|
HC WHFO W/JOINT(S) CUSTOM FABRCTD
|
Facility
|
IP
|
$670.00
|
|
|
Service Code
|
CPT L3806
|
| Hospital Charge Code |
915353806
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$134.00 |
| Max. Negotiated Rate |
$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
|
|
|
HC WHFO WO JOINTS GAUNTLET CF
|
Facility
|
OP
|
$1,004.00
|
|
|
Service Code
|
CPT L3906
|
| Hospital Charge Code |
915353906
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$328.81 |
| Max. Negotiated Rate |
$903.60 |
| Rate for Payer: Adventist Health Commercial |
$411.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$853.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$552.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$753.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$584.03
|
| Rate for Payer: Blue Shield of California Commercial |
$805.21
|
| Rate for Payer: Blue Shield of California EPN |
$506.02
|
| Rate for Payer: Cash Price |
$451.80
|
| Rate for Payer: Cash Price |
$451.80
|
| Rate for Payer: Central Health Plan Commercial |
$803.20
|
| Rate for Payer: Cigna of CA HMO |
$702.80
|
| Rate for Payer: Cigna of CA PPO |
$702.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$853.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$853.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$853.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$702.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$401.60
|
| Rate for Payer: EPIC Health Plan Senior |
$401.60
|
| Rate for Payer: Galaxy Health WC |
$853.40
|
| Rate for Payer: Global Benefits Group Commercial |
$602.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$903.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$533.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$637.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$589.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$592.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$411.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$702.80
|
| Rate for Payer: Multiplan Commercial |
$753.00
|
| Rate for Payer: Networks By Design Commercial |
$502.00
|
| Rate for Payer: Prime Health Services Commercial |
$853.40
|
| Rate for Payer: Riverside University Health System MISP |
$401.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$602.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$602.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$376.80
|
| Rate for Payer: United Healthcare All Other HMO |
$366.76
|
| Rate for Payer: United Healthcare HMO Rider |
$358.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$328.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$853.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$853.40
|
| Rate for Payer: Vantage Medical Group Senior |
$853.40
|
|
|
HC WHFO WO JOINTS GAUNTLET CF
|
Facility
|
IP
|
$1,004.00
|
|
|
Service Code
|
CPT L3906
|
| Hospital Charge Code |
905353906
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$200.80 |
| Max. Negotiated Rate |
$903.60 |
| Rate for Payer: Adventist Health Commercial |
$200.80
|
| Rate for Payer: Blue Shield of California Commercial |
$805.21
|
| Rate for Payer: Blue Shield of California EPN |
$506.02
|
| Rate for Payer: Cash Price |
$451.80
|
| Rate for Payer: Central Health Plan Commercial |
$803.20
|
| Rate for Payer: Cigna of CA HMO |
$702.80
|
| Rate for Payer: Cigna of CA PPO |
$702.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$702.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$401.60
|
| Rate for Payer: EPIC Health Plan Senior |
$401.60
|
| Rate for Payer: Galaxy Health WC |
$853.40
|
| Rate for Payer: Global Benefits Group Commercial |
$602.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$903.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$637.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$592.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$200.80
|
| Rate for Payer: Multiplan Commercial |
$753.00
|
| Rate for Payer: Networks By Design Commercial |
$652.60
|
| Rate for Payer: Prime Health Services Commercial |
$853.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$376.80
|
| Rate for Payer: United Healthcare All Other HMO |
$366.76
|
| Rate for Payer: United Healthcare HMO Rider |
$358.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$328.81
|
|
|
HC WHFO WO JOINTS GAUNTLET CF
|
Facility
|
OP
|
$1,004.00
|
|
|
Service Code
|
CPT L3906
|
| Hospital Charge Code |
905353906
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$328.81 |
| Max. Negotiated Rate |
$903.60 |
| Rate for Payer: Adventist Health Commercial |
$411.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$853.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$552.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$753.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$584.03
|
| Rate for Payer: Blue Shield of California Commercial |
$805.21
|
| Rate for Payer: Blue Shield of California EPN |
$506.02
|
| Rate for Payer: Cash Price |
$451.80
|
| Rate for Payer: Cash Price |
$451.80
|
| Rate for Payer: Central Health Plan Commercial |
$803.20
|
| Rate for Payer: Cigna of CA HMO |
$702.80
|
| Rate for Payer: Cigna of CA PPO |
