|
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 |
$190.80 |
| Rate for Payer: Adventist Health Commercial |
$42.40
|
| Rate for Payer: Blue Shield of California Commercial |
$170.02
|
| Rate for Payer: Blue Shield of California EPN |
$106.85
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Central Health Plan Commercial |
$169.60
|
| 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: Health Management Network EPO/PPO |
$190.80
|
| 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 |
$42.40
|
| Rate for Payer: Multiplan Commercial |
$159.00
|
| 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 |
$190.80 |
| Rate for Payer: Adventist Health Commercial |
$42.40
|
| Rate for Payer: Blue Shield of California Commercial |
$170.02
|
| Rate for Payer: Blue Shield of California EPN |
$106.85
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Central Health Plan Commercial |
$169.60
|
| 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: Health Management Network EPO/PPO |
$190.80
|
| 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 |
$42.40
|
| Rate for Payer: Multiplan Commercial |
$159.00
|
| 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
|
OP
|
$212.00
|
|
|
Service Code
|
CPT L3912
|
| Hospital Charge Code |
905353912
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$69.43 |
| Max. Negotiated Rate |
$190.80 |
| 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 |
$123.32
|
| Rate for Payer: Blue Shield of California Commercial |
$170.02
|
| Rate for Payer: Blue Shield of California EPN |
$106.85
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Central Health Plan Commercial |
$169.60
|
| 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: Health Management Network EPO/PPO |
$190.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$107.90
|
| 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 |
$86.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$148.40
|
| Rate for Payer: Multiplan Commercial |
$159.00
|
| Rate for Payer: Networks By Design Commercial |
$106.00
|
| Rate for Payer: Prime Health Services Commercial |
$180.20
|
| Rate for Payer: Riverside University Health System MISP |
$84.80
|
| 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 FLEXOR HINGE CABLE DRIVEN
|
Facility
|
OP
|
$1,588.00
|
|
|
Service Code
|
CPT L3901
|
| Hospital Charge Code |
905353901
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$520.07 |
| 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 |
$923.74
|
| Rate for Payer: Blue Shield of California Commercial |
$1,273.58
|
| Rate for Payer: Blue Shield of California EPN |
$800.35
|
| Rate for Payer: Cash Price |
$714.60
|
| Rate for Payer: Cash Price |
$714.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,270.40
|
| 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: Health Management Network EPO/PPO |
$1,429.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,402.63
|
| 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 |
$651.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,111.60
|
| Rate for Payer: Multiplan Commercial |
$1,191.00
|
| Rate for Payer: Networks By Design Commercial |
$794.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,349.80
|
| Rate for Payer: Riverside University Health System MISP |
$635.20
|
| 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 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 |
$2,997.00 |
| Rate for Payer: Adventist Health Commercial |
$666.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,670.66
|
| Rate for Payer: Blue Shield of California EPN |
$1,678.32
|
| Rate for Payer: Cash Price |
$1,498.50
|
| Rate for Payer: Central Health Plan Commercial |
$2,664.00
|
| 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: Health Management Network EPO/PPO |
$2,997.00
|
| 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 |
$666.00
|
| Rate for Payer: Multiplan Commercial |
$2,497.50
|
| 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
|
$3,330.00
|
|
|
Service Code
|
CPT L3901
|
| Hospital Charge Code |
915353901
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,090.58 |
| Max. Negotiated Rate |
$2,997.00 |
| 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 |
$1,937.06
|
| Rate for Payer: Blue Shield of California Commercial |
$2,670.66
|
| Rate for Payer: Blue Shield of California EPN |
$1,678.32
|
| Rate for Payer: Cash Price |
$1,498.50
|
| Rate for Payer: Cash Price |
$1,498.50
|
| Rate for Payer: Central Health Plan Commercial |
$2,664.00
|
| 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: Health Management Network EPO/PPO |
$2,997.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,402.63
|
| 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 |
$1,365.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,331.00
|
| Rate for Payer: Multiplan Commercial |
$2,497.50
|
| Rate for Payer: Networks By Design Commercial |
$1,665.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,830.50
|
| Rate for Payer: Riverside University Health System MISP |
$1,332.00
|
| 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
|
| Rate for Payer: Vantage Medical Group Senior |
$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 |
$1,429.20 |
| Rate for Payer: Adventist Health Commercial |
$317.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,273.58
