|
HC WHEELCHAIR MGMT 15MIN PT
|
Facility
|
OP
|
$133.00
|
|
|
Service Code
|
CPT 97542
|
| Hospital Charge Code |
900407542
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$50.67 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$54.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$80.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$73.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$99.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$73.15
|
| Rate for Payer: Cash Price |
$73.15
|
| Rate for Payer: Cash Price |
$73.15
|
| Rate for Payer: Central Health Plan Commercial |
$106.40
|
| Rate for Payer: Cigna of CA HMO |
$85.12
|
| Rate for Payer: Cigna of CA PPO |
$98.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$113.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$113.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$53.20
|
| Rate for Payer: EPIC Health Plan Senior |
$53.20
|
| Rate for Payer: Galaxy Health WC |
$113.05
|
| Rate for Payer: Global Benefits Group Commercial |
$79.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$119.70
|
| Rate for Payer: InnovAge PACE Commercial |
$66.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$88.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$82.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$93.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$93.10
|
| Rate for Payer: Multiplan Commercial |
$99.75
|
| Rate for Payer: Networks By Design Commercial |
$86.45
|
| Rate for Payer: Prime Health Services Commercial |
$113.05
|
| Rate for Payer: Riverside University Health System MISP |
$53.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$79.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$79.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$113.05
|
| Rate for Payer: Vantage Medical Group Senior |
$113.05
|
|
|
HC WHEELCHAIR MGMT 15MIN PT
|
Facility
|
IP
|
$133.00
|
|
|
Service Code
|
CPT 97542
|
| Hospital Charge Code |
900407542
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$26.60 |
| Max. Negotiated Rate |
$119.70 |
| Rate for Payer: Adventist Health Commercial |
$26.60
|
| Rate for Payer: Cash Price |
$73.15
|
| Rate for Payer: Central Health Plan Commercial |
$106.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$53.20
|
| Rate for Payer: EPIC Health Plan Senior |
$53.20
|
| Rate for Payer: Galaxy Health WC |
$113.05
|
| Rate for Payer: Global Benefits Group Commercial |
$79.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$119.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$88.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$82.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.60
|
| Rate for Payer: Multiplan Commercial |
$99.75
|
| Rate for Payer: Networks By Design Commercial |
$86.45
|
| Rate for Payer: Prime Health Services Commercial |
$113.05
|
|
|
HC WHEELCHAIR MGMT 15 MIN PT COMM MCARE
|
Facility
|
IP
|
$133.00
|
|
|
Service Code
|
CPT 97542
|
| Hospital Charge Code |
900417542
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$26.60 |
| Max. Negotiated Rate |
$119.70 |
| Rate for Payer: Adventist Health Commercial |
$26.60
|
| Rate for Payer: Cash Price |
$73.15
|
| Rate for Payer: Central Health Plan Commercial |
$106.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$53.20
|
| Rate for Payer: EPIC Health Plan Senior |
$53.20
|
| Rate for Payer: Galaxy Health WC |
$113.05
|
| Rate for Payer: Global Benefits Group Commercial |
$79.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$119.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$88.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$82.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.60
|
| Rate for Payer: Multiplan Commercial |
$99.75
|
| Rate for Payer: Networks By Design Commercial |
$86.45
|
| Rate for Payer: Prime Health Services Commercial |
$113.05
|
|
|
HC WHEELCHAIR MGMT 15 MIN PT COMM MCARE
|
Facility
|
OP
|
$133.00
|
|
|
Service Code
|
CPT 97542
|
| Hospital Charge Code |
900417542
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$50.67 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$54.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$80.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$73.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$99.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$73.15
|
| Rate for Payer: Cash Price |
$73.15
|
| Rate for Payer: Cash Price |
$73.15
|
| Rate for Payer: Central Health Plan Commercial |
$106.40
|
| Rate for Payer: Cigna of CA HMO |
$85.12
|
| Rate for Payer: Cigna of CA PPO |
$98.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$113.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$113.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$53.20
|
| Rate for Payer: EPIC Health Plan Senior |
$53.20
|
| Rate for Payer: Galaxy Health WC |
$113.05
|
| Rate for Payer: Global Benefits Group Commercial |
$79.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$119.70
|
| Rate for Payer: InnovAge PACE Commercial |
$66.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$88.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$82.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$93.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$93.10
|
| Rate for Payer: Multiplan Commercial |
$99.75
|
| Rate for Payer: Networks By Design Commercial |
$86.45
|
| Rate for Payer: Prime Health Services Commercial |
$113.05
|
| Rate for Payer: Riverside University Health System MISP |
$53.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$79.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$79.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$113.05
|
| Rate for Payer: Vantage Medical Group Senior |
$113.05
|
|
|
HC WHFO ADD 2ND MP ABDUCT ASSIST
|
Facility
|
IP
|
$215.00
|
|
| Hospital Charge Code |
903203815
