|
HC WHFO LONG OPPONENS WO ATTACH
|
Facility
|
IP
|
$936.00
|
|
|
Service Code
|
CPT L3808
|
| Hospital Charge Code |
901309111
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$187.20 |
| Max. Negotiated Rate |
$842.40 |
| Rate for Payer: Adventist Health Commercial |
$187.20
|
| Rate for Payer: Blue Shield of California Commercial |
$750.67
|
| Rate for Payer: Blue Shield of California EPN |
$471.74
|
| Rate for Payer: Cash Price |
$421.20
|
| Rate for Payer: Central Health Plan Commercial |
$748.80
|
| Rate for Payer: Cigna of CA HMO |
$655.20
|
| Rate for Payer: Cigna of CA PPO |
$655.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$655.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$374.40
|
| Rate for Payer: EPIC Health Plan Senior |
$374.40
|
| Rate for Payer: Galaxy Health WC |
$795.60
|
| Rate for Payer: Global Benefits Group Commercial |
$561.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$842.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$594.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$552.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$187.20
|
| Rate for Payer: Multiplan Commercial |
$702.00
|
| Rate for Payer: Networks By Design Commercial |
$608.40
|
| Rate for Payer: Prime Health Services Commercial |
$795.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$351.28
|
| Rate for Payer: United Healthcare All Other HMO |
$341.92
|
| Rate for Payer: United Healthcare HMO Rider |
$334.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$306.54
|
|
|
HC WHFO LONG OPPONENS WO ATTACH
|
Facility
|
OP
|
$936.00
|
|
|
Service Code
|
CPT L3808
|
| Hospital Charge Code |
901309111
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$289.67 |
| Max. Negotiated Rate |
$842.40 |
| Rate for Payer: Adventist Health Commercial |
$383.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$795.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$514.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$702.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$544.47
|
| Rate for Payer: Blue Shield of California Commercial |
$750.67
|
| Rate for Payer: Blue Shield of California EPN |
$471.74
|
| Rate for Payer: Cash Price |
$421.20
|
| Rate for Payer: Cash Price |
$421.20
|
| Rate for Payer: Central Health Plan Commercial |
$748.80
|
| Rate for Payer: Cigna of CA HMO |
$655.20
|
| Rate for Payer: Cigna of CA PPO |
$655.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$795.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$795.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$795.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$655.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$374.40
|
| Rate for Payer: EPIC Health Plan Senior |
$374.40
|
| Rate for Payer: Galaxy Health WC |
$795.60
|
| Rate for Payer: Global Benefits Group Commercial |
$561.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$842.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$289.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$594.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$319.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$552.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$383.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$655.20
|
| Rate for Payer: Multiplan Commercial |
$702.00
|
| Rate for Payer: Networks By Design Commercial |
$468.00
|
| Rate for Payer: Prime Health Services Commercial |
$795.60
|
| Rate for Payer: Riverside University Health System MISP |
$374.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$561.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$561.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$351.28
|
| Rate for Payer: United Healthcare All Other HMO |
$341.92
|
| Rate for Payer: United Healthcare HMO Rider |
$334.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$306.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$795.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$795.60
|
| Rate for Payer: Vantage Medical Group Senior |
$795.60
|
|
|
HC WHFO LONG OPPONENS WO ATTACH CF
|
Facility
|
OP
|
$549.00
|
|
|
Service Code
|
CPT L3808
|
| Hospital Charge Code |
903203805
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$179.80 |
| Max. Negotiated Rate |
$494.10 |
| Rate for Payer: Adventist Health Commercial |
$225.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$466.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$301.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$411.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$319.35
|
| Rate for Payer: Blue Shield of California Commercial |
$440.30
|
| Rate for Payer: Blue Shield of California EPN |
$276.70
|
| Rate for Payer: Cash Price |
$247.05
|
| Rate for Payer: Cash Price |
$247.05
|
| Rate for Payer: Central Health Plan Commercial |
$439.20
|
| Rate for Payer: Cigna of CA HMO |
$384.30
|
| Rate for Payer: Cigna of CA PPO |
$384.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$466.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$466.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$466.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$384.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$219.60
|
| Rate for Payer: EPIC Health Plan Senior |
$219.60
|
| Rate for Payer: Galaxy Health WC |
$466.65
|
| Rate for Payer: Global Benefits Group Commercial |
$329.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$494.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$289.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$348.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$319.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$323.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$225.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$384.30
|
| Rate for Payer: Multiplan Commercial |
$411.75
|
| Rate for Payer: Networks By Design Commercial |
$274.50
|
| Rate for Payer: Prime Health Services Commercial |
$466.65
|
| Rate for Payer: Riverside University Health System MISP |
$219.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$329.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$329.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$206.04
|
