113.50
|
| Rate for Payer: Prime Health Services Commercial |
$192.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$136.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$136.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$85.19
|
| Rate for Payer: United Healthcare All Other HMO |
$82.92
|
| Rate for Payer: United Healthcare HMO Rider |
$81.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$74.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$192.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$192.95
|
| Rate for Payer: Vantage Medical Group Senior |
$192.95
|
|
|
HC WHFO RIGID W/O JOINTS
|
Facility
|
IP
|
$697.00
|
|
|
Service Code
|
CPT L3808
|
| Hospital Charge Code |
905353808
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$139.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$139.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$383.35
|
| Rate for Payer: Cash Price |
$383.35
|
| Rate for Payer: Cigna of CA HMO |
$487.90
|
| Rate for Payer: Cigna of CA PPO |
$487.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$278.80
|
| Rate for Payer: EPIC Health Plan Senior |
$278.80
|
| Rate for Payer: Galaxy Health WC |
$592.45
|
| Rate for Payer: Global Benefits Group Commercial |
$418.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$464.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$265.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$431.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$167.28
|
| Rate for Payer: Multiplan Commercial |
$557.60
|
| Rate for Payer: Networks By Design Commercial |
$348.50
|
| Rate for Payer: Prime Health Services Commercial |
$592.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$261.58
|
| Rate for Payer: United Healthcare All Other HMO |
$254.61
|
| Rate for Payer: United Healthcare HMO Rider |
$249.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$228.27
|
|
|
HC WHFO RIGID W/O JOINTS
|
Facility
|
OP
|
$697.00
|
|
|
Service Code
|
CPT L3808
|
| Hospital Charge Code |
905353808
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$167.28 |
| Max. Negotiated Rate |
$592.45 |
| Rate for Payer: Adventist Health Commercial |
$285.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$592.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$383.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$522.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$403.70
|
| Rate for Payer: Blue Shield of California Commercial |
$514.39
|
| Rate for Payer: Blue Shield of California EPN |
$338.74
|
| Rate for Payer: Cash Price |
$383.35
|
| Rate for Payer: Cash Price |
$383.35
|
| Rate for Payer: Cigna of CA HMO |
$487.90
|
| Rate for Payer: Cigna of CA PPO |
$487.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$592.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$592.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$592.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$278.80
|
| Rate for Payer: EPIC Health Plan Senior |
$278.80
|
| Rate for Payer: Galaxy Health WC |
$592.45
|
| Rate for Payer: Global Benefits Group Commercial |
$418.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$282.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$464.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$319.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$431.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$167.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$487.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$487.90
|
| Rate for Payer: Multiplan Commercial |
$557.60
|
| Rate for Payer: Networks By Design Commercial |
$348.50
|
| Rate for Payer: Prime Health Services Commercial |
$592.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$418.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$418.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$261.58
|
| Rate for Payer: United Healthcare All Other HMO |
$254.61
|
| Rate for Payer: United Healthcare HMO Rider |
$249.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$228.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$592.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$592.45
|
| Rate for Payer: Vantage Medical Group Senior |
$592.45
|
|
|
HC WHFO SAFETY PIN MODIFIED
|
Facility
|
IP
|
$132.00
|
|
|
Service Code
|
CPT L3925
|
| Hospital Charge Code |
905353934
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$26.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$26.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Cigna of CA HMO |
$92.40
|
| Rate for Payer: Cigna of CA PPO |
$92.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.80
|
| Rate for Payer: EPIC Health Plan Senior |
$52.80
|
| Rate for Payer: Galaxy Health WC |
$112.20
|
| Rate for Payer: Global Benefits Group Commercial |
$79.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$88.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$81.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.68
|
| Rate for Payer: Multiplan Commercial |
$105.60
|
| Rate for Payer: Networks By Design Commercial |
$66.00
|
| Rate for Payer: Prime Health Services Commercial |
$112.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$49.54
|
| Rate for Payer: United Healthcare All Other HMO |
$48.22
|
| Rate for Payer: United Healthcare HMO Rider |
$47.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$43.23
|
|
|
HC WHFO SAFETY PIN MODIFIED
|
Facility
|
OP
|
$132.00
|
|
|
Service Code
|
CPT L3925
|
| Hospital Charge Code |
905353934
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$31.68 |
| Max. Negotiated Rate |
$112.20 |
| Rate for Payer: Adventist Health Commercial |
$54.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$112.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$72.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$99.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$76.45
|
| Rate for Payer: Blue Shield of California Commercial |
$97.42
|
| Rate for Payer: Blue Shield of California EPN |
$64.15
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Cigna of CA HMO |
$92.40
|