|
| Rate for Payer: Blue Shield of California EPN |
$800.35
|
| Rate for Payer: Cash Price |
$714.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,270.40
|
| 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: Health Management Network EPO/PPO |
$1,429.20
|
| 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 |
$317.60
|
| Rate for Payer: Multiplan Commercial |
$1,191.00
|
| 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 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 |
$2,250.00 |
| Rate for Payer: Adventist Health Commercial |
$500.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,005.00
|
| Rate for Payer: Blue Shield of California EPN |
$1,260.00
|
| Rate for Payer: Cash Price |
$1,125.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,000.00
|
| 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: Health Management Network EPO/PPO |
$2,250.00
|
| 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 |
$500.00
|
| Rate for Payer: Multiplan Commercial |
$1,875.00
|
| 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
|
OP
|
$2,500.00
|
|
|
Service Code
|
CPT L3900
|
| Hospital Charge Code |
915353900
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$818.75 |
| Max. Negotiated Rate |
$2,250.00 |
| 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 |
$1,454.25
|
| Rate for Payer: Blue Shield of California Commercial |
$2,005.00
|
| Rate for Payer: Blue Shield of California EPN |
$1,260.00
|
| Rate for Payer: Cash Price |
$1,125.00
|
| Rate for Payer: Cash Price |
$1,125.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,000.00
|
| 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: Health Management Network EPO/PPO |
$2,250.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,053.60
|
| 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 |
$1,025.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,750.00
|
| Rate for Payer: Multiplan Commercial |
$1,875.00
|
| Rate for Payer: Networks By Design Commercial |
$1,250.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,125.00
|
| Rate for Payer: Riverside University Health System MISP |
$1,000.00
|
| 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 |
$818.75 |
| Max. Negotiated Rate |
$2,250.00 |
| 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 |
$1,454.25
|
| Rate for Payer: Blue Shield of California Commercial |
$2,005.00
|
| Rate for Payer: Blue Shield of California EPN |
$1,260.00
|
| Rate for Payer: Cash Price |
$1,125.00
|
| Rate for Payer: Cash Price |
$1,125.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,000.00
|
| 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: Health Management Network EPO/PPO |
$2,250.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,053.60
|
| 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 |
$1,025.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,750.00
|
| Rate for Payer: Multiplan Commercial |
$1,875.00
|
| Rate for Payer: Networks By Design Commercial |
$1,250.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,125.00
|
| Rate for Payer: Riverside University Health System MISP |
$1,000.00
|
| 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 |
$2,250.00 |
| Rate for Payer: Adventist Health Commercial |
$500.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,005.00
|
| Rate for Payer: Blue Shield of California EPN |
$1,260.00
|
| Rate for Payer: Cash Price |
$1,125.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,000.00
|
| 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: Health Management Network EPO/PPO |
$2,250.00
|
| 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 |
$500.00
|
| Rate for Payer: Multiplan Commercial |
$1,875.00
|
| 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 IP EXT ASSIST W MP STOP
|
Facility
|
OP
|
$245.00
|
|
| Hospital Charge Code |
903203820
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$80.24 |
| Max. Negotiated Rate |
$220.50 |
| Rate for Payer: Adventist Health Commercial |
$100.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$208.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$134.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$183.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$142.52
|
| Rate for Payer: Blue Shield of California Commercial |
$196.49
|
| Rate for Payer: Blue Shield of California EPN |
$123.48
|
| Rate for Payer: Cash Price |
$110.25
|
| Rate for Payer: Central Health Plan Commercial |
$196.00
|
| Rate for Payer: Cigna of CA HMO |
$171.50
|
| Rate for Payer: Cigna of CA PPO |
$171.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$208.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$208.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$208.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$171.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.00
|
| Rate for Payer: EPIC Health Plan Senior |
$98.00
|
| Rate for Payer: Galaxy Health WC |
$208.25
|
| Rate for Payer: Global Benefits Group Commercial |
$147.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$220.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$155.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$88.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$144.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$171.50
|
| Rate for Payer: Multiplan Commercial |