$702.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$853.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$853.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$853.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$702.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$401.60
|
| Rate for Payer: EPIC Health Plan Senior |
$401.60
|
| Rate for Payer: Galaxy Health WC |
$853.40
|
| Rate for Payer: Global Benefits Group Commercial |
$602.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$903.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$533.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$637.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$589.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$592.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$411.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$702.80
|
| Rate for Payer: Multiplan Commercial |
$753.00
|
| Rate for Payer: Networks By Design Commercial |
$502.00
|
| Rate for Payer: Prime Health Services Commercial |
$853.40
|
| Rate for Payer: Riverside University Health System MISP |
$401.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$602.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$602.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$376.80
|
| Rate for Payer: United Healthcare All Other HMO |
$366.76
|
| Rate for Payer: United Healthcare HMO Rider |
$358.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$328.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$853.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$853.40
|
| Rate for Payer: Vantage Medical Group Senior |
$853.40
|
|
|
HC WHFO WO JOINTS GAUNTLET CF
|
Facility
|
IP
|
$1,004.00
|
|
|
Service Code
|
CPT L3906
|
| Hospital Charge Code |
915353906
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$200.80 |
| Max. Negotiated Rate |
$903.60 |
| Rate for Payer: Adventist Health Commercial |
$200.80
|
| Rate for Payer: Blue Shield of California Commercial |
$805.21
|
| Rate for Payer: Blue Shield of California EPN |
$506.02
|
| Rate for Payer: Cash Price |
$451.80
|
| Rate for Payer: Central Health Plan Commercial |
$803.20
|
| Rate for Payer: Cigna of CA HMO |
$702.80
|
| Rate for Payer: Cigna of CA PPO |
$702.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$702.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$401.60
|
| Rate for Payer: EPIC Health Plan Senior |
$401.60
|
| Rate for Payer: Galaxy Health WC |
$853.40
|
| Rate for Payer: Global Benefits Group Commercial |
$602.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$903.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$637.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$592.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$200.80
|
| Rate for Payer: Multiplan Commercial |
$753.00
|
| Rate for Payer: Networks By Design Commercial |
$652.60
|
| Rate for Payer: Prime Health Services Commercial |
$853.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$376.80
|
| Rate for Payer: United Healthcare All Other HMO |
$366.76
|
| Rate for Payer: United Healthcare HMO Rider |
$358.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$328.81
|
|
|
HC WHFO W/O JOINT(S) PF
|
Facility
|
IP
|
$383.00
|
|
|
Service Code
|
CPT L3807
|
| Hospital Charge Code |
905353807
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$76.60 |
| Max. Negotiated Rate |
$344.70 |
| Rate for Payer: Adventist Health Commercial |
$76.60
|
| Rate for Payer: Blue Shield of California Commercial |
$307.17
|
| Rate for Payer: Blue Shield of California EPN |
$193.03
|
| Rate for Payer: Cash Price |
$172.35
|
| Rate for Payer: Central Health Plan Commercial |
$306.40
|
| Rate for Payer: Cigna of CA HMO |
$268.10
|
| Rate for Payer: Cigna of CA PPO |
$268.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$268.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.20
|
| Rate for Payer: EPIC Health Plan Senior |
$153.20
|
| Rate for Payer: Galaxy Health WC |
$325.55
|
| Rate for Payer: Global Benefits Group Commercial |
$229.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$344.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$243.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$225.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.60
|
| Rate for Payer: Multiplan Commercial |
$287.25
|
| Rate for Payer: Networks By Design Commercial |
$248.95
|
| Rate for Payer: Prime Health Services Commercial |
$325.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$143.74
|
| Rate for Payer: United Healthcare All Other HMO |
$139.91
|
| Rate for Payer: United Healthcare HMO Rider |
$136.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$125.43
|
|
|
HC WHFO W/O JOINT(S) PF
|
Facility
|
OP
|
$383.00
|
|
|
Service Code
|
CPT L3807
|
| Hospital Charge Code |
905353807
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$125.43 |
| Max. Negotiated Rate |
$344.70 |
| Rate for Payer: Adventist Health Commercial |
$157.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$325.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$210.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$287.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$222.79
