|
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
|
|
|
HC WHFO ELASTIC PF(NEOPRENE,LYCRA
|
Facility
|
IP
|
$44.00
|
|
|
Service Code
|
CPT L3911
|
| Hospital Charge Code |
903203911
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$8.80 |
| Max. Negotiated Rate |
$39.60 |
| Rate for Payer: Adventist Health Commercial |
$8.80
|
| Rate for Payer: Blue Shield of California Commercial |
$34.01
|
| Rate for Payer: Blue Shield of California EPN |
$22.18
|
| Rate for Payer: Cash Price |
$24.20
|
| Rate for Payer: Central Health Plan Commercial |
$35.20
|
| Rate for Payer: Cigna of CA HMO |
$30.80
|
| Rate for Payer: Cigna of CA PPO |
$30.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.60
|
| Rate for Payer: EPIC Health Plan Senior |
$17.60
|
| Rate for Payer: Galaxy Health WC |
$37.40
|
| Rate for Payer: Global Benefits Group Commercial |
$26.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$39.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.80
|
| Rate for Payer: Multiplan Commercial |
$33.00
|
| Rate for Payer: Networks By Design Commercial |
$28.60
|
| Rate for Payer: Prime Health Services Commercial |
$37.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.51
|
| Rate for Payer: United Healthcare All Other HMO |
$16.07
|
| Rate for Payer: United Healthcare HMO Rider |
$15.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.41
|
|
|
HC WHFO ELASTIC PF(NEOPRENE,LYCRA
|
Facility
|
OP
|
$44.00
|
|
|
Service Code
|
CPT L3911
|
| Hospital Charge Code |
903203911
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$14.41 |
| Max. Negotiated Rate |
$39.60 |
| Rate for Payer: Adventist Health Commercial |
$18.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$33.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.84
|
| Rate for Payer: Blue Shield of California Commercial |
$34.01
|
| Rate for Payer: Blue Shield of California EPN |
$22.18
|
| Rate for Payer: Cash Price |
$24.20
|
| Rate for Payer: Central Health Plan Commercial |
$35.20
|
| Rate for Payer: Cigna of CA HMO |
$30.80
|
| Rate for Payer: Cigna of CA PPO |
$30.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$37.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.60
|
| Rate for Payer: EPIC Health Plan Senior |
$17.60
|
| Rate for Payer: Galaxy Health WC |
$37.40
|
| Rate for Payer: Global Benefits Group Commercial |
$26.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$39.60
|
| Rate for Payer: InnovAge PACE Commercial |
$22.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30.80
|
| Rate for Payer: Multiplan Commercial |
$33.00
|
| Rate for Payer: Networks By Design Commercial |
$22.00
|
| Rate for Payer: Prime Health Services Commercial |
$37.40
|
| Rate for Payer: Riverside University Health System MISP |
$17.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.51
|
| Rate for Payer: United Healthcare All Other HMO |
$16.07
|
| Rate for Payer: United Healthcare HMO Rider |
$15.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$37.40
|
| Rate for Payer: Vantage Medical Group Senior |
$37.40
|
|
|
HC WHFO ELECTRIC POWERED
|
Facility
|
OP
|
$6,604.00
|
|
|
Service Code
|
CPT L3904
|
| Hospital Charge Code |
905353904
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,162.81 |
| Max. Negotiated Rate |
$5,943.60 |
| Rate for Payer: Adventist Health Commercial |
$2,707.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,613.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,632.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,953.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,878.53
|
| Rate for Payer: Blue Shield of California Commercial |
$5,104.89
|
| Rate for Payer: Blue Shield of California EPN |
$3,328.42
|
| Rate for Payer: Cash Price |
$3,632.20
|
| Rate for Payer: Cash Price |
$3,632.20
|
| Rate for Payer: Central Health Plan Commercial |
$5,283.20
|
| Rate for Payer: Cigna of CA HMO |
$4,622.80
|
| Rate for Payer: Cigna of CA PPO |
$4,622.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,613.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,613.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,613.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,641.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,641.60
|
| Rate for Payer: Galaxy Health WC |
$5,613.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,962.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,943.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,525.79
|
| Rate for Payer: InnovAge PACE Commercial |
$3,302.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,404.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,894.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,087.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,707.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,622.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,622.80
|
| Rate for Payer: Multiplan Commercial |
$4,953.00
|
| Rate for Payer: Networks By Design Commercial |
$3,302.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,613.40
|
| Rate for Payer: Riverside University Health System MISP |
$2,641.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,962.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,962.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,478.48
|
| Rate for Payer: United Healthcare All Other HMO |
$2,412.44
|
| Rate for Payer: United Healthcare HMO Rider |
$2,360.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,162.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,613.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,613.40
|
| Rate for Payer: Vantage Medical Group Senior |
$5,613.40
|
|
|
HC WHFO ELECTRIC POWERED
|
Facility
|
IP
|
$6,604.00
|
|
|
Service Code
|
CPT L3904
|
| Hospital Charge Code |
905353904