| Rate for Payer: Cigna of CA PPO |
$92.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$112.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$112.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$112.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.80
|
| Rate for Payer: EPIC Health Plan Senior |
$52.80
|
| Rate for Payer: Galaxy Health WC |
$112.20
|
| Rate for Payer: Global Benefits Group Commercial |
$79.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$67.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$88.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$76.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$81.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$92.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$92.40
|
| Rate for Payer: Multiplan Commercial |
$105.60
|
| Rate for Payer: Networks By Design Commercial |
$66.00
|
| Rate for Payer: Prime Health Services Commercial |
$112.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$79.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$79.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$49.54
|
| Rate for Payer: United Healthcare All Other HMO |
$48.22
|
| Rate for Payer: United Healthcare HMO Rider |
$47.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$43.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$112.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$112.20
|
| Rate for Payer: Vantage Medical Group Senior |
$112.20
|
|
|
HC WHFO SAFETY PIN SPRING WIRE
|
Facility
|
OP
|
$145.00
|
|
|
Service Code
|
CPT L3925
|
| Hospital Charge Code |
905353932
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$34.80 |
| Max. Negotiated Rate |
$123.25 |
| Rate for Payer: Adventist Health Commercial |
$59.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$123.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$79.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$108.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$83.98
|
| Rate for Payer: Blue Shield of California Commercial |
$107.01
|
| Rate for Payer: Blue Shield of California EPN |
$70.47
|
| Rate for Payer: Cash Price |
$79.75
|
| Rate for Payer: Cash Price |
$79.75
|
| Rate for Payer: Cigna of CA HMO |
$101.50
|
| Rate for Payer: Cigna of CA PPO |
$101.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$123.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$123.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.00
|
| Rate for Payer: EPIC Health Plan Senior |
$58.00
|
| Rate for Payer: Galaxy Health WC |
$123.25
|
| Rate for Payer: Global Benefits Group Commercial |
$87.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$67.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$96.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$76.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$89.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$101.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$101.50
|
| Rate for Payer: Multiplan Commercial |
$116.00
|
| Rate for Payer: Networks By Design Commercial |
$72.50
|
| Rate for Payer: Prime Health Services Commercial |
$123.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$87.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$87.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$54.42
|
| Rate for Payer: United Healthcare All Other HMO |
$52.97
|
| Rate for Payer: United Healthcare HMO Rider |
$51.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$47.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$123.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.25
|
| Rate for Payer: Vantage Medical Group Senior |
$123.25
|
|
|
HC WHFO SAFETY PIN SPRING WIRE
|
Facility
|
IP
|
$145.00
|
|
|
Service Code
|
CPT L3925
|
| Hospital Charge Code |
905353932
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$29.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Networks By Design Commercial |
$72.50
|
| Rate for Payer: Adventist Health Commercial |
$29.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$79.75
|
| Rate for Payer: Cash Price |
$79.75
|
| Rate for Payer: Cigna of CA HMO |
$101.50
|
| Rate for Payer: Cigna of CA PPO |
$101.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.00
|
| Rate for Payer: EPIC Health Plan Senior |
$58.00
|
| Rate for Payer: Galaxy Health WC |
$123.25
|
| Rate for Payer: Global Benefits Group Commercial |
$87.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$96.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$55.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$89.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.80
|
| Rate for Payer: Multiplan Commercial |
$116.00
|
| Rate for Payer: Prime Health Services Commercial |
$123.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$54.42
|
| Rate for Payer: United Healthcare All Other HMO |
$52.97
|
| Rate for Payer: United Healthcare HMO Rider |
$51.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$47.49
|
|
|
HC WHFO SHORT OPPONENS
|
Facility
|
OP
|
$297.00
|
|
|
Service Code
|
CPT L3808
|
| Hospital Charge Code |
905353800
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$71.28 |
| Max. Negotiated Rate |
$319.98 |
| Rate for Payer: Adventist Health Commercial |
$121.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$252.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$163.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$222.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$172.02
|
| Rate for Payer: Blue Shield of California Commercial |
$219.19
|
| Rate for Payer: Blue Shield of California EPN |
$144.34
|
| Rate for Payer: Cash Price |
$163.35
|
| Rate for Payer: Cash Price |
$163.35
|
| Rate for Payer: Cigna of CA HMO |
$207.90
|
| Rate for Payer: Cigna of CA PPO |
$207.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$252.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$252.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$252.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$118.80
|
| Rate for Payer: EPIC Health Plan Senior |
$118.80
|
| Rate for Payer: Galaxy Health WC |