| Rate for Payer: United Healthcare All Other HMO |
$200.55
|
| Rate for Payer: United Healthcare HMO Rider |
$196.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$179.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$466.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$466.65
|
| Rate for Payer: Vantage Medical Group Senior |
$466.65
|
|
|
HC WHFO LONG OPPONENS WO ATTACH CF
|
Facility
|
IP
|
$549.00
|
|
|
Service Code
|
CPT L3808
|
| Hospital Charge Code |
903203805
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$109.80 |
| Max. Negotiated Rate |
$494.10 |
| Rate for Payer: Adventist Health Commercial |
$109.80
|
| Rate for Payer: Blue Shield of California Commercial |
$440.30
|
| Rate for Payer: Blue Shield of California EPN |
$276.70
|
| Rate for Payer: Cash Price |
$247.05
|
| Rate for Payer: Central Health Plan Commercial |
$439.20
|
| Rate for Payer: Cigna of CA HMO |
$384.30
|
| Rate for Payer: Cigna of CA PPO |
$384.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$384.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$219.60
|
| Rate for Payer: EPIC Health Plan Senior |
$219.60
|
| Rate for Payer: Galaxy Health WC |
$466.65
|
| Rate for Payer: Global Benefits Group Commercial |
$329.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$494.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$348.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$323.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$109.80
|
| Rate for Payer: Multiplan Commercial |
$411.75
|
| Rate for Payer: Networks By Design Commercial |
$356.85
|
| Rate for Payer: Prime Health Services Commercial |
$466.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$206.04
|
| Rate for Payer: United Healthcare All Other HMO |
$200.55
|
| Rate for Payer: United Healthcare HMO Rider |
$196.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$179.80
|
|
|
HC WHFO MP EXT ASSIST
|
Facility
|
IP
|
$170.00
|
|
| Hospital Charge Code |
903203830
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$34.00 |
| Max. Negotiated Rate |
$153.00 |
| Rate for Payer: Adventist Health Commercial |
$34.00
|
| Rate for Payer: Blue Shield of California Commercial |
$136.34
|
| Rate for Payer: Blue Shield of California EPN |
$85.68
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Central Health Plan Commercial |
$136.00
|
| Rate for Payer: Cigna of CA HMO |
$119.00
|
| Rate for Payer: Cigna of CA PPO |
$119.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$119.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.00
|
| Rate for Payer: EPIC Health Plan Senior |
$68.00
|
| Rate for Payer: Galaxy Health WC |
$144.50
|
| Rate for Payer: Global Benefits Group Commercial |
$102.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$153.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$107.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$100.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.00
|
| Rate for Payer: Multiplan Commercial |
$127.50
|
| Rate for Payer: Networks By Design Commercial |
$110.50
|
| Rate for Payer: Prime Health Services Commercial |
$144.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$63.80
|
| Rate for Payer: United Healthcare All Other HMO |
$62.10
|
| Rate for Payer: United Healthcare HMO Rider |
$60.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$55.67
|
|
|
HC WHFO MP EXT ASSIST
|
Facility
|
OP
|
$170.00
|
|
| Hospital Charge Code |
903203830
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$55.67 |
| Max. Negotiated Rate |
$153.00 |
| Rate for Payer: Adventist Health Commercial |
$69.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$144.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$93.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$127.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$98.89
|
| Rate for Payer: Blue Shield of California Commercial |
$136.34
|
| Rate for Payer: Blue Shield of California EPN |
$85.68
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Central Health Plan Commercial |
$136.00
|
| Rate for Payer: Cigna of CA HMO |
$119.00
|
| Rate for Payer: Cigna of CA PPO |
$119.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$144.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$144.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$144.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$119.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.00
|
| Rate for Payer: EPIC Health Plan Senior |
$68.00
|
| Rate for Payer: Galaxy Health WC |
$144.50
|
| Rate for Payer: Global Benefits Group Commercial |
$102.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$153.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$107.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$61.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$100.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$119.00
|
| Rate for Payer: Multiplan Commercial |
$127.50
|
| Rate for Payer: Networks By Design Commercial |
$85.00
|
| Rate for Payer: Prime Health Services Commercial |
$144.50
|
| Rate for Payer: Riverside University Health System MISP |
$68.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$102.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$102.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$63.80
|
| Rate for Payer: United Healthcare All Other HMO |
$62.10
|
| Rate for Payer: United Healthcare HMO Rider |
$60.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$55.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$144.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$144.50
|
| Rate for Payer: Vantage Medical Group Senior |
$144.50
|
|
|
HC WHFO MP SPRNG EXT ASSIST
|
Facility
|
OP
|
$265.00
|
|
| Hospital Charge Code |
903203835
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$86.79 |
| Max. Negotiated Rate |
$238.50 |
| Rate for Payer: Adventist Health Commercial |
$108.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$225.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$145.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$154.15
|
| Rate for Payer: Blue Shield of California Commercial |
$212.53
|
| Rate for Payer: Blue Shield of California EPN |
$133.56
|
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: Central Health Plan Commercial |
