|
HC WHFO ELECTRIC POWERED
|
Facility
|
IP
|
$6,604.00
|
|
|
Service Code
|
CPT L3904
|
| Hospital Charge Code |
905353904
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,320.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$1,320.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$2,971.80
|
| Rate for Payer: Cash Price |
$2,971.80
|
| Rate for Payer: Cigna of CA HMO |
$4,622.80
|
| Rate for Payer: Cigna of CA PPO |
$4,622.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,622.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,641.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,641.60
|
| Rate for Payer: Galaxy Health WC |
$5,613.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,962.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,193.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,896.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,584.96
|
| Rate for Payer: Multiplan Commercial |
$5,283.20
|
| Rate for Payer: Networks By Design Commercial |
$4,292.60
|
| Rate for Payer: Prime Health Services Commercial |
$5,613.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,478.48
|
| Rate for Payer: United Healthcare All Other HMO |
$2,412.44
|
| Rate for Payer: United Healthcare HMO Rider |
$2,360.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,162.81
|
|
|
HC WHFO ELECTRIC POWERED
|
Facility
|
OP
|
$6,604.00
|
|
|
Service Code
|
CPT L3904
|
| Hospital Charge Code |
905353904
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,584.96 |
| Max. Negotiated Rate |
$5,613.40 |
| Rate for Payer: Adventist Health Commercial |
$2,707.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,613.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,632.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,953.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,997.40
|
| Rate for Payer: Blue Shield of California Commercial |
$5,078.48
|
| Rate for Payer: Blue Shield of California Commercial |
$3,348.23
|
| Rate for Payer: Cash Price |
$2,971.80
|
| Rate for Payer: Cash Price |
$2,971.80
|
| Rate for Payer: Cigna of CA HMO |
$4,622.80
|
| Rate for Payer: Cigna of CA PPO |
$4,622.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,613.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,613.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,613.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,622.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,641.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,641.60
|
| Rate for Payer: Galaxy Health WC |
$5,613.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,962.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,443.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,193.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,894.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,896.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,584.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,622.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,622.80
|
| Rate for Payer: Multiplan Commercial |
$5,283.20
|
| Rate for Payer: Networks By Design Commercial |
$3,302.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,613.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,962.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,962.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,478.48
|
| Rate for Payer: United Healthcare All Other HMO |
$2,412.44
|
| Rate for Payer: United Healthcare HMO Rider |
$2,360.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,162.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,613.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,613.40
|
| Rate for Payer: Vantage Medical Group Senior |
$5,613.40
|
|
|
HC WHFO FINGER EXTENSION
|
Facility
|
IP
|
$157.00
|
|
|
Service Code
|
CPT L3929
|
| Hospital Charge Code |
905363928
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$31.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$31.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$70.65
|
| Rate for Payer: Cash Price |
$70.65
|
| Rate for Payer: Cigna of CA HMO |
$109.90
|
| Rate for Payer: Cigna of CA PPO |
$109.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$109.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.80
|
| Rate for Payer: EPIC Health Plan Senior |
$62.80
|
| Rate for Payer: Galaxy Health WC |
$133.45
|
| Rate for Payer: Global Benefits Group Commercial |
$94.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$99.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$92.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.68
|
| Rate for Payer: Multiplan Commercial |
$125.60
|
| Rate for Payer: Networks By Design Commercial |
$102.05
|
| Rate for Payer: Prime Health Services Commercial |
$133.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$58.92
|
| Rate for Payer: United Healthcare All Other HMO |
$57.35
|
| Rate for Payer: United Healthcare HMO Rider |
$56.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$51.42
|
|
|
HC WHFO FINGER EXTENSION
|
Facility
|
OP
|
$157.00
|
|
|
Service Code
|
CPT L3929
|
| Hospital Charge Code |
905353928
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$37.68 |
| Max. Negotiated Rate |
$133.45 |
| Rate for Payer: Adventist Health Commercial |
$64.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$133.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$86.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$117.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$95.03
|
| Rate for Payer: Blue Shield of California Commercial |
$79.60
|
| Rate for Payer: Blue Shield of California Commercial |
$120.73
|
| Rate for Payer: Cash Price |
$70.65
|
| Rate for Payer: Cash Price |
$70.65
|
| Rate for Payer: Cigna of CA HMO |
$109.90
|
| Rate for Payer: Cigna of CA PPO |
$109.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$133.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$133.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$133.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$109.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.80