$252.45
|
| Rate for Payer: Global Benefits Group Commercial |
$178.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$282.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$198.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$319.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$183.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$207.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$207.90
|
| Rate for Payer: Multiplan Commercial |
$237.60
|
| Rate for Payer: Networks By Design Commercial |
$148.50
|
| Rate for Payer: Prime Health Services Commercial |
$252.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$178.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$178.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$111.46
|
| Rate for Payer: United Healthcare All Other HMO |
$108.49
|
| Rate for Payer: United Healthcare HMO Rider |
$106.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$97.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$252.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$252.45
|
| Rate for Payer: Vantage Medical Group Senior |
$252.45
|
|
|
HC WHFO SHORT OPPONENS
|
Facility
|
IP
|
$297.00
|
|
|
Service Code
|
CPT L3808
|
| Hospital Charge Code |
905353800
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$59.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$59.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$163.35
|
| Rate for Payer: Cash Price |
$163.35
|
| Rate for Payer: Cigna of CA HMO |
$207.90
|
| Rate for Payer: Cigna of CA PPO |
$207.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$118.80
|
| Rate for Payer: EPIC Health Plan Senior |
$118.80
|
| Rate for Payer: Galaxy Health WC |
$252.45
|
| Rate for Payer: Global Benefits Group Commercial |
$178.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$198.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$113.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$183.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.28
|
| Rate for Payer: Multiplan Commercial |
$237.60
|
| Rate for Payer: Networks By Design Commercial |
$148.50
|
| Rate for Payer: Prime Health Services Commercial |
$252.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$111.46
|
| Rate for Payer: United Healthcare All Other HMO |
$108.49
|
| Rate for Payer: United Healthcare HMO Rider |
$106.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$97.27
|
|
|
HC WHFO SPREADING HAND
|
Facility
|
IP
|
$144.00
|
|
|
Service Code
|
CPT L3923
|
| Hospital Charge Code |
905353954
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$28.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$28.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cigna of CA HMO |
$100.80
|
| Rate for Payer: Cigna of CA PPO |
$100.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.60
|
| Rate for Payer: EPIC Health Plan Senior |
$57.60
|
| Rate for Payer: Galaxy Health WC |
$122.40
|
| Rate for Payer: Global Benefits Group Commercial |
$86.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$96.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$89.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.56
|
| Rate for Payer: Multiplan Commercial |
$115.20
|
| Rate for Payer: Networks By Design Commercial |
$72.00
|
| Rate for Payer: Prime Health Services Commercial |
$122.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$54.04
|
| Rate for Payer: United Healthcare All Other HMO |
$52.60
|
| Rate for Payer: United Healthcare HMO Rider |
$51.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$47.16
|
|
|
HC WHFO SPREADING HAND
|
Facility
|
OP
|
$144.00
|
|
|
Service Code
|
CPT L3923
|
| Hospital Charge Code |
905353954
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$34.56 |
| Max. Negotiated Rate |
$122.40 |
| Rate for Payer: Adventist Health Commercial |
$59.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$122.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$79.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$108.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$83.40
|
| Rate for Payer: Blue Shield of California Commercial |
$106.27
|
| Rate for Payer: Blue Shield of California EPN |
$69.98
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cigna of CA HMO |
$100.80
|
| Rate for Payer: Cigna of CA PPO |
$100.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$122.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$122.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$122.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.60
|
| Rate for Payer: EPIC Health Plan Senior |
$57.60
|
| Rate for Payer: Galaxy Health WC |
$122.40
|
| Rate for Payer: Global Benefits Group Commercial |
$86.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$37.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$96.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$89.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$100.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$100.80
|
| Rate for Payer: Multiplan Commercial |
$115.20
|
| Rate for Payer: Networks By Design Commercial |
$72.00
|
| Rate for Payer: Prime Health Services Commercial |
$122.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$86.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$86.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$54.04
|
| Rate for Payer: United Healthcare All Other HMO |
$52.60
|
| Rate for Payer: United Healthcare HMO Rider |
$51.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$47.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$122.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$122.40
|
| Rate for Payer: Vantage Medical Group Senior |
$122.40
|
|
|
HC WHFO SWANSON DESIGN
|
Facility
|
OP
|
$512.00
|
|
|
Service Code
|
CPT L3931
|
| Hospital Charge Code |
905353910
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$122.88 |
| Max. Negotiated Rate |
$435.20 |
| Rate for Payer: Adventist Health Commercial |
