|
HC WHFO ADJ MP FLEX CNTRL
|
Facility
OP
|
$370.00
|
|
| Hospital Charge Code |
903203855
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$129.50 |
| Max. Negotiated Rate |
$333.00 |
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$314.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$203.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$203.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$179.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$218.60
|
| Rate for Payer: BCBS Transplant Transplant |
$222.00
|
| Rate for Payer: Blue Shield of California Commercial |
$277.50
|
| Rate for Payer: Blue Shield of California EPN |
$201.28
|
| Rate for Payer: Cash Price |
$166.50
|
| Rate for Payer: Cash Price |
$166.50
|
| Rate for Payer: Central Health Plan Commercial |
$296.00
|
| Rate for Payer: Cigna of CA HMO |
$259.00
|
| Rate for Payer: Cigna of CA PPO |
$259.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$314.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$148.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$148.00
|
| Rate for Payer: Galaxy Health WC |
$314.50
|
| Rate for Payer: Global Benefits Group Commercial |
$222.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$333.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$277.50
|
| Rate for Payer: IEHP medi-cal |
$129.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$246.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$151.70
|
| Rate for Payer: Multiplan Commercial |
$277.50
|
| Rate for Payer: Networks By Design Commercial |
$185.00
|
| Rate for Payer: Prime Health Services Commercial |
$314.50
|
| Rate for Payer: Riverside University Health MISP |
$148.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$222.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$222.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$185.00
|
| Rate for Payer: United Healthcare All Other HMO |
$185.00
|
| Rate for Payer: United Healthcare HMO Rider |
$185.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$185.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$314.50
|
| Rate for Payer: Vantage Medical Group Senior |
$314.50
|
|
|
HC WHFO ADJ MP FLEX CNTRL
|
Facility
IP
|
$370.00
|
|
| Hospital Charge Code |
903203855
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$74.00 |
| Max. Negotiated Rate |
$333.00 |
| Rate for Payer: Blue Shield of California EPN |
$197.58
|
| Rate for Payer: Cash Price |
$166.50
|
| Rate for Payer: Central Health Plan Commercial |
$296.00
|
| Rate for Payer: Cigna of CA HMO |
$259.00
|
| Rate for Payer: Cigna of CA PPO |
$259.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$148.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$148.00
|
| Rate for Payer: Galaxy Health WC |
$314.50
|
| Rate for Payer: Global Benefits Group Commercial |
$222.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$333.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$246.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.00
|
| Rate for Payer: Multiplan Commercial |
$277.50
|
| Rate for Payer: Networks By Design Commercial |
$185.00
|
| Rate for Payer: Prime Health Services Commercial |
$314.50
|
|
|
HC WHFO ADJ MP FLEX CNTRL + IP
|
Facility
IP
|
$445.00
|
|
| Hospital Charge Code |
903203860
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$89.00 |
| Max. Negotiated Rate |
$400.50 |
| Rate for Payer: Blue Shield of California EPN |
$237.63
|
| Rate for Payer: Cash Price |
$200.25
|
| Rate for Payer: Central Health Plan Commercial |
$356.00
|
| Rate for Payer: Cigna of CA HMO |
$311.50
|
| Rate for Payer: Cigna of CA PPO |
$311.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$178.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$178.00
|
| Rate for Payer: Galaxy Health WC |
$378.25
|
| Rate for Payer: Global Benefits Group Commercial |
$267.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$400.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$296.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.00
|
| Rate for Payer: Multiplan Commercial |
$333.75
|
| Rate for Payer: Networks By Design Commercial |
$222.50
|
| Rate for Payer: Prime Health Services Commercial |
$378.25
|
|
|
HC WHFO ADJ MP FLEX CNTRL + IP
|
Facility
OP
|
$445.00
|
|
| Hospital Charge Code |
903203860
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$155.75 |
| Max. Negotiated Rate |
$400.50 |
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$378.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$244.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$244.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$215.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$262.91
|
| Rate for Payer: BCBS Transplant Transplant |
$267.00
|
| Rate for Payer: Blue Shield of California Commercial |
$333.75
|
| Rate for Payer: Blue Shield of California EPN |
$242.08
|
| Rate for Payer: Cash Price |
$200.25
|