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$43.00 |
| Max. Negotiated Rate |
$193.50 |
| Rate for Payer: Adventist Health Commercial |
$43.00
|
| Rate for Payer: Blue Shield of California Commercial |
$166.19
|
| Rate for Payer: Blue Shield of California EPN |
$108.36
|
| Rate for Payer: Cash Price |
$118.25
|
| Rate for Payer: Central Health Plan Commercial |
$172.00
|
| Rate for Payer: Cigna of CA HMO |
$150.50
|
| Rate for Payer: Cigna of CA PPO |
$150.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.00
|
| Rate for Payer: EPIC Health Plan Senior |
$86.00
|
| Rate for Payer: Galaxy Health WC |
$182.75
|
| Rate for Payer: Global Benefits Group Commercial |
$129.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$193.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$143.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$81.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$133.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.00
|
| Rate for Payer: Multiplan Commercial |
$161.25
|
| Rate for Payer: Networks By Design Commercial |
$139.75
|
| Rate for Payer: Prime Health Services Commercial |
$182.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$80.69
|
| Rate for Payer: United Healthcare All Other HMO |
$78.54
|
| Rate for Payer: United Healthcare HMO Rider |
$76.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$70.41
|
|
|
HC WHFO ADD 2ND MP ABDUCT ASSIST
|
Facility
|
OP
|
$215.00
|
|
| Hospital Charge Code |
903203815
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$70.41 |
| Max. Negotiated Rate |
$193.50 |
| Rate for Payer: Adventist Health Commercial |
$88.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$182.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$118.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$161.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$126.27
|
| Rate for Payer: Blue Shield of California Commercial |
$166.19
|
| Rate for Payer: Blue Shield of California EPN |
$108.36
|
| Rate for Payer: Cash Price |
$118.25
|
| Rate for Payer: Central Health Plan Commercial |
$172.00
|
| Rate for Payer: Cigna of CA HMO |
$150.50
|
| Rate for Payer: Cigna of CA PPO |
$150.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$182.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$182.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$182.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.00
|
| Rate for Payer: EPIC Health Plan Senior |
$86.00
|
| Rate for Payer: Galaxy Health WC |
$182.75
|
| Rate for Payer: Global Benefits Group Commercial |
$129.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$193.50
|
| Rate for Payer: InnovAge PACE Commercial |
$107.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$143.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$81.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$133.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$150.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$150.50
|
| Rate for Payer: Multiplan Commercial |
$161.25
|
| Rate for Payer: Networks By Design Commercial |
$107.50
|
| Rate for Payer: Prime Health Services Commercial |
$182.75
|
| Rate for Payer: Riverside University Health System MISP |
$86.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$129.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$129.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$80.69
|
| Rate for Payer: United Healthcare All Other HMO |
$78.54
|
| Rate for Payer: United Healthcare HMO Rider |
$76.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$70.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$182.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$182.75
|
| Rate for Payer: Vantage Medical Group Senior |
$182.75
|
|
|
HC WHFO ADD TO OPPONENS MP EXT S
|
Facility
|
IP
|
$175.00
|
|
| Hospital Charge Code |
903203825
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Adventist Health Commercial |
$35.00
|
| Rate for Payer: Blue Shield of California Commercial |
$135.28
|
| Rate for Payer: Blue Shield of California EPN |
$88.20
|
| Rate for Payer: Cash Price |
$96.25
|
| Rate for Payer: Central Health Plan Commercial |
$140.00
|
| Rate for Payer: Cigna of CA HMO |
$122.50
|
| Rate for Payer: Cigna of CA PPO |
$122.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.00
|
| Rate for Payer: EPIC Health Plan Senior |
$70.00
|
| Rate for Payer: Galaxy Health WC |
$148.75
|
| Rate for Payer: Global Benefits Group Commercial |
$105.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$157.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$116.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$108.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.00
|
| Rate for Payer: Multiplan Commercial |
$131.25
|
| Rate for Payer: Networks By Design Commercial |
$113.75
|
| Rate for Payer: Prime Health Services Commercial |
$148.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$65.68
|
| Rate for Payer: United Healthcare All Other HMO |
$63.93
|
| Rate for Payer: United Healthcare HMO Rider |
$62.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$57.31
|
|
|
HC WHFO ADD TO OPPONENS MP EXT S
|
Facility
|
OP
|
$175.00
|
|
| Hospital Charge Code |
903203825
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$57.31 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Adventist Health Commercial |
$71.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$148.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$96.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$131.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$102.78
|
| Rate for Payer: Blue Shield of California Commercial |
$135.28
|
| Rate for Payer: Blue Shield of California EPN |
$88.20
|
| Rate for Payer: Cash Price |
$96.25
|
| Rate for Payer: Central Health Plan Commercial |
$140.00
|
| Rate for Payer: Cigna of CA HMO |