|
| Rate for Payer: Blue Shield of California Commercial |
$307.17
|
| Rate for Payer: Blue Shield of California EPN |
$193.03
|
| Rate for Payer: Cash Price |
$172.35
|
| Rate for Payer: Central Health Plan Commercial |
$306.40
|
| Rate for Payer: Cigna of CA HMO |
$268.10
|
| Rate for Payer: Cigna of CA PPO |
$268.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$325.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$325.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$325.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$268.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.20
|
| Rate for Payer: EPIC Health Plan Senior |
$153.20
|
| Rate for Payer: Galaxy Health WC |
$325.55
|
| Rate for Payer: Global Benefits Group Commercial |
$229.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$344.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$243.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$225.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$157.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$268.10
|
| Rate for Payer: Multiplan Commercial |
$287.25
|
| Rate for Payer: Networks By Design Commercial |
$191.50
|
| Rate for Payer: Prime Health Services Commercial |
$325.55
|
| Rate for Payer: Riverside University Health System MISP |
$153.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$229.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$229.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$143.74
|
| Rate for Payer: United Healthcare All Other HMO |
$139.91
|
| Rate for Payer: United Healthcare HMO Rider |
$136.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$125.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$325.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$325.55
|
| Rate for Payer: Vantage Medical Group Senior |
$325.55
|
|
|
HC WHFO W/O JOINT(S) PF
|
Facility
|
IP
|
$383.00
|
|
|
Service Code
|
CPT L3807
|
| Hospital Charge Code |
915353807
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$76.60 |
| Max. Negotiated Rate |
$344.70 |
| Rate for Payer: Adventist Health Commercial |
$76.60
|
| Rate for Payer: Blue Shield of California Commercial |
$307.17
|
| Rate for Payer: Blue Shield of California EPN |
$193.03
|
| Rate for Payer: Cash Price |
$172.35
|
| Rate for Payer: Central Health Plan Commercial |
$306.40
|
| Rate for Payer: Cigna of CA HMO |
$268.10
|
| Rate for Payer: Cigna of CA PPO |
$268.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$268.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.20
|
| Rate for Payer: EPIC Health Plan Senior |
$153.20
|
| Rate for Payer: Galaxy Health WC |
$325.55
|
| Rate for Payer: Global Benefits Group Commercial |
$229.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$344.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$243.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$225.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.60
|
| Rate for Payer: Multiplan Commercial |
$287.25
|
| Rate for Payer: Networks By Design Commercial |
$248.95
|
| Rate for Payer: Prime Health Services Commercial |
$325.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$143.74
|
| Rate for Payer: United Healthcare All Other HMO |
$139.91
|
| Rate for Payer: United Healthcare HMO Rider |
$136.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$125.43
|
|
|
HC WHFO W/O JOINT(S) PF
|
Facility
|
OP
|
$383.00
|
|
|
Service Code
|
CPT L3807
|
| Hospital Charge Code |
915353807
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$125.43 |
| Max. Negotiated Rate |
$344.70 |
| Rate for Payer: Adventist Health Commercial |
$157.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$325.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$210.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$287.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$222.79
|
| Rate for Payer: Blue Shield of California Commercial |
$307.17
|
| Rate for Payer: Blue Shield of California EPN |
$193.03
|
| Rate for Payer: Cash Price |
$172.35
|
| Rate for Payer: Central Health Plan Commercial |
$306.40
|
| Rate for Payer: Cigna of CA HMO |
$268.10
|
| Rate for Payer: Cigna of CA PPO |
$268.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$325.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$325.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$325.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$268.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.20
|
| Rate for Payer: EPIC Health Plan Senior |
$153.20
|
| Rate for Payer: Galaxy Health WC |
$325.55
|
| Rate for Payer: Global Benefits Group Commercial |
$229.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$344.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$243.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$225.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$157.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$268.10
|
| Rate for Payer: Multiplan Commercial |
$287.25
|
| Rate for Payer: Networks By Design Commercial |
$191.50
|
| Rate for Payer: Prime Health Services Commercial |
$325.55
|
| Rate for Payer: Riverside University Health System MISP |
