|
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 |
$230.40
|
| Rate for Payer: Cash Price |
$230.40
|
| 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 |
$230.40
|
| Rate for Payer: Cash Price |
$230.40
|
| 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 |
$152.55
|
| Rate for Payer: Cash Price |
$152.55
|
| 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 |
$152.55
|
| Rate for Payer: Cash Price |
$152.55
|
| 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 |
$301.50
|
| Rate for Payer: Cash Price |
$301.50
|
| 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
|
|
|
HC WHFO W/JOINT(S) CUSTOM FABRCTD
|
Facility
|
OP
|
$670.00
|
|
|
Service Code
|
CPT L3806
|
| Hospital Charge Code |
905353806
|
|
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 |
$301.50
|
| Rate for Payer: Cash Price |
$301.50
|
| 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
|
|
|
HC WHFO W/JOINT(S) CUSTOM FABRCTD
|
Facility
|
IP
|
$670.00
|
|
|
Service Code
|
CPT L3806
|
| Hospital Charge Code |
915353806
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$134.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$134.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$301.50
|
| Rate for Payer: Cash Price |
$301.50
|
| Rate for Payer: Cigna of CA HMO |
$469.00
|
| Rate for Payer: Cigna of CA PPO |
$469.00
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$446.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$255.27
|
| 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: 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: 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
|
|
|
HC WHFO W/JOINT(S) CUSTOM FABRCTD
|
Facility
|
IP
|
$670.00
|
|
|
Service Code
|
CPT L3806
|
| Hospital Charge Code |
905353806
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$134.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$134.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$301.50
|
| Rate for Payer: Cash Price |
$301.50
|
| Rate for Payer: Cigna of CA HMO |
$469.00
|
| Rate for Payer: Cigna of CA PPO |
$469.00
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$446.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$255.27
|
| 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: 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: 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
|
|
|
HC WHFO WO JOINTS GAUNTLET CF
|
Facility
|
OP
|
$1,004.00
|
|
|
Service Code
|
CPT L3906
|
| Hospital Charge Code |
915353906
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$240.96 |
| Max. Negotiated Rate |
$853.40 |
| Rate for Payer: Adventist Health Commercial |
$411.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$853.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$552.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$753.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$581.52
|
| Rate for Payer: Blue Shield of California Commercial |
$740.95
|
| Rate for Payer: Blue Shield of California EPN |
$487.94
|
| Rate for Payer: Cash Price |
$451.80
|
| Rate for Payer: Cash Price |
$451.80
|
| Rate for Payer: Cigna of CA HMO |
$702.80
|
| Rate for Payer: Cigna of CA PPO |
$702.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$853.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$853.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$853.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$401.60
|
| Rate for Payer: EPIC Health Plan Senior |
$401.60
|
| Rate for Payer: Galaxy Health WC |
$853.40
|
| Rate for Payer: Global Benefits Group Commercial |
$602.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$521.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$669.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$589.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$621.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$240.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$702.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$702.80
|
| Rate for Payer: Multiplan Commercial |
$803.20
|
| Rate for Payer: Networks By Design Commercial |
$502.00
|
| Rate for Payer: Prime Health Services Commercial |
$853.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$602.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$602.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$376.80
|
| Rate for Payer: United Healthcare All Other HMO |
$366.76
|
| Rate for Payer: United Healthcare HMO Rider |
$358.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$328.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$853.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$853.40
|
| Rate for Payer: Vantage Medical Group Senior |
$853.40
|
|
|
HC WHFO WO JOINTS GAUNTLET CF
|
Facility
|
IP
|
$1,004.00
|
|
|
Service Code
|
CPT L3906
|
| Hospital Charge Code |
905353906
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$200.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$200.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$451.80
|
| Rate for Payer: Cash Price |
$451.80
|
| Rate for Payer: Cigna of CA HMO |
$702.80
|
| Rate for Payer: Cigna of CA PPO |