$209.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$435.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$281.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$384.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$296.55
|
| Rate for Payer: Blue Shield of California Commercial |
$377.86
|
| Rate for Payer: Blue Shield of California EPN |
$248.83
|
| Rate for Payer: Cash Price |
$281.60
|
| Rate for Payer: Cash Price |
$281.60
|
| Rate for Payer: Cigna of CA HMO |
$358.40
|
| Rate for Payer: Cigna of CA PPO |
$358.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$435.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$435.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$435.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$204.80
|
| Rate for Payer: EPIC Health Plan Senior |
$204.80
|
| Rate for Payer: Galaxy Health WC |
$435.20
|
| Rate for Payer: Global Benefits Group Commercial |
$307.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$246.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$341.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$279.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$316.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$122.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$358.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$358.40
|
| Rate for Payer: Multiplan Commercial |
$409.60
|
| Rate for Payer: Networks By Design Commercial |
$256.00
|
| Rate for Payer: Prime Health Services Commercial |
$435.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$307.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$307.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$192.15
|
| Rate for Payer: United Healthcare All Other HMO |
$187.03
|
| Rate for Payer: United Healthcare HMO Rider |
$182.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$167.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$435.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$435.20
|
| Rate for Payer: Vantage Medical Group Senior |
$435.20
|
|
|
HC WHFO SWANSON DESIGN
|
Facility
|
IP
|
$512.00
|
|
|
Service Code
|
CPT L3931
|
| Hospital Charge Code |
905353910
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$102.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$102.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$281.60
|
| Rate for Payer: Cash Price |
$281.60
|
| Rate for Payer: Cigna of CA HMO |
$358.40
|
| Rate for Payer: Cigna of CA PPO |
$358.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$204.80
|
| Rate for Payer: EPIC Health Plan Senior |
$204.80
|
| Rate for Payer: Galaxy Health WC |
$435.20
|
| Rate for Payer: Global Benefits Group Commercial |
$307.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$341.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$195.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$316.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$122.88
|
| Rate for Payer: Multiplan Commercial |
$409.60
|
| Rate for Payer: Networks By Design Commercial |
$256.00
|
| Rate for Payer: Prime Health Services Commercial |
$435.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$192.15
|
| Rate for Payer: United Healthcare All Other HMO |
$187.03
|
| Rate for Payer: United Healthcare HMO Rider |
$182.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$167.68
|
|
|
HC WHFO THOMAS SUSPENSION
|
Facility
|
IP
|
$339.00
|
|
|
Service Code
|
CPT L3931
|
| Hospital Charge Code |
905353926
|
|
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 THOMAS SUSPENSION
|
Facility
|
OP
|
$339.00
|
|
|
Service Code
|
CPT L3931
|
| Hospital Charge Code |
905353926
|
|
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 |
$246.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$226.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$279.19
|
| 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 W/JOINT(S) CUSTOM FABRCTD
|
Facility
|
OP
|
$670.00
|
|
|
Service Code
|
CPT L3806
|
| Hospital Charge Code |
915353806
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$160.80 |
| Max. Negotiated Rate |
$569.50 |
| Rate for Payer: Adventist Health Commercial |
$274.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$569.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$368.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$502.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$388.06
|
| Rate for Payer: Blue Shield of California Commercial |
$494.46
|
| Rate for Payer: Blue Shield of California EPN |
$325.62
|
| Rate for Payer: Cash Price |
$368.50
|
| Rate for Payer: Cash Price |
$368.50
|
| Rate for Payer: Cigna of CA HMO |
$469.00
|
| Rate for Payer: Cigna of CA PPO |
$469.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$569.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$569.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$569.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$268.00
|
| Rate for Payer: EPIC Health Plan Senior |
$268.00
|
| Rate for Payer: Galaxy Health WC |
$569.50
|
| Rate for Payer: Global Benefits Group Commercial |
$402.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$491.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$446.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$555.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$414.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$160.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$469.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$469.00
|
| Rate for Payer: Multiplan Commercial |
$536.00
|
| Rate for Payer: Networks By Design Commercial |
$335.00
|
| Rate for Payer: Prime Health Services Commercial |
$569.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$402.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$402.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$251.45
|
| Rate for Payer: United Healthcare All Other HMO |
$244.75
|
| Rate for Payer: United Healthcare HMO Rider |
$239.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$219.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$569.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$569.50
|
| Rate for Payer: Vantage Medical Group Senior |
$569.50
|
|