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,320.80 |
| Max. Negotiated Rate |
$5,943.60 |
| Rate for Payer: Adventist Health Commercial |
$1,320.80
|
| Rate for Payer: Blue Shield of California Commercial |
$5,104.89
|
| Rate for Payer: Blue Shield of California EPN |
$3,328.42
|
| Rate for Payer: Cash Price |
$3,632.20
|
| Rate for Payer: Central Health Plan Commercial |
$5,283.20
|
| Rate for Payer: Cigna of CA HMO |
$4,622.80
|
| Rate for Payer: Cigna of CA PPO |
$4,622.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,641.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,641.60
|
| Rate for Payer: Galaxy Health WC |
$5,613.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,962.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,943.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,404.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,516.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,087.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,320.80
|
| Rate for Payer: Multiplan Commercial |
$4,953.00
|
| Rate for Payer: Networks By Design Commercial |
$4,292.60
|
| Rate for Payer: Prime Health Services Commercial |
$5,613.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,478.48
|
| Rate for Payer: United Healthcare All Other HMO |
$2,412.44
|
| Rate for Payer: United Healthcare HMO Rider |
$2,360.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,162.81
|
|
|
HC WHFO ELECTRIC POWERED
|
Facility
|
OP
|
$6,604.00
|
|
|
Service Code
|
CPT L3904
|
| Hospital Charge Code |
915353904
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,162.81 |
| Max. Negotiated Rate |
$5,943.60 |
| Rate for Payer: Adventist Health Commercial |
$2,707.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,613.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,632.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,953.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,878.53
|
| Rate for Payer: Blue Shield of California Commercial |
$5,104.89
|
| Rate for Payer: Blue Shield of California EPN |
$3,328.42
|
| Rate for Payer: Cash Price |
$3,632.20
|
| Rate for Payer: Cash Price |
$3,632.20
|
| Rate for Payer: Central Health Plan Commercial |
$5,283.20
|
| Rate for Payer: Cigna of CA HMO |
$4,622.80
|
| Rate for Payer: Cigna of CA PPO |
$4,622.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,613.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,613.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,613.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,641.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,641.60
|
| Rate for Payer: Galaxy Health WC |
$5,613.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,962.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,943.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,525.79
|
| Rate for Payer: InnovAge PACE Commercial |
$3,302.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,404.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,894.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,087.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,707.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,622.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,622.80
|
| Rate for Payer: Multiplan Commercial |
$4,953.00
|
| Rate for Payer: Networks By Design Commercial |
$3,302.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,613.40
|
| Rate for Payer: Riverside University Health System MISP |
$2,641.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,962.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,962.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,478.48
|
| Rate for Payer: United Healthcare All Other HMO |
$2,412.44
|
| Rate for Payer: United Healthcare HMO Rider |
$2,360.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,162.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,613.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,613.40
|
| Rate for Payer: Vantage Medical Group Senior |
$5,613.40
|
|
|
HC WHFO ELECTRIC POWERED
|
Facility
|
IP
|
$6,604.00
|
|
|
Service Code
|
CPT L3904
|
| Hospital Charge Code |
915353904
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,320.80 |
| Max. Negotiated Rate |
$5,943.60 |
| Rate for Payer: Adventist Health Commercial |
$1,320.80
|
| Rate for Payer: Blue Shield of California Commercial |
$5,104.89
|
| Rate for Payer: Blue Shield of California EPN |
$3,328.42
|
| Rate for Payer: Cash Price |
$3,632.20
|
| Rate for Payer: Central Health Plan Commercial |
$5,283.20
|
| Rate for Payer: Cigna of CA HMO |
$4,622.80
|
| Rate for Payer: Cigna of CA PPO |
$4,622.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,641.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,641.60
|
| Rate for Payer: Galaxy Health WC |
$5,613.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,962.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,943.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,404.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,516.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,087.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,320.80
|
| Rate for Payer: Multiplan Commercial |
$4,953.00
|
| Rate for Payer: Networks By Design Commercial |
$4,292.60
|
| Rate for Payer: Prime Health Services Commercial |
$5,613.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,478.48
|
| Rate for Payer: United Healthcare All Other HMO |
$2,412.44
|
| Rate for Payer: United Healthcare HMO Rider |
$2,360.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,162.81
|
|
|
HC WHFO FINGER EXTENSION
|
Facility
|
OP
|
$157.00
|
|
|
Service Code
|
CPT L3929
|
| Hospital Charge Code |
905363928
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$51.42 |
| Max. Negotiated Rate |