$702.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$401.60
|
| Rate for Payer: EPIC Health Plan Senior |
$401.60
|
| Rate for Payer: Galaxy Health WC |
$853.40
|
| Rate for Payer: Global Benefits Group Commercial |
$602.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$669.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$382.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$621.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$240.96
|
| Rate for Payer: Multiplan Commercial |
$803.20
|
| Rate for Payer: Networks By Design Commercial |
$502.00
|
| Rate for Payer: Prime Health Services Commercial |
$853.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$376.80
|
| Rate for Payer: United Healthcare All Other HMO |
$366.76
|
| Rate for Payer: United Healthcare HMO Rider |
$358.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$328.81
|
|
|
HC WHFO WO JOINTS GAUNTLET CF
|
Facility
|
IP
|
$1,004.00
|
|
|
Service Code
|
CPT L3906
|
| Hospital Charge Code |
915353906
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$200.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$200.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$451.80
|
| Rate for Payer: Cash Price |
$451.80
|
| Rate for Payer: Cigna of CA HMO |
$702.80
|
| Rate for Payer: Cigna of CA PPO |
$702.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$401.60
|
| Rate for Payer: EPIC Health Plan Senior |
$401.60
|
| Rate for Payer: Galaxy Health WC |
$853.40
|
| Rate for Payer: Global Benefits Group Commercial |
$602.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$669.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$382.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$621.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$240.96
|
| Rate for Payer: Multiplan Commercial |
$803.20
|
| Rate for Payer: Networks By Design Commercial |
$502.00
|
| Rate for Payer: Prime Health Services Commercial |
$853.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$376.80
|
| Rate for Payer: United Healthcare All Other HMO |
$366.76
|
| Rate for Payer: United Healthcare HMO Rider |
$358.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$328.81
|
|
|
HC WHFO WO JOINTS GAUNTLET CF
|
Facility
|
OP
|
$1,004.00
|
|
|
Service Code
|
CPT L3906
|
| Hospital Charge Code |
905353906
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$240.96 |
| Max. Negotiated Rate |
$853.40 |
| Rate for Payer: Adventist Health Commercial |
$411.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$853.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$552.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$753.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$581.52
|
| Rate for Payer: Blue Shield of California Commercial |
$740.95
|
| Rate for Payer: Blue Shield of California EPN |
$487.94
|
| Rate for Payer: Cash Price |
$451.80
|
| Rate for Payer: Cash Price |
$451.80
|
| Rate for Payer: Cigna of CA HMO |
$702.80
|
| Rate for Payer: Cigna of CA PPO |
$702.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$853.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$853.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$853.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$401.60
|
| Rate for Payer: EPIC Health Plan Senior |
$401.60
|
| Rate for Payer: Galaxy Health WC |
$853.40
|
| Rate for Payer: Global Benefits Group Commercial |
$602.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$521.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$669.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$589.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$621.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$240.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$702.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$702.80
|
| Rate for Payer: Multiplan Commercial |
$803.20
|
| Rate for Payer: Networks By Design Commercial |
$502.00
|
| Rate for Payer: Prime Health Services Commercial |
$853.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$602.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$602.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$376.80
|
| Rate for Payer: United Healthcare All Other HMO |
$366.76
|
| Rate for Payer: United Healthcare HMO Rider |
$358.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$328.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$853.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$853.40
|
| Rate for Payer: Vantage Medical Group Senior |
$853.40
|
|
|
HC WHFO W/O JOINT(S) PF
|
Facility
|
IP
|
$383.00
|
|
|
Service Code
|
CPT L3807
|
| Hospital Charge Code |
905353807
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$76.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$76.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$172.35
|
| Rate for Payer: Cash Price |
$172.35
|
| Rate for Payer: Cigna of CA HMO |
$268.10
|
| Rate for Payer: Cigna of CA PPO |
$268.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.20
|
| Rate for Payer: EPIC Health Plan Senior |
$153.20
|
| Rate for Payer: Galaxy Health WC |
$325.55
|
| Rate for Payer: Global Benefits Group Commercial |