|
| Rate for Payer: EPIC Health Plan Senior |
$62.80
|
| Rate for Payer: Galaxy Health WC |
$133.45
|
| Rate for Payer: Global Benefits Group Commercial |
$94.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$110.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$99.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$125.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$92.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$109.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$109.90
|
| Rate for Payer: Multiplan Commercial |
$125.60
|
| Rate for Payer: Networks By Design Commercial |
$78.50
|
| Rate for Payer: Prime Health Services Commercial |
$133.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$94.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$94.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$58.92
|
| Rate for Payer: United Healthcare All Other HMO |
$57.35
|
| Rate for Payer: United Healthcare HMO Rider |
$56.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$51.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$133.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$133.45
|
| Rate for Payer: Vantage Medical Group Senior |
$133.45
|
|
|
HC WHFO FINGER EXTENSION
|
Facility
|
OP
|
$157.00
|
|
|
Service Code
|
CPT L3929
|
| Hospital Charge Code |
905363928
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$37.68 |
| Max. Negotiated Rate |
$133.45 |
| Rate for Payer: Adventist Health Commercial |
$64.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$133.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$86.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$117.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$95.03
|
| Rate for Payer: Blue Shield of California Commercial |
$79.60
|
| Rate for Payer: Blue Shield of California Commercial |
$120.73
|
| Rate for Payer: Cash Price |
$70.65
|
| Rate for Payer: Cash Price |
$70.65
|
| Rate for Payer: Cigna of CA HMO |
$109.90
|
| Rate for Payer: Cigna of CA PPO |
$109.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$133.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$133.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$133.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$109.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.80
|
| Rate for Payer: EPIC Health Plan Senior |
$62.80
|
| Rate for Payer: Galaxy Health WC |
$133.45
|
| Rate for Payer: Global Benefits Group Commercial |
$94.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$110.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$99.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$125.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$92.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$109.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$109.90
|
| Rate for Payer: Multiplan Commercial |
$125.60
|
| Rate for Payer: Networks By Design Commercial |
$78.50
|
| Rate for Payer: Prime Health Services Commercial |
$133.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$94.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$94.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$58.92
|
| Rate for Payer: United Healthcare All Other HMO |
$57.35
|
| Rate for Payer: United Healthcare HMO Rider |
$56.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$51.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$133.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$133.45
|
| Rate for Payer: Vantage Medical Group Senior |
$133.45
|
|
|
HC WHFO FINGER EXTENSION
|
Facility
|
IP
|
$157.00
|
|
|
Service Code
|
CPT L3929
|
| Hospital Charge Code |
905353928
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$31.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$31.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$70.65
|
| Rate for Payer: Cash Price |
$70.65
|
| Rate for Payer: Cigna of CA HMO |
$109.90
|
| Rate for Payer: Cigna of CA PPO |
$109.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$109.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.80
|
| Rate for Payer: EPIC Health Plan Senior |
$62.80
|
| Rate for Payer: Galaxy Health WC |
$133.45
|
| Rate for Payer: Global Benefits Group Commercial |
$94.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$99.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$92.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.68
|
| Rate for Payer: Multiplan Commercial |
$125.60
|
| Rate for Payer: Networks By Design Commercial |
$102.05
|
| Rate for Payer: Prime Health Services Commercial |
$133.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$58.92
|
| Rate for Payer: United Healthcare All Other HMO |
$57.35
|
| Rate for Payer: United Healthcare HMO Rider |
$56.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$51.42
|
|
|
HC WHFO FINGER KNUCKLE BENDER
|
Facility
|
OP
|
$54.00
|
|
|
Service Code
|
CPT L3929
|
| Hospital Charge Code |
905353948
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$12.96 |
| Max. Negotiated Rate |
$125.00 |
| Rate for Payer: Adventist Health Commercial |
$22.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$45.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$40.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.69
|
| Rate for Payer: Blue Shield of California Commercial |
$41.53
|
| Rate for Payer: Blue Shield of California Commercial |
$27.38
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cigna of CA HMO |
$37.80
|
| Rate for Payer: Cigna of CA PPO |
$37.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$45.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$45.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$45.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$37.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.60
|
| Rate for Payer: EPIC Health Plan Senior |
$21.60
|
| Rate for Payer: Galaxy Health WC |
$45.90
|
| Rate for Payer: Global Benefits Group Commercial |
$32.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$110.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$34.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$125.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$37.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$37.80
