|
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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$200.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$637.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$592.36
|
| 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 |
$652.60
|
| 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 |
$607.72
|
| Rate for Payer: Blue Shield of California Commercial |
$772.08
|
| Rate for Payer: Blue Shield of California Commercial |
$509.03
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$521.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$637.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$589.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$592.36
|
| 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
|
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 |
$607.72
|
| Rate for Payer: Blue Shield of California Commercial |
$772.08
|
| Rate for Payer: Blue Shield of California Commercial |
$509.03
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$521.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$637.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$589.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$592.36
|
| 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 |
915353906
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$200.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$200.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$637.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$592.36
|
| 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 |
$652.60
|
| 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 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 |
$231.83
|
| Rate for Payer: Blue Shield of California Commercial |
$194.18
|
| Rate for Payer: Blue Shield of California Commercial |
$294.53
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$243.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$225.97
|
| 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$76.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$243.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$225.97
|
| 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 |
$248.95
|
| 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 |
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 |
$231.83
|
| Rate for Payer: Blue Shield of California Commercial |
$194.18
|
| Rate for Payer: Blue Shield of California Commercial |
$294.53
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$243.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$225.97
|
| 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 |
905353807
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$76.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$76.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$243.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$225.97
|
| 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 |
$248.95
|
| 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 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$178.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$565.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$525.69
|
| 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 |
$579.15
|
| 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 |
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 |
$539.32
|
| Rate for Payer: Blue Shield of California Commercial |
$685.18
|
| Rate for Payer: Blue Shield of California Commercial |
$451.74
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$282.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$565.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$319.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$525.69
|
| 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
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$207.20
|
| 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 Foundation Hospitals Commercial/Self Funded |
$187.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$174.64
|
| 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 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 |
$478.00 |
| Rate for Payer: Adventist Health Commercial |
$121.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$106.92
|
| 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 |
$478.00
|
| Rate for Payer: Blue Shield of California Commercial |
$291.00
|
| Rate for Payer: Blue Shield of California Commercial |
$439.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$207.20
|
| 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: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$187.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$174.64
|
| 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 MCARE COM
|
Facility
|
OP
|
$296.00
|
|
|
Service Code
|
CPT 97022
|
| Hospital Charge Code |
900407040
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$18.72 |
| Max. Negotiated Rate |
$478.00 |
| Rate for Payer: Adventist Health Commercial |
$121.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$106.92
|
| 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 |
$478.00
|
| Rate for Payer: Blue Shield of California Commercial |
$291.00
|
| Rate for Payer: Blue Shield of California Commercial |
$439.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$207.20
|
| 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: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$187.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$174.64
|
| 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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$207.20
|
| 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 Foundation Hospitals Commercial/Self Funded |
$187.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$174.64
|
| 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 WHITAKER TEST
|
Facility
|
OP
|
$1,742.00
|
|
|
Service Code
|
CPT 50396
|
| Hospital Charge Code |
909000169
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$76.93 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$348.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,345.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$986.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$896.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Cash Price |
$783.90
|
| Rate for Payer: Cash Price |
$783.90
|
| Rate for Payer: Cash Price |
$783.90
|
| Rate for Payer: Cigna of CA HMO |
$1,114.88
|
| Rate for Payer: Cigna of CA PPO |
$1,289.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,345.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$986.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$896.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,219.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,479.79
|
| Rate for Payer: EPIC Health Plan Senior |
$986.52
|
| Rate for Payer: Galaxy Health WC |
