|
HC WHFO IP EXT ASSIST W MP STOP
|
Facility
|
IP
|
$245.00
|
|
| Hospital Charge Code |
903203820
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$49.00 |
| Max. Negotiated Rate |
$220.50 |
| Rate for Payer: Blue Shield of California EPN |
$130.83
|
| 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: 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: Kaiser Permanente of CA Commercial/Self Funded |
$163.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$93.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.00
|
| Rate for Payer: Multiplan Commercial |
$183.75
|
| Rate for Payer: Networks By Design Commercial |
$122.50
|
| Rate for Payer: Prime Health Services Commercial |
$208.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$92.51
|
| Rate for Payer: United Healthcare All Other HMO |
$90.36
|
| Rate for Payer: United Healthcare HMO Rider |
$88.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$80.85
|
|
|
HC WHFO IP EXT ASST W/MP STOP
|
Facility
|
IP
|
$165.00
|
|
| Hospital Charge Code |
903203845
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$33.00 |
| Max. Negotiated Rate |
$148.50 |
| Rate for Payer: Blue Shield of California EPN |
$88.11
|
| Rate for Payer: Cash Price |
$74.25
|
| Rate for Payer: Central Health Plan Commercial |
$132.00
|
| Rate for Payer: Cigna of CA HMO |
$115.50
|
| Rate for Payer: Cigna of CA PPO |
$115.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$66.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$66.00
|
| Rate for Payer: Galaxy Health WC |
$140.25
|
| Rate for Payer: Global Benefits Group Commercial |
$99.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$148.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$110.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$62.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.00
|
| Rate for Payer: Multiplan Commercial |
$123.75
|
| Rate for Payer: Networks By Design Commercial |
$82.50
|
| Rate for Payer: Prime Health Services Commercial |
$140.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$62.30
|
| Rate for Payer: United Healthcare All Other HMO |
$60.85
|
| Rate for Payer: United Healthcare HMO Rider |
$59.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$54.45
|
|
|
HC WHFO IP EXT ASST W/MP STOP
|
Facility
|
OP
|
$165.00
|
|
| Hospital Charge Code |
903203845
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$57.75 |
| Max. Negotiated Rate |
$148.50 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$140.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$90.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$90.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$79.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$97.48
|
| Rate for Payer: Blue Distinction Transplant |
$99.00
|
| Rate for Payer: Blue Shield of California Commercial |
$123.75
|
| Rate for Payer: Blue Shield of California EPN |
$89.76
|
| Rate for Payer: Cash Price |
$74.25
|
| Rate for Payer: Central Health Plan Commercial |
$132.00
|
| Rate for Payer: Cigna of CA HMO |
$115.50
|
| Rate for Payer: Cigna of CA PPO |
$115.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$140.25
|
| Rate for Payer: Dignity Health Media |
$140.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$140.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$66.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$66.00
|
| Rate for Payer: Galaxy Health WC |
$140.25
|
| Rate for Payer: Global Benefits Group Commercial |
$99.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$148.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$123.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$57.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$110.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$62.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.65
|
| Rate for Payer: Multiplan Commercial |
$123.75
|
| Rate for Payer: Networks By Design Commercial |
$82.50
|
| Rate for Payer: Prime Health Services Commercial |
$140.25
|
| Rate for Payer: Riverside University Health System MISP |
$66.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$99.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$99.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$82.50
|
| Rate for Payer: United Healthcare All Other HMO |
$82.50
|
| Rate for Payer: United Healthcare HMO Rider |
$82.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$82.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$140.25
|
| Rate for Payer: Vantage Medical Group Senior |
$140.25
|
|
|
HC WHFO KNUCKLE BENDER 2 SEG
|
Facility
|
IP
|
$420.00
|
|
|
Service Code
|
CPT L3925
|
| Hospital Charge Code |
905353922
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$378.00 |
| Rate for Payer: Blue Shield of California EPN |
$224.28
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Central Health Plan Commercial |
$336.00
|
| Rate for Payer: Cigna of CA HMO |
$294.00
|
| Rate for Payer: Cigna of CA PPO |
$294.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$168.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$168.00
|
| Rate for Payer: Galaxy Health WC |
$357.00
|
| Rate for Payer: Global Benefits Group Commercial |
$252.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$378.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$280.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$160.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Multiplan Commercial |