$153.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$229.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$229.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$143.74
|
| Rate for Payer: United Healthcare All Other HMO |
$139.91
|
| Rate for Payer: United Healthcare HMO Rider |
$136.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$125.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$325.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$325.55
|
| Rate for Payer: Vantage Medical Group Senior |
$325.55
|
|
|
HC WHFO WRIST EXT COCKUP PF
|
Facility
|
IP
|
$249.00
|
|
|
Service Code
|
CPT L3908
|
| Hospital Charge Code |
905109314
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$49.80 |
| Max. Negotiated Rate |
$224.10 |
| Rate for Payer: Adventist Health Commercial |
$49.80
|
| Rate for Payer: Blue Shield of California Commercial |
$199.70
|
| Rate for Payer: Blue Shield of California EPN |
$125.50
|
| Rate for Payer: Cash Price |
$112.05
|
| Rate for Payer: Central Health Plan Commercial |
$199.20
|
| Rate for Payer: Cigna of CA HMO |
$174.30
|
| Rate for Payer: Cigna of CA PPO |
$174.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$174.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.60
|
| Rate for Payer: EPIC Health Plan Senior |
$99.60
|
| Rate for Payer: Galaxy Health WC |
$211.65
|
| Rate for Payer: Global Benefits Group Commercial |
$149.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$224.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$158.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$146.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.80
|
| Rate for Payer: Multiplan Commercial |
$186.75
|
| Rate for Payer: Networks By Design Commercial |
$161.85
|
| Rate for Payer: Prime Health Services Commercial |
$211.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$93.45
|
| Rate for Payer: United Healthcare All Other HMO |
$90.96
|
| Rate for Payer: United Healthcare HMO Rider |
$88.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$81.55
|
|
|
HC WHFO WRIST EXT COCKUP PF
|
Facility
|
OP
|
$249.00
|
|
|
Service Code
|
CPT L3908
|
| Hospital Charge Code |
905109314
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$80.98 |
| Max. Negotiated Rate |
$224.10 |
| Rate for Payer: Adventist Health Commercial |
$102.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$211.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$136.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$186.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$144.84
|
| Rate for Payer: Blue Shield of California Commercial |
$199.70
|
| Rate for Payer: Blue Shield of California EPN |
$125.50
|
| Rate for Payer: Cash Price |
$112.05
|
| Rate for Payer: Cash Price |
$112.05
|
| Rate for Payer: Central Health Plan Commercial |
$199.20
|
| Rate for Payer: Cigna of CA HMO |
$174.30
|
| Rate for Payer: Cigna of CA PPO |
$174.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$211.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$211.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$211.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$174.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.60
|
| Rate for Payer: EPIC Health Plan Senior |
$99.60
|
| Rate for Payer: Galaxy Health WC |
$211.65
|
| Rate for Payer: Global Benefits Group Commercial |
$149.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$224.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$80.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$158.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$89.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$146.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$174.30
|
| Rate for Payer: Multiplan Commercial |
$186.75
|
| Rate for Payer: Networks By Design Commercial |
$124.50
|
| Rate for Payer: Prime Health Services Commercial |
$211.65
|
| Rate for Payer: Riverside University Health System MISP |
$99.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$149.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$149.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$93.45
|
| Rate for Payer: United Healthcare All Other HMO |
$90.96
|
| Rate for Payer: United Healthcare HMO Rider |
$88.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$81.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$211.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$211.65
|
| Rate for Payer: Vantage Medical Group Senior |
$211.65
|
|
|
HC WHFO WRIST GAUNLET THUMB SPICA
|
Facility
|
IP
|
$891.00
|
|
|
Service Code
|
CPT L3808
|
| Hospital Charge Code |
915353907
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$178.20 |
| Max. Negotiated Rate |
$801.90 |
| Rate for Payer: Adventist Health Commercial |
$178.20
|
| Rate for Payer: Blue Shield of California Commercial |
$714.58
|
| Rate for Payer: Blue Shield of California EPN |
$449.06
|
| Rate for Payer: Cash Price |
$400.95
|
| Rate for Payer: Central Health Plan Commercial |
$712.80
|
| Rate for Payer: Cigna of CA HMO |
$623.70
|
| Rate for Payer: Cigna of CA PPO |
$623.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$623.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$356.40
|