$212.00
|
| Rate for Payer: Cigna of CA HMO |
$185.50
|
| Rate for Payer: Cigna of CA PPO |
$185.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$225.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$225.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$185.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.00
|
| Rate for Payer: EPIC Health Plan Senior |
$106.00
|
| Rate for Payer: Galaxy Health WC |
$225.25
|
| Rate for Payer: Global Benefits Group Commercial |
$159.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$238.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$168.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$96.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$185.50
|
| Rate for Payer: Multiplan Commercial |
$198.75
|
| Rate for Payer: Networks By Design Commercial |
$132.50
|
| Rate for Payer: Prime Health Services Commercial |
$225.25
|
| Rate for Payer: Riverside University Health System MISP |
$106.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$159.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$159.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$99.45
|
| Rate for Payer: United Healthcare All Other HMO |
$96.80
|
| Rate for Payer: United Healthcare HMO Rider |
$94.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$86.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$225.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$225.25
|
| Rate for Payer: Vantage Medical Group Senior |
$225.25
|
|
|
HC WHFO MP SPRNG EXT ASSIST
|
Facility
|
IP
|
$265.00
|
|
| Hospital Charge Code |
903203835
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$53.00 |
| Max. Negotiated Rate |
$238.50 |
| Rate for Payer: Adventist Health Commercial |
$53.00
|
| Rate for Payer: Blue Shield of California Commercial |
$212.53
|
| Rate for Payer: Blue Shield of California EPN |
$133.56
|
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: Central Health Plan Commercial |
$212.00
|
| Rate for Payer: Cigna of CA HMO |
$185.50
|
| Rate for Payer: Cigna of CA PPO |
$185.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$185.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.00
|
| Rate for Payer: EPIC Health Plan Senior |
$106.00
|
| Rate for Payer: Galaxy Health WC |
$225.25
|
| Rate for Payer: Global Benefits Group Commercial |
$159.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$238.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$168.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.00
|
| Rate for Payer: Multiplan Commercial |
$198.75
|
| Rate for Payer: Networks By Design Commercial |
$172.25
|
| Rate for Payer: Prime Health Services Commercial |
$225.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$99.45
|
| Rate for Payer: United Healthcare All Other HMO |
$96.80
|
| Rate for Payer: United Healthcare HMO Rider |
$94.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$86.79
|
|
|
HC WHFO NONTORSION JOINT(S) PREFA
|
Facility
|
OP
|
$459.00
|
|
|
Service Code
|
CPT L3931
|
| Hospital Charge Code |
905353931
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$150.32 |
| Max. Negotiated Rate |
$413.10 |
| Rate for Payer: Adventist Health Commercial |
$188.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$390.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$252.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$344.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$267.00
|
| Rate for Payer: Blue Shield of California Commercial |
$368.12
|
| Rate for Payer: Blue Shield of California EPN |
$231.34
|
| Rate for Payer: Cash Price |
$206.55
|
| Rate for Payer: Cash Price |
$206.55
|
| Rate for Payer: Central Health Plan Commercial |
$367.20
|
| Rate for Payer: Cigna of CA HMO |
$321.30
|
| Rate for Payer: Cigna of CA PPO |
$321.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$390.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$390.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$390.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$321.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$183.60
|
| Rate for Payer: EPIC Health Plan Senior |
$183.60
|
| Rate for Payer: Galaxy Health WC |
$390.15
|
| Rate for Payer: Global Benefits Group Commercial |
$275.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$413.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$252.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$291.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$279.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$270.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$188.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$321.30
|
| Rate for Payer: Multiplan Commercial |
$344.25
|
| Rate for Payer: Networks By Design Commercial |
$229.50
|
| Rate for Payer: Prime Health Services Commercial |
$390.15
|
| Rate for Payer: Riverside University Health System MISP |
$183.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$275.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$275.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$172.26
|
| Rate for Payer: United Healthcare All Other HMO |
$167.67
|
| Rate for Payer: United Healthcare HMO Rider |
$164.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$150.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$390.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$390.15
|
| Rate for Payer: Vantage Medical Group Senior |
$390.15
|
|
|
HC WHFO NONTORSION JOINT(S) PREFA
|
Facility
|
IP
|
$459.00
|
|
|
Service Code
|
CPT L3931
|
| Hospital Charge Code |
905353931
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$91.80 |
| Max. Negotiated Rate |
$413.10 |
| Rate for Payer: Adventist Health Commercial |
$91.80
|
| Rate for Payer: Blue Shield of California Commercial |
$368.12
|
| Rate for Payer: Blue Shield of California EPN |
$231.34
|
| Rate for Payer: Cash Price |
$206.55
|
| Rate for Payer: Central Health Plan Commercial |
$367.20
|
| Rate for Payer: Cigna of CA HMO |
$321.30
|
| Rate for Payer: Cigna of CA PPO |
$321.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$321.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$183.60
|
| Rate for Payer: EPIC Health Plan Senior |