$183.75
|
| Rate for Payer: Networks By Design Commercial |
$122.50
|
| Rate for Payer: Prime Health Services Commercial |
$208.25
|
| Rate for Payer: Riverside University Health System MISP |
$98.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$147.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$147.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$91.95
|
| Rate for Payer: United Healthcare All Other HMO |
$89.50
|
| Rate for Payer: United Healthcare HMO Rider |
$87.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$80.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$208.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$208.25
|
| Rate for Payer: Vantage Medical Group Senior |
$208.25
|
|
|
HC WHFO IP EXT ASSIST W MP STOP
|
Facility
|
IP
|
$245.00
|
|
| Hospital Charge Code |
903203820
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$49.00 |
| Max. Negotiated Rate |
$220.50 |
| Rate for Payer: Adventist Health Commercial |
$49.00
|
| Rate for Payer: Blue Shield of California Commercial |
$196.49
|
| Rate for Payer: Blue Shield of California EPN |
$123.48
|
| Rate for Payer: Cash Price |
$110.25
|
| Rate for Payer: Central Health Plan Commercial |
$196.00
|
| Rate for Payer: Cigna of CA HMO |
$171.50
|
| Rate for Payer: Cigna of CA PPO |
$171.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$171.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.00
|
| Rate for Payer: EPIC Health Plan Senior |
$98.00
|
| Rate for Payer: Galaxy Health WC |
$208.25
|
| Rate for Payer: Global Benefits Group Commercial |
$147.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$220.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$155.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$144.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.00
|
| Rate for Payer: Multiplan Commercial |
$183.75
|
| Rate for Payer: Networks By Design Commercial |
$159.25
|
| Rate for Payer: Prime Health Services Commercial |
$208.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$91.95
|
| Rate for Payer: United Healthcare All Other HMO |
$89.50
|
| Rate for Payer: United Healthcare HMO Rider |
$87.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$80.24
|
|
|
HC WHFO IP EXT ASST W/MP STOP
|
Facility
|
IP
|
$165.00
|
|
| Hospital Charge Code |
903203845
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$33.00 |
| Max. Negotiated Rate |
$148.50 |
| Rate for Payer: Adventist Health Commercial |
$33.00
|
| Rate for Payer: Blue Shield of California Commercial |
$132.33
|
| Rate for Payer: Blue Shield of California EPN |
$83.16
|
| Rate for Payer: Cash Price |
$74.25
|
| Rate for Payer: Central Health Plan Commercial |
$132.00
|
| Rate for Payer: Cigna of CA HMO |
$115.50
|
| Rate for Payer: Cigna of CA PPO |
$115.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$115.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$66.00
|
| Rate for Payer: EPIC Health Plan Senior |
$66.00
|
| Rate for Payer: Galaxy Health WC |
$140.25
|
| Rate for Payer: Global Benefits Group Commercial |
$99.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$148.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$104.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$97.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.00
|
| Rate for Payer: Multiplan Commercial |
$123.75
|
| Rate for Payer: Networks By Design Commercial |
$107.25
|
| Rate for Payer: Prime Health Services Commercial |
$140.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$61.92
|
| Rate for Payer: United Healthcare All Other HMO |
$60.27
|
| Rate for Payer: United Healthcare HMO Rider |
$58.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$54.04
|
|
|
HC WHFO IP EXT ASST W/MP STOP
|
Facility
|
OP
|
$165.00
|
|
| Hospital Charge Code |
903203845
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$54.04 |
| Max. Negotiated Rate |
$148.50 |
| Rate for Payer: Adventist Health Commercial |
$67.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$140.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$90.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$123.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$95.98
|
| Rate for Payer: Blue Shield of California Commercial |
$132.33
|
| Rate for Payer: Blue Shield of California EPN |
$83.16
|
| Rate for Payer: Cash Price |
$74.25
|
| Rate for Payer: Central Health Plan Commercial |
$132.00
|
| Rate for Payer: Cigna of CA HMO |
$115.50
|
| Rate for Payer: Cigna of CA PPO |
$115.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$140.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$140.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$140.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$115.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$66.00
|
| Rate for Payer: EPIC Health Plan Senior |
$66.00
|
| Rate for Payer: Galaxy Health WC |
$140.25
|
| Rate for Payer: Global Benefits Group Commercial |
$99.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$148.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$104.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$59.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$97.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$115.50
|
| Rate for Payer: Multiplan Commercial |
$123.75
|
| Rate for Payer: Networks By Design Commercial |