|
| Rate for Payer: Multiplan Commercial |
$43.20
|
| Rate for Payer: Networks By Design Commercial |
$27.00
|
| Rate for Payer: Prime Health Services Commercial |
$45.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.27
|
| Rate for Payer: United Healthcare All Other HMO |
$19.73
|
| Rate for Payer: United Healthcare HMO Rider |
$19.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$45.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45.90
|
| Rate for Payer: Vantage Medical Group Senior |
$45.90
|
|
|
HC WHFO FINGER KNUCKLE BENDER
|
Facility
|
IP
|
$54.00
|
|
|
Service Code
|
CPT L3929
|
| Hospital Charge Code |
905353948
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$10.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$10.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cigna of CA HMO |
$37.80
|
| Rate for Payer: Cigna of CA PPO |
$37.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$37.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.60
|
| Rate for Payer: EPIC Health Plan Senior |
$21.60
|
| Rate for Payer: Galaxy Health WC |
$45.90
|
| Rate for Payer: Global Benefits Group Commercial |
$32.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$34.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.96
|
| Rate for Payer: Multiplan Commercial |
$43.20
|
| Rate for Payer: Networks By Design Commercial |
$35.10
|
| Rate for Payer: Prime Health Services Commercial |
$45.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.27
|
| Rate for Payer: United Healthcare All Other HMO |
$19.73
|
| Rate for Payer: United Healthcare HMO Rider |
$19.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.68
|
|
|
HC WHFO FING EXT WRIST SUPPORT
|
Facility
|
OP
|
$560.00
|
|
|
Service Code
|
CPT L3931
|
| Hospital Charge Code |
901300801
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$476.00 |
| Rate for Payer: Adventist Health Commercial |
$229.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$476.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$308.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$420.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$338.97
|
| Rate for Payer: Blue Shield of California Commercial |
$430.64
|
| Rate for Payer: Blue Shield of California Commercial |
$283.92
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cash Price |
$252.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$246.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$355.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$279.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$330.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$134.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$392.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$392.00
|
| Rate for Payer: Multiplan Commercial |
$448.00
|
| Rate for Payer: Networks By Design Commercial |
$280.00
|
| Rate for Payer: Prime Health Services Commercial |
$476.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$336.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$336.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$210.17
|
| Rate for Payer: United Healthcare All Other HMO |
$204.57
|
| Rate for Payer: United Healthcare HMO Rider |
$200.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$183.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$476.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$476.00
|
| Rate for Payer: Vantage Medical Group Senior |
$476.00
|
|
|
HC WHFO FING EXT WRIST SUPPORT
|
Facility
|
IP
|
$560.00
|
|
|
Service Code
|
CPT L3931
|
| Hospital Charge Code |
901300801
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$112.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cigna of CA HMO |
$392.00
|
| Rate for Payer: Cigna of CA PPO |
$392.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$355.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$330.40
|
| 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 |
$364.00
|
| 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
|
| Rate for Payer: Adventist Health Commercial |
$112.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
|
|
HC WHFO FLEXION GLOVE
|
Facility
|
OP
|
$212.00
|
|
|
Service Code
|
CPT L3912
|
| Hospital Charge Code |
915353912
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$50.88 |
| Max. Negotiated Rate |
$180.20 |
| Rate for Payer: Adventist Health Commercial |
$86.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$180.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$116.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$159.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$128.32
|
| Rate for Payer: Blue Shield of California Commercial |
$163.03
|
| Rate for Payer: Blue Shield of California Commercial |
$107.48
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Cigna of CA HMO |
$148.40
|
| Rate for Payer: Cigna of CA PPO |
$148.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$180.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$180.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$148.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.80
|
| Rate for Payer: EPIC Health Plan Senior |
$84.80
|
| Rate for Payer: Galaxy Health WC |
$180.20
|
| Rate for Payer: Global Benefits Group Commercial |
$127.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$105.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$134.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$119.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$125.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$148.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$148.40
|
| Rate for Payer: Multiplan Commercial |
$169.60
|
| Rate for Payer: Networks By Design Commercial |
$106.00
|
| Rate for Payer: Prime Health Services Commercial |
$180.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$127.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$127.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$79.56