$315.00
|
| Rate for Payer: Networks By Design Commercial |
$210.00
|
| Rate for Payer: Prime Health Services Commercial |
$357.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$158.59
|
| Rate for Payer: United Healthcare All Other HMO |
$154.90
|
| Rate for Payer: United Healthcare HMO Rider |
$151.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$138.60
|
|
|
HC WHFO KNUCKLE BENDER 2 SEG
|
Facility
|
OP
|
$420.00
|
|
|
Service Code
|
CPT L3925
|
| Hospital Charge Code |
905353922
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$76.48 |
| Max. Negotiated Rate |
$378.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$357.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$231.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$231.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$203.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$248.14
|
| Rate for Payer: Blue Distinction Transplant |
$252.00
|
| Rate for Payer: Blue Shield of California Commercial |
$315.00
|
| Rate for Payer: Blue Shield of California EPN |
$228.48
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Central Health Plan Commercial |
$336.00
|
| Rate for Payer: Cigna of CA HMO |
$294.00
|
| Rate for Payer: Cigna of CA PPO |
$294.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$357.00
|
| Rate for Payer: Dignity Health Media |
$357.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$357.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$168.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$168.00
|
| Rate for Payer: Galaxy Health WC |
$357.00
|
| Rate for Payer: Global Benefits Group Commercial |
$252.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$378.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$315.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$147.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$280.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$76.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$172.20
|
| Rate for Payer: Multiplan Commercial |
$315.00
|
| Rate for Payer: Networks By Design Commercial |
$210.00
|
| Rate for Payer: Prime Health Services Commercial |
$357.00
|
| Rate for Payer: Riverside University Health System MISP |
$168.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$252.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$252.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$210.00
|
| Rate for Payer: United Healthcare All Other HMO |
$210.00
|
| Rate for Payer: United Healthcare HMO Rider |
$210.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$210.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$357.00
|
| Rate for Payer: Vantage Medical Group Senior |
$357.00
|
|
|
HC WHFO LONG OPPONENS WO ATTACH
|
Facility
|
IP
|
$936.00
|
|
|
Service Code
|
CPT L3808
|
| Hospital Charge Code |
901309111
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$187.20 |
| Max. Negotiated Rate |
$842.40 |
| Rate for Payer: Cash Price |
$421.20
|
| Rate for Payer: Central Health Plan Commercial |
$748.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$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 Permanente of CA Commercial/Self Funded |
$624.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$356.62
|
| 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 LONG OPPONENS WO ATTACH
|
Facility
|
OP
|
$936.00
|
|
|
Service Code
|
CPT L3808
|
| Hospital Charge Code |
901309111
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$196.00 |
| Max. Negotiated Rate |
$1,345.31 |
| 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 |
$514.80
|
| 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: Blue Distinction Transplant |
$561.60
|
| 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 |
$421.20
|
| 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 Media |
$795.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$795.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$374.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$702.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$327.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$624.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$319.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$383.76
|
| 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 |
$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 |
$795.60
|
| Rate for Payer: Vantage Medical Group Senior |
$795.60
|
|
|
HC WHFO LONG OPPONENS WO ATTACH CF
|
Facility
|
IP
|
$549.00
|
|
|
Service Code
|
CPT L3808
|
| Hospital Charge Code |
903203805
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$109.80 |
| Max. Negotiated Rate |
$494.10 |
| Rate for Payer: Blue Shield of California EPN |
$293.17
|
| Rate for Payer: Cash Price |
$247.05
|
| Rate for Payer: Central Health Plan Commercial |
$439.20
|
| Rate for Payer: Cigna of CA HMO |
$384.30
|
| Rate for Payer: Cigna of CA PPO |
$384.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$219.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$219.60
|
| Rate for Payer: Galaxy Health WC |
$466.65
|
| Rate for Payer: Global Benefits Group Commercial |
$329.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$494.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$366.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$209.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$109.80
|
| Rate for Payer: Multiplan Commercial |