$141.30 |
| Rate for Payer: Adventist Health Commercial |
$64.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$133.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$86.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$117.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$92.21
|
| Rate for Payer: Blue Shield of California Commercial |
$121.36
|
| Rate for Payer: Blue Shield of California EPN |
$79.13
|
| Rate for Payer: Cash Price |
$86.35
|
| Rate for Payer: Cash Price |
$86.35
|
| Rate for Payer: Central Health Plan Commercial |
$125.60
|
| Rate for Payer: Cigna of CA HMO |
$109.90
|
| Rate for Payer: Cigna of CA PPO |
$109.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$133.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$133.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$133.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.80
|
| Rate for Payer: EPIC Health Plan Senior |
$62.80
|
| Rate for Payer: Galaxy Health WC |
$133.45
|
| Rate for Payer: Global Benefits Group Commercial |
$94.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$141.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$113.16
|
| Rate for Payer: InnovAge PACE Commercial |
$78.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$104.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$125.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$97.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$109.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$109.90
|
| Rate for Payer: Multiplan Commercial |
$117.75
|
| Rate for Payer: Networks By Design Commercial |
$78.50
|
| Rate for Payer: Prime Health Services Commercial |
$133.45
|
| Rate for Payer: Riverside University Health System MISP |
$62.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$94.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$94.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$58.92
|
| Rate for Payer: United Healthcare All Other HMO |
$57.35
|
| Rate for Payer: United Healthcare HMO Rider |
$56.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$51.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$133.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$133.45
|
| Rate for Payer: Vantage Medical Group Senior |
$133.45
|
|
|
HC WHFO FINGER EXTENSION
|
Facility
|
IP
|
$157.00
|
|
|
Service Code
|
CPT L3929
|
| Hospital Charge Code |
905363928
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$31.40 |
| Max. Negotiated Rate |
$141.30 |
| Rate for Payer: Adventist Health Commercial |
$31.40
|
| Rate for Payer: Blue Shield of California Commercial |
$121.36
|
| Rate for Payer: Blue Shield of California EPN |
$79.13
|
| Rate for Payer: Cash Price |
$86.35
|
| Rate for Payer: Central Health Plan Commercial |
$125.60
|
| Rate for Payer: Cigna of CA HMO |
$109.90
|
| Rate for Payer: Cigna of CA PPO |
$109.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.80
|
| Rate for Payer: EPIC Health Plan Senior |
$62.80
|
| Rate for Payer: Galaxy Health WC |
$133.45
|
| Rate for Payer: Global Benefits Group Commercial |
$94.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$141.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$104.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$97.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.40
|
| Rate for Payer: Multiplan Commercial |
$117.75
|
| Rate for Payer: Networks By Design Commercial |
$102.05
|
| Rate for Payer: Prime Health Services Commercial |
$133.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$58.92
|
| Rate for Payer: United Healthcare All Other HMO |
$57.35
|
| Rate for Payer: United Healthcare HMO Rider |
$56.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$51.42
|
|
|
HC WHFO FINGER EXTENSION
|
Facility
|
IP
|
$157.00
|
|
|
Service Code
|
CPT L3929
|
| Hospital Charge Code |
905353928
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$31.40 |
| Max. Negotiated Rate |
$141.30 |
| Rate for Payer: Adventist Health Commercial |
$31.40
|
| Rate for Payer: Blue Shield of California Commercial |
$121.36
|
| Rate for Payer: Blue Shield of California EPN |
$79.13
|
| Rate for Payer: Cash Price |
$86.35
|
| Rate for Payer: Central Health Plan Commercial |
$125.60
|
| Rate for Payer: Cigna of CA HMO |
$109.90
|
| Rate for Payer: Cigna of CA PPO |
$109.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.80
|
| Rate for Payer: EPIC Health Plan Senior |
$62.80
|
| Rate for Payer: Galaxy Health WC |
$133.45
|
| Rate for Payer: Global Benefits Group Commercial |
$94.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$141.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$104.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$97.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.40
|
| Rate for Payer: Multiplan Commercial |
$117.75
|
| Rate for Payer: Networks By Design Commercial |
$102.05
|
| Rate for Payer: Prime Health Services Commercial |
$133.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$58.92
|
| Rate for Payer: United Healthcare All Other HMO |
$57.35
|
| Rate for Payer: United Healthcare HMO Rider |
$56.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$51.42
|
|
|
HC WHFO FINGER EXTENSION
|
Facility
|
OP
|
$157.00
|
|
|
Service Code
|
CPT L3929
|
| Hospital Charge Code |
905353928
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$51.42 |
| Max. Negotiated Rate |
$141.30 |
| Rate for Payer: Adventist Health Commercial |
$64.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$133.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$86.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$117.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$92.21
|
| Rate for Payer: Blue Shield of California Commercial |
$121.36
|
| Rate for Payer: Blue Shield of California EPN |