$122.50
|
| Rate for Payer: Cigna of CA PPO |
$122.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$148.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$148.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.00
|
| Rate for Payer: EPIC Health Plan Senior |
$70.00
|
| Rate for Payer: Galaxy Health WC |
$148.75
|
| Rate for Payer: Global Benefits Group Commercial |
$105.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$157.50
|
| Rate for Payer: InnovAge PACE Commercial |
$87.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$116.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$108.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$122.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$122.50
|
| Rate for Payer: Multiplan Commercial |
$131.25
|
| Rate for Payer: Networks By Design Commercial |
$87.50
|
| Rate for Payer: Prime Health Services Commercial |
$148.75
|
| Rate for Payer: Riverside University Health System MISP |
$70.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$105.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$105.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$65.68
|
| Rate for Payer: United Healthcare All Other HMO |
$63.93
|
| Rate for Payer: United Healthcare HMO Rider |
$62.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$57.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$148.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.75
|
| Rate for Payer: Vantage Medical Group Senior |
$148.75
|
|
|
HC WHFO ADD TO OPPONENS, SPRNG SW
|
Facility
|
IP
|
$180.00
|
|
| Hospital Charge Code |
903203840
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$36.00 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Adventist Health Commercial |
$36.00
|
| Rate for Payer: Blue Shield of California Commercial |
$139.14
|
| Rate for Payer: Blue Shield of California EPN |
$90.72
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Central Health Plan Commercial |
$144.00
|
| Rate for Payer: Cigna of CA HMO |
$126.00
|
| Rate for Payer: Cigna of CA PPO |
$126.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.00
|
| Rate for Payer: EPIC Health Plan Senior |
$72.00
|
| Rate for Payer: Galaxy Health WC |
$153.00
|
| Rate for Payer: Global Benefits Group Commercial |
$108.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$162.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$120.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.00
|
| Rate for Payer: Multiplan Commercial |
$135.00
|
| Rate for Payer: Networks By Design Commercial |
$117.00
|
| Rate for Payer: Prime Health Services Commercial |
$153.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$67.55
|
| Rate for Payer: United Healthcare All Other HMO |
$65.75
|
| Rate for Payer: United Healthcare HMO Rider |
$64.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$58.95
|
|
|
HC WHFO ADD TO OPPONENS, SPRNG SW
|
Facility
|
OP
|
$180.00
|
|
| Hospital Charge Code |
903203840
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$58.95 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Adventist Health Commercial |
$73.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$153.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$99.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$105.71
|
| Rate for Payer: Blue Shield of California Commercial |
$139.14
|
| Rate for Payer: Blue Shield of California EPN |
$90.72
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Central Health Plan Commercial |
$144.00
|
| Rate for Payer: Cigna of CA HMO |
$126.00
|
| Rate for Payer: Cigna of CA PPO |
$126.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$153.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$153.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$153.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.00
|
| Rate for Payer: EPIC Health Plan Senior |
$72.00
|
| Rate for Payer: Galaxy Health WC |
$153.00
|
| Rate for Payer: Global Benefits Group Commercial |
$108.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$162.00
|
| Rate for Payer: InnovAge PACE Commercial |
$90.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$120.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$126.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$126.00
|
| Rate for Payer: Multiplan Commercial |
$135.00
|
| Rate for Payer: Networks By Design Commercial |
$90.00
|
| Rate for Payer: Prime Health Services Commercial |
$153.00
|
| Rate for Payer: Riverside University Health System MISP |
$72.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$108.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$108.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$67.55
|
| Rate for Payer: United Healthcare All Other HMO |
$65.75
|
| Rate for Payer: United Healthcare HMO Rider |
$64.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$58.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$153.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$153.00
|
| Rate for Payer: Vantage Medical Group Senior |
$153.00
|
|
|
HC WHFO ADJ MP FLEX CNTRL
|
Facility
|
OP
|
$370.00
|
|
| Hospital Charge Code |
903203855
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$121.17 |
| Max. Negotiated Rate |
$333.00 |
| Rate for Payer: Adventist Health Commercial |
$151.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$314.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$203.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$277.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$217.30
|
| Rate for Payer: Blue Shield of California Commercial |
$286.01
|
| Rate for Payer: Blue Shield of California EPN |
$186.48
|
| Rate for Payer: Cash Price |
$203.50
|
| Rate for Payer: Central Health Plan Commercial |
$296.00
|
| Rate for Payer: Cigna of CA HMO |
$259.00
|
| Rate for Payer: Cigna of CA PPO |