$411.75
|
| Rate for Payer: Networks By Design Commercial |
$274.50
|
| Rate for Payer: Prime Health Services Commercial |
$466.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$207.30
|
| Rate for Payer: United Healthcare All Other HMO |
$202.47
|
| Rate for Payer: United Healthcare HMO Rider |
$198.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$181.17
|
|
|
HC WHFO LONG OPPONENS WO ATTACH CF
|
Facility
|
OP
|
$549.00
|
|
|
Service Code
|
CPT L3808
|
| Hospital Charge Code |
903203805
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$192.15 |
| Max. Negotiated Rate |
$494.10 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$466.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$301.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$301.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$265.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$324.35
|
| Rate for Payer: Blue Distinction Transplant |
$329.40
|
| Rate for Payer: Blue Shield of California Commercial |
$411.75
|
| Rate for Payer: Blue Shield of California EPN |
$298.66
|
| Rate for Payer: Cash Price |
$247.05
|
| Rate for Payer: Cash Price |
$247.05
|
| Rate for Payer: Central Health Plan Commercial |
$439.20
|
| Rate for Payer: Cigna of CA HMO |
$384.30
|
| Rate for Payer: Cigna of CA PPO |
$384.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$466.65
|
| Rate for Payer: Dignity Health Media |
$466.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$466.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$219.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$219.60
|
| Rate for Payer: Galaxy Health WC |
$466.65
|
| Rate for Payer: Global Benefits Group Commercial |
$329.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$494.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$411.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$192.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$366.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$319.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$225.09
|
| Rate for Payer: Multiplan Commercial |
$411.75
|
| Rate for Payer: Networks By Design Commercial |
$274.50
|
| Rate for Payer: Prime Health Services Commercial |
$466.65
|
| Rate for Payer: Riverside University Health System MISP |
$219.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$329.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$329.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$274.50
|
| Rate for Payer: United Healthcare All Other HMO |
$274.50
|
| Rate for Payer: United Healthcare HMO Rider |
$274.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$274.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$466.65
|
| Rate for Payer: Vantage Medical Group Senior |
$466.65
|
|
|
HC WHFO MP EXT ASSIST
|
Facility
|
IP
|
$170.00
|
|
| Hospital Charge Code |
903203830
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$34.00 |
| Max. Negotiated Rate |
$153.00 |
| Rate for Payer: Blue Shield of California EPN |
$90.78
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Central Health Plan Commercial |
$136.00
|
| Rate for Payer: Cigna of CA HMO |
$119.00
|
| Rate for Payer: Cigna of CA PPO |
$119.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$68.00
|
| Rate for Payer: Galaxy Health WC |
$144.50
|
| Rate for Payer: Global Benefits Group Commercial |
$102.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$153.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$113.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.00
|
| Rate for Payer: Multiplan Commercial |
$127.50
|
| Rate for Payer: Networks By Design Commercial |
$85.00
|
| Rate for Payer: Prime Health Services Commercial |
$144.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$64.19
|
| Rate for Payer: United Healthcare All Other HMO |
$62.70
|
| Rate for Payer: United Healthcare HMO Rider |
$61.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$56.10
|
|
|
HC WHFO MP EXT ASSIST
|
Facility
|
OP
|
$170.00
|
|
| Hospital Charge Code |
903203830
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$59.50 |
| Max. Negotiated Rate |
$153.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$144.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$93.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$93.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$82.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$100.44
|
| Rate for Payer: Blue Distinction Transplant |
$102.00
|
| Rate for Payer: Blue Shield of California Commercial |
$127.50
|
| Rate for Payer: Blue Shield of California EPN |
$92.48
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Central Health Plan Commercial |
$136.00
|
| Rate for Payer: Cigna of CA HMO |
$119.00
|
| Rate for Payer: Cigna of CA PPO |
$119.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$144.50
|
| Rate for Payer: Dignity Health Media |
$144.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$144.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$68.00
|
| Rate for Payer: Galaxy Health WC |
$144.50
|
| Rate for Payer: Global Benefits Group Commercial |
$102.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$153.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$127.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$59.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$113.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.70
|