$82.50
|
| Rate for Payer: Prime Health Services Commercial |
$140.25
|
| Rate for Payer: Riverside University Health System MISP |
$66.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$99.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$99.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$61.92
|
| Rate for Payer: United Healthcare All Other HMO |
$60.27
|
| Rate for Payer: United Healthcare HMO Rider |
$58.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$54.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$140.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$140.25
|
| Rate for Payer: Vantage Medical Group Senior |
$140.25
|
|
|
HC WHFO KNUCKLE BENDER
|
Facility
|
OP
|
$339.00
|
|
|
Service Code
|
CPT L3929
|
| Hospital Charge Code |
905353918
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$111.02 |
| Max. Negotiated Rate |
$305.10 |
| 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 |
$197.20
|
| Rate for Payer: Blue Shield of California Commercial |
$271.88
|
| Rate for Payer: Blue Shield of California EPN |
$170.86
|
| Rate for Payer: Cash Price |
$152.55
|
| Rate for Payer: Cash Price |
$152.55
|
| Rate for Payer: Central Health Plan Commercial |
$271.20
|
| 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: Health Management Network EPO/PPO |
$305.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$113.16
|
| 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 |
$138.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$237.30
|
| Rate for Payer: Multiplan Commercial |
$254.25
|
| Rate for Payer: Networks By Design Commercial |
$169.50
|
| Rate for Payer: Prime Health Services Commercial |
$288.15
|
| Rate for Payer: Riverside University Health System MISP |
$135.60
|
| 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 |
$305.10 |
| Rate for Payer: Adventist Health Commercial |
$67.80
|
| Rate for Payer: Blue Shield of California Commercial |
$271.88
|
| Rate for Payer: Blue Shield of California EPN |
$170.86
|
| Rate for Payer: Cash Price |
$152.55
|
| Rate for Payer: Central Health Plan Commercial |
$271.20
|
| 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: Health Management Network EPO/PPO |
$305.10
|
| 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 |
$67.80
|
| Rate for Payer: Multiplan Commercial |
$254.25
|
| 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
|
IP
|
$420.00
|
|
|
Service Code
|
CPT L3925
|
| Hospital Charge Code |
915353922
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$378.00 |
| Rate for Payer: Adventist Health Commercial |
$84.00
|
| Rate for Payer: Blue Shield of California Commercial |
$336.84
|
| Rate for Payer: Blue Shield of California EPN |
$211.68
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Central Health Plan Commercial |
$336.00
|
| Rate for Payer: Cigna of CA HMO |
$294.00
|
| Rate for Payer: Cigna of CA PPO |
$294.00
|
| 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: Health Management Network EPO/PPO |
$378.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$266.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$247.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Multiplan Commercial |
$315.00
|
| Rate for Payer: Networks By Design Commercial |
$273.00
|
| Rate for Payer: Prime Health Services Commercial |
$357.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$157.63
|
| Rate for Payer: United Healthcare All Other HMO |
$153.43
|
| Rate for Payer: United Healthcare HMO Rider |
$150.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$137.55
|
|
|
HC WHFO KNUCKLE BENDER 2 SEG
|
Facility
|
OP
|
$420.00
|
|
|
Service Code
|
CPT L3925
|
| Hospital Charge Code |
905353922
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$69.23 |
| Max. Negotiated Rate |
$378.00 |
| 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 |
$244.31
|
| Rate for Payer: Blue Shield of California Commercial |
$336.84
|
| Rate for Payer: Blue Shield of California EPN |
$211.68
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Central Health Plan Commercial |
$336.00
|
| 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: Health Management Network EPO/PPO |
$378.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$69.23
|
| 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 |
$172.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$294.00
|
| Rate for Payer: Multiplan Commercial |
$315.00
|
| Rate for Payer: Networks By Design Commercial |
$210.00
|
| Rate for Payer: Prime Health Services Commercial |
$357.00
|
| Rate for Payer: Riverside University Health System MISP |
$168.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$252.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$252.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$157.63
|
| Rate for Payer: United Healthcare All Other HMO |
$153.43
|
| Rate for Payer: United Healthcare HMO Rider |
$150.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$137.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$357.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$357.00
|
| Rate for Payer: Vantage Medical Group Senior |
$357.00
|
|
|
HC WHFO KNUCKLE BENDER 2 SEG
|
Facility
|
IP
|
$420.00
|
|
|
Service Code
|
CPT L3925
|
| Hospital Charge Code |
905353922
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$378.00 |