| Rate for Payer: EPIC Health Plan Senior |
$356.40
|
| Rate for Payer: Galaxy Health WC |
$757.35
|
| Rate for Payer: Global Benefits Group Commercial |
$534.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$801.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$565.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$525.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$178.20
|
| Rate for Payer: Multiplan Commercial |
$668.25
|
| Rate for Payer: Networks By Design Commercial |
$579.15
|
| Rate for Payer: Prime Health Services Commercial |
$757.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$334.39
|
| Rate for Payer: United Healthcare All Other HMO |
$325.48
|
| Rate for Payer: United Healthcare HMO Rider |
$318.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$291.80
|
|
|
HC WHFO WRIST GAUNLET THUMB SPICA
|
Facility
|
OP
|
$891.00
|
|
|
Service Code
|
CPT L3808
|
| Hospital Charge Code |
915353907
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$289.67 |
| Max. Negotiated Rate |
$801.90 |
| Rate for Payer: Adventist Health Commercial |
$365.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$757.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$490.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$668.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$518.29
|
| Rate for Payer: Blue Shield of California Commercial |
$714.58
|
| Rate for Payer: Blue Shield of California EPN |
$449.06
|
| Rate for Payer: Cash Price |
$400.95
|
| Rate for Payer: Cash Price |
$400.95
|
| Rate for Payer: Central Health Plan Commercial |
$712.80
|
| Rate for Payer: Cigna of CA HMO |
$623.70
|
| Rate for Payer: Cigna of CA PPO |
$623.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$757.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$757.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$757.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$623.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$356.40
|
| Rate for Payer: EPIC Health Plan Senior |
$356.40
|
| Rate for Payer: Galaxy Health WC |
$757.35
|
| Rate for Payer: Global Benefits Group Commercial |
$534.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$801.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$289.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$565.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$319.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$525.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$365.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$623.70
|
| Rate for Payer: Multiplan Commercial |
$668.25
|
| Rate for Payer: Networks By Design Commercial |
$445.50
|
| Rate for Payer: Prime Health Services Commercial |
$757.35
|
| Rate for Payer: Riverside University Health System MISP |
$356.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$534.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$534.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$334.39
|
| Rate for Payer: United Healthcare All Other HMO |
$325.48
|
| Rate for Payer: United Healthcare HMO Rider |
$318.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$291.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$757.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$757.35
|
| Rate for Payer: Vantage Medical Group Senior |
$757.35
|
|
|
HC WHFO WRIST GAUNTLET MOLDED
|
Facility
|
IP
|
$760.00
|
|
|
Service Code
|
CPT L3906
|
| Hospital Charge Code |
901309100
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$152.00 |
| Max. Negotiated Rate |
$684.00 |
| Rate for Payer: Adventist Health Commercial |
$152.00
|
| Rate for Payer: Blue Shield of California Commercial |
$609.52
|
| Rate for Payer: Blue Shield of California EPN |
$383.04
|
| Rate for Payer: Cash Price |
$342.00
|
| Rate for Payer: Central Health Plan Commercial |
$608.00
|
| Rate for Payer: Cigna of CA HMO |
$532.00
|
| Rate for Payer: Cigna of CA PPO |
$532.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$532.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$304.00
|
| Rate for Payer: EPIC Health Plan Senior |
$304.00
|
| Rate for Payer: Galaxy Health WC |
$646.00
|
| Rate for Payer: Global Benefits Group Commercial |
$456.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$684.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$482.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$448.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$152.00
|
| Rate for Payer: Multiplan Commercial |
$570.00
|
| Rate for Payer: Networks By Design Commercial |
$494.00
|
| Rate for Payer: Prime Health Services Commercial |
$646.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$285.23
|
| Rate for Payer: United Healthcare All Other HMO |
$277.63
|
| Rate for Payer: United Healthcare HMO Rider |
$271.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$248.90
|
|
|
HC WHFO WRIST GAUNTLET MOLDED
|
Facility
|
OP
|
$760.00
|
|
|
Service Code
|
CPT L3906
|
| Hospital Charge Code |
901309100
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$248.90 |
| Max. Negotiated Rate |
$684.00 |
| Rate for Payer: Adventist Health Commercial |