| Rate for Payer: Multiplan Commercial |
$127.50
|
| Rate for Payer: Networks By Design Commercial |
$85.00
|
| Rate for Payer: Prime Health Services Commercial |
$144.50
|
| Rate for Payer: Riverside University Health System MISP |
$68.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$102.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$102.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$85.00
|
| Rate for Payer: United Healthcare All Other HMO |
$85.00
|
| Rate for Payer: United Healthcare HMO Rider |
$85.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$85.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$144.50
|
| Rate for Payer: Vantage Medical Group Senior |
$144.50
|
|
|
HC WHFO MP SPRNG EXT ASSIST
|
Facility
|
OP
|
$265.00
|
|
| Hospital Charge Code |
903203835
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$92.75 |
| Max. Negotiated Rate |
$238.50 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$225.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$145.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$145.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$128.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$156.56
|
| Rate for Payer: Blue Distinction Transplant |
$159.00
|
| Rate for Payer: Blue Shield of California Commercial |
$198.75
|
| Rate for Payer: Blue Shield of California EPN |
$144.16
|
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: Central Health Plan Commercial |
$212.00
|
| Rate for Payer: Cigna of CA HMO |
$185.50
|
| Rate for Payer: Cigna of CA PPO |
$185.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$225.25
|
| Rate for Payer: Dignity Health Media |
$225.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$225.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$106.00
|
| Rate for Payer: Galaxy Health WC |
$225.25
|
| Rate for Payer: Global Benefits Group Commercial |
$159.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$238.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$198.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$92.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$176.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.65
|
| Rate for Payer: Multiplan Commercial |
$198.75
|
| Rate for Payer: Networks By Design Commercial |
$132.50
|
| Rate for Payer: Prime Health Services Commercial |
$225.25
|
| Rate for Payer: Riverside University Health System MISP |
$106.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$159.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$159.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$132.50
|
| Rate for Payer: United Healthcare All Other HMO |
$132.50
|
| Rate for Payer: United Healthcare HMO Rider |
$132.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$132.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$225.25
|
| Rate for Payer: Vantage Medical Group Senior |
$225.25
|
|
|
HC WHFO MP SPRNG EXT ASSIST
|
Facility
|
IP
|
$265.00
|
|
| Hospital Charge Code |
903203835
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$53.00 |
| Max. Negotiated Rate |
$238.50 |
| Rate for Payer: Blue Shield of California EPN |
$141.51
|
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: Central Health Plan Commercial |
$212.00
|
| Rate for Payer: Cigna of CA HMO |
$185.50
|
| Rate for Payer: Cigna of CA PPO |
$185.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$106.00
|
| Rate for Payer: Galaxy Health WC |
$225.25
|
| Rate for Payer: Global Benefits Group Commercial |
$159.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$238.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$176.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.00
|
| Rate for Payer: Multiplan Commercial |
$198.75
|
| Rate for Payer: Networks By Design Commercial |
$132.50
|
| Rate for Payer: Prime Health Services Commercial |
$225.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$100.06
|
| Rate for Payer: United Healthcare All Other HMO |
$97.73
|
| Rate for Payer: United Healthcare HMO Rider |
$95.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$87.45
|
|
|
HC WHFO NONTORSION JOINT(S) PREFA
|
Facility
|
IP
|
$459.00
|
|
|
Service Code
|
CPT L3931
|
| Hospital Charge Code |
905353931
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$91.80 |
| Max. Negotiated Rate |
$413.10 |
| Rate for Payer: Blue Shield of California EPN |
$245.11
|
| Rate for Payer: Cash Price |
$206.55
|
| Rate for Payer: Central Health Plan Commercial |
$367.20
|
| Rate for Payer: Cigna of CA HMO |
$321.30
|
| Rate for Payer: Cigna of CA PPO |
$321.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$183.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$183.60
|
| Rate for Payer: Galaxy Health WC |
$390.15
|
| Rate for Payer: Global Benefits Group Commercial |
$275.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$413.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$306.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$174.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$91.80
|
| Rate for Payer: Multiplan Commercial |
$344.25
|
| Rate for Payer: Networks By Design Commercial |
$229.50
|
| Rate for Payer: Prime Health Services Commercial |
$390.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$173.32
|
| Rate for Payer: United Healthcare All Other HMO |
$169.28
|
| Rate for Payer: United Healthcare HMO Rider |
$165.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$151.47
