|
HC WHFO W/O JOINT(S) PF
|
Facility
OP
|
$383.00
|
|
|
Service Code
|
CPT L3807
|
| Hospital Charge Code |
905353807
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$134.05 |
| Max. Negotiated Rate |
$902.62 |
| Rate for Payer: Aetna of CA HMO/PPO |
$902.62
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$325.55
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$210.65
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$210.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$185.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$226.28
|
| Rate for Payer: BCBS Transplant Transplant |
$229.80
|
| Rate for Payer: Blue Shield of California Commercial |
$287.25
|
| Rate for Payer: Blue Shield of California EPN |
$208.35
|
| Rate for Payer: Cash Price |
$172.35
|
| Rate for Payer: Cash Price |
$172.35
|
| Rate for Payer: Central Health Plan Commercial |
$306.40
|
| Rate for Payer: Cigna of CA HMO |
$268.10
|
| Rate for Payer: Cigna of CA PPO |
$268.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$325.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$153.20
|
| Rate for Payer: Galaxy Health WC |
$325.55
|
| Rate for Payer: Global Benefits Group Commercial |
$229.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$344.70
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$287.25
|
| Rate for Payer: IEHP medi-cal |
$134.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$255.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$157.03
|
| Rate for Payer: Multiplan Commercial |
$287.25
|
| Rate for Payer: Networks By Design Commercial |
$191.50
|
| Rate for Payer: Prime Health Services Commercial |
$325.55
|
| Rate for Payer: Riverside University Health MISP |
$153.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$229.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$229.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$191.50
|
| Rate for Payer: United Healthcare All Other HMO |
$191.50
|
| Rate for Payer: United Healthcare HMO Rider |
$191.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$191.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$325.55
|
| Rate for Payer: Vantage Medical Group Senior |
$325.55
|
|
|
HC WHFO W/O JOINT(S) PF
|
Facility
IP
|
$383.00
|
|
|
Service Code
|
CPT L3807
|
| Hospital Charge Code |
905353807
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$76.60 |
| Max. Negotiated Rate |
$344.70 |
| Rate for Payer: Blue Shield of California EPN |
$204.52
|
| Rate for Payer: Cash Price |
$172.35
|
| Rate for Payer: Central Health Plan Commercial |
$306.40
|
| Rate for Payer: Cigna of CA HMO |
$268.10
|
| Rate for Payer: Cigna of CA PPO |
$268.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$153.20
|
| Rate for Payer: Galaxy Health WC |
$325.55
|
| Rate for Payer: Global Benefits Group Commercial |
$229.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$344.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$255.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.60
|
| Rate for Payer: Multiplan Commercial |
$287.25
|
| Rate for Payer: Networks By Design Commercial |
$191.50
|
| Rate for Payer: Prime Health Services Commercial |
$325.55
|
|
|
HC WHFO WRIST EXT COCKUP PF
|
Facility
OP
|
$249.00
|
|
|
Service Code
|
CPT L3908
|
| Hospital Charge Code |
905109314
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$87.15 |
| Max. Negotiated Rate |
$243.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$243.40
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$211.65
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$136.95
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$136.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$120.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$147.11
|
| Rate for Payer: BCBS Transplant Transplant |
$149.40
|
| Rate for Payer: Blue Shield of California Commercial |
$186.75
|
| Rate for Payer: Blue Shield of California EPN |
$135.46
|
| Rate for Payer: Cash Price |
$112.05
|
| Rate for Payer: Cash Price |
$112.05
|
| Rate for Payer: Central Health Plan Commercial |
$199.20
|
| Rate for Payer: Cigna of CA HMO |
$174.30
|
| Rate for Payer: Cigna of CA PPO |
$174.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$211.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$99.60
|
| Rate for Payer: Galaxy Health WC |
$211.65
|
| Rate for Payer: Global Benefits Group Commercial |
$149.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$224.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$186.75
|
| Rate for Payer: IEHP medi-cal |
$87.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$166.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.09
|
| Rate for Payer: Multiplan Commercial |
$186.75
|
| Rate for Payer: Networks By Design Commercial |
$124.50
|
| Rate for Payer: Prime Health Services Commercial |
$211.65
|
| Rate for Payer: Riverside University Health MISP |
$99.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$149.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$149.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$124.50
|
| Rate for Payer: United Healthcare All Other HMO |
$124.50
|
| Rate for Payer: United Healthcare HMO Rider |
$124.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$124.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$211.65
|