$311.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$646.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$418.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$570.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$442.09
|
| Rate for Payer: Blue Shield of California Commercial |
$609.52
|
| Rate for Payer: Blue Shield of California EPN |
$383.04
|
| Rate for Payer: Cash Price |
$342.00
|
| Rate for Payer: Cash Price |
$342.00
|
| Rate for Payer: Central Health Plan Commercial |
$608.00
|
| Rate for Payer: Cigna of CA HMO |
$532.00
|
| Rate for Payer: Cigna of CA PPO |
$532.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$646.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$646.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$646.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$532.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$304.00
|
| Rate for Payer: EPIC Health Plan Senior |
$304.00
|
| Rate for Payer: Galaxy Health WC |
$646.00
|
| Rate for Payer: Global Benefits Group Commercial |
$456.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$684.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$533.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$482.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$589.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$448.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$311.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$532.00
|
| Rate for Payer: Multiplan Commercial |
$570.00
|
| Rate for Payer: Networks By Design Commercial |
$380.00
|
| Rate for Payer: Prime Health Services Commercial |
$646.00
|
| Rate for Payer: Riverside University Health System MISP |
$304.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$456.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$456.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$285.23
|
| Rate for Payer: United Healthcare All Other HMO |
$277.63
|
| Rate for Payer: United Healthcare HMO Rider |
$271.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$248.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$646.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$646.00
|
| Rate for Payer: Vantage Medical Group Senior |
$646.00
|
|
|
HC WHFO WRIST GAUNT W/THUMB SPIC
|
Facility
|
IP
|
$936.00
|
|
|
Service Code
|
CPT L3808
|
| Hospital Charge Code |
901309101
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$187.20 |
| Max. Negotiated Rate |
$842.40 |
| Rate for Payer: Adventist Health Commercial |
$187.20
|
| Rate for Payer: Cash Price |
$421.20
|
| Rate for Payer: Central Health Plan Commercial |
$748.80
|
| 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
|
|
|
HC WHFO WRIST GAUNT W/THUMB SPIC
|
Facility
|
OP
|
$936.00
|
|
|
Service Code
|
CPT L3808
|
| Hospital Charge Code |
901309101
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$206.00 |
| Max. Negotiated Rate |
$1,345.31 |
| Rate for Payer: Adventist Health Commercial |
$383.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,345.31
|
| 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 Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$421.20
|
| 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 |
$599.04
|
| Rate for Payer: Cigna of CA PPO |
$692.64
|
| 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 |
$608.40
|
| 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 |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$795.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$795.60
|
| Rate for Payer: Vantage Medical Group Senior |
$795.60
|
|
|
HC WHIRLPOOL MCAL
|
Facility
|
IP
|
$217.00
|
|
|
Service Code
|
CPT 97022
|
| Hospital Charge Code |
901300045
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$43.40 |
| Max. Negotiated Rate |
$195.30 |
| Rate for Payer: Adventist Health Commercial |
$43.40
|
| Rate for Payer: Cash Price |
$97.65
|
| Rate for Payer: Central Health Plan Commercial |
$173.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$151.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.80
|
| Rate for Payer: EPIC Health Plan Senior |
$86.80
|
| Rate for Payer: Galaxy Health WC |
$184.45
|
| Rate for Payer: Global Benefits Group Commercial |
$130.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$195.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$137.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$128.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.40
|
| Rate for Payer: Multiplan Commercial |
$162.75
|
| Rate for Payer: Networks By Design Commercial |
$141.05
|
| Rate for Payer: Prime Health Services Commercial |
$184.45
|
|
|
HC WHIRLPOOL MCAL
|
Facility
|
OP
|
$217.00
|
|
|
Service Code
|
CPT 97022
|
| Hospital Charge Code |
901300045
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$19.16 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$88.97
|
| Rate for Payer: Aetna of CA HMO/PPO |
$94.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$184.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$119.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$162.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$97.65
|
| Rate for Payer: Cash Price |
$97.65
|
| Rate for Payer: Cash Price |
$97.65
|
| Rate for Payer: Central Health Plan Commercial |