$79.13
|
| Rate for Payer: Cash Price |
$86.35
|
| Rate for Payer: Cash Price |
$86.35
|
| Rate for Payer: Central Health Plan Commercial |
$125.60
|
| Rate for Payer: Cigna of CA HMO |
$109.90
|
| Rate for Payer: Cigna of CA PPO |
$109.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$133.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$133.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$133.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.80
|
| Rate for Payer: EPIC Health Plan Senior |
$62.80
|
| Rate for Payer: Galaxy Health WC |
$133.45
|
| Rate for Payer: Global Benefits Group Commercial |
$94.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$141.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$113.16
|
| Rate for Payer: InnovAge PACE Commercial |
$78.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$104.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$125.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$97.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$109.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$109.90
|
| Rate for Payer: Multiplan Commercial |
$117.75
|
| Rate for Payer: Networks By Design Commercial |
$78.50
|
| Rate for Payer: Prime Health Services Commercial |
$133.45
|
| Rate for Payer: Riverside University Health System MISP |
$62.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$94.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$94.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$58.92
|
| Rate for Payer: United Healthcare All Other HMO |
$57.35
|
| Rate for Payer: United Healthcare HMO Rider |
$56.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$51.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$133.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$133.45
|
| Rate for Payer: Vantage Medical Group Senior |
$133.45
|
|
|
HC WHFO FINGER EXT W/CLOCK SPRIN
|
Facility
|
OP
|
$141.00
|
|
|
Service Code
|
CPT L3929
|
| Hospital Charge Code |
901309105
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$46.18 |
| Max. Negotiated Rate |
$126.90 |
| Rate for Payer: Adventist Health Commercial |
$57.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$119.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$77.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$105.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$82.81
|
| Rate for Payer: Blue Shield of California Commercial |
$108.99
|
| Rate for Payer: Blue Shield of California EPN |
$71.06
|
| Rate for Payer: Cash Price |
$77.55
|
| Rate for Payer: Cash Price |
$77.55
|
| Rate for Payer: Central Health Plan Commercial |
$112.80
|
| Rate for Payer: Cigna of CA HMO |
$98.70
|
| Rate for Payer: Cigna of CA PPO |
$98.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$119.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$119.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$119.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.40
|
| Rate for Payer: EPIC Health Plan Senior |
$56.40
|
| Rate for Payer: Galaxy Health WC |
$119.85
|
| Rate for Payer: Global Benefits Group Commercial |
$84.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$126.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$113.16
|
| Rate for Payer: InnovAge PACE Commercial |
$70.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$94.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$125.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$87.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$98.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$98.70
|
| Rate for Payer: Multiplan Commercial |
$105.75
|
| Rate for Payer: Networks By Design Commercial |
$70.50
|
| Rate for Payer: Prime Health Services Commercial |
$119.85
|
| Rate for Payer: Riverside University Health System MISP |
$56.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$84.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$84.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$52.92
|
| Rate for Payer: United Healthcare All Other HMO |
$51.51
|
| Rate for Payer: United Healthcare HMO Rider |
$50.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$46.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$119.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$119.85
|
| Rate for Payer: Vantage Medical Group Senior |
$119.85
|
|
|
HC WHFO FINGER EXT W/CLOCK SPRIN
|
Facility
|
IP
|
$141.00
|
|
|
Service Code
|
CPT L3929
|
| Hospital Charge Code |
901309105
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$28.20 |
| Max. Negotiated Rate |
$126.90 |
| Rate for Payer: Adventist Health Commercial |
$28.20
|
| Rate for Payer: Blue Shield of California Commercial |
$108.99
|
| Rate for Payer: Blue Shield of California EPN |
$71.06
|
| Rate for Payer: Cash Price |
$77.55
|
| Rate for Payer: Central Health Plan Commercial |
$112.80
|
| Rate for Payer: Cigna of CA HMO |
$98.70
|
| Rate for Payer: Cigna of CA PPO |
$98.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.40
|
| Rate for Payer: EPIC Health Plan Senior |
$56.40
|
| Rate for Payer: Galaxy Health WC |
$119.85
|
| Rate for Payer: Global Benefits Group Commercial |
$84.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$126.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$94.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$87.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.20
|
| Rate for Payer: Multiplan Commercial |
$105.75
|
| Rate for Payer: Networks By Design Commercial |
$91.65
|
| Rate for Payer: Prime Health Services Commercial |
$119.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$52.92
|
| Rate for Payer: United Healthcare All Other HMO |
$51.51
|
| Rate for Payer: United Healthcare HMO Rider |
$50.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$46.18