| Rate for Payer: Vantage Medical Group Senior |
$211.65
|
|
|
HC WHFO WRIST EXT COCKUP PF
|
Facility
IP
|
$249.00
|
|
|
Service Code
|
CPT L3908
|
| Hospital Charge Code |
905109314
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$49.80 |
| Max. Negotiated Rate |
$224.10 |
| Rate for Payer: Blue Shield of California EPN |
$132.97
|
| Rate for Payer: Cash Price |
$112.05
|
| Rate for Payer: Central Health Plan Commercial |
$199.20
|
| Rate for Payer: Cigna of CA HMO |
$174.30
|
| Rate for Payer: Cigna of CA PPO |
$174.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$99.60
|
| Rate for Payer: Galaxy Health WC |
$211.65
|
| Rate for Payer: Global Benefits Group Commercial |
$149.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$224.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$166.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.80
|
| Rate for Payer: Multiplan Commercial |
$186.75
|
| Rate for Payer: Networks By Design Commercial |
$124.50
|
| Rate for Payer: Prime Health Services Commercial |
$211.65
|
|
|
HC WHFO WRIST GAUNTLET MOLDED
|
Facility
OP
|
$760.00
|
|
|
Service Code
|
CPT L3906
|
| Hospital Charge Code |
901309100
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$196.00 |
| Max. Negotiated Rate |
$1,605.28 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,605.28
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$646.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$418.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$418.00
|
| 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 |
$456.00
|
| 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 |
$342.00
|
| Rate for Payer: Cash Price |
$342.00
|
| Rate for Payer: Cash Price |
$342.00
|
| Rate for Payer: Cash Price |
$342.00
|
| Rate for Payer: Central Health Plan Commercial |
$608.00
|
| Rate for Payer: Cigna of CA HMO |
$486.40
|
| Rate for Payer: Cigna of CA PPO |
$562.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$646.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$304.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$304.00
|
| Rate for Payer: Galaxy Health WC |
$646.00
|
| Rate for Payer: Global Benefits Group Commercial |
$456.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$684.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$570.00
|
| Rate for Payer: IEHP medi-cal |
$266.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$506.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$311.60
|
| Rate for Payer: Multiplan Commercial |
$570.00
|
| Rate for Payer: Networks By Design Commercial |
$494.00
|
| Rate for Payer: Prime Health Services Commercial |
$646.00
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$456.00
|
| Rate for Payer: Riverside University Health MISP |
$304.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$456.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$456.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$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 |
$646.00
|
| Rate for Payer: Vantage Medical Group Senior |
$646.00
|
|
|
HC WHFO WRIST GAUNTLET MOLDED
|
Facility
IP
|
$760.00
|
|
|
Service Code
|
CPT L3906
|
| Hospital Charge Code |
901309100
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$152.00 |
| Max. Negotiated Rate |
$684.00 |
| Rate for Payer: Cash Price |
$342.00
|
| Rate for Payer: Central Health Plan Commercial |
$608.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$304.00
|
| Rate for Payer: Galaxy Health WC |
$646.00
|
| Rate for Payer: Global Benefits Group Commercial |
$456.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$684.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$506.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$152.00
|
| Rate for Payer: Multiplan Commercial |
$570.00
|
| Rate for Payer: Networks By Design Commercial |
$494.00
|
| Rate for Payer: Prime Health Services Commercial |
$646.00
|
|
|
HC WHFO WRIST GAUNT W/THUMB SPIC
|
Facility
IP
|
$936.00
|
|
|
Service Code
|
CPT L3808
|
| Hospital Charge Code |
901309101
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$187.20 |
| Max. Negotiated Rate |
$842.40 |
| Rate for Payer: 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: LLUH Dept of Risk Management WC |
$187.20
|
| Rate for Payer: Multiplan Commercial |
$702.00
|
| Rate for Payer: Networks By Design Commercial |
$608.40
|
| Rate for Payer: Prime Health Services Commercial |
$795.60
|
|
|
HC WHFO WRIST GAUNT W/THUMB SPIC
|
Facility
OP
|
$936.00
|
|
|
Service Code
|
CPT L3808
|
| Hospital Charge Code |
901309101
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$196.00 |
| Max. Negotiated Rate |
$1,345.31 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,345.31
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$795.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$514.80
|
| Rate for Payer: AlphaCare 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: BCBS Transplant 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: 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 Transplant Other |
$702.00
|
| Rate for Payer: IEHP medi-cal |
$327.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$624.31
|
| 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: Redlands Yucaipa Medical Group Commercial/Senior |
$561.60
|
| Rate for Payer: Riverside University Health 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 WHIRLPOOL MCAL