$173.60
|
| Rate for Payer: Cigna of CA HMO |
$138.88
|
| Rate for Payer: Cigna of CA PPO |
$160.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$184.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$184.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$184.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$151.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.80
|
| Rate for Payer: EPIC Health Plan Senior |
$86.80
|
| Rate for Payer: Galaxy Health WC |
$184.45
|
| Rate for Payer: Global Benefits Group Commercial |
$130.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$195.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$137.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$128.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$151.90
|
| Rate for Payer: Multiplan Commercial |
$162.75
|
| Rate for Payer: Networks By Design Commercial |
$141.05
|
| Rate for Payer: Prime Health Services Commercial |
$184.45
|
| Rate for Payer: Riverside University Health System MISP |
$86.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$130.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$130.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$184.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$184.45
|
| Rate for Payer: Vantage Medical Group Senior |
$184.45
|
|
|
HC WHIRLPOOL MCARE COM
|
Facility
|
OP
|
$217.00
|
|
|
Service Code
|
CPT 97022
|
| Hospital Charge Code |
900407040
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$19.16 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$88.97
|
| Rate for Payer: Aetna of CA HMO/PPO |
$94.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$184.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$119.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$162.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$97.65
|
| Rate for Payer: Cash Price |
$97.65
|
| Rate for Payer: Cash Price |
$97.65
|
| Rate for Payer: Central Health Plan Commercial |
$173.60
|
| Rate for Payer: Cigna of CA HMO |
$138.88
|
| Rate for Payer: Cigna of CA PPO |
$160.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$184.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$184.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$184.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$151.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.80
|
| Rate for Payer: EPIC Health Plan Senior |
$86.80
|
| Rate for Payer: Galaxy Health WC |
$184.45
|
| Rate for Payer: Global Benefits Group Commercial |
$130.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$195.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$137.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$128.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$151.90
|
| Rate for Payer: Multiplan Commercial |
$162.75
|
| Rate for Payer: Networks By Design Commercial |
$141.05
|
| Rate for Payer: Prime Health Services Commercial |
$184.45
|
| Rate for Payer: Riverside University Health System MISP |
$86.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$130.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$130.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$184.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$184.45
|
| Rate for Payer: Vantage Medical Group Senior |
$184.45
|
|
|
HC WHIRLPOOL MCARE COM
|
Facility
|
IP
|
$217.00
|
|
|
Service Code
|
CPT 97022
|
| Hospital Charge Code |
900407040
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$43.40 |
| Max. Negotiated Rate |
$195.30 |
| Rate for Payer: Adventist Health Commercial |
$43.40
|
| Rate for Payer: Cash Price |
$97.65
|
| Rate for Payer: Central Health Plan Commercial |
$173.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$151.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.80
|
| Rate for Payer: EPIC Health Plan Senior |
$86.80
|
| Rate for Payer: Galaxy Health WC |
$184.45
|
| Rate for Payer: Global Benefits Group Commercial |
$130.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$195.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$137.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$128.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.40
|
| Rate for Payer: Multiplan Commercial |
$162.75
|
| Rate for Payer: Networks By Design Commercial |
$141.05
|
| Rate for Payer: Prime Health Services Commercial |
$184.45
|
|
|
HC WHIRLPOOL OT
|
Facility
|
OP
|
$217.00
|
|
|
Service Code
|
CPT 97022
|
| Hospital Charge Code |
903207022
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$19.16 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$88.97
|
| Rate for Payer: Aetna of CA HMO/PPO |
$94.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$184.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$119.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$162.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$97.65
|
| Rate for Payer: Cash Price |
$97.65
|
| Rate for Payer: Cash Price |
$97.65
|
| Rate for Payer: Central Health Plan Commercial |
$173.60
|
| Rate for Payer: Cigna of CA HMO |
$138.88
|
| Rate for Payer: Cigna of CA PPO |