$183.60
|
| Rate for Payer: Galaxy Health WC |
$390.15
|
| Rate for Payer: Global Benefits Group Commercial |
$275.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$413.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$291.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$270.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$91.80
|
| Rate for Payer: Multiplan Commercial |
$344.25
|
| Rate for Payer: Networks By Design Commercial |
$298.35
|
| Rate for Payer: Prime Health Services Commercial |
$390.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$172.26
|
| Rate for Payer: United Healthcare All Other HMO |
$167.67
|
| Rate for Payer: United Healthcare HMO Rider |
$164.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$150.32
|
|
|
HC WHFO OPPENHEIMER
|
Facility
|
OP
|
$427.00
|
|
|
Service Code
|
CPT L3931
|
| Hospital Charge Code |
915353924
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$139.84 |
| Max. Negotiated Rate |
$384.30 |
| Rate for Payer: Adventist Health Commercial |
$175.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$362.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$234.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$320.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$248.39
|
| Rate for Payer: Blue Shield of California Commercial |
$342.45
|
| Rate for Payer: Blue Shield of California EPN |
$215.21
|
| Rate for Payer: Cash Price |
$192.15
|
| Rate for Payer: Cash Price |
$192.15
|
| Rate for Payer: Central Health Plan Commercial |
$341.60
|
| Rate for Payer: Cigna of CA HMO |
$298.90
|
| Rate for Payer: Cigna of CA PPO |
$298.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$362.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$362.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$362.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$298.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$170.80
|
| Rate for Payer: EPIC Health Plan Senior |
$170.80
|
| Rate for Payer: Galaxy Health WC |
$362.95
|
| Rate for Payer: Global Benefits Group Commercial |
$256.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$384.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$252.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$271.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$279.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$251.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$175.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$298.90
|
| Rate for Payer: Multiplan Commercial |
$320.25
|
| Rate for Payer: Networks By Design Commercial |
$213.50
|
| Rate for Payer: Prime Health Services Commercial |
$362.95
|
| Rate for Payer: Riverside University Health System MISP |
$170.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$256.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$256.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$160.25
|
| Rate for Payer: United Healthcare All Other HMO |
$155.98
|
| Rate for Payer: United Healthcare HMO Rider |
$152.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$139.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$362.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$362.95
|
| Rate for Payer: Vantage Medical Group Senior |
$362.95
|
|
|
HC WHFO OPPENHEIMER
|
Facility
|
IP
|
$427.00
|
|
|
Service Code
|
CPT L3931
|
| Hospital Charge Code |
915353924
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$85.40 |
| Max. Negotiated Rate |
$384.30 |
| Rate for Payer: Cash Price |
$192.15
|
| Rate for Payer: Central Health Plan Commercial |
$341.60
|
| Rate for Payer: Cigna of CA HMO |
$298.90
|
| Rate for Payer: Cigna of CA PPO |
$298.90
|
| Rate for Payer: Adventist Health Commercial |
$85.40
|
| Rate for Payer: Blue Shield of California Commercial |
$342.45
|
| Rate for Payer: Blue Shield of California EPN |
$215.21
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$298.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$170.80
|
| Rate for Payer: EPIC Health Plan Senior |
$170.80
|
| Rate for Payer: Galaxy Health WC |
$362.95
|
| Rate for Payer: Global Benefits Group Commercial |
$256.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$384.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$271.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$251.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$85.40
|
| Rate for Payer: Multiplan Commercial |
$320.25
|
| Rate for Payer: Networks By Design Commercial |
$277.55
|
| Rate for Payer: Prime Health Services Commercial |
$362.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$160.25
|
| Rate for Payer: United Healthcare All Other HMO |
$155.98
|
| Rate for Payer: United Healthcare HMO Rider |
$152.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$139.84
|
|
|
HC WHFO OPPENHEIMER OT
|
Facility
|
OP
|
$560.00
|
|
|
Service Code
|
CPT L3931
|
| Hospital Charge Code |
901300800
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$183.40 |
| Max. Negotiated Rate |
$504.00 |
| Rate for Payer: Adventist Health Commercial |
$229.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$476.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$308.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$420.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$325.75
|
| Rate for Payer: Blue Shield of California Commercial |
$449.12
|
| Rate for Payer: Blue Shield of California EPN |
$282.24
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Central Health Plan Commercial |
$448.00
|
| Rate for Payer: Cigna of CA HMO |
$392.00
|
| Rate for Payer: Cigna of CA PPO |
$392.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$476.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$476.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$476.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$392.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$224.00
|
| Rate for Payer: EPIC Health Plan Senior |
$224.00
|
| Rate for Payer: Galaxy Health WC |
$476.00
|
| Rate for Payer: Global Benefits Group Commercial |