|
| Rate for Payer: United Healthcare All Other HMO |
$77.44
|
| Rate for Payer: United Healthcare HMO Rider |
$75.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$69.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$180.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.20
|
| Rate for Payer: Vantage Medical Group Senior |
$180.20
|
|
|
HC WHFO FLEXION GLOVE
|
Facility
|
OP
|
$212.00
|
|
|
Service Code
|
CPT L3912
|
| Hospital Charge Code |
905353912
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$50.88 |
| Max. Negotiated Rate |
$180.20 |
| Rate for Payer: Adventist Health Commercial |
$86.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$180.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$116.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$159.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$128.32
|
| Rate for Payer: Blue Shield of California Commercial |
$163.03
|
| Rate for Payer: Blue Shield of California Commercial |
$107.48
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Cigna of CA HMO |
$148.40
|
| Rate for Payer: Cigna of CA PPO |
$148.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$180.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$180.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$148.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.80
|
| Rate for Payer: EPIC Health Plan Senior |
$84.80
|
| Rate for Payer: Galaxy Health WC |
$180.20
|
| Rate for Payer: Global Benefits Group Commercial |
$127.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$105.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$134.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$119.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$125.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$148.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$148.40
|
| Rate for Payer: Multiplan Commercial |
$169.60
|
| Rate for Payer: Networks By Design Commercial |
$106.00
|
| Rate for Payer: Prime Health Services Commercial |
$180.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$127.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$127.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$79.56
|
| Rate for Payer: United Healthcare All Other HMO |
$77.44
|
| Rate for Payer: United Healthcare HMO Rider |
$75.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$69.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$180.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.20
|
| Rate for Payer: Vantage Medical Group Senior |
$180.20
|
|
|
HC WHFO FLEXION GLOVE
|
Facility
|
IP
|
$212.00
|
|
|
Service Code
|
CPT L3912
|
| Hospital Charge Code |
905353912
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$42.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$42.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Cigna of CA HMO |
$148.40
|
| Rate for Payer: Cigna of CA PPO |
$148.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$148.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.80
|
| Rate for Payer: EPIC Health Plan Senior |
$84.80
|
| Rate for Payer: Galaxy Health WC |
$180.20
|
| Rate for Payer: Global Benefits Group Commercial |
$127.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$134.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$125.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.88
|
| Rate for Payer: Multiplan Commercial |
$169.60
|
| Rate for Payer: Networks By Design Commercial |
$137.80
|
| Rate for Payer: Prime Health Services Commercial |
$180.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$79.56
|
| Rate for Payer: United Healthcare All Other HMO |
$77.44
|
| Rate for Payer: United Healthcare HMO Rider |
$75.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$69.43
|
|
|
HC WHFO FLEXION GLOVE
|
Facility
|
IP
|
$212.00
|
|
|
Service Code
|
CPT L3912
|
| Hospital Charge Code |
915353912
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$42.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$42.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Cigna of CA HMO |
$148.40
|
| Rate for Payer: Cigna of CA PPO |
$148.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$148.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.80
|
| Rate for Payer: EPIC Health Plan Senior |
$84.80
|
| Rate for Payer: Galaxy Health WC |
$180.20
|
| Rate for Payer: Global Benefits Group Commercial |
$127.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$134.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$125.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.88
|
| Rate for Payer: Multiplan Commercial |
$169.60
|
| Rate for Payer: Networks By Design Commercial |
$137.80
|
| Rate for Payer: Prime Health Services Commercial |
$180.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$79.56
|
| Rate for Payer: United Healthcare All Other HMO |
$77.44
|
| Rate for Payer: United Healthcare HMO Rider |
$75.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$69.43
|
|
|
HC WHFO FLEXOR HINGE CABLE DRIVEN
|
Facility
|
OP
|
$3,330.00
|
|
|
Service Code
|
CPT L3901
|
| Hospital Charge Code |
915353901
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$799.20 |
| Max. Negotiated Rate |
$2,830.50 |
| Rate for Payer: Vantage Medical Group Senior |
$2,830.50
|
| Rate for Payer: Adventist Health Commercial |
$1,365.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,830.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,831.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,497.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,015.65
|
| Rate for Payer: Blue Shield of California Commercial |
$2,560.77
|
| Rate for Payer: Blue Shield of California Commercial |
$1,688.31
|
| Rate for Payer: Cash Price |
$1,498.50
|
| Rate for Payer: Cash Price |
$1,498.50
|
| Rate for Payer: Cigna of CA HMO |
$2,331.00
|
| Rate for Payer: Cigna of CA PPO |
$2,331.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,830.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,830.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,830.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,331.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,332.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,332.00