| Rate for Payer: Cash Price |
$200.25
|
| Rate for Payer: Central Health Plan Commercial |
$356.00
|
| Rate for Payer: Cigna of CA HMO |
$311.50
|
| Rate for Payer: Cigna of CA PPO |
$311.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$378.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$178.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$178.00
|
| Rate for Payer: Galaxy Health WC |
$378.25
|
| Rate for Payer: Global Benefits Group Commercial |
$267.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$400.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$333.75
|
| Rate for Payer: IEHP medi-cal |
$155.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$296.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$182.45
|
| Rate for Payer: Multiplan Commercial |
$333.75
|
| Rate for Payer: Networks By Design Commercial |
$222.50
|
| Rate for Payer: Prime Health Services Commercial |
$378.25
|
| Rate for Payer: Riverside University Health MISP |
$178.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$267.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$267.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$222.50
|
| Rate for Payer: United Healthcare All Other HMO |
$222.50
|
| Rate for Payer: United Healthcare HMO Rider |
$222.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$222.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$378.25
|
| Rate for Payer: Vantage Medical Group Senior |
$378.25
|
|
|
HC WHFO COCK UP SPLINT
|
Facility
OP
|
$281.00
|
|
|
Service Code
|
CPT L3908
|
| Hospital Charge Code |
905363908
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$98.35 |
| Max. Negotiated Rate |
$252.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$243.40
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$238.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$154.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$154.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$136.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$166.01
|
| Rate for Payer: BCBS Transplant Transplant |
$168.60
|
| Rate for Payer: Blue Shield of California Commercial |
$210.75
|
| Rate for Payer: Blue Shield of California EPN |
$152.86
|
| Rate for Payer: Cash Price |
$126.45
|
| Rate for Payer: Cash Price |
$126.45
|
| Rate for Payer: Central Health Plan Commercial |
$224.80
|
| Rate for Payer: Cigna of CA HMO |
$196.70
|
| Rate for Payer: Cigna of CA PPO |
$196.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$238.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$112.40
|
| Rate for Payer: Galaxy Health WC |
$238.85
|
| Rate for Payer: Global Benefits Group Commercial |
$168.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$252.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$210.75
|
| Rate for Payer: IEHP medi-cal |
$98.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$187.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.21
|
| Rate for Payer: Multiplan Commercial |
$210.75
|
| Rate for Payer: Networks By Design Commercial |
$140.50
|
| Rate for Payer: Prime Health Services Commercial |
$238.85
|
| Rate for Payer: Riverside University Health MISP |
$112.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$168.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$168.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$140.50
|
| Rate for Payer: United Healthcare All Other HMO |
$140.50
|
| Rate for Payer: United Healthcare HMO Rider |
$140.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$140.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$238.85
|
| Rate for Payer: Vantage Medical Group Senior |
$238.85
|
|
|
HC WHFO COCK UP SPLINT
|
Facility
IP
|
$281.00
|
|
|
Service Code
|
CPT L3908
|
| Hospital Charge Code |
905363908
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$56.20 |
| Max. Negotiated Rate |
$252.90 |
| Rate for Payer: Blue Shield of California EPN |
$150.05
|
| Rate for Payer: Cash Price |
$126.45
|
| Rate for Payer: Central Health Plan Commercial |
$224.80
|
| Rate for Payer: Cigna of CA HMO |
$196.70
|
| Rate for Payer: Cigna of CA PPO |
$196.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$112.40
|
| Rate for Payer: Galaxy Health WC |
$238.85
|
| Rate for Payer: Global Benefits Group Commercial |
$168.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$252.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$187.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.20
|
| Rate for Payer: Multiplan Commercial |
$210.75
|
| Rate for Payer: Networks By Design Commercial |
$140.50
|
| Rate for Payer: Prime Health Services Commercial |
$238.85
|
|
|
HC WHFO COMB OPPEN W KNUCKLE BNDR
|
Facility
OP
|
$251.00
|
|
|
Service Code
|
CPT L3925
|
| Hospital Charge Code |
903203950
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$87.85 |
| Max. Negotiated Rate |
$225.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$200.51