$336.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$504.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$252.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$355.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$279.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$330.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$229.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$392.00
|
| Rate for Payer: Multiplan Commercial |
$420.00
|
| Rate for Payer: Networks By Design Commercial |
$280.00
|
| Rate for Payer: Prime Health Services Commercial |
$476.00
|
| Rate for Payer: Riverside University Health System MISP |
$224.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$336.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$336.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$210.17
|
| Rate for Payer: United Healthcare All Other HMO |
$204.57
|
| Rate for Payer: United Healthcare HMO Rider |
$200.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$183.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$476.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$476.00
|
| Rate for Payer: Vantage Medical Group Senior |
$476.00
|
|
|
HC WHFO OPPENHEIMER OT
|
Facility
|
IP
|
$560.00
|
|
|
Service Code
|
CPT L3931
|
| Hospital Charge Code |
901300800
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$112.00 |
| Max. Negotiated Rate |
$504.00 |
| Rate for Payer: Adventist Health Commercial |
$112.00
|
| Rate for Payer: Blue Shield of California Commercial |
$449.12
|
| Rate for Payer: Blue Shield of California EPN |
$282.24
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Central Health Plan Commercial |
$448.00
|
| Rate for Payer: Cigna of CA HMO |
$392.00
|
| Rate for Payer: Cigna of CA PPO |
$392.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$392.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$224.00
|
| Rate for Payer: EPIC Health Plan Senior |
$224.00
|
| Rate for Payer: Galaxy Health WC |
$476.00
|
| Rate for Payer: Global Benefits Group Commercial |
$336.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$504.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$355.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$330.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.00
|
| Rate for Payer: Multiplan Commercial |
$420.00
|
| Rate for Payer: Networks By Design Commercial |
$364.00
|
| Rate for Payer: Prime Health Services Commercial |
$476.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$210.17
|
| Rate for Payer: United Healthcare All Other HMO |
$204.57
|
| Rate for Payer: United Healthcare HMO Rider |
$200.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$183.40
|
|
|
HC WHFO REVERSE KNUCKLE BENDER
|
Facility
|
IP
|
$198.00
|
|
|
Service Code
|
CPT L3929
|
| Hospital Charge Code |
905353942
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$39.60 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Adventist Health Commercial |
$39.60
|
| Rate for Payer: Blue Shield of California Commercial |
$158.80
|
| Rate for Payer: Blue Shield of California EPN |
$99.79
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Central Health Plan Commercial |
$158.40
|
| Rate for Payer: Cigna of CA HMO |
$138.60
|
| Rate for Payer: Cigna of CA PPO |
$138.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$138.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.20
|
| Rate for Payer: EPIC Health Plan Senior |
$79.20
|
| Rate for Payer: Galaxy Health WC |
$168.30
|
| Rate for Payer: Global Benefits Group Commercial |
$118.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$178.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$125.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$116.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.60
|
| Rate for Payer: Multiplan Commercial |
$148.50
|
| Rate for Payer: Networks By Design Commercial |
$128.70
|
| Rate for Payer: Prime Health Services Commercial |
$168.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$74.31
|
| Rate for Payer: United Healthcare All Other HMO |
$72.33
|
| Rate for Payer: United Healthcare HMO Rider |
$70.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$64.84
|
|
|
HC WHFO REVERSE KNUCKLE BENDER
|
Facility
|
OP
|
$198.00
|
|
|
Service Code
|
CPT L3929
|
| Hospital Charge Code |
905353942
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$64.84 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Adventist Health Commercial |
$81.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$168.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$108.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$148.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$115.18
|
| Rate for Payer: Blue Shield of California Commercial |
$158.80
|
| Rate for Payer: Blue Shield of California EPN |
$99.79
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Central Health Plan Commercial |
$158.40
|
| Rate for Payer: Cigna of CA HMO |
$138.60
|
| Rate for Payer: Cigna of CA PPO |
$138.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$168.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$168.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$168.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$138.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.20
|
| Rate for Payer: EPIC Health Plan Senior |
$79.20
|
| Rate for Payer: Galaxy Health WC |
$168.30
|
| Rate for Payer: Global Benefits Group Commercial |
$118.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$178.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$113.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$125.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$125.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$116.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$138.60
|
| Rate for Payer: Multiplan Commercial |
$148.50
|
| Rate for Payer: Networks By Design Commercial |
$99.00
|
| Rate for Payer: Prime Health Services Commercial |
$168.30
|
| Rate for Payer: Riverside University Health System MISP |
$79.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$118.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$118.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$74.31
|
| Rate for Payer: United Healthcare All Other HMO |
$72.33
|
| Rate for Payer: United Healthcare HMO Rider |
