|
HC WHFO SAFETY PIN MODIFIED
|
Facility
|
OP
|
$132.00
|
|
|
Service Code
|
CPT L3925
|
| Hospital Charge Code |
905353934
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$43.23 |
| Max. Negotiated Rate |
$118.80 |
| Rate for Payer: Adventist Health Commercial |
$54.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$112.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$72.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$99.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$77.52
|
| Rate for Payer: Blue Shield of California Commercial |
$102.04
|
| Rate for Payer: Blue Shield of California EPN |
$66.53
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Central Health Plan Commercial |
$105.60
|
| Rate for Payer: Cigna of CA HMO |
$92.40
|
| Rate for Payer: Cigna of CA PPO |
$92.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$112.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$112.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$112.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.80
|
| Rate for Payer: EPIC Health Plan Senior |
$52.80
|
| Rate for Payer: Galaxy Health WC |
$112.20
|
| Rate for Payer: Global Benefits Group Commercial |
$79.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$118.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$69.23
|
| Rate for Payer: InnovAge PACE Commercial |
$66.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$88.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$76.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$81.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$92.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$92.40
|
| Rate for Payer: Multiplan Commercial |
$99.00
|
| Rate for Payer: Networks By Design Commercial |
$66.00
|
| Rate for Payer: Prime Health Services Commercial |
$112.20
|
| Rate for Payer: Riverside University Health System MISP |
$52.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$79.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$79.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$49.54
|
| Rate for Payer: United Healthcare All Other HMO |
$48.22
|
| Rate for Payer: United Healthcare HMO Rider |
$47.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$43.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$112.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$112.20
|
| Rate for Payer: Vantage Medical Group Senior |
$112.20
|
|
|
HC WHFO SAFETY PIN MODIFIED
|
Facility
|
IP
|
$132.00
|
|
|
Service Code
|
CPT L3925
|
| Hospital Charge Code |
905353934
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$26.40 |
| Max. Negotiated Rate |
$118.80 |
| Rate for Payer: Adventist Health Commercial |
$26.40
|
| Rate for Payer: Blue Shield of California Commercial |
$102.04
|
| Rate for Payer: Blue Shield of California EPN |
$66.53
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Central Health Plan Commercial |
$105.60
|
| Rate for Payer: Cigna of CA HMO |
$92.40
|
| Rate for Payer: Cigna of CA PPO |
$92.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.80
|
| Rate for Payer: EPIC Health Plan Senior |
$52.80
|
| Rate for Payer: Galaxy Health WC |
$112.20
|
| Rate for Payer: Global Benefits Group Commercial |
$79.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$118.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$88.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$81.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.40
|
| Rate for Payer: Multiplan Commercial |
$99.00
|
| Rate for Payer: Networks By Design Commercial |
$85.80
|
| Rate for Payer: Prime Health Services Commercial |
$112.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$49.54
|
| Rate for Payer: United Healthcare All Other HMO |
$48.22
|
| Rate for Payer: United Healthcare HMO Rider |
$47.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$43.23
|
|
|
HC WHFO SAFETY PIN SPRING WIRE
|
Facility
|
OP
|
$145.00
|
|
|
Service Code
|
CPT L3925
|
| Hospital Charge Code |
905353932
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$47.49 |
| Max. Negotiated Rate |
$130.50 |
| Rate for Payer: Adventist Health Commercial |
$59.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$123.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$79.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$108.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$85.16
|
| Rate for Payer: Blue Shield of California Commercial |
$112.08
|
| Rate for Payer: Blue Shield of California EPN |
$73.08
|
| Rate for Payer: Cash Price |
$79.75
|
| Rate for Payer: Cash Price |
$79.75
|
| Rate for Payer: Central Health Plan Commercial |
$116.00
|
| Rate for Payer: Cigna of CA HMO |
$101.50
|
| Rate for Payer: Cigna of CA PPO |
$101.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$123.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$123.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.00
|
| Rate for Payer: EPIC Health Plan Senior |
$58.00
|
| Rate for Payer: Galaxy Health WC |
$123.25
|
| Rate for Payer: Global Benefits Group Commercial |
$87.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$130.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$69.23
|
| Rate for Payer: InnovAge PACE Commercial |
$72.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$96.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$76.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$89.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$101.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$101.50
|
| Rate for Payer: Multiplan Commercial |
$108.75
|
| Rate for Payer: Networks By Design Commercial |
$72.50
|
| Rate for Payer: Prime Health Services Commercial |
$123.25
|
| Rate for Payer: Riverside University Health System MISP |
$58.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$87.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$87.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$54.42
|
| Rate for Payer: United Healthcare All Other HMO |
$52.97
|
| Rate for Payer: United Healthcare HMO Rider |
$51.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$47.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$123.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.25
|