|
|
|
HC WHFO FINGER KNUCKLE BENDER
|
Facility
|
IP
|
$54.00
|
|
|
Service Code
|
CPT L3929
|
| Hospital Charge Code |
905353948
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$10.80 |
| Max. Negotiated Rate |
$48.60 |
| Rate for Payer: Adventist Health Commercial |
$10.80
|
| Rate for Payer: Blue Shield of California Commercial |
$41.74
|
| Rate for Payer: Blue Shield of California EPN |
$27.22
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Central Health Plan Commercial |
$43.20
|
| Rate for Payer: Cigna of CA HMO |
$37.80
|
| Rate for Payer: Cigna of CA PPO |
$37.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.60
|
| Rate for Payer: EPIC Health Plan Senior |
$21.60
|
| Rate for Payer: Galaxy Health WC |
$45.90
|
| Rate for Payer: Global Benefits Group Commercial |
$32.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$48.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.80
|
| Rate for Payer: Multiplan Commercial |
$40.50
|
| Rate for Payer: Networks By Design Commercial |
$35.10
|
| Rate for Payer: Prime Health Services Commercial |
$45.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.27
|
| Rate for Payer: United Healthcare All Other HMO |
$19.73
|
| Rate for Payer: United Healthcare HMO Rider |
$19.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.68
|
|
|
HC WHFO FINGER KNUCKLE BENDER
|
Facility
|
OP
|
$54.00
|
|
|
Service Code
|
CPT L3929
|
| Hospital Charge Code |
905353948
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$17.68 |
| Max. Negotiated Rate |
$125.00 |
| Rate for Payer: Adventist Health Commercial |
$22.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$45.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$40.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$31.71
|
| Rate for Payer: Blue Shield of California Commercial |
$41.74
|
| Rate for Payer: Blue Shield of California EPN |
$27.22
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Central Health Plan Commercial |
$43.20
|
| Rate for Payer: Cigna of CA HMO |
$37.80
|
| Rate for Payer: Cigna of CA PPO |
$37.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$45.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$45.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$45.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.60
|
| Rate for Payer: EPIC Health Plan Senior |
$21.60
|
| Rate for Payer: Galaxy Health WC |
$45.90
|
| Rate for Payer: Global Benefits Group Commercial |
$32.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$48.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$113.16
|
| Rate for Payer: InnovAge PACE Commercial |
$27.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$125.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$37.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$37.80
|
| Rate for Payer: Multiplan Commercial |
$40.50
|
| Rate for Payer: Networks By Design Commercial |
$27.00
|
| Rate for Payer: Prime Health Services Commercial |
$45.90
|
| Rate for Payer: Riverside University Health System MISP |
$21.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.27
|
| Rate for Payer: United Healthcare All Other HMO |
$19.73
|
| Rate for Payer: United Healthcare HMO Rider |
$19.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$45.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45.90
|
| Rate for Payer: Vantage Medical Group Senior |
$45.90
|
|
|
HC WHFO FING EXT WRIST SUPPORT
|
Facility
|
OP
|
$264.00
|
|
|
Service Code
|
CPT L3931
|
| Hospital Charge Code |
905353930
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$86.46 |
| Max. Negotiated Rate |
$279.19 |
| Rate for Payer: Adventist Health Commercial |
$108.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$224.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$145.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$155.05
|
| Rate for Payer: Blue Shield of California Commercial |
$204.07
|
| Rate for Payer: Blue Shield of California EPN |
$133.06
|
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Central Health Plan Commercial |
$211.20
|
| Rate for Payer: Cigna of CA HMO |
$184.80
|
| Rate for Payer: Cigna of CA PPO |
$184.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$224.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$224.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$224.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$105.60
|
| Rate for Payer: EPIC Health Plan Senior |
$105.60
|
| Rate for Payer: Galaxy Health WC |
$224.40
|
| Rate for Payer: Global Benefits Group Commercial |
$158.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$237.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$252.74
|
| Rate for Payer: InnovAge PACE Commercial |
$132.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$176.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$279.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$184.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.80
|
| Rate for Payer: Multiplan Commercial |
$198.00
|
| Rate for Payer: Networks By Design Commercial |
$132.00
|
| Rate for Payer: Prime Health Services Commercial |
$224.40
|
| Rate for Payer: Riverside University Health System MISP |
$105.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$158.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$158.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$99.08
|
| Rate for Payer: United Healthcare All Other HMO |
$96.44
|
| Rate for Payer: United Healthcare HMO Rider |
$94.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$86.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$224.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$224.40
|
| Rate for Payer: Vantage Medical Group Senior |
$224.40
|
|
|
HC WHFO FING EXT WRIST SUPPORT