$70.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$64.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$168.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$168.30
|
| Rate for Payer: Vantage Medical Group Senior |
$168.30
|
|
|
HC WHFO REV KNUCK BNDR OUTRIGGER
|
Facility
|
IP
|
$227.00
|
|
|
Service Code
|
CPT L3929
|
| Hospital Charge Code |
905353944
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$45.40 |
| Max. Negotiated Rate |
$204.30 |
| Rate for Payer: Adventist Health Commercial |
$45.40
|
| Rate for Payer: Blue Shield of California Commercial |
$182.05
|
| Rate for Payer: Blue Shield of California EPN |
$114.41
|
| Rate for Payer: Cash Price |
$102.15
|
| Rate for Payer: Central Health Plan Commercial |
$181.60
|
| Rate for Payer: Cigna of CA HMO |
$158.90
|
| Rate for Payer: Cigna of CA PPO |
$158.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$158.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$90.80
|
| Rate for Payer: EPIC Health Plan Senior |
$90.80
|
| Rate for Payer: Galaxy Health WC |
$192.95
|
| Rate for Payer: Global Benefits Group Commercial |
$136.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$204.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$144.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$133.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.40
|
| Rate for Payer: Multiplan Commercial |
$170.25
|
| Rate for Payer: Networks By Design Commercial |
$147.55
|
| Rate for Payer: Prime Health Services Commercial |
$192.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$85.19
|
| Rate for Payer: United Healthcare All Other HMO |
$82.92
|
| Rate for Payer: United Healthcare HMO Rider |
$81.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$74.34
|
|
|
HC WHFO REV KNUCK BNDR OUTRIGGER
|
Facility
|
OP
|
$227.00
|
|
|
Service Code
|
CPT L3929
|
| Hospital Charge Code |
905353944
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$74.34 |
| Max. Negotiated Rate |
$204.30 |
| Rate for Payer: Adventist Health Commercial |
$93.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$192.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$124.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$170.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$132.05
|
| Rate for Payer: Blue Shield of California Commercial |
$182.05
|
| Rate for Payer: Blue Shield of California EPN |
$114.41
|
| Rate for Payer: Cash Price |
$102.15
|
| Rate for Payer: Cash Price |
$102.15
|
| Rate for Payer: Central Health Plan Commercial |
$181.60
|
| Rate for Payer: Cigna of CA HMO |
$158.90
|
| Rate for Payer: Cigna of CA PPO |
$158.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$192.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$192.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$192.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$158.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$90.80
|
| Rate for Payer: EPIC Health Plan Senior |
$90.80
|
| Rate for Payer: Galaxy Health WC |
$192.95
|
| Rate for Payer: Global Benefits Group Commercial |
$136.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$204.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$113.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$144.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$125.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$133.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$158.90
|
| Rate for Payer: Multiplan Commercial |
$170.25
|
| Rate for Payer: Networks By Design Commercial |
$113.50
|
| Rate for Payer: Prime Health Services Commercial |
$192.95
|
| Rate for Payer: Riverside University Health System MISP |
$90.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$136.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$136.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$85.19
|
| Rate for Payer: United Healthcare All Other HMO |
$82.92
|
| Rate for Payer: United Healthcare HMO Rider |
$81.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$74.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$192.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$192.95
|
| Rate for Payer: Vantage Medical Group Senior |
$192.95
|
|
|
HC WHFO RIGID W/O JOINTS
|
Facility
|
IP
|
$697.00
|
|
|
Service Code
|
CPT L3808
|
| Hospital Charge Code |
905353808
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$139.40 |
| Max. Negotiated Rate |
$627.30 |
| Rate for Payer: Adventist Health Commercial |
$139.40
|
| Rate for Payer: Blue Shield of California Commercial |
$558.99
|
| Rate for Payer: Blue Shield of California EPN |
$351.29
|
| Rate for Payer: Cash Price |
$313.65
|
| Rate for Payer: Central Health Plan Commercial |
$557.60
|
| Rate for Payer: Cigna of CA HMO |
$487.90
|
| Rate for Payer: Cigna of CA PPO |
$487.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$487.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$278.80
|
| Rate for Payer: EPIC Health Plan Senior |
$278.80
|
| Rate for Payer: Galaxy Health WC |
$592.45
|
| Rate for Payer: Global Benefits Group Commercial |
$418.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$627.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$442.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$411.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.40
|
| Rate for Payer: Multiplan Commercial |
$522.75
|
| Rate for Payer: Networks By Design Commercial |
$453.05
|
| Rate for Payer: Prime Health Services Commercial |
$592.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$261.58
|
| Rate for Payer: United Healthcare All Other HMO |
$254.61
|
| Rate for Payer: United Healthcare HMO Rider |
$249.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$228.27
|
|
|
HC WHFO RIGID W/O JOINTS
|
Facility
|
OP
|
$697.00
|
|
|
Service Code
|
CPT L3808
|
| Hospital Charge Code |
905353808
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$228.27 |
| Max. Negotiated Rate |
$627.30 |
| Rate for Payer: Adventist Health Commercial |
$285.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$592.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$383.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$522.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$405.44
|
| Rate for Payer: Blue Shield of California Commercial |