| Rate for Payer: Adventist Health Commercial |
$84.00
|
| Rate for Payer: Blue Shield of California Commercial |
$336.84
|
| Rate for Payer: Blue Shield of California EPN |
$211.68
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Central Health Plan Commercial |
$336.00
|
| Rate for Payer: Cigna of CA HMO |
$294.00
|
| Rate for Payer: Cigna of CA PPO |
$294.00
|
| 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: Health Management Network EPO/PPO |
$378.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$266.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$247.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Multiplan Commercial |
$315.00
|
| Rate for Payer: Networks By Design Commercial |
$273.00
|
| Rate for Payer: Prime Health Services Commercial |
$357.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$157.63
|
| Rate for Payer: United Healthcare All Other HMO |
$153.43
|
| Rate for Payer: United Healthcare HMO Rider |
$150.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$137.55
|
|
|
HC WHFO KNUCKLE BENDER 2 SEG
|
Facility
|
OP
|
$420.00
|
|
|
Service Code
|
CPT L3925
|
| Hospital Charge Code |
915353922
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$69.23 |
| Max. Negotiated Rate |
$378.00 |
| 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 |
$244.31
|
| Rate for Payer: Blue Shield of California Commercial |
$336.84
|
| Rate for Payer: Blue Shield of California EPN |
$211.68
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Central Health Plan Commercial |
$336.00
|
| 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: Health Management Network EPO/PPO |
$378.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$69.23
|
| 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 |
$172.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$294.00
|
| Rate for Payer: Multiplan Commercial |
$315.00
|
| Rate for Payer: Networks By Design Commercial |
$210.00
|
| Rate for Payer: Prime Health Services Commercial |
$357.00
|
| Rate for Payer: Riverside University Health System MISP |
$168.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$252.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$252.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$157.63
|
| Rate for Payer: United Healthcare All Other HMO |
$153.43
|
| Rate for Payer: United Healthcare HMO Rider |
$150.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$137.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$357.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$357.00
|
| Rate for Payer: Vantage Medical Group Senior |
$357.00
|
|
|
HC WHFO KNUCKLE BENDER OUTRIGGER
|
Facility
|
IP
|
$424.00
|
|
|
Service Code
|
CPT L3929
|
| Hospital Charge Code |
915353920
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$84.80 |
| Max. Negotiated Rate |
$381.60 |
| Rate for Payer: Networks By Design Commercial |
$275.60
|
| Rate for Payer: Adventist Health Commercial |
$84.80
|
| Rate for Payer: Blue Shield of California Commercial |
$340.05
|
| Rate for Payer: Blue Shield of California EPN |
$213.70
|
| Rate for Payer: Cash Price |
$190.80
|
| Rate for Payer: Central Health Plan Commercial |
$339.20
|
| Rate for Payer: Cigna of CA HMO |
$296.80
|
| Rate for Payer: Cigna of CA PPO |
$296.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$296.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$169.60
|
| Rate for Payer: EPIC Health Plan Senior |
$169.60
|
| Rate for Payer: Galaxy Health WC |
$360.40
|
| Rate for Payer: Global Benefits Group Commercial |
$254.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$381.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$269.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$250.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.80
|
| Rate for Payer: Multiplan Commercial |
$318.00
|
| Rate for Payer: Prime Health Services Commercial |
$360.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$159.13
|
| Rate for Payer: United Healthcare All Other HMO |
$154.89
|
| Rate for Payer: United Healthcare HMO Rider |
$151.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$138.86
|
|
|
HC WHFO KNUCKLE BENDER OUTRIGGER
|
Facility
|
OP
|
$424.00
|
|
|
Service Code
|
CPT L3929
|
| Hospital Charge Code |
915353920
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$113.16 |
| Max. Negotiated Rate |
$381.60 |
| Rate for Payer: Adventist Health Commercial |
$173.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$360.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$233.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$318.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$246.64
|
| Rate for Payer: Blue Shield of California Commercial |
$340.05
|
| Rate for Payer: Blue Shield of California EPN |
$213.70
|
| Rate for Payer: Cash Price |
$190.80
|
| Rate for Payer: Cash Price |
$190.80
|
| Rate for Payer: Central Health Plan Commercial |
$339.20
|
| Rate for Payer: Cigna of CA HMO |
$296.80
|
| Rate for Payer: Cigna of CA PPO |
$296.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$360.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$360.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$360.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$296.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$169.60
|
| Rate for Payer: EPIC Health Plan Senior |