|
| Rate for Payer: Galaxy Health WC |
$2,830.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,998.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,370.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,114.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,549.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,964.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$799.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,331.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,331.00
|
| Rate for Payer: Multiplan Commercial |
$2,664.00
|
| Rate for Payer: Networks By Design Commercial |
$1,665.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,830.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,998.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,998.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,249.75
|
| Rate for Payer: United Healthcare All Other HMO |
$1,216.45
|
| Rate for Payer: United Healthcare HMO Rider |
$1,190.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,090.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,830.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,830.50
|
|
|
HC WHFO FLEXOR HINGE CABLE DRIVEN
|
Facility
|
IP
|
$1,588.00
|
|
|
Service Code
|
CPT L3901
|
| Hospital Charge Code |
905353901
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$317.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$317.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$714.60
|
| Rate for Payer: Cash Price |
$714.60
|
| Rate for Payer: Cigna of CA HMO |
$1,111.60
|
| Rate for Payer: Cigna of CA PPO |
$1,111.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,111.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$635.20
|
| Rate for Payer: EPIC Health Plan Senior |
$635.20
|
| Rate for Payer: Galaxy Health WC |
$1,349.80
|
| Rate for Payer: Global Benefits Group Commercial |
$952.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,008.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$936.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$381.12
|
| Rate for Payer: Multiplan Commercial |
$1,270.40
|
| Rate for Payer: Networks By Design Commercial |
$1,032.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,349.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$595.98
|
| Rate for Payer: United Healthcare All Other HMO |
$580.10
|
| Rate for Payer: United Healthcare HMO Rider |
$567.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$520.07
|
|
|
HC WHFO FLEXOR HINGE CABLE DRIVEN
|
Facility
|
IP
|
$3,330.00
|
|
|
Service Code
|
CPT L3901
|
| Hospital Charge Code |
915353901
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$666.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$666.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$1,498.50
|
| Rate for Payer: Cash Price |
$1,498.50
|
| Rate for Payer: Cigna of CA HMO |
$2,331.00
|
| Rate for Payer: Cigna of CA PPO |
$2,331.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,331.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,332.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,332.00
|
| Rate for Payer: Galaxy Health WC |
$2,830.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,998.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,114.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,964.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$799.20
|
| Rate for Payer: Multiplan Commercial |
$2,664.00
|
| Rate for Payer: Networks By Design Commercial |
$2,164.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,830.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,249.75
|
| Rate for Payer: United Healthcare All Other HMO |
$1,216.45
|
| Rate for Payer: United Healthcare HMO Rider |
$1,190.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,090.58
|
|
|
HC WHFO FLEXOR HINGE CABLE DRIVEN
|
Facility
|
OP
|
$1,588.00
|
|
|
Service Code
|
CPT L3901
|
| Hospital Charge Code |
905353901
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$381.12 |
| Max. Negotiated Rate |
$1,549.41 |
| Rate for Payer: Adventist Health Commercial |
$651.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,349.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$873.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,191.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$961.22
|
| Rate for Payer: Blue Shield of California Commercial |
$805.12
|
| Rate for Payer: Blue Shield of California Commercial |
$1,221.17
|
| Rate for Payer: Cash Price |
$714.60
|
| Rate for Payer: Cash Price |
$714.60
|
| Rate for Payer: Cigna of CA HMO |
$1,111.60
|
| Rate for Payer: Cigna of CA PPO |
$1,111.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,349.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,349.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,349.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,111.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$635.20
|
| Rate for Payer: EPIC Health Plan Senior |
$635.20
|
| Rate for Payer: Galaxy Health WC |
$1,349.80
|
| Rate for Payer: Global Benefits Group Commercial |
$952.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,370.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,008.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,549.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$936.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$381.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,111.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,111.60
|
| Rate for Payer: Multiplan Commercial |
$1,270.40
|
| Rate for Payer: Networks By Design Commercial |
$794.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,349.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$952.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$952.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$595.98
|
| Rate for Payer: United Healthcare All Other HMO |
$580.10
|
| Rate for Payer: United Healthcare HMO Rider |