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$213.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$138.05
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$138.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$121.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$148.29
|
| Rate for Payer: BCBS Transplant Transplant |
$150.60
|
| Rate for Payer: Blue Shield of California Commercial |
$188.25
|
| Rate for Payer: Blue Shield of California EPN |
$136.54
|
| Rate for Payer: Cash Price |
$112.95
|
| Rate for Payer: Cash Price |
$112.95
|
| Rate for Payer: Central Health Plan Commercial |
$200.80
|
| Rate for Payer: Cigna of CA HMO |
$175.70
|
| Rate for Payer: Cigna of CA PPO |
$175.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$213.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$100.40
|
| Rate for Payer: Galaxy Health WC |
$213.35
|
| Rate for Payer: Global Benefits Group Commercial |
$150.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$225.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$188.25
|
| Rate for Payer: IEHP medi-cal |
$87.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$167.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.91
|
| Rate for Payer: Multiplan Commercial |
$188.25
|
| Rate for Payer: Networks By Design Commercial |
$125.50
|
| Rate for Payer: Prime Health Services Commercial |
$213.35
|
| Rate for Payer: Riverside University Health MISP |
$100.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$150.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$150.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$125.50
|
| Rate for Payer: United Healthcare All Other HMO |
$125.50
|
| Rate for Payer: United Healthcare HMO Rider |
$125.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$125.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$213.35
|
| Rate for Payer: Vantage Medical Group Senior |
$213.35
|
|
|
HC WHFO COMB OPPEN W KNUCKLE BNDR
|
Facility
IP
|
$251.00
|
|
|
Service Code
|
CPT L3925
|
| Hospital Charge Code |
903203950
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$50.20 |
| Max. Negotiated Rate |
$225.90 |
| Rate for Payer: Blue Shield of California EPN |
$134.03
|
| Rate for Payer: Cash Price |
$112.95
|
| Rate for Payer: Central Health Plan Commercial |
$200.80
|
| Rate for Payer: Cigna of CA HMO |
$175.70
|
| Rate for Payer: Cigna of CA PPO |
$175.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$100.40
|
| Rate for Payer: Galaxy Health WC |
$213.35
|
| Rate for Payer: Global Benefits Group Commercial |
$150.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$225.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$167.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.20
|
| Rate for Payer: Multiplan Commercial |
$188.25
|
| Rate for Payer: Networks By Design Commercial |
$125.50
|
| Rate for Payer: Prime Health Services Commercial |
$213.35
|
|
|
HC WHFO COMB OPPEN W/REVRS KNUCKL
|
Facility
OP
|
$244.00
|
|
|
Service Code
|
CPT L3931
|
| Hospital Charge Code |
903203952
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$85.40 |
| Max. Negotiated Rate |
$740.82 |
| Rate for Payer: Aetna of CA HMO/PPO |
$740.82
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$207.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$134.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$134.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$118.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$144.16
|
| Rate for Payer: BCBS Transplant Transplant |
$146.40
|
| Rate for Payer: Blue Shield of California Commercial |
$183.00
|
| Rate for Payer: Blue Shield of California EPN |
$132.74
|
| Rate for Payer: Cash Price |
$109.80
|
| Rate for Payer: Cash Price |
$109.80
|
| Rate for Payer: Central Health Plan Commercial |
$195.20
|
| Rate for Payer: Cigna of CA HMO |
$170.80
|
| Rate for Payer: Cigna of CA PPO |
$170.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$207.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$97.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$97.60
|
| Rate for Payer: Galaxy Health WC |
$207.40
|
| Rate for Payer: Global Benefits Group Commercial |
$146.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$219.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$183.00
|
| Rate for Payer: IEHP medi-cal |
$85.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$162.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.04
|
| Rate for Payer: Multiplan Commercial |
$183.00
|
| Rate for Payer: Networks By Design Commercial |
$122.00
|
| Rate for Payer: Prime Health Services Commercial |
$207.40
|
| Rate for Payer: Riverside University Health MISP |
$97.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$146.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$146.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$122.00
|
| Rate for Payer: United Healthcare All Other HMO |