$169.60
|
| Rate for Payer: Galaxy Health WC |
$360.40
|
| Rate for Payer: Global Benefits Group Commercial |
$254.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$381.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$113.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$269.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$125.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$250.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$173.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$296.80
|
| Rate for Payer: Multiplan Commercial |
$318.00
|
| Rate for Payer: Networks By Design Commercial |
$212.00
|
| Rate for Payer: Prime Health Services Commercial |
$360.40
|
| Rate for Payer: Riverside University Health System MISP |
$169.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$254.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$254.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$159.13
|
| Rate for Payer: United Healthcare All Other HMO |
$154.89
|
| Rate for Payer: United Healthcare HMO Rider |
$151.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$138.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$360.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$360.40
|
| Rate for Payer: Vantage Medical Group Senior |
$360.40
|
|
|
HC WHFO KNUCKLE BENDER OUTRIGGER
|
Facility
|
OP
|
$424.00
|
|
|
Service Code
|
CPT L3929
|
| Hospital Charge Code |
905353920
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$113.16 |
| Max. Negotiated Rate |
$381.60 |
| Rate for Payer: Adventist Health Commercial |
$173.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$360.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$233.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$318.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$246.64
|
| Rate for Payer: Blue Shield of California Commercial |
$340.05
|
| Rate for Payer: Blue Shield of California EPN |
$213.70
|
| Rate for Payer: Cash Price |
$190.80
|
| Rate for Payer: Cash Price |
$190.80
|
| Rate for Payer: Central Health Plan Commercial |
$339.20
|
| Rate for Payer: Cigna of CA HMO |
$296.80
|
| Rate for Payer: Cigna of CA PPO |
$296.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$360.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$360.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$360.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$296.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$169.60
|
| Rate for Payer: EPIC Health Plan Senior |
$169.60
|
| Rate for Payer: Galaxy Health WC |
$360.40
|
| Rate for Payer: Global Benefits Group Commercial |
$254.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$381.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$113.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$269.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$125.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$250.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$173.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$296.80
|
| Rate for Payer: Multiplan Commercial |
$318.00
|
| Rate for Payer: Networks By Design Commercial |
$212.00
|
| Rate for Payer: Prime Health Services Commercial |
$360.40
|
| Rate for Payer: Riverside University Health System MISP |
$169.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$254.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$254.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$159.13
|
| Rate for Payer: United Healthcare All Other HMO |
$154.89
|
| Rate for Payer: United Healthcare HMO Rider |
$151.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$138.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$360.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$360.40
|
| Rate for Payer: Vantage Medical Group Senior |
$360.40
|
|
|
HC WHFO KNUCKLE BENDER OUTRIGGER
|
Facility
|
IP
|
$424.00
|
|
|
Service Code
|
CPT L3929
|
| Hospital Charge Code |
905353920
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$84.80 |
| Max. Negotiated Rate |
$381.60 |
| Rate for Payer: Adventist Health Commercial |
$84.80
|
| Rate for Payer: Blue Shield of California Commercial |
$340.05
|
| Rate for Payer: Blue Shield of California EPN |
$213.70
|
| Rate for Payer: Cash Price |
$190.80
|
| Rate for Payer: Central Health Plan Commercial |
$339.20
|
| Rate for Payer: Cigna of CA HMO |
$296.80
|
| Rate for Payer: Cigna of CA PPO |
$296.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$296.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$169.60
|
| Rate for Payer: EPIC Health Plan Senior |
$169.60
|
| Rate for Payer: Galaxy Health WC |
$360.40
|
| Rate for Payer: Global Benefits Group Commercial |
$254.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$381.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$269.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$250.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.80
|
| Rate for Payer: Multiplan Commercial |
$318.00
|
| Rate for Payer: Networks By Design Commercial |
$275.60
|
| Rate for Payer: Prime Health Services Commercial |
$360.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$159.13
|
| Rate for Payer: United Healthcare All Other HMO |
$154.89
|
| Rate for Payer: United Healthcare HMO Rider |
$151.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$138.86
|
|