|
Facility
IP
|
$268.00
|
|
|
Service Code
|
CPT 97022
|
| Hospital Charge Code |
901300045
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$53.60 |
| Max. Negotiated Rate |
$241.20 |
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Central Health Plan Commercial |
$214.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.20
|
| Rate for Payer: Galaxy Health WC |
$227.80
|
| Rate for Payer: Global Benefits Group Commercial |
$160.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$241.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$178.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.60
|
| Rate for Payer: Multiplan Commercial |
$201.00
|
| Rate for Payer: Networks By Design Commercial |
$174.20
|
| Rate for Payer: Prime Health Services Commercial |
$227.80
|
|
|
HC WHIRLPOOL MCAL
|
Facility
OP
|
$268.00
|
|
|
Service Code
|
CPT 97022
|
| Hospital Charge Code |
901300045
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$85.47 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$85.47
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$227.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$147.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$147.40
|
| 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 |
$160.80
|
| 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 |
$120.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Central Health Plan Commercial |
$214.40
|
| Rate for Payer: Cigna of CA HMO |
$171.52
|
| Rate for Payer: Cigna of CA PPO |
$198.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$227.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$107.20
|
| Rate for Payer: Galaxy Health WC |
$227.80
|
| Rate for Payer: Global Benefits Group Commercial |
$160.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$241.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$201.00
|
| Rate for Payer: IEHP medi-cal |
$93.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$178.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$109.88
|
| Rate for Payer: Multiplan Commercial |
$201.00
|
| Rate for Payer: Networks By Design Commercial |
$174.20
|
| Rate for Payer: Prime Health Services Commercial |
$227.80
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$160.80
|
| Rate for Payer: Riverside University Health MISP |
$107.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$160.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$160.80
|
| 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 |
$227.80
|
| Rate for Payer: Vantage Medical Group Senior |
$227.80
|
|
|
HC WHIRLPOOL MCARE COM
|
Facility
OP
|
$268.00
|
|
|
Service Code
|
CPT 97022
|
| Hospital Charge Code |
900407040
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$85.47 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$85.47
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$227.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$147.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$147.40
|
| 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 |
$160.80
|
| 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 |
$120.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Central Health Plan Commercial |
$214.40
|
| Rate for Payer: Cigna of CA HMO |
$171.52
|
| Rate for Payer: Cigna of CA PPO |
$198.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$227.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$107.20
|
| Rate for Payer: Galaxy Health WC |
$227.80
|
| Rate for Payer: Global Benefits Group Commercial |
$160.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$241.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$201.00
|
| Rate for Payer: IEHP medi-cal |
$93.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$178.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$109.88
|
| Rate for Payer: Multiplan Commercial |
$201.00
|
| Rate for Payer: Networks By Design Commercial |
$174.20
|
| Rate for Payer: Prime Health Services Commercial |
$227.80
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$160.80
|
| Rate for Payer: Riverside University Health MISP |
$107.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$160.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$160.80
|
| 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 |
$227.80
|
| Rate for Payer: Vantage Medical Group Senior |
$227.80
|
|
|
HC WHIRLPOOL MCARE COM
|
Facility
IP
|
$268.00
|
|
|
Service Code
|
CPT 97022
|
| Hospital Charge Code |
900407040
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$53.60 |
| Max. Negotiated Rate |
$241.20 |
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Central Health Plan Commercial |
$214.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.20
|
| Rate for Payer: Galaxy Health WC |
$227.80
|
| Rate for Payer: Global Benefits Group Commercial |
$160.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$241.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$178.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.60
|
| Rate for Payer: Multiplan Commercial |
$201.00
|
| Rate for Payer: Networks By Design Commercial |
$174.20
|
| Rate for Payer: Prime Health Services Commercial |
$227.80
|
|
|
HC WHIRLPOOL OT
|
Facility
IP
|
$268.00
|
|
|
Service Code
|
CPT 97022
|
| Hospital Charge Code |
903207022