$122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$122.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$122.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$207.40
|
| Rate for Payer: Vantage Medical Group Senior |
$207.40
|
|
|
HC WHFO COMB OPPEN W/REVRS KNUCKL
|
Facility
IP
|
$244.00
|
|
|
Service Code
|
CPT L3931
|
| Hospital Charge Code |
903203952
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$48.80 |
| Max. Negotiated Rate |
$219.60 |
| Rate for Payer: Blue Shield of California EPN |
$130.30
|
| Rate for Payer: Cash Price |
$109.80
|
| Rate for Payer: Central Health Plan Commercial |
$195.20
|
| Rate for Payer: Cigna of CA HMO |
$170.80
|
| Rate for Payer: Cigna of CA PPO |
$170.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$97.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$97.60
|
| Rate for Payer: Galaxy Health WC |
$207.40
|
| Rate for Payer: Global Benefits Group Commercial |
$146.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$219.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$162.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.80
|
| Rate for Payer: Multiplan Commercial |
$183.00
|
| Rate for Payer: Networks By Design Commercial |
$122.00
|
| Rate for Payer: Prime Health Services Commercial |
$207.40
|
|
|
HC WHFO ELECTRIC POWERED
|
Facility
OP
|
$6,604.00
|
|
|
Service Code
|
CPT L3904
|
| Hospital Charge Code |
905353904
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,311.40 |
| Max. Negotiated Rate |
$11,897.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$11,897.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,613.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3,632.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,632.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,197.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,901.64
|
| Rate for Payer: BCBS Transplant Transplant |
$3,962.40
|
| Rate for Payer: Blue Shield of California Commercial |
$4,953.00
|
| Rate for Payer: Blue Shield of California EPN |
$3,592.58
|
| Rate for Payer: Cash Price |
$2,971.80
|
| Rate for Payer: Cash Price |
$2,971.80
|
| Rate for Payer: Central Health Plan Commercial |
$5,283.20
|
| Rate for Payer: Cigna of CA HMO |
$4,622.80
|
| Rate for Payer: Cigna of CA PPO |
$4,622.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,613.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,641.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,641.60
|
| Rate for Payer: Galaxy Health WC |
$5,613.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,962.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,943.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4,953.00
|
| Rate for Payer: IEHP medi-cal |
$2,311.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,404.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,707.64
|
| Rate for Payer: Multiplan Commercial |
$4,953.00
|
| Rate for Payer: Networks By Design Commercial |
$3,302.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,613.40
|
| Rate for Payer: Riverside University Health MISP |
$2,641.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,962.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,962.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,302.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,302.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,302.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,302.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,613.40
|
| Rate for Payer: Vantage Medical Group Senior |
$5,613.40
|
|
|
HC WHFO ELECTRIC POWERED
|
Facility
IP
|
$6,604.00
|
|
|
Service Code
|
CPT L3904
|
| Hospital Charge Code |
905353904
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,320.80 |
| Max. Negotiated Rate |
$5,943.60 |
| Rate for Payer: Blue Shield of California EPN |
$3,526.54
|
| Rate for Payer: Cash Price |
$2,971.80
|
| Rate for Payer: Central Health Plan Commercial |
$5,283.20
|
| Rate for Payer: Cigna of CA HMO |
$4,622.80
|
| Rate for Payer: Cigna of CA PPO |
$4,622.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,641.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,641.60
|
| Rate for Payer: Galaxy Health WC |
$5,613.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,962.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,943.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,404.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,320.80
|
| Rate for Payer: Multiplan Commercial |
$4,953.00
|
| Rate for Payer: Networks By Design Commercial |
$3,302.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,613.40
|
|
|
HC WHFO FINGER EXTENSION
|
Facility
OP
|
$157.00
|
|
|
Service Code
|
CPT L3929
|
| Hospital Charge Code |
905353928
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$54.95 |
| Max. Negotiated Rate |
$317.58 |
| Rate for Payer: Aetna of CA HMO/PPO |
$317.58
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$133.45