|
Facility
|
IP
|
$264.00
|
|
|
Service Code
|
CPT L3931
|
| Hospital Charge Code |
905353930
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$52.80 |
| Max. Negotiated Rate |
$237.60 |
| Rate for Payer: Adventist Health Commercial |
$52.80
|
| Rate for Payer: Blue Shield of California Commercial |
$204.07
|
| Rate for Payer: Blue Shield of California EPN |
$133.06
|
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Central Health Plan Commercial |
$211.20
|
| Rate for Payer: Cigna of CA HMO |
$184.80
|
| Rate for Payer: Cigna of CA PPO |
$184.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$105.60
|
| Rate for Payer: EPIC Health Plan Senior |
$105.60
|
| Rate for Payer: Galaxy Health WC |
$224.40
|
| Rate for Payer: Global Benefits Group Commercial |
$158.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$237.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$176.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.80
|
| Rate for Payer: Multiplan Commercial |
$198.00
|
| Rate for Payer: Networks By Design Commercial |
$171.60
|
| Rate for Payer: Prime Health Services Commercial |
$224.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$99.08
|
| Rate for Payer: United Healthcare All Other HMO |
$96.44
|
| Rate for Payer: United Healthcare HMO Rider |
$94.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$86.46
|
|
|
HC WHFO FING EXT WRIST SUPPORT
|
Facility
|
IP
|
$560.00
|
|
|
Service Code
|
CPT L3931
|
| Hospital Charge Code |
901300801
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$112.00 |
| Max. Negotiated Rate |
$504.00 |
| Rate for Payer: Adventist Health Commercial |
$112.00
|
| Rate for Payer: Blue Shield of California Commercial |
$432.88
|
| Rate for Payer: Blue Shield of California EPN |
$282.24
|
| Rate for Payer: Cash Price |
$308.00
|
| Rate for Payer: Central Health Plan Commercial |
$448.00
|
| Rate for Payer: Cigna of CA HMO |
$392.00
|
| Rate for Payer: Cigna of CA PPO |
$392.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$224.00
|
| Rate for Payer: EPIC Health Plan Senior |
$224.00
|
| Rate for Payer: Galaxy Health WC |
$476.00
|
| Rate for Payer: Global Benefits Group Commercial |
$336.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$504.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$373.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$213.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$346.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.00
|
| Rate for Payer: Multiplan Commercial |
$420.00
|
| Rate for Payer: Networks By Design Commercial |
$364.00
|
| Rate for Payer: Prime Health Services Commercial |
$476.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$210.17
|
| Rate for Payer: United Healthcare All Other HMO |
$204.57
|
| Rate for Payer: United Healthcare HMO Rider |
$200.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$183.40
|
|
|
HC WHFO FING EXT WRIST SUPPORT
|
Facility
|
OP
|
$560.00
|
|
|
Service Code
|
CPT L3931
|
| Hospital Charge Code |
901300801
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$183.40 |
| Max. Negotiated Rate |
$504.00 |
| Rate for Payer: Adventist Health Commercial |
$229.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$476.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$308.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$420.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$328.89
|
| Rate for Payer: Blue Shield of California Commercial |
$432.88
|
| Rate for Payer: Blue Shield of California EPN |
$282.24
|
| Rate for Payer: Cash Price |
$308.00
|
| Rate for Payer: Cash Price |
$308.00
|
| Rate for Payer: Central Health Plan Commercial |
$448.00
|
| Rate for Payer: Cigna of CA HMO |
$392.00
|
| Rate for Payer: Cigna of CA PPO |
$392.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$476.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$476.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$476.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$224.00
|
| Rate for Payer: EPIC Health Plan Senior |
$224.00
|
| Rate for Payer: Galaxy Health WC |
$476.00
|
| Rate for Payer: Global Benefits Group Commercial |
$336.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$504.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$252.74
|
| Rate for Payer: InnovAge PACE Commercial |
$280.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$373.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$279.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$346.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$229.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$392.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$392.00
|
| Rate for Payer: Multiplan Commercial |
$420.00
|
| Rate for Payer: Networks By Design Commercial |
$280.00
|
| Rate for Payer: Prime Health Services Commercial |
$476.00
|
| Rate for Payer: Riverside University Health System MISP |
$224.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$336.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$336.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$210.17
|
| Rate for Payer: United Healthcare All Other HMO |
$204.57
|
| Rate for Payer: United Healthcare HMO Rider |
$200.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$183.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$476.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$476.00
|
| Rate for Payer: Vantage Medical Group Senior |
$476.00
|
|
|
HC WHFO FLEXION GLOVE
|
Facility
|
OP
|
$212.00
|
|
|
Service Code
|
CPT L3912
|
| Hospital Charge Code |
915353912
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$69.43 |
| Max. Negotiated Rate |
$190.80 |
| Rate for Payer: Adventist Health Commercial |