$160.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$184.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$184.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$184.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$151.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.80
|
| Rate for Payer: EPIC Health Plan Senior |
$86.80
|
| Rate for Payer: Galaxy Health WC |
$184.45
|
| Rate for Payer: Global Benefits Group Commercial |
$130.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$195.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$137.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$128.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$151.90
|
| Rate for Payer: Multiplan Commercial |
$162.75
|
| Rate for Payer: Networks By Design Commercial |
$141.05
|
| Rate for Payer: Prime Health Services Commercial |
$184.45
|
| Rate for Payer: Riverside University Health System MISP |
$86.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$130.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$130.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$184.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$184.45
|
| Rate for Payer: Vantage Medical Group Senior |
$184.45
|
|
|
HC WHIRLPOOL OT
|
Facility
|
IP
|
$217.00
|
|
|
Service Code
|
CPT 97022
|
| Hospital Charge Code |
903207022
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$43.40 |
| Max. Negotiated Rate |
$195.30 |
| Rate for Payer: Adventist Health Commercial |
$43.40
|
| Rate for Payer: Cash Price |
$97.65
|
| Rate for Payer: Central Health Plan Commercial |
$173.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$151.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.80
|
| Rate for Payer: EPIC Health Plan Senior |
$86.80
|
| Rate for Payer: Galaxy Health WC |
$184.45
|
| Rate for Payer: Global Benefits Group Commercial |
$130.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$195.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$137.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$128.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.40
|
| Rate for Payer: Multiplan Commercial |
$162.75
|
| Rate for Payer: Networks By Design Commercial |
$141.05
|
| Rate for Payer: Prime Health Services Commercial |
$184.45
|
|
|
HC WHIRLPOOL PT
|
Facility
|
OP
|
$217.00
|
|
|
Service Code
|
CPT 97022
|
| Hospital Charge Code |
905103118
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$19.16 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$88.97
|
| Rate for Payer: Aetna of CA HMO/PPO |
$94.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$184.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$119.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$162.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$97.65
|
| Rate for Payer: Cash Price |
$97.65
|
| Rate for Payer: Cash Price |
$97.65
|
| Rate for Payer: Central Health Plan Commercial |
$173.60
|
| Rate for Payer: Cigna of CA HMO |
$138.88
|
| Rate for Payer: Cigna of CA PPO |
$160.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$184.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$184.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$184.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$151.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.80
|
| Rate for Payer: EPIC Health Plan Senior |
$86.80
|
| Rate for Payer: Galaxy Health WC |
$184.45
|
| Rate for Payer: Global Benefits Group Commercial |
$130.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$195.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$137.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$128.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$151.90
|
| Rate for Payer: Multiplan Commercial |
$162.75
|
| Rate for Payer: Networks By Design Commercial |
$141.05
|
| Rate for Payer: Prime Health Services Commercial |
$184.45
|
| Rate for Payer: Riverside University Health System MISP |
$86.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$130.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$130.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$184.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$184.45
|
| Rate for Payer: Vantage Medical Group Senior |
$184.45
|
|
|
HC WHIRLPOOL PT
|
Facility
|
IP
|
$217.00
|
|
|
Service Code
|
CPT 97022
|
| Hospital Charge Code |
905103118
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$43.40 |
| Max. Negotiated Rate |
$195.30 |
| Rate for Payer: Adventist Health Commercial |
$43.40
|
| Rate for Payer: Cash Price |
$97.65
|
| Rate for Payer: Central Health Plan Commercial |
$173.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$151.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.80
|
| Rate for Payer: EPIC Health Plan Senior |
$86.80
|
| Rate for Payer: Galaxy Health WC |
$184.45
|
| Rate for Payer: Global Benefits Group Commercial |
$130.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$195.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$137.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$128.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.40
|
| Rate for Payer: Multiplan Commercial |
$162.75
|
| Rate for Payer: Networks By Design Commercial |
$141.05
|
| Rate for Payer: Prime Health Services Commercial |
$184.45
|
|