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$53.60 |
| Max. Negotiated Rate |
$241.20 |
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Central Health Plan Commercial |
$214.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.20
|
| Rate for Payer: Galaxy Health WC |
$227.80
|
| Rate for Payer: Global Benefits Group Commercial |
$160.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$241.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$178.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.60
|
| Rate for Payer: Multiplan Commercial |
$201.00
|
| Rate for Payer: Networks By Design Commercial |
$174.20
|
| Rate for Payer: Prime Health Services Commercial |
$227.80
|
|
|
HC WHIRLPOOL OT
|
Facility
OP
|
$268.00
|
|
|
Service Code
|
CPT 97022
|
| Hospital Charge Code |
903207022
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$85.47 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$85.47
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$227.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$147.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$147.40
|
| 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 |
$160.80
|
| 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 |
$120.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Central Health Plan Commercial |
$214.40
|
| Rate for Payer: Cigna of CA HMO |
$171.52
|
| Rate for Payer: Cigna of CA PPO |
$198.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$227.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$107.20
|
| Rate for Payer: Galaxy Health WC |
$227.80
|
| Rate for Payer: Global Benefits Group Commercial |
$160.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$241.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$201.00
|
| Rate for Payer: IEHP medi-cal |
$93.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$178.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$109.88
|
| Rate for Payer: Multiplan Commercial |
$201.00
|
| Rate for Payer: Networks By Design Commercial |
$174.20
|
| Rate for Payer: Prime Health Services Commercial |
$227.80
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$160.80
|
| Rate for Payer: Riverside University Health MISP |
$107.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$160.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$160.80
|
| 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 |
$227.80
|
| Rate for Payer: Vantage Medical Group Senior |
$227.80
|
|
|
HC WHIRLPOOL PT
|
Facility
OP
|
$268.00
|
|
|
Service Code
|
CPT 97022
|
| Hospital Charge Code |
905103118
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$85.47 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$85.47
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$227.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$147.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$147.40
|
| 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 |
$160.80
|
| 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 |
$120.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Central Health Plan Commercial |
$214.40
|
| Rate for Payer: Cigna of CA HMO |
$171.52
|
| Rate for Payer: Cigna of CA PPO |
$198.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$227.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$107.20
|
| Rate for Payer: Galaxy Health WC |
$227.80
|
| Rate for Payer: Global Benefits Group Commercial |
$160.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$241.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$201.00
|
| Rate for Payer: IEHP medi-cal |
$93.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$178.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$109.88
|
| Rate for Payer: Multiplan Commercial |
$201.00
|
| Rate for Payer: Networks By Design Commercial |
$174.20
|
| Rate for Payer: Prime Health Services Commercial |
$227.80
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$160.80
|
| Rate for Payer: Riverside University Health MISP |
$107.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$160.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$160.80
|
| 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 |
$227.80
|
| Rate for Payer: Vantage Medical Group Senior |
$227.80
|
|
|
HC WHIRLPOOL PT
|
Facility
IP
|
$268.00
|
|
|
Service Code
|
CPT 97022
|
| Hospital Charge Code |
905103118
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$53.60 |
| Max. Negotiated Rate |
$241.20 |
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Central Health Plan Commercial |
$214.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.20
|
| Rate for Payer: Galaxy Health WC |
$227.80
|
| Rate for Payer: Global Benefits Group Commercial |
$160.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$241.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$178.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.60
|
| Rate for Payer: Multiplan Commercial |
$201.00
|
| Rate for Payer: Networks By Design Commercial |
$174.20
|
| Rate for Payer: Prime Health Services Commercial |
$227.80
|
|
|
HC WHIRLPOOL PT
|
Facility
OP
|
$268.00
|
|
|
Service Code
|
CPT 97022
|
| Hospital Charge Code |
900419063
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$85.47 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$85.47