|
|
|
HC WHFO NONTORSION JOINT(S) PREFA
|
Facility
|
OP
|
$459.00
|
|
|
Service Code
|
CPT L3931
|
| Hospital Charge Code |
905353931
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$160.65 |
| Max. Negotiated Rate |
$413.10 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$390.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$252.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$222.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$271.18
|
| Rate for Payer: Blue Distinction Transplant |
$275.40
|
| Rate for Payer: Blue Shield of California Commercial |
$344.25
|
| Rate for Payer: Blue Shield of California EPN |
$249.70
|
| Rate for Payer: Cash Price |
$206.55
|
| Rate for Payer: Cash Price |
$206.55
|
| Rate for Payer: Central Health Plan Commercial |
$367.20
|
| Rate for Payer: Cigna of CA HMO |
$321.30
|
| Rate for Payer: Cigna of CA PPO |
$321.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$390.15
|
| Rate for Payer: Dignity Health Media |
$390.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$390.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$183.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$183.60
|
| Rate for Payer: Galaxy Health WC |
$390.15
|
| Rate for Payer: Global Benefits Group Commercial |
$275.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$413.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$344.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$160.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$306.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$279.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$188.19
|
| Rate for Payer: Multiplan Commercial |
$344.25
|
| Rate for Payer: Networks By Design Commercial |
$229.50
|
| Rate for Payer: Prime Health Services Commercial |
$390.15
|
| Rate for Payer: Riverside University Health System MISP |
$183.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$275.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$275.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$229.50
|
| Rate for Payer: United Healthcare All Other HMO |
$229.50
|
| Rate for Payer: United Healthcare HMO Rider |
$229.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$229.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$390.15
|
| Rate for Payer: Vantage Medical Group Senior |
$390.15
|
|
|
HC WHFO OPPENHEIMER OT
|
Facility
|
IP
|
$560.00
|
|
|
Service Code
|
CPT L3931
|
| Hospital Charge Code |
901300800
|
|
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: Kaiser Permanente of CA Medi-Cal |
$213.36
|
| 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 OPPENHEIMER OT
|
Facility
|
OP
|
$560.00
|
|
|
Service Code
|
CPT L3931
|
| Hospital Charge Code |
901300800
|
|
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: Alpha Care Medical Group Commercial/Exchange |
$476.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$308.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$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: Blue Distinction 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: Dignity Health Media |
$476.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$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) Other |
$420.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$196.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$373.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$279.19
|
| 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: Riverside University Health System MISP |
$224.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$336.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$336.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$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 RIGID W/O JOINTS
|
Facility
|
OP
|
$697.00
|
|
|
Service Code
|
CPT L3808
|
| Hospital Charge Code |
905353808
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$243.95 |
| Max. Negotiated Rate |
$627.30 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$592.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$383.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$383.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$337.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$411.79
|
| Rate for Payer: Blue Distinction Transplant |
$418.20
|
| Rate for Payer: Blue Shield of California Commercial |
$522.75
|
| Rate for Payer: Blue Shield of California EPN |
$379.17
|
| Rate for Payer: Cash Price |
$313.65
|
| Rate for Payer: Cash Price |
$313.65
|
| Rate for Payer: Central Health Plan Commercial |
$557.60
|
| Rate for Payer: Cigna of CA HMO |
$487.90
|
| Rate for Payer: Cigna of CA PPO |
$487.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$592.45
|
| Rate for Payer: Dignity Health Media |
$592.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$592.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$278.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$278.80
|
| Rate for Payer: Galaxy Health WC |
$592.45
|
| Rate for Payer: Global Benefits Group Commercial |
$418.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$627.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$522.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$243.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$464.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$319.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$285.77
|