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$86.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$86.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$76.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$92.76
|
| Rate for Payer: BCBS Transplant Transplant |
$94.20
|
| Rate for Payer: Blue Shield of California Commercial |
$117.75
|
| Rate for Payer: Blue Shield of California EPN |
$85.41
|
| Rate for Payer: Cash Price |
$70.65
|
| Rate for Payer: Cash Price |
$70.65
|
| Rate for Payer: Central Health Plan Commercial |
$125.60
|
| Rate for Payer: Cigna of CA HMO |
$109.90
|
| Rate for Payer: Cigna of CA PPO |
$109.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$133.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$62.80
|
| Rate for Payer: Galaxy Health WC |
$133.45
|
| Rate for Payer: Global Benefits Group Commercial |
$94.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$141.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$117.75
|
| Rate for Payer: IEHP medi-cal |
$54.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$104.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.37
|
| Rate for Payer: Multiplan Commercial |
$117.75
|
| Rate for Payer: Networks By Design Commercial |
$78.50
|
| Rate for Payer: Prime Health Services Commercial |
$133.45
|
| Rate for Payer: Riverside University Health MISP |
$62.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$94.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$94.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$78.50
|
| Rate for Payer: United Healthcare All Other HMO |
$78.50
|
| Rate for Payer: United Healthcare HMO Rider |
$78.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$78.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$133.45
|
| Rate for Payer: Vantage Medical Group Senior |
$133.45
|
|
|
HC WHFO FINGER EXTENSION
|
Facility
IP
|
$157.00
|
|
|
Service Code
|
CPT L3929
|
| Hospital Charge Code |
905353928
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$31.40 |
| Max. Negotiated Rate |
$141.30 |
| Rate for Payer: Blue Shield of California EPN |
$83.84
|
| Rate for Payer: Cash Price |
$70.65
|
| Rate for Payer: Central Health Plan Commercial |
$125.60
|
| Rate for Payer: Cigna of CA HMO |
$109.90
|
| Rate for Payer: Cigna of CA PPO |
$109.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$62.80
|
| Rate for Payer: Galaxy Health WC |
$133.45
|
| Rate for Payer: Global Benefits Group Commercial |
$94.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$141.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$104.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.40
|
| Rate for Payer: Multiplan Commercial |
$117.75
|
| Rate for Payer: Networks By Design Commercial |
$78.50
|
| Rate for Payer: Prime Health Services Commercial |
$133.45
|
|
|
HC WHFO FINGER EXT W/CLOCK SPRIN
|
Facility
IP
|
$141.00
|
|
|
Service Code
|
CPT L3929
|
| Hospital Charge Code |
901309105
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$28.20 |
| Max. Negotiated Rate |
$126.90 |
| Rate for Payer: Blue Shield of California EPN |
$75.29
|
| Rate for Payer: Cash Price |
$63.45
|
| Rate for Payer: Central Health Plan Commercial |
$112.80
|
| Rate for Payer: Cigna of CA HMO |
$98.70
|
| Rate for Payer: Cigna of CA PPO |
$98.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$56.40
|
| Rate for Payer: Galaxy Health WC |
$119.85
|
| Rate for Payer: Global Benefits Group Commercial |
$84.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$126.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$94.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.20
|
| Rate for Payer: Multiplan Commercial |
$105.75
|
| Rate for Payer: Networks By Design Commercial |
$70.50
|
| Rate for Payer: Prime Health Services Commercial |
$119.85
|
|
|
HC WHFO FINGER EXT W/CLOCK SPRIN
|
Facility
OP
|
$141.00
|
|
|
Service Code
|
CPT L3929
|
| Hospital Charge Code |
901309105
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$49.35 |
| Max. Negotiated Rate |
$317.58 |
| Rate for Payer: Aetna of CA HMO/PPO |
$317.58
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$119.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$77.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$77.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$68.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$83.30
|
| Rate for Payer: BCBS Transplant Transplant |
$84.60
|
| Rate for Payer: Blue Shield of California Commercial |
$105.75
|
| Rate for Payer: Blue Shield of California EPN |
$76.70
|
| Rate for Payer: Cash Price |
$63.45
|
| Rate for Payer: Cash Price |
$63.45
|
| Rate for Payer: Central Health Plan Commercial |
$112.80
|
| Rate for Payer: Cigna of CA HMO |
$98.70
|
| Rate for Payer: Cigna of CA PPO |
$98.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$119.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$56.40
|
| Rate for Payer: Galaxy Health WC |
$119.85
|