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$227.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$147.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$147.40
|
| 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 |
$160.80
|
| 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 |
$120.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Central Health Plan Commercial |
$214.40
|
| Rate for Payer: Cigna of CA HMO |
$171.52
|
| Rate for Payer: Cigna of CA PPO |
$198.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$227.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$107.20
|
| Rate for Payer: Galaxy Health WC |
$227.80
|
| Rate for Payer: Global Benefits Group Commercial |
$160.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$241.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$201.00
|
| Rate for Payer: IEHP medi-cal |
$93.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$178.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$109.88
|
| Rate for Payer: Multiplan Commercial |
$201.00
|
| Rate for Payer: Networks By Design Commercial |
$174.20
|
| Rate for Payer: Prime Health Services Commercial |
$227.80
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$160.80
|
| Rate for Payer: Riverside University Health MISP |
$107.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$160.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$160.80
|
| 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 |
$227.80
|
| Rate for Payer: Vantage Medical Group Senior |
$227.80
|
|
|
HC WHIRLPOOL PT
|
Facility
IP
|
$268.00
|
|
|
Service Code
|
CPT 97022
|
| Hospital Charge Code |
900419063
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$53.60 |
| Max. Negotiated Rate |
$241.20 |
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Central Health Plan Commercial |
$214.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.20
|
| Rate for Payer: Galaxy Health WC |
$227.80
|
| Rate for Payer: Global Benefits Group Commercial |
$160.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$241.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$178.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.60
|
| Rate for Payer: Multiplan Commercial |
$201.00
|
| Rate for Payer: Networks By Design Commercial |
$174.20
|
| Rate for Payer: Prime Health Services Commercial |
$227.80
|
|
|
HC WHITAKER TEST
|
Facility
OP
|
$1,550.00
|
|
|
Service Code
|
CPT 50396
|
| Hospital Charge Code |
909000169
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$310.00 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$853.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,280.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$938.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$853.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: BCBS Transplant Transplant |
$930.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$853.50
|
| Rate for Payer: Cash Price |
$697.50
|
| Rate for Payer: Cash Price |
$697.50
|
| Rate for Payer: Cash Price |
$697.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,240.00
|
| Rate for Payer: Cigna of CA PPO |
$1,147.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,280.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,152.22
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$853.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$853.50
|
| Rate for Payer: Galaxy Health WC |
$1,317.50
|
| Rate for Payer: Global Benefits Group Commercial |
$930.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,395.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,162.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,399.74
|
| Rate for Payer: IEHP medi-cal |
$1,408.28
|
| Rate for Payer: IEHP Medicare Advantage |
$853.50
|
| Rate for Payer: Innovage PACE Commercial |
$1,280.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,033.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$853.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$310.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,143.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,143.69
|
| Rate for Payer: Multiplan Commercial |
$1,162.50
|
| Rate for Payer: Networks By Design Commercial |
$1,007.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,317.50
|
| Rate for Payer: Prime Health Services Medicare |
$904.71
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$930.00
|
| Rate for Payer: Riverside University Health MISP |
$938.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$930.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,280.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$938.85
|
| Rate for Payer: Vantage Medical Group Senior |
$853.50
|
|
|
HC WHITAKER TEST
|
Facility
IP
|
$1,550.00
|
|
|
Service Code
|
CPT 50396
|
| Hospital Charge Code |
909000169
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$310.00 |
| Max. Negotiated Rate |
$1,395.00 |
| Rate for Payer: Cash Price |
$697.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,240.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$620.00
|
| Rate for Payer: Galaxy Health WC |
$1,317.50
|
| Rate for Payer: Global Benefits Group Commercial |
$930.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,395.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,033.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$310.00
|
| Rate for Payer: Multiplan Commercial |