$259.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$314.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$314.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$314.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$148.00
|
| Rate for Payer: EPIC Health Plan Senior |
$148.00
|
| Rate for Payer: Galaxy Health WC |
$314.50
|
| Rate for Payer: Global Benefits Group Commercial |
$222.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$333.00
|
| Rate for Payer: InnovAge PACE Commercial |
$185.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$246.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$140.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$229.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$151.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$259.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$259.00
|
| Rate for Payer: Multiplan Commercial |
$277.50
|
| Rate for Payer: Networks By Design Commercial |
$185.00
|
| Rate for Payer: Prime Health Services Commercial |
$314.50
|
| Rate for Payer: Riverside University Health System MISP |
$148.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$222.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$222.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$138.86
|
| Rate for Payer: United Healthcare All Other HMO |
$135.16
|
| Rate for Payer: United Healthcare HMO Rider |
$132.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$121.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$314.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$314.50
|
| Rate for Payer: Vantage Medical Group Senior |
$314.50
|
|
|
HC WHFO ADJ MP FLEX CNTRL
|
Facility
|
IP
|
$370.00
|
|
| Hospital Charge Code |
903203855
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$74.00 |
| Max. Negotiated Rate |
$333.00 |
| Rate for Payer: Adventist Health Commercial |
$74.00
|
| Rate for Payer: Blue Shield of California Commercial |
$286.01
|
| Rate for Payer: Blue Shield of California EPN |
$186.48
|
| Rate for Payer: Cash Price |
$203.50
|
| Rate for Payer: Central Health Plan Commercial |
$296.00
|
| Rate for Payer: Cigna of CA HMO |
$259.00
|
| Rate for Payer: Cigna of CA PPO |
$259.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$148.00
|
| Rate for Payer: EPIC Health Plan Senior |
$148.00
|
| Rate for Payer: Galaxy Health WC |
$314.50
|
| Rate for Payer: Global Benefits Group Commercial |
$222.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$333.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$246.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$140.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$229.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.00
|
| Rate for Payer: Multiplan Commercial |
$277.50
|
| Rate for Payer: Networks By Design Commercial |
$240.50
|
| Rate for Payer: Prime Health Services Commercial |
$314.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$138.86
|
| Rate for Payer: United Healthcare All Other HMO |
$135.16
|
| Rate for Payer: United Healthcare HMO Rider |
$132.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$121.17
|
|
|
HC WHFO ADJ MP FLEX CNTRL + IP
|
Facility
|
OP
|
$445.00
|
|
| Hospital Charge Code |
903203860
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$145.74 |
| Max. Negotiated Rate |
$400.50 |
| Rate for Payer: Adventist Health Commercial |
$182.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$378.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$244.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$333.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$261.35
|
| Rate for Payer: Blue Shield of California Commercial |
$343.99
|
| Rate for Payer: Blue Shield of California EPN |
$224.28
|
| Rate for Payer: Cash Price |
$244.75
|
| Rate for Payer: Central Health Plan Commercial |
$356.00
|
| Rate for Payer: Cigna of CA HMO |
$311.50
|
| Rate for Payer: Cigna of CA PPO |
$311.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$378.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$378.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$378.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$178.00
|
| Rate for Payer: EPIC Health Plan Senior |
$178.00
|
| Rate for Payer: Galaxy Health WC |
$378.25
|
| Rate for Payer: Global Benefits Group Commercial |
$267.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$400.50
|
| Rate for Payer: InnovAge PACE Commercial |
$222.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$296.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$169.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$275.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$182.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$311.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$311.50
|
| Rate for Payer: Multiplan Commercial |
$333.75
|
| Rate for Payer: Networks By Design Commercial |
$222.50
|
| Rate for Payer: Prime Health Services Commercial |
$378.25
|
| Rate for Payer: Riverside University Health System MISP |
$178.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$267.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$267.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$167.01
|
| Rate for Payer: United Healthcare All Other HMO |
$162.56
|
| Rate for Payer: United Healthcare HMO Rider |
$159.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$145.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$378.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$378.25
|
| Rate for Payer: Vantage Medical Group Senior |
$378.25
|
|
|
HC WHFO ADJ MP FLEX CNTRL + IP
|
Facility
|
IP
|
$445.00
|
|
| Hospital Charge Code |
903203860
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$89.00 |
| Max. Negotiated Rate |
$400.50 |
| Rate for Payer: Adventist Health Commercial |
$89.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.99