| Rate for Payer: Global Benefits Group Commercial |
$84.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$126.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$105.75
|
| Rate for Payer: IEHP medi-cal |
$49.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$94.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.81
|
| Rate for Payer: Multiplan Commercial |
$105.75
|
| Rate for Payer: Networks By Design Commercial |
$70.50
|
| Rate for Payer: Prime Health Services Commercial |
$119.85
|
| Rate for Payer: Riverside University Health MISP |
$56.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$84.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$84.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$70.50
|
| Rate for Payer: United Healthcare All Other HMO |
$70.50
|
| Rate for Payer: United Healthcare HMO Rider |
$70.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$70.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$119.85
|
| Rate for Payer: Vantage Medical Group Senior |
$119.85
|
|
|
HC WHFO FING EXT WRIST SUPPORT
|
Facility
OP
|
$560.00
|
|
|
Service Code
|
CPT L3931
|
| Hospital Charge Code |
901300801
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$196.00 |
| Max. Negotiated Rate |
$740.82 |
| Rate for Payer: Aetna of CA HMO/PPO |
$740.82
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$476.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$308.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$308.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: BCBS Transplant Transplant |
$336.00
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cash Price |
$252.00
|
| 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 |
$358.40
|
| Rate for Payer: Cigna of CA PPO |
$414.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$476.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$224.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$420.00
|
| Rate for Payer: IEHP medi-cal |
$196.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$373.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$229.60
|
| 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: Redlands Yucaipa Medical Group Commercial/Senior |
$336.00
|
| Rate for Payer: Riverside University Health 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 |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$476.00
|
| Rate for Payer: Vantage Medical Group Senior |
$476.00
|
|
|
HC WHFO FING EXT WRIST SUPPORT
|
Facility
IP
|
$560.00
|
|
|
Service Code
|
CPT L3931
|
| Hospital Charge Code |
901300801
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$112.00 |
| Max. Negotiated Rate |
$504.00 |
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Central Health Plan Commercial |
$448.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$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 Permanente of CA Commercial/Self Funded |
$373.52
|
| 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
|
|
|
HC WHFO FLEXION GLOVE
|
Facility
IP
|
$212.00
|
|
|
Service Code
|
CPT L3912
|
| Hospital Charge Code |
905353912
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$42.40 |
| Max. Negotiated Rate |
$190.80 |
| Rate for Payer: Blue Shield of California EPN |
$113.21
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Central Health Plan Commercial |
$169.60
|
| Rate for Payer: Cigna of CA HMO |
$148.40
|
| Rate for Payer: Cigna of CA PPO |
$148.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$84.80
|
| Rate for Payer: Galaxy Health WC |
$180.20
|
| Rate for Payer: Global Benefits Group Commercial |
$127.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$190.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$141.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.40
|
| Rate for Payer: Multiplan Commercial |
$159.00
|
| Rate for Payer: Networks By Design Commercial |
$106.00
|
| Rate for Payer: Prime Health Services Commercial |
$180.20
|
|
|
HC WHFO FLEXION GLOVE
|
Facility
OP
|
$212.00
|
|
|
Service Code
|
CPT L3912
|
| Hospital Charge Code |
905353912
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$74.20 |
| Max. Negotiated Rate |
$385.26 |
| Rate for Payer: Aetna of CA HMO/PPO |
$385.26
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$180.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$116.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$116.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$102.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$125.25
|
| Rate for Payer: BCBS Transplant Transplant |
$127.20
|
| Rate for Payer: Blue Shield of California Commercial |
$159.00
|
| Rate for Payer: Blue Shield of California EPN |
$115.33
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Central Health Plan Commercial |
$169.60
|
| Rate for Payer: Cigna of CA HMO |
$148.40
|
| Rate for Payer: Cigna of CA PPO |
$148.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$180.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$84.80