$1,162.50
|
| Rate for Payer: Networks By Design Commercial |
$1,007.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,317.50
|
|
|
HC WHITE CAP 15MM
|
Facility
OP
|
$44.69
|
|
| Hospital Charge Code |
900800856
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.94 |
| Max. Negotiated Rate |
$40.22 |
| Rate for Payer: Aetna of CA HMO/PPO |
$27.14
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$37.99
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$24.58
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$24.58
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$21.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.40
|
| Rate for Payer: BCBS Transplant Transplant |
$26.81
|
| Rate for Payer: Blue Shield of California Commercial |
$28.11
|
| Rate for Payer: Blue Shield of California EPN |
$21.85
|
| Rate for Payer: Cash Price |
$20.11
|
| Rate for Payer: Central Health Plan Commercial |
$35.75
|
| Rate for Payer: Cigna of CA HMO |
$28.60
|
| Rate for Payer: Cigna of CA PPO |
$33.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$17.88
|
| Rate for Payer: Galaxy Health WC |
$37.99
|
| Rate for Payer: Global Benefits Group Commercial |
$26.81
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.22
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$33.52
|
| Rate for Payer: IEHP medi-cal |
$15.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.94
|
| Rate for Payer: Multiplan Commercial |
$33.52
|
| Rate for Payer: Networks By Design Commercial |
$29.05
|
| Rate for Payer: Prime Health Services Commercial |
$37.99
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$26.81
|
| Rate for Payer: Riverside University Health MISP |
$17.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26.81
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.34
|
| Rate for Payer: United Healthcare All Other HMO |
$22.34
|
| Rate for Payer: United Healthcare HMO Rider |
$22.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$37.99
|
| Rate for Payer: Vantage Medical Group Senior |
$37.99
|
|
|
HC WHITE CAP 15MM
|
Facility
IP
|
$44.69
|
|
| Hospital Charge Code |
900800856
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.94 |
| Max. Negotiated Rate |
$40.22 |
| Rate for Payer: Cash Price |
$20.11
|
| Rate for Payer: Central Health Plan Commercial |
$35.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.88
|
| Rate for Payer: Galaxy Health WC |
$37.99
|
| Rate for Payer: Global Benefits Group Commercial |
$26.81
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.94
|
| Rate for Payer: Multiplan Commercial |
$33.52
|
| Rate for Payer: Networks By Design Commercial |
$29.05
|
| Rate for Payer: Prime Health Services Commercial |
$37.99
|
|
|
HC WHO ADD TO OPPONENS ACTN W/FLX
|
Facility
IP
|
$245.00
|
|
| Hospital Charge Code |
903203850
|
|
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: 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
|
|
|
HC WHO ADD TO OPPONENS ACTN W/FLX
|
Facility
OP
|
$245.00
|
|
| Hospital Charge Code |
903203850
|
|
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
|
|
|
HC WHO W/JOINT(S) CF
|
Facility
OP
|
$991.00
|
|
|
Service Code
|
CPT L3915
|
| Hospital Charge Code |
903203915
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$346.85 |
| Max. Negotiated Rate |
$1,918.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,918.88
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$842.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$545.05
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$545.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$479.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$585.48
|
| Rate for Payer: BCBS Transplant Transplant |
$594.60
|
| Rate for Payer: Blue Shield of California Commercial |
$743.25
|
| Rate for Payer: Blue Shield of California EPN |
$539.10
|
| Rate for Payer: Cash Price |
$445.95
|
| Rate for Payer: Cash Price |
$445.95
|
| Rate for Payer: Central Health Plan Commercial |
$792.80
|
| Rate for Payer: Cigna of CA HMO |
$693.70
|
| Rate for Payer: Cigna of CA PPO |
$693.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$842.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$396.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$396.40
|
| Rate for Payer: Galaxy Health WC |
$842.35
|
| Rate for Payer: Global Benefits Group Commercial |
$594.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$891.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$743.25
|
| Rate for Payer: IEHP medi-cal |
$346.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$661.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$406.31
|
| Rate for Payer: Multiplan Commercial |
$743.25
|
| Rate for Payer: Networks By Design Commercial |
$495.50
|
| Rate for Payer: Prime Health Services Commercial |
$842.35
|
| Rate for Payer: Riverside University Health MISP |
$396.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$594.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$594.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$495.50
|
| Rate for Payer: United Healthcare All Other HMO |
$495.50
|
| Rate for Payer: United Healthcare HMO Rider |
$495.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$495.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$842.35
|
| Rate for Payer: Vantage Medical Group Senior |
$842.35
|
|