$1,480.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,045.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,470.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$76.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$896.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,106.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$87.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,255.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$418.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,130.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,201.77
|
| Rate for Payer: Multiplan Commercial |
$1,393.60
|
| Rate for Payer: Multiplan WC |
$1,351.26
|
| Rate for Payer: Networks By Design Commercial |
$1,132.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,480.70
|
| Rate for Payer: Prime Health Services WC |
$1,337.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,045.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$871.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$896.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,345.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$986.52
|
| Rate for Payer: Vantage Medical Group Senior |
$896.84
|
|
|
HC WHITAKER TEST
|
Facility
|
IP
|
$1,742.00
|
|
|
Service Code
|
CPT 50396
|
| Hospital Charge Code |
909000169
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$348.40 |
| Max. Negotiated Rate |
$1,480.70 |
| Rate for Payer: Adventist Health Commercial |
$348.40
|
| Rate for Payer: Cash Price |
$783.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,219.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$696.80
|
| Rate for Payer: EPIC Health Plan Senior |
$696.80
|
| Rate for Payer: Galaxy Health WC |
$1,480.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,045.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,106.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,027.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$418.08
|
| Rate for Payer: Multiplan Commercial |
$1,393.60
|
| Rate for Payer: Networks By Design Commercial |
$1,132.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,480.70
|
|
|
HC WHITE CAP 15MM
|
Facility
|
OP
|
$44.69
|
|
| Hospital Charge Code |
900800856
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.94 |
| Max. Negotiated Rate |
$37.99 |
| Rate for Payer: Adventist Health Commercial |
$8.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$29.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$33.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.68
|
| Rate for Payer: Cash Price |
$20.11
|
| Rate for Payer: Cigna of CA HMO |
$28.60
|
| Rate for Payer: Cigna of CA PPO |
$33.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$37.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.99
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$31.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.88
|
| Rate for Payer: EPIC Health Plan Senior |
$17.88
|
| Rate for Payer: Galaxy Health WC |
$37.99
|
| Rate for Payer: Global Benefits Group Commercial |
$26.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$28.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$31.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$31.28
|
| Rate for Payer: Multiplan Commercial |
$35.75
|
| Rate for Payer: Networks By Design Commercial |
$29.05
|
| Rate for Payer: Prime Health Services Commercial |
$37.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26.81
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.34
|
| Rate for Payer: United Healthcare All Other HMO |
$22.34
|
| Rate for Payer: United Healthcare HMO Rider |
$22.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$37.99
|
| Rate for Payer: Vantage Medical Group Senior |
$37.99
|
|
|
HC WHITE CAP 15MM
|
Facility
|
IP
|
$44.69
|
|
| Hospital Charge Code |
900800856
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.94 |
| Max. Negotiated Rate |
$37.99 |
| Rate for Payer: Adventist Health Commercial |
$8.94
|
| Rate for Payer: Cash Price |
$20.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$31.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.88
|
| Rate for Payer: EPIC Health Plan Senior |
$17.88
|
| Rate for Payer: Galaxy Health WC |
$37.99
|
| Rate for Payer: Global Benefits Group Commercial |
$26.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$28.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.73
|
| Rate for Payer: Multiplan Commercial |
$35.75
|
| Rate for Payer: Networks By Design Commercial |
$29.05
|
| Rate for Payer: Prime Health Services Commercial |
$37.99
|
|
|
HC WHO ELASTIC PREFAB INC FIT/ADJ
|
Facility
|
OP
|
$25.00
|
|
| Hospital Charge Code |
905353909
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$21.25 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$16.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.04
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cigna of CA HMO |
$16.00
|
| Rate for Payer: Cigna of CA PPO |
$18.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10.00
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.50
|
| Rate for Payer: Multiplan Commercial |
$20.00
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.50
|
| Rate for Payer: United Healthcare All Other HMO |
$12.50
|
| Rate for Payer: United Healthcare HMO Rider |
$12.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.25
|
| Rate for Payer: Vantage Medical Group Senior |
$21.25
|
|
|
HC WHO ELASTIC PREFAB INC FIT/ADJ
|
Facility
|
IP
|
$25.00
|
|
| Hospital Charge Code |
905353909
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$21.25 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10.00
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$20.00
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
|
|
HC WHO W/NONTORSION JNT(S) CF
|
Facility
|
OP
|
$1,480.00
|
|
|
Service Code
|
CPT L3905
|
| Hospital Charge Code |
905353905
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$355.20 |
| Max. Negotiated Rate |
$1,258.00 |
| Rate for Payer: Adventist Health Commercial |
$606.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,258.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$814.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,110.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$895.84
|
| Rate for Payer: Blue Shield of California Commercial |
$750.36
|
| Rate for Payer: Blue Shield of California Commercial |
$1,138.12
|
| Rate for Payer: Cash Price |
$666.00
|
| Rate for Payer: Cash Price |
$666.00
|
| Rate for Payer: Cigna of CA HMO |
$1,036.00
|
| Rate for Payer: Cigna of CA PPO |
$1,036.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,258.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,258.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,258.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,036.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$592.00
|
| Rate for Payer: EPIC Health Plan Senior |
$592.00
|
| Rate for Payer: Galaxy Health WC |
$1,258.00
|
| Rate for Payer: Global Benefits Group Commercial |
$888.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$953.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$939.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,077.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$873.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$355.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,036.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,036.00