|
| Rate for Payer: Galaxy Health WC |
$180.20
|
| Rate for Payer: Global Benefits Group Commercial |
$127.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$190.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$159.00
|
| Rate for Payer: IEHP medi-cal |
$74.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$141.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.92
|
| Rate for Payer: Multiplan Commercial |
$159.00
|
| Rate for Payer: Networks By Design Commercial |
$106.00
|
| Rate for Payer: Prime Health Services Commercial |
$180.20
|
| Rate for Payer: Riverside University Health MISP |
$84.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$127.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$127.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$106.00
|
| Rate for Payer: United Healthcare All Other HMO |
$106.00
|
| Rate for Payer: United Healthcare HMO Rider |
$106.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$106.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.20
|
| Rate for Payer: Vantage Medical Group Senior |
$180.20
|
|
|
HC WHFO FLEXOR HINGE CABLE DRIVEN
|
Facility
IP
|
$1,588.00
|
|
|
Service Code
|
CPT L3901
|
| Hospital Charge Code |
905353901
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$317.60 |
| Max. Negotiated Rate |
$1,429.20 |
| Rate for Payer: Blue Shield of California EPN |
$847.99
|
| Rate for Payer: Cash Price |
$714.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,270.40
|
| Rate for Payer: Cigna of CA HMO |
$1,111.60
|
| Rate for Payer: Cigna of CA PPO |
$1,111.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$635.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$635.20
|
| Rate for Payer: Galaxy Health WC |
$1,349.80
|
| Rate for Payer: Global Benefits Group Commercial |
$952.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,429.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,059.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$317.60
|
| Rate for Payer: Multiplan Commercial |
$1,191.00
|
| Rate for Payer: Networks By Design Commercial |
$794.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,349.80
|
|
|
HC WHFO FLEXOR HINGE CABLE DRIVEN
|
Facility
OP
|
$1,588.00
|
|
|
Service Code
|
CPT L3901
|
| Hospital Charge Code |
905353901
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$555.80 |
| Max. Negotiated Rate |
$6,528.63 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6,528.63
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,349.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$873.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$873.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$768.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$938.19
|
| Rate for Payer: BCBS Transplant Transplant |
$952.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,191.00
|
| Rate for Payer: Blue Shield of California EPN |
$863.87
|
| Rate for Payer: Cash Price |
$714.60
|
| Rate for Payer: Cash Price |
$714.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,270.40
|
| Rate for Payer: Cigna of CA HMO |
$1,111.60
|
| Rate for Payer: Cigna of CA PPO |
$1,111.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,349.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$635.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$635.20
|
| Rate for Payer: Galaxy Health WC |
$1,349.80
|
| Rate for Payer: Global Benefits Group Commercial |
$952.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,429.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,191.00
|
| Rate for Payer: IEHP medi-cal |
$555.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,059.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$651.08
|
| Rate for Payer: Multiplan Commercial |
$1,191.00
|
| Rate for Payer: Networks By Design Commercial |
$794.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,349.80
|
| Rate for Payer: Riverside University Health MISP |
$635.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$952.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$952.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$794.00
|
| Rate for Payer: United Healthcare All Other HMO |
$794.00
|
| Rate for Payer: United Healthcare HMO Rider |
$794.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$794.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,349.80
|
| Rate for Payer: Vantage Medical Group Senior |
$1,349.80
|
|
|
HC WHFO FLEXOR HINGE WRIST DRIVEN
|
Facility
OP
|
$2,500.00
|
|
|
Service Code
|
CPT L3900
|
| Hospital Charge Code |
905353900
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$5,256.76 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5,256.76
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,125.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,375.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,375.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,210.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,477.00