$229.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$255.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$145.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$237.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$91.92
|
| Rate for Payer: Multiplan Commercial |
$306.40
|
| Rate for Payer: Networks By Design Commercial |
$191.50
|
| Rate for Payer: Prime Health Services Commercial |
$325.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$143.74
|
| Rate for Payer: United Healthcare All Other HMO |
$139.91
|
| Rate for Payer: United Healthcare HMO Rider |
$136.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$125.43
|
|
|
HC WHFO W/O JOINT(S) PF
|
Facility
|
OP
|
$383.00
|
|
|
Service Code
|
CPT L3807
|
| Hospital Charge Code |
905353807
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$91.92 |
| Max. Negotiated Rate |
$325.55 |
| Rate for Payer: Adventist Health Commercial |
$157.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$325.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$210.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$287.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$221.83
|
| Rate for Payer: Blue Shield of California Commercial |
$282.65
|
| Rate for Payer: Blue Shield of California EPN |
$186.14
|
| Rate for Payer: Cash Price |
$172.35
|
| Rate for Payer: Cigna of CA HMO |
$268.10
|
| Rate for Payer: Cigna of CA PPO |
$268.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$325.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$325.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$325.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.20
|
| Rate for Payer: EPIC Health Plan Senior |
$153.20
|
| Rate for Payer: Galaxy Health WC |
$325.55
|
| Rate for Payer: Global Benefits Group Commercial |
$229.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$255.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$237.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$91.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$268.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$268.10
|
| Rate for Payer: Multiplan Commercial |
$306.40
|
| Rate for Payer: Networks By Design Commercial |
$191.50
|
| Rate for Payer: Prime Health Services Commercial |
$325.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$229.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$229.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$143.74
|
| Rate for Payer: United Healthcare All Other HMO |
$139.91
|
| Rate for Payer: United Healthcare HMO Rider |
$136.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$125.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$325.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$325.55
|
| Rate for Payer: Vantage Medical Group Senior |
$325.55
|
|
|
HC WHFO W/O JOINT(S) PF
|
Facility
|
OP
|
$383.00
|
|
|
Service Code
|
CPT L3807
|
| Hospital Charge Code |
915353807
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$91.92 |
| Max. Negotiated Rate |
$325.55 |
| Rate for Payer: Adventist Health Commercial |
$157.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$325.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$210.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$287.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$221.83
|
| Rate for Payer: Blue Shield of California Commercial |
$282.65
|
| Rate for Payer: Blue Shield of California EPN |
$186.14
|
| Rate for Payer: Cash Price |
$172.35
|
| Rate for Payer: Cigna of CA HMO |
$268.10
|
| Rate for Payer: Cigna of CA PPO |
$268.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$325.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$325.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$325.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.20
|
| Rate for Payer: EPIC Health Plan Senior |
$153.20
|
| Rate for Payer: Galaxy Health WC |
$325.55
|
| Rate for Payer: Global Benefits Group Commercial |
$229.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$255.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$237.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$91.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$268.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$268.10
|
| Rate for Payer: Multiplan Commercial |
$306.40
|
| Rate for Payer: Networks By Design Commercial |
$191.50
|
| Rate for Payer: Prime Health Services Commercial |
$325.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$229.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$229.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$143.74
|
| Rate for Payer: United Healthcare All Other HMO |
$139.91
|
| Rate for Payer: United Healthcare HMO Rider |
$136.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$125.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$325.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$325.55
|
| Rate for Payer: Vantage Medical Group Senior |
$325.55
|
|
|
HC WHFO W/O JOINT(S) PF
|
Facility
|
IP
|
$383.00
|
|
|
Service Code
|
CPT L3807
|
| Hospital Charge Code |
915353807
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$76.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$76.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$172.35