|
| Rate for Payer: Multiplan Commercial |
$1,184.00
|
| Rate for Payer: Networks By Design Commercial |
$740.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,258.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$888.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$888.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$555.44
|
| Rate for Payer: United Healthcare All Other HMO |
$540.64
|
| Rate for Payer: United Healthcare HMO Rider |
$528.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$484.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,258.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,258.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,258.00
|
|
|
HC WHO W/NONTORSION JNT(S) CF
|
Facility
|
OP
|
$1,480.00
|
|
|
Service Code
|
CPT L3905
|
| Hospital Charge Code |
915353905
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$355.20 |
| Max. Negotiated Rate |
$1,258.00 |
| Rate for Payer: Adventist Health Commercial |
$606.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,258.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$814.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,110.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$895.84
|
| Rate for Payer: Blue Shield of California Commercial |
$750.36
|
| Rate for Payer: Blue Shield of California Commercial |
$1,138.12
|
| Rate for Payer: Cash Price |
$666.00
|
| Rate for Payer: Cash Price |
$666.00
|
| Rate for Payer: Cigna of CA HMO |
$1,036.00
|
| Rate for Payer: Cigna of CA PPO |
$1,036.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,258.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,258.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,258.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,036.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$592.00
|
| Rate for Payer: EPIC Health Plan Senior |
$592.00
|
| Rate for Payer: Galaxy Health WC |
$1,258.00
|
| Rate for Payer: Global Benefits Group Commercial |
$888.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$953.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$939.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,077.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$873.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$355.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,036.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,036.00
|
| Rate for Payer: Multiplan Commercial |
$1,184.00
|
| Rate for Payer: Networks By Design Commercial |
$740.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,258.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$888.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$888.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$555.44
|
| Rate for Payer: United Healthcare All Other HMO |
$540.64
|
| Rate for Payer: United Healthcare HMO Rider |
$528.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$484.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,258.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,258.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,258.00
|
|
|
HC WHO W/NONTORSION JNT(S) CF
|
Facility
|
IP
|
$1,480.00
|
|
|
Service Code
|
CPT L3905
|
| Hospital Charge Code |
915353905
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$296.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$296.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$666.00
|
| Rate for Payer: Cash Price |
$666.00
|
| Rate for Payer: Cigna of CA HMO |
$1,036.00
|
| Rate for Payer: Cigna of CA PPO |
$1,036.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,036.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$592.00
|
| Rate for Payer: EPIC Health Plan Senior |
$592.00
|
| Rate for Payer: Galaxy Health WC |
$1,258.00
|
| Rate for Payer: Global Benefits Group Commercial |
$888.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$939.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$873.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$355.20
|
| Rate for Payer: Multiplan Commercial |
$1,184.00
|
| Rate for Payer: Networks By Design Commercial |
$962.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,258.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$555.44
|
| Rate for Payer: United Healthcare All Other HMO |
$540.64
|
| Rate for Payer: United Healthcare HMO Rider |
$528.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$484.70
|
|
|
HC WHO W/NONTORSION JNT(S) CF
|
Facility
|
IP
|
$1,480.00
|
|
|
Service Code
|
CPT L3905
|
| Hospital Charge Code |
905353905
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$296.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$296.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$666.00
|
| Rate for Payer: Cash Price |
$666.00
|
| Rate for Payer: Cigna of CA HMO |
$1,036.00
|
| Rate for Payer: Cigna of CA PPO |
$1,036.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,036.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$592.00
|
| Rate for Payer: EPIC Health Plan Senior |
$592.00
|
| Rate for Payer: Galaxy Health WC |
$1,258.00
|
| Rate for Payer: Global Benefits Group Commercial |
$888.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$939.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$873.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$355.20
|
| Rate for Payer: Multiplan Commercial |
$1,184.00
|
| Rate for Payer: Networks By Design Commercial |
$962.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,258.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$555.44
|
| Rate for Payer: United Healthcare All Other HMO |
$540.64
|
| Rate for Payer: United Healthcare HMO Rider |
$528.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$484.70
|
|
|
HC WHO W/NONTORSION JOINTS(S) PREFAB
|
Facility
|
IP
|
$1,345.03
|
|
|
Service Code
|
CPT L3915
|
| Hospital Charge Code |
905353915
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$269.01 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$269.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$605.26
|
| Rate for Payer: Cash Price |
$605.26
|
| Rate for Payer: Cigna of CA HMO |
$941.52
|
| Rate for Payer: Cigna of CA PPO |
$941.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$941.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$538.01
|
| Rate for Payer: EPIC Health Plan Senior |
$538.01
|
| Rate for Payer: Galaxy Health WC |
$1,143.28
|
| Rate for Payer: Global Benefits Group Commercial |
$807.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$854.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$793.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$322.81
|
| Rate for Payer: Multiplan Commercial |
$1,076.02
|
| Rate for Payer: Networks By Design Commercial |
$874.27
|
| Rate for Payer: Prime Health Services Commercial |
$1,143.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$504.79
|
| Rate for Payer: United Healthcare All Other HMO |
$491.34
|
| Rate for Payer: United Healthcare HMO Rider |
$480.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.50
|
|