|
| Rate for Payer: Blue Shield of California EPN |
$224.28
|
| Rate for Payer: Cash Price |
$244.75
|
| Rate for Payer: Central Health Plan Commercial |
$356.00
|
| Rate for Payer: Cigna of CA HMO |
$311.50
|
| Rate for Payer: Cigna of CA PPO |
$311.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$178.00
|
| Rate for Payer: EPIC Health Plan Senior |
$178.00
|
| Rate for Payer: Galaxy Health WC |
$378.25
|
| Rate for Payer: Global Benefits Group Commercial |
$267.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$400.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$296.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$169.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$275.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.00
|
| Rate for Payer: Multiplan Commercial |
$333.75
|
| Rate for Payer: Networks By Design Commercial |
$289.25
|
| Rate for Payer: Prime Health Services Commercial |
$378.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$167.01
|
| Rate for Payer: United Healthcare All Other HMO |
$162.56
|
| Rate for Payer: United Healthcare HMO Rider |
$159.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$145.74
|
|
|
HC WHFO COCK UP SPLINT
|
Facility
|
IP
|
$281.00
|
|
|
Service Code
|
CPT L3908
|
| Hospital Charge Code |
915363908
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$56.20 |
| Max. Negotiated Rate |
$252.90 |
| Rate for Payer: Adventist Health Commercial |
$56.20
|
| Rate for Payer: Blue Shield of California Commercial |
$217.21
|
| Rate for Payer: Blue Shield of California EPN |
$141.62
|
| Rate for Payer: Cash Price |
$154.55
|
| Rate for Payer: Central Health Plan Commercial |
$224.80
|
| Rate for Payer: Cigna of CA HMO |
$196.70
|
| Rate for Payer: Cigna of CA PPO |
$196.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.40
|
| Rate for Payer: EPIC Health Plan Senior |
$112.40
|
| Rate for Payer: Galaxy Health WC |
$238.85
|
| Rate for Payer: Global Benefits Group Commercial |
$168.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$252.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$187.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$173.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.20
|
| Rate for Payer: Multiplan Commercial |
$210.75
|
| Rate for Payer: Networks By Design Commercial |
$182.65
|
| Rate for Payer: Prime Health Services Commercial |
$238.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$105.46
|
| Rate for Payer: United Healthcare All Other HMO |
$102.65
|
| Rate for Payer: United Healthcare HMO Rider |
$100.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$92.03
|
|
|
HC WHFO COCK UP SPLINT
|
Facility
|
OP
|
$281.00
|
|
|
Service Code
|
CPT L3908
|
| Hospital Charge Code |
915363908
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$80.98 |
| Max. Negotiated Rate |
$252.90 |
| Rate for Payer: Adventist Health Commercial |
$115.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$238.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$154.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$210.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$165.03
|
| Rate for Payer: Blue Shield of California Commercial |
$217.21
|
| Rate for Payer: Blue Shield of California EPN |
$141.62
|
| Rate for Payer: Cash Price |
$154.55
|
| Rate for Payer: Cash Price |
$154.55
|
| Rate for Payer: Central Health Plan Commercial |
$224.80
|
| Rate for Payer: Cigna of CA HMO |
$196.70
|
| Rate for Payer: Cigna of CA PPO |
$196.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$238.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$238.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$238.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.40
|
| Rate for Payer: EPIC Health Plan Senior |
$112.40
|
| Rate for Payer: Galaxy Health WC |
$238.85
|
| Rate for Payer: Global Benefits Group Commercial |
$168.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$252.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$80.98
|
| Rate for Payer: InnovAge PACE Commercial |
$140.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$187.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$173.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$196.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$196.70
|
| Rate for Payer: Multiplan Commercial |
$210.75
|
| Rate for Payer: Networks By Design Commercial |
$140.50
|
| Rate for Payer: Prime Health Services Commercial |
$238.85
|
| Rate for Payer: Riverside University Health System MISP |
$112.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$168.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$168.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$105.46
|
| Rate for Payer: United Healthcare All Other HMO |
$102.65
|
| Rate for Payer: United Healthcare HMO Rider |
$100.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$92.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$238.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$238.85
|
| Rate for Payer: Vantage Medical Group Senior |
$238.85
|
|
|
HC WHFO COCK UP SPLINT
|
Facility
|
IP
|
$281.00
|
|
|
Service Code
|
CPT L3908
|
| Hospital Charge Code |
905363908
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$56.20 |
| Max. Negotiated Rate |
$252.90 |
| Rate for Payer: Adventist Health Commercial |
$56.20
|
| Rate for Payer: Blue Shield of California Commercial |
$217.21
|
| Rate for Payer: Blue Shield of California EPN |
$141.62
|
| Rate for Payer: Cash Price |
$154.55
|
| Rate for Payer: Central Health Plan Commercial |
$224.80
|
| Rate for Payer: Cigna of CA HMO |
$196.70
|
| Rate for Payer: Cigna of CA PPO |
$196.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.40
|
| Rate for Payer: EPIC Health Plan Senior |
$112.40
|
| Rate for Payer: Galaxy Health WC |
$238.85
|