| Rate for Payer: Multiplan Commercial |
$522.75
|
| Rate for Payer: Networks By Design Commercial |
$348.50
|
| Rate for Payer: Prime Health Services Commercial |
$592.45
|
| Rate for Payer: Riverside University Health System MISP |
$278.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$418.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$418.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$348.50
|
| Rate for Payer: United Healthcare All Other HMO |
$348.50
|
| Rate for Payer: United Healthcare HMO Rider |
$348.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$348.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$592.45
|
| Rate for Payer: Vantage Medical Group Senior |
$592.45
|
|
|
HC WHFO RIGID W/O JOINTS
|
Facility
|
IP
|
$697.00
|
|
|
Service Code
|
CPT L3808
|
| Hospital Charge Code |
905353808
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$139.40 |
| Max. Negotiated Rate |
$627.30 |
| Rate for Payer: Blue Shield of California EPN |
$372.20
|
| Rate for Payer: Cash Price |
$313.65
|
| Rate for Payer: Central Health Plan Commercial |
$557.60
|
| Rate for Payer: Cigna of CA HMO |
$487.90
|
| Rate for Payer: Cigna of CA PPO |
$487.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$278.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$278.80
|
| Rate for Payer: Galaxy Health WC |
$592.45
|
| Rate for Payer: Global Benefits Group Commercial |
$418.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$627.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$464.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$265.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.40
|
| Rate for Payer: Multiplan Commercial |
$522.75
|
| Rate for Payer: Networks By Design Commercial |
$348.50
|
| Rate for Payer: Prime Health Services Commercial |
$592.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$263.19
|
| Rate for Payer: United Healthcare All Other HMO |
$257.05
|
| Rate for Payer: United Healthcare HMO Rider |
$251.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$230.01
|
|
|
HC WHFO VOLAR COCK-UP W/FLEX OUTRIGGER
|
Facility
|
OP
|
$214.00
|
|
|
Service Code
|
CPT L3931
|
| Hospital Charge Code |
901301038
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$74.90 |
| Max. Negotiated Rate |
$279.19 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$181.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$117.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$117.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$103.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$126.43
|
| Rate for Payer: Blue Distinction Transplant |
$128.40
|
| Rate for Payer: Blue Shield of California Commercial |
$160.50
|
| Rate for Payer: Blue Shield of California EPN |
$116.42
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Central Health Plan Commercial |
$171.20
|
| Rate for Payer: Cigna of CA HMO |
$149.80
|
| Rate for Payer: Cigna of CA PPO |
$149.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$181.90
|
| Rate for Payer: Dignity Health Media |
$181.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$181.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$85.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$85.60
|
| Rate for Payer: Galaxy Health WC |
$181.90
|
| Rate for Payer: Global Benefits Group Commercial |
$128.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$192.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$160.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$74.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$142.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$279.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.74
|
| Rate for Payer: Multiplan Commercial |
$160.50
|
| Rate for Payer: Networks By Design Commercial |
$107.00
|
| Rate for Payer: Prime Health Services Commercial |
$181.90
|
| Rate for Payer: Riverside University Health System MISP |
$85.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$128.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$128.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$107.00
|
| Rate for Payer: United Healthcare All Other HMO |
$107.00
|
| Rate for Payer: United Healthcare HMO Rider |
$107.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$107.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$181.90
|
| Rate for Payer: Vantage Medical Group Senior |
$181.90
|
|
|
HC WHFO VOLAR COCK-UP W/FLEX OUTRIGGER
|
Facility
|
IP
|
$214.00
|
|
|
Service Code
|
CPT L3931
|
| Hospital Charge Code |
901301038
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$42.80 |
| Max. Negotiated Rate |
$192.60 |
| Rate for Payer: Blue Shield of California EPN |
$114.28
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Central Health Plan Commercial |
$171.20
|
| Rate for Payer: Cigna of CA HMO |
$149.80
|
| Rate for Payer: Cigna of CA PPO |
$149.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$85.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$85.60
|
| Rate for Payer: Galaxy Health WC |
$181.90
|
| Rate for Payer: Global Benefits Group Commercial |
$128.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$192.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$142.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$81.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.80
|
| Rate for Payer: Multiplan Commercial |
$160.50
|
| Rate for Payer: Networks By Design Commercial |