$558.99
|
| Rate for Payer: Blue Shield of California EPN |
$351.29
|
| Rate for Payer: Cash Price |
$313.65
|
| Rate for Payer: Cash Price |
$313.65
|
| Rate for Payer: Central Health Plan Commercial |
$557.60
|
| Rate for Payer: Cigna of CA HMO |
$487.90
|
| Rate for Payer: Cigna of CA PPO |
$487.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$592.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$592.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$592.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$487.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$278.80
|
| Rate for Payer: EPIC Health Plan Senior |
$278.80
|
| Rate for Payer: Galaxy Health WC |
$592.45
|
| Rate for Payer: Global Benefits Group Commercial |
$418.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$627.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$289.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$442.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$319.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$411.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$285.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$487.90
|
| Rate for Payer: Multiplan Commercial |
$522.75
|
| Rate for Payer: Networks By Design Commercial |
$348.50
|
| Rate for Payer: Prime Health Services Commercial |
$592.45
|
| Rate for Payer: Riverside University Health System MISP |
$278.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$418.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$418.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$261.58
|
| Rate for Payer: United Healthcare All Other HMO |
$254.61
|
| Rate for Payer: United Healthcare HMO Rider |
$249.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$228.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$592.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$592.45
|
| Rate for Payer: Vantage Medical Group Senior |
$592.45
|
|
|
HC WHFO VOLAR COCK-UP W/FLEX OUTRIGGER
|
Facility
|
IP
|
$214.00
|
|
|
Service Code
|
CPT L3931
|
| Hospital Charge Code |
901301038
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$42.80 |
| Max. Negotiated Rate |
$192.60 |
| Rate for Payer: Adventist Health Commercial |
$42.80
|
| Rate for Payer: Blue Shield of California Commercial |
$171.63
|
| Rate for Payer: Blue Shield of California EPN |
$107.86
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Central Health Plan Commercial |
$171.20
|
| Rate for Payer: Cigna of CA HMO |
$149.80
|
| Rate for Payer: Cigna of CA PPO |
$149.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$149.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$85.60
|
| Rate for Payer: EPIC Health Plan Senior |
$85.60
|
| Rate for Payer: Galaxy Health WC |
$181.90
|
| Rate for Payer: Global Benefits Group Commercial |
$128.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$192.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$135.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$126.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.80
|
| Rate for Payer: Multiplan Commercial |
$160.50
|
| Rate for Payer: Networks By Design Commercial |
$139.10
|
| Rate for Payer: Prime Health Services Commercial |
$181.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$80.31
|
| Rate for Payer: United Healthcare All Other HMO |
$78.17
|
| Rate for Payer: United Healthcare HMO Rider |
$76.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$70.08
|
|
|
HC WHFO VOLAR COCK-UP W/FLEX OUTRIGGER
|
Facility
|
OP
|
$214.00
|
|
|
Service Code
|
CPT L3931
|
| Hospital Charge Code |
901301038
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$70.08 |
| Max. Negotiated Rate |
$279.19 |
| Rate for Payer: Adventist Health Commercial |
$87.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$181.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$117.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$160.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$124.48
|
| Rate for Payer: Blue Shield of California Commercial |
$171.63
|
| Rate for Payer: Blue Shield of California EPN |
$107.86
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Central Health Plan Commercial |
$171.20
|
| Rate for Payer: Cigna of CA HMO |
$149.80
|
| Rate for Payer: Cigna of CA PPO |
$149.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$181.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$181.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$181.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$149.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$85.60
|
| Rate for Payer: EPIC Health Plan Senior |
$85.60
|
| Rate for Payer: Galaxy Health WC |
$181.90
|
| Rate for Payer: Global Benefits Group Commercial |
$128.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$192.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$252.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$135.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$279.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$126.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$149.80
|
| Rate for Payer: Multiplan Commercial |
$160.50
|
| Rate for Payer: Networks By Design Commercial |
$107.00
|
| Rate for Payer: Prime Health Services Commercial |
$181.90
|
| Rate for Payer: Riverside University Health System MISP |
$85.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$128.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$128.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$80.31
|
| Rate for Payer: United Healthcare All Other HMO |
$78.17
|
| Rate for Payer: United Healthcare HMO Rider |
$76.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$70.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$181.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$181.90
|
| Rate for Payer: Vantage Medical Group Senior |
$181.90
|
|
|
HC WHFO W/JOINT(S) CUSTOM FABRCTD
|
Facility
|
OP
|
$670.00
|
|
|
Service Code
|
CPT L3806
|
| Hospital Charge Code |
905353806
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$219.43 |
| Max. Negotiated Rate |
$603.00 |
| Rate for Payer: Adventist Health Commercial |