| Rate for Payer: Global Benefits Group Commercial |
$168.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$252.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$187.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$173.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.20
|
| Rate for Payer: Multiplan Commercial |
$210.75
|
| Rate for Payer: Networks By Design Commercial |
$182.65
|
| Rate for Payer: Prime Health Services Commercial |
$238.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$105.46
|
| Rate for Payer: United Healthcare All Other HMO |
$102.65
|
| Rate for Payer: United Healthcare HMO Rider |
$100.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$92.03
|
|
|
HC WHFO COCK UP SPLINT
|
Facility
|
OP
|
$281.00
|
|
|
Service Code
|
CPT L3908
|
| Hospital Charge Code |
905363908
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$80.98 |
| Max. Negotiated Rate |
$252.90 |
| Rate for Payer: Adventist Health Commercial |
$115.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$238.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$154.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$210.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$165.03
|
| Rate for Payer: Blue Shield of California Commercial |
$217.21
|
| Rate for Payer: Blue Shield of California EPN |
$141.62
|
| Rate for Payer: Cash Price |
$154.55
|
| Rate for Payer: Cash Price |
$154.55
|
| Rate for Payer: Central Health Plan Commercial |
$224.80
|
| Rate for Payer: Cigna of CA HMO |
$196.70
|
| Rate for Payer: Cigna of CA PPO |
$196.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$238.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$238.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$238.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.40
|
| Rate for Payer: EPIC Health Plan Senior |
$112.40
|
| Rate for Payer: Galaxy Health WC |
$238.85
|
| Rate for Payer: Global Benefits Group Commercial |
$168.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$252.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$80.98
|
| Rate for Payer: InnovAge PACE Commercial |
$140.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$187.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$173.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$196.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$196.70
|
| Rate for Payer: Multiplan Commercial |
$210.75
|
| Rate for Payer: Networks By Design Commercial |
$140.50
|
| Rate for Payer: Prime Health Services Commercial |
$238.85
|
| Rate for Payer: Riverside University Health System MISP |
$112.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$168.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$168.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$105.46
|
| Rate for Payer: United Healthcare All Other HMO |
$102.65
|
| Rate for Payer: United Healthcare HMO Rider |
$100.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$92.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$238.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$238.85
|
| Rate for Payer: Vantage Medical Group Senior |
$238.85
|
|
|
HC WHFO COMB OPPEN W KNUCKLE BNDR
|
Facility
|
IP
|
$251.00
|
|
|
Service Code
|
CPT L3925
|
| Hospital Charge Code |
903203950
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$50.20 |
| Max. Negotiated Rate |
$225.90 |
| Rate for Payer: Adventist Health Commercial |
$50.20
|
| Rate for Payer: Blue Shield of California Commercial |
$194.02
|
| Rate for Payer: Blue Shield of California EPN |
$126.50
|
| Rate for Payer: Cash Price |
$138.05
|
| Rate for Payer: Central Health Plan Commercial |
$200.80
|
| Rate for Payer: Cigna of CA HMO |
$175.70
|
| Rate for Payer: Cigna of CA PPO |
$175.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.40
|
| Rate for Payer: EPIC Health Plan Senior |
$100.40
|
| Rate for Payer: Galaxy Health WC |
$213.35
|
| Rate for Payer: Global Benefits Group Commercial |
$150.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$225.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$167.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$95.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$155.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.20
|
| Rate for Payer: Multiplan Commercial |
$188.25
|
| Rate for Payer: Networks By Design Commercial |
$163.15
|
| Rate for Payer: Prime Health Services Commercial |
$213.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$94.20
|
| Rate for Payer: United Healthcare All Other HMO |
$91.69
|
| Rate for Payer: United Healthcare HMO Rider |
$89.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$82.20
|
|
|
HC WHFO COMB OPPEN W KNUCKLE BNDR
|
Facility
|
OP
|
$251.00
|
|
|
Service Code
|
CPT L3925
|
| Hospital Charge Code |
903203950
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$69.23 |
| Max. Negotiated Rate |
$225.90 |
| Rate for Payer: Adventist Health Commercial |
$102.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$213.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$138.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$188.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$147.41
|
| Rate for Payer: Blue Shield of California Commercial |
$194.02
|
| Rate for Payer: Blue Shield of California EPN |
$126.50
|
| Rate for Payer: Cash Price |
$138.05
|
| Rate for Payer: Cash Price |
$138.05
|
| Rate for Payer: Central Health Plan Commercial |
$200.80
|
| Rate for Payer: Cigna of CA HMO |
$175.70
|
| Rate for Payer: Cigna of CA PPO |
$175.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$213.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$213.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$213.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.40
|
| Rate for Payer: EPIC Health Plan Senior |
$100.40
|
| Rate for Payer: Galaxy Health WC |