$107.00
|
| Rate for Payer: Prime Health Services Commercial |
$181.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$80.81
|
| Rate for Payer: United Healthcare All Other HMO |
$78.92
|
| Rate for Payer: United Healthcare HMO Rider |
$77.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$70.62
|
|
|
HC WHFO W/JOINT(S) CUSTOM FABRCTD
|
Facility
|
IP
|
$670.00
|
|
|
Service Code
|
CPT L3806
|
| Hospital Charge Code |
905353806
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$134.00 |
| Max. Negotiated Rate |
$603.00 |
| Rate for Payer: Blue Shield of California EPN |
$357.78
|
| 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: EPIC Health Plan Commercial |
$268.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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 Permanente of CA Commercial/Self Funded |
$446.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$255.27
|
| 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 |
$335.00
|
| Rate for Payer: Prime Health Services Commercial |
$569.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$252.99
|
| Rate for Payer: United Healthcare All Other HMO |
$247.10
|
| Rate for Payer: United Healthcare HMO Rider |
$241.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$221.10
|
|
|
HC WHFO W/JOINT(S) CUSTOM FABRCTD
|
Facility
|
OP
|
$670.00
|
|
|
Service Code
|
CPT L3806
|
| Hospital Charge Code |
905353806
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$234.50 |
| Max. Negotiated Rate |
$603.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$569.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$368.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$368.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$324.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$395.84
|
| Rate for Payer: Blue Distinction Transplant |
$402.00
|
| Rate for Payer: Blue Shield of California Commercial |
$502.50
|
| Rate for Payer: Blue Shield of California EPN |
$364.48
|
| Rate for Payer: Cash Price |
$301.50
|
| Rate for Payer: Cash Price |
$301.50
|
| Rate for Payer: Central Health Plan Commercial |
$536.00
|
| Rate for Payer: Cigna of CA HMO |
$469.00
|
| Rate for Payer: Cigna of CA PPO |
$469.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$569.50
|
| Rate for Payer: Dignity Health Media |
$569.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$569.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$268.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$502.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$234.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$446.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$555.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$274.70
|
| Rate for Payer: Multiplan Commercial |
$502.50
|
| Rate for Payer: Networks By Design Commercial |
$335.00
|
| Rate for Payer: Prime Health Services Commercial |
$569.50
|
| Rate for Payer: Riverside University Health System MISP |
$268.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$402.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$402.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$335.00
|
| Rate for Payer: United Healthcare All Other HMO |
$335.00
|
| Rate for Payer: United Healthcare HMO Rider |
$335.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$335.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$569.50
|
| Rate for Payer: Vantage Medical Group Senior |
$569.50
|
|
|
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 |
$351.40 |
| Max. Negotiated Rate |
$903.60 |
| 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 |
$552.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$486.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$593.16
|
| Rate for Payer: Blue Distinction Transplant |
$602.40
|
| Rate for Payer: Blue Shield of California Commercial |
$753.00
|
| Rate for Payer: Blue Shield of California EPN |
$546.18
|
| 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 Media |
$853.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$853.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$401.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$753.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$351.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$669.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$589.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$411.64
|
| 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 |
$502.00
|
| Rate for Payer: United Healthcare All Other HMO |
$502.00
|
| Rate for Payer: United Healthcare HMO Rider |
$502.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$502.00
|
| 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: Blue Shield of California EPN |
$536.14
|
| 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: EPIC Health Plan Commercial |
$401.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$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 Permanente of CA Commercial/Self Funded |
$669.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$382.52
|
| 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 |
$502.00
|
| Rate for Payer: Prime Health Services Commercial |
$853.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$379.11
|
| Rate for Payer: United Healthcare All Other HMO |
$370.28
|
| Rate for Payer: United Healthcare HMO Rider |
$362.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$331.32
|
|