|
| Rate for Payer: BCBS Transplant Transplant |
$1,500.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,875.00
|
| Rate for Payer: Blue Shield of California EPN |
$1,360.00
|
| Rate for Payer: Cash Price |
$1,125.00
|
| Rate for Payer: Cash Price |
$1,125.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,000.00
|
| Rate for Payer: Cigna of CA HMO |
$1,750.00
|
| Rate for Payer: Cigna of CA PPO |
$1,750.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,125.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,000.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,000.00
|
| Rate for Payer: Galaxy Health WC |
$2,125.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,500.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,250.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,875.00
|
| Rate for Payer: IEHP medi-cal |
$875.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,667.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,025.00
|
| Rate for Payer: Multiplan Commercial |
$1,875.00
|
| Rate for Payer: Networks By Design Commercial |
$1,250.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,125.00
|
| Rate for Payer: Riverside University Health MISP |
$1,000.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,500.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,500.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,250.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,250.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,250.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,250.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,125.00
|
| Rate for Payer: Vantage Medical Group Senior |
$2,125.00
|
|
|
HC WHFO FLEXOR HINGE WRIST DRIVEN
|
Facility
IP
|
$2,500.00
|
|
|
Service Code
|
CPT L3900
|
| Hospital Charge Code |
905353900
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$500.00 |
| Max. Negotiated Rate |
$2,250.00 |
| Rate for Payer: Blue Shield of California EPN |
$1,335.00
|
| Rate for Payer: Cash Price |
$1,125.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,000.00
|
| Rate for Payer: Cigna of CA HMO |
$1,750.00
|
| Rate for Payer: Cigna of CA PPO |
$1,750.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,000.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,000.00
|
| Rate for Payer: Galaxy Health WC |
$2,125.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,500.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,250.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,667.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$500.00
|
| Rate for Payer: Multiplan Commercial |
$1,875.00
|
| Rate for Payer: Networks By Design Commercial |
$1,250.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,125.00
|
|
|
HC WHFO IP EXT ASSIST W MP STOP
|
Facility
OP
|
$245.00
|
|
| Hospital Charge Code |
903203820
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$85.75 |
| Max. Negotiated Rate |
$220.50 |
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$208.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$134.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$134.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$118.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$144.75
|
| Rate for Payer: BCBS Transplant Transplant |
$147.00
|
| Rate for Payer: Blue Shield of California Commercial |
$183.75
|
| Rate for Payer: Blue Shield of California EPN |
$133.28
|
| Rate for Payer: Cash Price |
$110.25
|
| Rate for Payer: Cash Price |
$110.25
|
| Rate for Payer: Central Health Plan Commercial |
$196.00
|
| Rate for Payer: Cigna of CA HMO |
$171.50
|
| Rate for Payer: Cigna of CA PPO |
$171.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$208.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$98.00
|
| Rate for Payer: Galaxy Health WC |
$208.25
|
| Rate for Payer: Global Benefits Group Commercial |
$147.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$220.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$183.75
|
| Rate for Payer: IEHP medi-cal |
$85.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$163.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.45
|
| Rate for Payer: Multiplan Commercial |
$183.75
|
| Rate for Payer: Networks By Design Commercial |
$122.50
|
| Rate for Payer: Prime Health Services Commercial |
$208.25
|
| Rate for Payer: Riverside University Health MISP |
$98.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$147.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$147.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$122.50
|
| Rate for Payer: United Healthcare All Other HMO |
$122.50
|
| Rate for Payer: United Healthcare HMO Rider |
$122.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$122.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$208.25
|
| Rate for Payer: Vantage Medical Group Senior |
$208.25
|
|