|
| Rate for Payer: Cash Price |
$172.35
|
| Rate for Payer: Cigna of CA HMO |
$268.10
|
| Rate for Payer: Cigna of CA PPO |
$268.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.20
|
| Rate for Payer: EPIC Health Plan Senior |
$153.20
|
| Rate for Payer: Galaxy Health WC |
$325.55
|
| Rate for Payer: Global Benefits Group Commercial |
$229.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$255.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$145.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$237.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$91.92
|
| Rate for Payer: Multiplan Commercial |
$306.40
|
| Rate for Payer: Networks By Design Commercial |
$191.50
|
| Rate for Payer: Prime Health Services Commercial |
$325.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$143.74
|
| Rate for Payer: United Healthcare All Other HMO |
$139.91
|
| Rate for Payer: United Healthcare HMO Rider |
$136.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$125.43
|
|
|
HC WHFO WRIST EXT S/OUTRIGGER
|
Facility
|
OP
|
$196.00
|
|
|
Service Code
|
CPT L3931
|
| Hospital Charge Code |
905353916
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$47.04 |
| Max. Negotiated Rate |
$279.19 |
| Rate for Payer: Adventist Health Commercial |
$80.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$166.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$107.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$147.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$113.52
|
| Rate for Payer: Blue Shield of California Commercial |
$144.65
|
| Rate for Payer: Blue Shield of California EPN |
$95.26
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Cigna of CA HMO |
$137.20
|
| Rate for Payer: Cigna of CA PPO |
$137.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$166.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$166.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$166.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.40
|
| Rate for Payer: EPIC Health Plan Senior |
$78.40
|
| Rate for Payer: Galaxy Health WC |
$166.60
|
| Rate for Payer: Global Benefits Group Commercial |
$117.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$246.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$130.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$279.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$121.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$137.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$137.20
|
| Rate for Payer: Multiplan Commercial |
$156.80
|
| Rate for Payer: Networks By Design Commercial |
$98.00
|
| Rate for Payer: Prime Health Services Commercial |
$166.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$117.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$117.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$73.56
|
| Rate for Payer: United Healthcare All Other HMO |
$71.60
|
| Rate for Payer: United Healthcare HMO Rider |
$70.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$64.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$166.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$166.60
|
| Rate for Payer: Vantage Medical Group Senior |
$166.60
|
|
|
HC WHFO WRIST EXT S/OUTRIGGER
|
Facility
|
IP
|
$196.00
|
|
|
Service Code
|
CPT L3931
|
| Hospital Charge Code |
905353916
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$39.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Cigna of CA HMO |
$137.20
|
| Rate for Payer: Cigna of CA PPO |
$137.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.40
|
| Rate for Payer: EPIC Health Plan Senior |
$78.40
|
| Rate for Payer: Galaxy Health WC |
$166.60
|
| Rate for Payer: Global Benefits Group Commercial |
$117.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$130.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$74.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$121.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.04
|
| Rate for Payer: Multiplan Commercial |
$156.80
|
| Rate for Payer: Networks By Design Commercial |
$98.00
|
| Rate for Payer: Prime Health Services Commercial |
$166.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$73.56
|
| Rate for Payer: United Healthcare All Other HMO |
$71.60
|
| Rate for Payer: United Healthcare HMO Rider |
$70.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$64.19
|
|
|
HC WHFO WRIST GAUNLET THUMB SPICA
|
Facility
|
OP
|
$891.00
|
|
|
Service Code
|
CPT L3808
|
| Hospital Charge Code |
915353907
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$213.84 |
| Max. Negotiated Rate |
$757.35 |
| Rate for Payer: Adventist Health Commercial |
$365.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$757.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$490.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$668.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$516.07
|
| Rate for Payer: Blue Shield of California Commercial |
$657.56
|
| Rate for Payer: Blue Shield of California EPN |
$433.03
|
| Rate for Payer: Cash Price |
$400.95
|
| Rate for Payer: Cash Price |
$400.95