$567.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$520.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,349.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,349.80
|
| Rate for Payer: Vantage Medical Group Senior |
$1,349.80
|
|
|
HC WHFO FLEXOR HINGE WRIST DRIVEN
|
Facility
|
OP
|
$2,500.00
|
|
|
Service Code
|
CPT L3900
|
| Hospital Charge Code |
915353900
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$600.00 |
| Max. Negotiated Rate |
$2,125.00 |
| Rate for Payer: Adventist Health Commercial |
$1,025.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,125.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,375.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,875.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,513.25
|
| Rate for Payer: Blue Shield of California Commercial |
$1,922.50
|
| Rate for Payer: Blue Shield of California Commercial |
$1,267.50
|
| Rate for Payer: Cash Price |
$1,125.00
|
| Rate for Payer: Cash Price |
$1,125.00
|
| Rate for Payer: Cigna of CA HMO |
$1,750.00
|
| Rate for Payer: Cigna of CA PPO |
$1,750.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,125.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,125.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,125.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,750.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,000.00
|
| Rate for Payer: Galaxy Health WC |
$2,125.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,500.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,029.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,587.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,163.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,475.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$600.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,750.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,750.00
|
| Rate for Payer: Multiplan Commercial |
$2,000.00
|
| Rate for Payer: Networks By Design Commercial |
$1,250.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,125.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,500.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,500.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$938.25
|
| Rate for Payer: United Healthcare All Other HMO |
$913.25
|
| Rate for Payer: United Healthcare HMO Rider |
$893.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$818.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,125.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,125.00
|
| Rate for Payer: Vantage Medical Group Senior |
$2,125.00
|
|
|
HC WHFO FLEXOR HINGE WRIST DRIVEN
|
Facility
|
OP
|
$2,500.00
|
|
|
Service Code
|
CPT L3900
|
| Hospital Charge Code |
905353900
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$600.00 |
| Max. Negotiated Rate |
$2,125.00 |
| Rate for Payer: Adventist Health Commercial |
$1,025.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,125.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,375.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,875.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,513.25
|
| Rate for Payer: Blue Shield of California Commercial |
$1,922.50
|
| Rate for Payer: Blue Shield of California Commercial |
$1,267.50
|
| Rate for Payer: Cash Price |
$1,125.00
|
| Rate for Payer: Cash Price |
$1,125.00
|
| Rate for Payer: Cigna of CA HMO |
$1,750.00
|
| Rate for Payer: Cigna of CA PPO |
$1,750.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,125.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,125.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,125.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,750.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,000.00
|
| Rate for Payer: Galaxy Health WC |
$2,125.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,500.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,029.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,587.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,163.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,475.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$600.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,750.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,750.00
|
| Rate for Payer: Multiplan Commercial |
$2,000.00
|
| Rate for Payer: Networks By Design Commercial |
$1,250.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,125.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,500.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,500.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$938.25
|
| Rate for Payer: United Healthcare All Other HMO |
$913.25
|
| Rate for Payer: United Healthcare HMO Rider |
$893.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$818.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,125.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,125.00
|
| Rate for Payer: Vantage Medical Group Senior |
$2,125.00
|
|
|
HC WHFO FLEXOR HINGE WRIST DRIVEN
|
Facility
|
IP
|
$2,500.00
|
|
|
Service Code
|
CPT L3900
|
| Hospital Charge Code |
915353900
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$500.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$500.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$1,125.00
|
| Rate for Payer: Cash Price |
$1,125.00
|
| Rate for Payer: Cigna of CA HMO |
$1,750.00
|
| Rate for Payer: Cigna of CA PPO |
$1,750.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,750.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,000.00
|
| Rate for Payer: Galaxy Health WC |
$2,125.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,500.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,587.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,475.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$600.00
|
| Rate for Payer: Multiplan Commercial |
$2,000.00
|
| Rate for Payer: Networks By Design Commercial |
$1,625.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,125.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$938.25
|
| Rate for Payer: United Healthcare All Other HMO |