$213.35
|
| Rate for Payer: Global Benefits Group Commercial |
$150.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$225.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$69.23
|
| Rate for Payer: InnovAge PACE Commercial |
$125.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$167.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$76.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$155.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$175.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$175.70
|
| Rate for Payer: Multiplan Commercial |
$188.25
|
| Rate for Payer: Networks By Design Commercial |
$125.50
|
| Rate for Payer: Prime Health Services Commercial |
$213.35
|
| Rate for Payer: Riverside University Health System MISP |
$100.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$150.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$150.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$94.20
|
| Rate for Payer: United Healthcare All Other HMO |
$91.69
|
| Rate for Payer: United Healthcare HMO Rider |
$89.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$82.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$213.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$213.35
|
| Rate for Payer: Vantage Medical Group Senior |
$213.35
|
|
|
HC WHFO COMB OPPEN W/REVRS KNUCKL
|
Facility
|
IP
|
$244.00
|
|
|
Service Code
|
CPT L3931
|
| Hospital Charge Code |
903203952
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$48.80 |
| Max. Negotiated Rate |
$219.60 |
| Rate for Payer: Adventist Health Commercial |
$48.80
|
| Rate for Payer: Blue Shield of California Commercial |
$188.61
|
| Rate for Payer: Blue Shield of California EPN |
$122.98
|
| Rate for Payer: Cash Price |
$134.20
|
| Rate for Payer: Central Health Plan Commercial |
$195.20
|
| Rate for Payer: Cigna of CA HMO |
$170.80
|
| Rate for Payer: Cigna of CA PPO |
$170.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$97.60
|
| Rate for Payer: EPIC Health Plan Senior |
$97.60
|
| Rate for Payer: Galaxy Health WC |
$207.40
|
| Rate for Payer: Global Benefits Group Commercial |
$146.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$219.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$162.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$151.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.80
|
| Rate for Payer: Multiplan Commercial |
$183.00
|
| Rate for Payer: Networks By Design Commercial |
$158.60
|
| Rate for Payer: Prime Health Services Commercial |
$207.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$91.57
|
| Rate for Payer: United Healthcare All Other HMO |
$89.13
|
| Rate for Payer: United Healthcare HMO Rider |
$87.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$79.91
|
|
|
HC WHFO COMB OPPEN W/REVRS KNUCKL
|
Facility
|
OP
|
$244.00
|
|
|
Service Code
|
CPT L3931
|
| Hospital Charge Code |
903203952
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$79.91 |
| Max. Negotiated Rate |
$279.19 |
| Rate for Payer: Adventist Health Commercial |
$100.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$207.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$134.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$183.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$143.30
|
| Rate for Payer: Blue Shield of California Commercial |
$188.61
|
| Rate for Payer: Blue Shield of California EPN |
$122.98
|
| Rate for Payer: Cash Price |
$134.20
|
| Rate for Payer: Cash Price |
$134.20
|
| Rate for Payer: Central Health Plan Commercial |
$195.20
|
| Rate for Payer: Cigna of CA HMO |
$170.80
|
| Rate for Payer: Cigna of CA PPO |
$170.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$207.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$207.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$207.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$97.60
|
| Rate for Payer: EPIC Health Plan Senior |
$97.60
|
| Rate for Payer: Galaxy Health WC |
$207.40
|
| Rate for Payer: Global Benefits Group Commercial |
$146.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$219.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$252.74
|
| Rate for Payer: InnovAge PACE Commercial |
$122.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$162.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$279.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$151.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$170.80
|
| Rate for Payer: Multiplan Commercial |
$183.00
|
| Rate for Payer: Networks By Design Commercial |
$122.00
|
| Rate for Payer: Prime Health Services Commercial |
$207.40
|
| Rate for Payer: Riverside University Health System MISP |
$97.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$146.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$146.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$91.57
|
| Rate for Payer: United Healthcare All Other HMO |
$89.13
|
| Rate for Payer: United Healthcare HMO Rider |
$87.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$79.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$207.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$207.40
|
| Rate for Payer: Vantage Medical Group Senior |
$207.40
|
|
|
HC WHFO DORSAL WRIST
|
Facility
|
IP
|
$231.00
|
|
|
Service Code
|
CPT L3931
|
| Hospital Charge Code |
905353938
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$46.20 |
| Max. Negotiated Rate |
$207.90 |
| Rate for Payer: Adventist Health Commercial |
$46.20
|
| Rate for Payer: Blue Shield of California Commercial |
$178.56
|
| Rate for Payer: Blue Shield of California EPN |
$116.42
|
| Rate for Payer: Cash Price |
$127.05
|
| Rate for Payer: Central Health Plan Commercial |
$184.80
|
| Rate for Payer: Cigna of CA HMO |
$161.70
|
| Rate for Payer: Cigna of CA PPO |
$161.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.40