$86.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$180.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$116.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$159.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$124.51
|
| Rate for Payer: Blue Shield of California Commercial |
$163.88
|
| Rate for Payer: Blue Shield of California EPN |
$106.85
|
| Rate for Payer: Cash Price |
$116.60
|
| Rate for Payer: Cash Price |
$116.60
|
| Rate for Payer: Central Health Plan Commercial |
$169.60
|
| Rate for Payer: Cigna of CA HMO |
$148.40
|
| Rate for Payer: Cigna of CA PPO |
$148.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$180.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$180.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.80
|
| Rate for Payer: EPIC Health Plan Senior |
$84.80
|
| Rate for Payer: Galaxy Health WC |
$180.20
|
| Rate for Payer: Global Benefits Group Commercial |
$127.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$190.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$107.90
|
| Rate for Payer: InnovAge PACE Commercial |
$106.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$141.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$119.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$131.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$148.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$148.40
|
| Rate for Payer: Multiplan Commercial |
$159.00
|
| Rate for Payer: Networks By Design Commercial |
$106.00
|
| Rate for Payer: Prime Health Services Commercial |
$180.20
|
| Rate for Payer: Riverside University Health System MISP |
$84.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$127.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$127.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$79.56
|
| Rate for Payer: United Healthcare All Other HMO |
$77.44
|
| Rate for Payer: United Healthcare HMO Rider |
$75.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$69.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$180.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.20
|
| Rate for Payer: Vantage Medical Group Senior |
$180.20
|
|
|
HC WHFO FLEXION GLOVE
|
Facility
|
OP
|
$212.00
|
|
|
Service Code
|
CPT L3912
|
| Hospital Charge Code |
905353912
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$69.43 |
| Max. Negotiated Rate |
$190.80 |
| Rate for Payer: Adventist Health Commercial |
$86.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$180.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$116.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$159.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$124.51
|
| Rate for Payer: Blue Shield of California Commercial |
$163.88
|
| Rate for Payer: Blue Shield of California EPN |
$106.85
|
| Rate for Payer: Cash Price |
$116.60
|
| Rate for Payer: Cash Price |
$116.60
|
| Rate for Payer: Central Health Plan Commercial |
$169.60
|
| Rate for Payer: Cigna of CA HMO |
$148.40
|
| Rate for Payer: Cigna of CA PPO |
$148.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$180.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$180.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.80
|
| Rate for Payer: EPIC Health Plan Senior |
$84.80
|
| Rate for Payer: Galaxy Health WC |
$180.20
|
| Rate for Payer: Global Benefits Group Commercial |
$127.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$190.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$107.90
|
| Rate for Payer: InnovAge PACE Commercial |
$106.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$141.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$119.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$131.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$148.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$148.40
|
| Rate for Payer: Multiplan Commercial |
$159.00
|
| Rate for Payer: Networks By Design Commercial |
$106.00
|
| Rate for Payer: Prime Health Services Commercial |
$180.20
|
| Rate for Payer: Riverside University Health System MISP |
$84.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$127.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$127.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$79.56
|
| Rate for Payer: United Healthcare All Other HMO |
$77.44
|
| Rate for Payer: United Healthcare HMO Rider |
$75.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$69.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$180.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.20
|
| Rate for Payer: Vantage Medical Group Senior |
$180.20
|
|
|
HC WHFO FLEXION GLOVE
|
Facility
|
IP
|
$212.00
|
|
|
Service Code
|
CPT L3912
|
| Hospital Charge Code |
915353912
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$42.40 |
| Max. Negotiated Rate |
$190.80 |
| Rate for Payer: Adventist Health Commercial |
$42.40
|
| Rate for Payer: Blue Shield of California Commercial |
$163.88
|
| Rate for Payer: Blue Shield of California EPN |
$106.85
|
| Rate for Payer: Cash Price |
$116.60
|
| Rate for Payer: Central Health Plan Commercial |
$169.60
|
| Rate for Payer: Cigna of CA HMO |
$148.40
|
| Rate for Payer: Cigna of CA PPO |
$148.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.80
|
| Rate for Payer: EPIC Health Plan Senior |
$84.80
|
| Rate for Payer: Galaxy Health WC |
$180.20
|
| Rate for Payer: Global Benefits Group Commercial |
$127.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$190.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$141.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$131.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.40
|
| Rate for Payer: Multiplan Commercial |
$159.00
|
| Rate for Payer: Networks By Design Commercial |
$137.80
|
| Rate for Payer: Prime Health Services Commercial |