|
| Rate for Payer: Cigna of CA HMO |
$623.70
|
| Rate for Payer: Cigna of CA PPO |
$623.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$757.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$757.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$757.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$356.40
|
| Rate for Payer: EPIC Health Plan Senior |
$356.40
|
| Rate for Payer: Galaxy Health WC |
$757.35
|
| Rate for Payer: Global Benefits Group Commercial |
$534.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$282.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$594.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$319.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$551.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$213.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$623.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$623.70
|
| Rate for Payer: Multiplan Commercial |
$712.80
|
| Rate for Payer: Networks By Design Commercial |
$445.50
|
| Rate for Payer: Prime Health Services Commercial |
$757.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$534.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$534.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$334.39
|
| Rate for Payer: United Healthcare All Other HMO |
$325.48
|
| Rate for Payer: United Healthcare HMO Rider |
$318.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$291.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$757.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$757.35
|
| Rate for Payer: Vantage Medical Group Senior |
$757.35
|
|
|
HC WHFO WRIST GAUNLET THUMB SPICA
|
Facility
|
IP
|
$891.00
|
|
|
Service Code
|
CPT L3808
|
| Hospital Charge Code |
915353907
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$178.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$178.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$400.95
|
| Rate for Payer: Cash Price |
$400.95
|
| Rate for Payer: Cigna of CA HMO |
$623.70
|
| Rate for Payer: Cigna of CA PPO |
$623.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$356.40
|
| Rate for Payer: EPIC Health Plan Senior |
$356.40
|
| Rate for Payer: Galaxy Health WC |
$757.35
|
| Rate for Payer: Global Benefits Group Commercial |
$534.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$594.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$339.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$551.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$213.84
|
| Rate for Payer: Multiplan Commercial |
$712.80
|
| Rate for Payer: Networks By Design Commercial |
$445.50
|
| Rate for Payer: Prime Health Services Commercial |
$757.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$334.39
|
| Rate for Payer: United Healthcare All Other HMO |
$325.48
|
| Rate for Payer: United Healthcare HMO Rider |
$318.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$291.80
|
|
|
HC WHFO WRIST GAUNLET THUMB SPICA
|
Facility
|
IP
|
$891.00
|
|
|
Service Code
|
CPT L3808
|
| Hospital Charge Code |
905353907
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$178.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$178.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$400.95
|
| Rate for Payer: Cash Price |
$400.95
|
| Rate for Payer: Cigna of CA HMO |
$623.70
|
| Rate for Payer: Cigna of CA PPO |
$623.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$356.40
|
| Rate for Payer: EPIC Health Plan Senior |
$356.40
|
| Rate for Payer: Galaxy Health WC |
$757.35
|
| Rate for Payer: Global Benefits Group Commercial |
$534.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$594.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$339.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$551.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$213.84
|
| Rate for Payer: Multiplan Commercial |
$712.80
|
| Rate for Payer: Networks By Design Commercial |
$445.50
|
| Rate for Payer: Prime Health Services Commercial |
$757.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$334.39
|
| Rate for Payer: United Healthcare All Other HMO |
$325.48
|
| Rate for Payer: United Healthcare HMO Rider |
$318.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$291.80
|
|
|
HC WHFO WRIST GAUNLET THUMB SPICA
|
Facility
|
OP
|
$891.00
|
|
|
Service Code
|
CPT L3808
|
| Hospital Charge Code |
905353907
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$213.84 |
| Max. Negotiated Rate |
$757.35 |
| Rate for Payer: Adventist Health Commercial |
$365.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$757.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$490.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$668.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$516.07
|
| Rate for Payer: Blue Shield of California Commercial |
$657.56
|
| Rate for Payer: Blue Shield of California EPN |
$433.03
|
| Rate for Payer: Cash Price |
$400.95
|
| Rate for Payer: Cash Price |
$400.95
|
| Rate for Payer: Cigna of CA HMO |
$623.70
|
| Rate for Payer: Cigna of CA PPO |
$623.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$757.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$757.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$757.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$356.40