|
| Rate for Payer: EPIC Health Plan Senior |
$92.40
|
| Rate for Payer: Galaxy Health WC |
$196.35
|
| Rate for Payer: Global Benefits Group Commercial |
$138.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$207.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$154.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$88.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$142.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.20
|
| Rate for Payer: Multiplan Commercial |
$173.25
|
| Rate for Payer: Networks By Design Commercial |
$150.15
|
| Rate for Payer: Prime Health Services Commercial |
$196.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$86.69
|
| Rate for Payer: United Healthcare All Other HMO |
$84.38
|
| Rate for Payer: United Healthcare HMO Rider |
$82.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$75.65
|
|
|
HC WHFO DORSAL WRIST
|
Facility
|
OP
|
$231.00
|
|
|
Service Code
|
CPT L3931
|
| Hospital Charge Code |
905353938
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$75.65 |
| Max. Negotiated Rate |
$279.19 |
| Rate for Payer: Adventist Health Commercial |
$94.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$196.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$127.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$173.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$135.67
|
| Rate for Payer: Blue Shield of California Commercial |
$178.56
|
| Rate for Payer: Blue Shield of California EPN |
$116.42
|
| Rate for Payer: Cash Price |
$127.05
|
| Rate for Payer: Cash Price |
$127.05
|
| Rate for Payer: Central Health Plan Commercial |
$184.80
|
| Rate for Payer: Cigna of CA HMO |
$161.70
|
| Rate for Payer: Cigna of CA PPO |
$161.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$196.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$196.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$196.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.40
|
| Rate for Payer: EPIC Health Plan Senior |
$92.40
|
| Rate for Payer: Galaxy Health WC |
$196.35
|
| Rate for Payer: Global Benefits Group Commercial |
$138.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$207.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$252.74
|
| Rate for Payer: InnovAge PACE Commercial |
$115.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$154.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$279.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$142.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$161.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$161.70
|
| Rate for Payer: Multiplan Commercial |
$173.25
|
| Rate for Payer: Networks By Design Commercial |
$115.50
|
| Rate for Payer: Prime Health Services Commercial |
$196.35
|
| Rate for Payer: Riverside University Health System MISP |
$92.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$138.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$138.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$86.69
|
| Rate for Payer: United Healthcare All Other HMO |
$84.38
|
| Rate for Payer: United Healthcare HMO Rider |
$82.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$75.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$196.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$196.35
|
| Rate for Payer: Vantage Medical Group Senior |
$196.35
|
|
|
HC WHFO DORSAL WRIST W/OUTRIGGER
|
Facility
|
OP
|
$182.00
|
|
|
Service Code
|
CPT L3931
|
| Hospital Charge Code |
905353940
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$59.60 |
| Max. Negotiated Rate |
$279.19 |
| Rate for Payer: Adventist Health Commercial |
$74.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$154.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$100.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$136.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$106.89
|
| Rate for Payer: Blue Shield of California Commercial |
$140.69
|
| Rate for Payer: Blue Shield of California EPN |
$91.73
|
| Rate for Payer: Cash Price |
$100.10
|
| Rate for Payer: Cash Price |
$100.10
|
| Rate for Payer: Central Health Plan Commercial |
$145.60
|
| Rate for Payer: Cigna of CA HMO |
$127.40
|
| Rate for Payer: Cigna of CA PPO |
$127.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$154.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$154.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$154.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.80
|
| Rate for Payer: EPIC Health Plan Senior |
$72.80
|
| Rate for Payer: Galaxy Health WC |
$154.70
|
| Rate for Payer: Global Benefits Group Commercial |
$109.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$163.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$252.74
|
| Rate for Payer: InnovAge PACE Commercial |
$91.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$121.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$279.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$112.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$127.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$127.40
|
| Rate for Payer: Multiplan Commercial |
$136.50
|
| Rate for Payer: Networks By Design Commercial |
$91.00
|
| Rate for Payer: Prime Health Services Commercial |
$154.70
|
| Rate for Payer: Riverside University Health System MISP |
$72.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$109.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$109.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$68.30
|
| Rate for Payer: United Healthcare All Other HMO |
$66.48
|
| Rate for Payer: United Healthcare HMO Rider |
$65.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$59.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$154.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$154.70
|
| Rate for Payer: Vantage Medical Group Senior |
$154.70
|
|