$913.25
|
| Rate for Payer: United Healthcare HMO Rider |
$893.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$818.75
|
|
|
HC WHFO FLEXOR HINGE WRIST DRIVEN
|
Facility
|
IP
|
$2,500.00
|
|
|
Service Code
|
CPT L3900
|
| Hospital Charge Code |
905353900
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$500.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$500.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$1,125.00
|
| Rate for Payer: Cash Price |
$1,125.00
|
| Rate for Payer: Cigna of CA HMO |
$1,750.00
|
| Rate for Payer: Cigna of CA PPO |
$1,750.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,750.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,000.00
|
| Rate for Payer: Galaxy Health WC |
$2,125.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,500.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,587.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,475.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$600.00
|
| Rate for Payer: Multiplan Commercial |
$2,000.00
|
| Rate for Payer: Networks By Design Commercial |
$1,625.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,125.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$938.25
|
| Rate for Payer: United Healthcare All Other HMO |
$913.25
|
| Rate for Payer: United Healthcare HMO Rider |
$893.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$818.75
|
|
|
HC WHFO KNUCKLE BENDER
|
Facility
|
OP
|
$339.00
|
|
|
Service Code
|
CPT L3929
|
| Hospital Charge Code |
905353918
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$81.36 |
| Max. Negotiated Rate |
$288.15 |
| Rate for Payer: Adventist Health Commercial |
$138.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$288.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$186.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$254.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$205.20
|
| Rate for Payer: Blue Shield of California Commercial |
$260.69
|
| Rate for Payer: Blue Shield of California Commercial |
$171.87
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$110.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$215.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$125.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$200.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$237.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$237.30
|
| Rate for Payer: Multiplan Commercial |
$271.20
|
| Rate for Payer: Networks By Design Commercial |
$169.50
|
| Rate for Payer: Prime Health Services Commercial |
$288.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$203.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$203.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$127.23
|
| Rate for Payer: United Healthcare All Other HMO |
$123.84
|
| Rate for Payer: United Healthcare HMO Rider |
$121.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$111.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$288.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$288.15
|
| Rate for Payer: Vantage Medical Group Senior |
$288.15
|
|
|
HC WHFO KNUCKLE BENDER
|
Facility
|
IP
|
$339.00
|
|
|
Service Code
|
CPT L3929
|
| Hospital Charge Code |
905353918
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$67.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$67.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$215.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$200.01
|
| 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 |
$220.35
|
| Rate for Payer: Prime Health Services Commercial |
$288.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$127.23
|
| Rate for Payer: United Healthcare All Other HMO |
$123.84
|
| Rate for Payer: United Healthcare HMO Rider |
$121.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$111.02
|
|
|
HC WHFO KNUCKLE BENDER 2 SEG
|
Facility
|
OP
|
$420.00
|
|
|
Service Code
|
CPT L3925
|
| Hospital Charge Code |
915353922
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$67.62 |
| Max. Negotiated Rate |
$357.00 |
| Rate for Payer: Adventist Health Commercial |
$172.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$357.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$231.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$315.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$254.23
|
| Rate for Payer: Blue Shield of California Commercial |
$322.98
|
| Rate for Payer: Blue Shield of California Commercial |
$212.94
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cigna of CA HMO |
$294.00
|
| Rate for Payer: Cigna of CA PPO |
$294.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$357.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$357.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$357.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$294.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$168.00
|
| Rate for Payer: EPIC Health Plan Senior |
$168.00
|
| Rate for Payer: Galaxy Health WC |
$357.00
|
| Rate for Payer: Global Benefits Group Commercial |
$252.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$67.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$266.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$76.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$247.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$294.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$294.00
|
| Rate for Payer: Multiplan Commercial |
$336.00
|
| Rate for Payer: Networks By Design Commercial |
$210.00
|
| Rate for Payer: Prime Health Services Commercial |
$357.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$252.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$252.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$157.63
|
| Rate for Payer: United Healthcare All Other HMO |
$153.43
|
| Rate for Payer: United Healthcare HMO Rider |
$150.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$137.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$357.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$357.00
|
| Rate for Payer: Vantage Medical Group Senior |
$357.00
|
|