|
| Rate for Payer: EPIC Health Plan Senior |
$356.40
|
| Rate for Payer: Galaxy Health WC |
$757.35
|
| Rate for Payer: Global Benefits Group Commercial |
$534.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$282.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$594.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$319.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$551.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$213.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$623.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$623.70
|
| Rate for Payer: Multiplan Commercial |
$712.80
|
| Rate for Payer: Networks By Design Commercial |
$445.50
|
| Rate for Payer: Prime Health Services Commercial |
$757.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$534.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$534.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$334.39
|
| Rate for Payer: United Healthcare All Other HMO |
$325.48
|
| Rate for Payer: United Healthcare HMO Rider |
$318.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$291.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$757.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$757.35
|
| Rate for Payer: Vantage Medical Group Senior |
$757.35
|
|
|
HC WHIRLPOOL MCAL
|
Facility
|
OP
|
$296.00
|
|
|
Service Code
|
CPT 97022
|
| Hospital Charge Code |
901300045
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$18.72 |
| Max. Negotiated Rate |
$457.00 |
| Rate for Payer: Adventist Health Commercial |
$121.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$194.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$251.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$162.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$222.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cash Price |
$133.20
|
| Rate for Payer: Cash Price |
$133.20
|
| Rate for Payer: Cash Price |
$133.20
|
| Rate for Payer: Cash Price |
$133.20
|
| Rate for Payer: Cigna of CA HMO |
$189.44
|
| Rate for Payer: Cigna of CA PPO |
$219.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$251.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$251.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$251.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$118.40
|
| Rate for Payer: EPIC Health Plan Senior |
$118.40
|
| Rate for Payer: Galaxy Health WC |
$251.60
|
| Rate for Payer: Global Benefits Group Commercial |
$177.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$197.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$183.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$207.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$207.20
|
| Rate for Payer: Multiplan Commercial |
$236.80
|
| Rate for Payer: Networks By Design Commercial |
$192.40
|
| Rate for Payer: Prime Health Services Commercial |
$251.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$177.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$177.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$251.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$251.60
|
| Rate for Payer: Vantage Medical Group Senior |
$251.60
|
|
|
HC WHIRLPOOL MCAL
|
Facility
|
IP
|
$296.00
|
|
|
Service Code
|
CPT 97022
|
| Hospital Charge Code |
901300045
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$59.20 |
| Max. Negotiated Rate |
$251.60 |
| Rate for Payer: Adventist Health Commercial |
$59.20
|
| Rate for Payer: Cash Price |
$133.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$118.40
|
| Rate for Payer: EPIC Health Plan Senior |
$118.40
|
| Rate for Payer: Galaxy Health WC |
$251.60
|
| Rate for Payer: Global Benefits Group Commercial |
$177.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$197.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$112.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$183.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.04
|
| Rate for Payer: Multiplan Commercial |
$236.80
|
| Rate for Payer: Networks By Design Commercial |
$192.40
|
| Rate for Payer: Prime Health Services Commercial |
$251.60
|
|
|
HC WHIRLPOOL MCARE COM
|
Facility
|
IP
|
$296.00
|
|
|
Service Code
|
CPT 97022
|
| Hospital Charge Code |
900407040
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$59.20 |
| Max. Negotiated Rate |
$251.60 |
| Rate for Payer: Adventist Health Commercial |
$59.20
|
| Rate for Payer: Cash Price |
$133.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$118.40
|
| Rate for Payer: EPIC Health Plan Senior |
$118.40
|
| Rate for Payer: Galaxy Health WC |
$251.60
|
| Rate for Payer: Global Benefits Group Commercial |
$177.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$197.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$112.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$183.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.04
|
| Rate for Payer: Multiplan Commercial |
$236.80
|
| Rate for Payer: Networks By Design Commercial |
$192.40
|
| Rate for Payer: Prime Health Services Commercial |
$251.60
|
|