$274.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$569.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$368.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$502.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$389.74
|
| Rate for Payer: Blue Shield of California Commercial |
$537.34
|
| Rate for Payer: Blue Shield of California EPN |
$337.68
|
| Rate for Payer: Cash Price |
$301.50
|
| Rate for Payer: Cash Price |
$301.50
|
| Rate for Payer: Central Health Plan Commercial |
$536.00
|
| Rate for Payer: Cigna of CA HMO |
$469.00
|
| Rate for Payer: Cigna of CA PPO |
$469.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$569.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$569.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$569.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$469.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$268.00
|
| Rate for Payer: EPIC Health Plan Senior |
$268.00
|
| Rate for Payer: Galaxy Health WC |
$569.50
|
| Rate for Payer: Global Benefits Group Commercial |
$402.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$603.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$502.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$425.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$555.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$395.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$274.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$469.00
|
| Rate for Payer: Multiplan Commercial |
$502.50
|
| Rate for Payer: Networks By Design Commercial |
$335.00
|
| Rate for Payer: Prime Health Services Commercial |
$569.50
|
| Rate for Payer: Riverside University Health System MISP |
$268.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$402.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$402.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$251.45
|
| Rate for Payer: United Healthcare All Other HMO |
$244.75
|
| Rate for Payer: United Healthcare HMO Rider |
$239.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$219.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$569.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$569.50
|
| Rate for Payer: Vantage Medical Group Senior |
$569.50
|
|
|
HC WHFO W/JOINT(S) CUSTOM FABRCTD
|
Facility
|
OP
|
$670.00
|
|
|
Service Code
|
CPT L3806
|
| Hospital Charge Code |
915353806
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$219.43 |
| Max. Negotiated Rate |
$603.00 |
| Rate for Payer: Adventist Health Commercial |
$274.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$569.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$368.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$502.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$389.74
|
| Rate for Payer: Blue Shield of California Commercial |
$537.34
|
| Rate for Payer: Blue Shield of California EPN |
$337.68
|
| Rate for Payer: Cash Price |
$301.50
|
| Rate for Payer: Cash Price |
$301.50
|
| Rate for Payer: Central Health Plan Commercial |
$536.00
|
| Rate for Payer: Cigna of CA HMO |
$469.00
|
| Rate for Payer: Cigna of CA PPO |
$469.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$569.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$569.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$569.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$469.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$268.00
|
| Rate for Payer: EPIC Health Plan Senior |
$268.00
|
| Rate for Payer: Galaxy Health WC |
$569.50
|
| Rate for Payer: Global Benefits Group Commercial |
$402.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$603.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$502.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$425.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$555.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$395.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$274.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$469.00
|
| Rate for Payer: Multiplan Commercial |
$502.50
|
| Rate for Payer: Networks By Design Commercial |
$335.00
|
| Rate for Payer: Prime Health Services Commercial |
$569.50
|
| Rate for Payer: Riverside University Health System MISP |
$268.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$402.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$402.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$251.45
|
| Rate for Payer: United Healthcare All Other HMO |
$244.75
|
| Rate for Payer: United Healthcare HMO Rider |
$239.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$219.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$569.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$569.50
|
| Rate for Payer: Vantage Medical Group Senior |
$569.50
|
|
|
HC WHFO W/JOINT(S) CUSTOM FABRCTD
|
Facility
|
IP
|
$670.00
|
|
|
Service Code
|
CPT L3806
|
| Hospital Charge Code |
905353806
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$134.00 |
| Max. Negotiated Rate |
$603.00 |
| Rate for Payer: Adventist Health Commercial |
$134.00
|
| Rate for Payer: Blue Shield of California Commercial |
$537.34
|
| Rate for Payer: Blue Shield of California EPN |
$337.68
|
| Rate for Payer: Cash Price |
$301.50
|
| Rate for Payer: Central Health Plan Commercial |
$536.00
|
| Rate for Payer: Cigna of CA HMO |
$469.00
|
| Rate for Payer: Cigna of CA PPO |
$469.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$469.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$268.00
|
| Rate for Payer: EPIC Health Plan Senior |
$268.00
|
| Rate for Payer: Galaxy Health WC |
$569.50
|
| Rate for Payer: Global Benefits Group Commercial |
$402.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$603.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$425.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$395.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$134.00
|
| Rate for Payer: Multiplan Commercial |
$502.50
|
| Rate for Payer: Networks By Design Commercial |
$435.50
|
| Rate for Payer: Prime Health Services Commercial |
$569.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$251.45
|
| Rate for Payer: United Healthcare All Other HMO |
$244.75
|
| Rate for Payer: United Healthcare HMO Rider |
$239.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$219.43
|
|