$180.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$79.56
|
| Rate for Payer: United Healthcare All Other HMO |
$77.44
|
| Rate for Payer: United Healthcare HMO Rider |
$75.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$69.43
|
|
|
HC WHFO FLEXION GLOVE
|
Facility
|
IP
|
$212.00
|
|
|
Service Code
|
CPT L3912
|
| Hospital Charge Code |
905353912
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$42.40 |
| Max. Negotiated Rate |
$190.80 |
| Rate for Payer: Adventist Health Commercial |
$42.40
|
| Rate for Payer: Blue Shield of California Commercial |
$163.88
|
| Rate for Payer: Blue Shield of California EPN |
$106.85
|
| Rate for Payer: Cash Price |
$116.60
|
| Rate for Payer: Central Health Plan Commercial |
$169.60
|
| Rate for Payer: Cigna of CA HMO |
$148.40
|
| Rate for Payer: Cigna of CA PPO |
$148.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.80
|
| Rate for Payer: EPIC Health Plan Senior |
$84.80
|
| Rate for Payer: Galaxy Health WC |
$180.20
|
| Rate for Payer: Global Benefits Group Commercial |
$127.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$190.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$141.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$131.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.40
|
| Rate for Payer: Multiplan Commercial |
$159.00
|
| Rate for Payer: Networks By Design Commercial |
$137.80
|
| Rate for Payer: Prime Health Services Commercial |
$180.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$79.56
|
| Rate for Payer: United Healthcare All Other HMO |
$77.44
|
| Rate for Payer: United Healthcare HMO Rider |
$75.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$69.43
|
|
|
HC WHFO FLEXOR HINGE CABLE DRIVEN
|
Facility
|
IP
|
$1,588.00
|
|
|
Service Code
|
CPT L3901
|
| Hospital Charge Code |
905353901
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$317.60 |
| Max. Negotiated Rate |
$1,429.20 |
| Rate for Payer: Adventist Health Commercial |
$317.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,227.52
|
| Rate for Payer: Blue Shield of California EPN |
$800.35
|
| Rate for Payer: Cash Price |
$873.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,270.40
|
| Rate for Payer: Cigna of CA HMO |
$1,111.60
|
| Rate for Payer: Cigna of CA PPO |
$1,111.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$635.20
|
| Rate for Payer: EPIC Health Plan Senior |
$635.20
|
| Rate for Payer: Galaxy Health WC |
$1,349.80
|
| Rate for Payer: Global Benefits Group Commercial |
$952.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,429.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,059.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$605.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$982.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$317.60
|
| Rate for Payer: Multiplan Commercial |
$1,191.00
|
| Rate for Payer: Networks By Design Commercial |
$1,032.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,349.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$595.98
|
| Rate for Payer: United Healthcare All Other HMO |
$580.10
|
| Rate for Payer: United Healthcare HMO Rider |
$567.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$520.07
|
|
|
HC WHFO FLEXOR HINGE CABLE DRIVEN
|
Facility
|
OP
|
$1,588.00
|
|
|
Service Code
|
CPT L3901
|
| Hospital Charge Code |
905353901
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$520.07 |
| Max. Negotiated Rate |
$1,549.41 |
| Rate for Payer: Adventist Health Commercial |
$651.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,349.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$873.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,191.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$932.63
|
| Rate for Payer: Blue Shield of California Commercial |
$1,227.52
|
| Rate for Payer: Blue Shield of California EPN |
$800.35
|
| Rate for Payer: Cash Price |
$873.40
|
| Rate for Payer: Cash Price |
$873.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,270.40
|
| Rate for Payer: Cigna of CA HMO |
$1,111.60
|
| Rate for Payer: Cigna of CA PPO |
$1,111.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,349.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,349.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,349.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$635.20
|
| Rate for Payer: EPIC Health Plan Senior |
$635.20
|
| Rate for Payer: Galaxy Health WC |
$1,349.80
|
| Rate for Payer: Global Benefits Group Commercial |
$952.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,429.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,402.63
|
| Rate for Payer: InnovAge PACE Commercial |
$794.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,059.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,549.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$982.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$651.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,111.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,111.60
|
| Rate for Payer: Multiplan Commercial |
$1,191.00
|
| Rate for Payer: Networks By Design Commercial |
$794.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,349.80
|
| Rate for Payer: Riverside University Health System MISP |
$635.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$952.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$952.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$595.98
|
| Rate for Payer: United Healthcare All Other HMO |
$580.10
|
| Rate for Payer: United Healthcare HMO Rider |
$567.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$520.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,349.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,349.80
|
| Rate for Payer: Vantage Medical Group Senior |
$1,349.80
|
|