| Rate for Payer: Vantage Medical Group Senior |
$123.25
|
|
|
HC WHFO SAFETY PIN SPRING WIRE
|
Facility
|
IP
|
$145.00
|
|
|
Service Code
|
CPT L3925
|
| Hospital Charge Code |
905353932
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$29.00 |
| Max. Negotiated Rate |
$130.50 |
| Rate for Payer: Adventist Health Commercial |
$29.00
|
| Rate for Payer: Blue Shield of California Commercial |
$112.08
|
| Rate for Payer: Blue Shield of California EPN |
$73.08
|
| Rate for Payer: Cash Price |
$79.75
|
| Rate for Payer: Central Health Plan Commercial |
$116.00
|
| Rate for Payer: Cigna of CA HMO |
$101.50
|
| Rate for Payer: Cigna of CA PPO |
$101.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.00
|
| Rate for Payer: EPIC Health Plan Senior |
$58.00
|
| Rate for Payer: Galaxy Health WC |
$123.25
|
| Rate for Payer: Global Benefits Group Commercial |
$87.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$130.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$96.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$55.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$89.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.00
|
| Rate for Payer: Multiplan Commercial |
$108.75
|
| Rate for Payer: Networks By Design Commercial |
$94.25
|
| Rate for Payer: Prime Health Services Commercial |
$123.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$54.42
|
| Rate for Payer: United Healthcare All Other HMO |
$52.97
|
| Rate for Payer: United Healthcare HMO Rider |
$51.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$47.49
|
|
|
HC WHFO SHORT OPPONENS
|
Facility
|
IP
|
$297.00
|
|
|
Service Code
|
CPT L3808
|
| Hospital Charge Code |
905353800
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$59.40 |
| Max. Negotiated Rate |
$267.30 |
| Rate for Payer: Adventist Health Commercial |
$59.40
|
| Rate for Payer: Blue Shield of California Commercial |
$229.58
|
| Rate for Payer: Blue Shield of California EPN |
$149.69
|
| Rate for Payer: Cash Price |
$163.35
|
| Rate for Payer: Central Health Plan Commercial |
$237.60
|
| Rate for Payer: Cigna of CA HMO |
$207.90
|
| Rate for Payer: Cigna of CA PPO |
$207.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$118.80
|
| Rate for Payer: EPIC Health Plan Senior |
$118.80
|
| Rate for Payer: Galaxy Health WC |
$252.45
|
| Rate for Payer: Global Benefits Group Commercial |
$178.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$267.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$198.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$113.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$183.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.40
|
| Rate for Payer: Multiplan Commercial |
$222.75
|
| Rate for Payer: Networks By Design Commercial |
$193.05
|
| Rate for Payer: Prime Health Services Commercial |
$252.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$111.46
|
| Rate for Payer: United Healthcare All Other HMO |
$108.49
|
| Rate for Payer: United Healthcare HMO Rider |
$106.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$97.27
|
|
|
HC WHFO SHORT OPPONENS
|
Facility
|
OP
|
$297.00
|
|
|
Service Code
|
CPT L3808
|
| Hospital Charge Code |
905353800
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$97.27 |
| Max. Negotiated Rate |
$319.98 |
| Rate for Payer: Adventist Health Commercial |
$121.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$252.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$163.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$222.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$174.43
|
| Rate for Payer: Blue Shield of California Commercial |
$229.58
|
| Rate for Payer: Blue Shield of California EPN |
$149.69
|
| Rate for Payer: Cash Price |
$163.35
|
| Rate for Payer: Cash Price |
$163.35
|
| Rate for Payer: Central Health Plan Commercial |
$237.60
|
| Rate for Payer: Cigna of CA HMO |
$207.90
|
| Rate for Payer: Cigna of CA PPO |
$207.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$252.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$252.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$252.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$118.80
|
| Rate for Payer: EPIC Health Plan Senior |
$118.80
|
| Rate for Payer: Galaxy Health WC |
$252.45
|
| Rate for Payer: Global Benefits Group Commercial |
$178.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$267.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$289.67
|
| Rate for Payer: InnovAge PACE Commercial |
$148.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$198.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$319.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$183.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$207.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$207.90
|
| Rate for Payer: Multiplan Commercial |
$222.75
|
| Rate for Payer: Networks By Design Commercial |
$148.50
|
| Rate for Payer: Prime Health Services Commercial |
$252.45
|
| Rate for Payer: Riverside University Health System MISP |
$118.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$178.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$178.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$111.46
|
| Rate for Payer: United Healthcare All Other HMO |
$108.49
|
| Rate for Payer: United Healthcare HMO Rider |
$106.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$97.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$252.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$252.45
|
| Rate for Payer: Vantage Medical Group Senior |
$252.45
|
|
|
HC WHFO SPREADING HAND
|
Facility
|
IP
|
$144.00
|
|
|
Service Code
|
CPT L3923
|
| Hospital Charge Code |
905353954
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$28.80 |
| Max. Negotiated Rate |
$129.60 |
| Rate for Payer: Adventist Health Commercial |
$28.80
|
| Rate for Payer: Blue Shield of California Commercial |
$111.31
|
| Rate for Payer: Blue Shield of California EPN |
$72.58
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Central Health Plan Commercial |
$115.20
|
| Rate for Payer: Cigna of CA HMO |
$100.80
|
| Rate for Payer: Cigna of CA PPO |
$100.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.60
|
| Rate for Payer: EPIC Health Plan Senior |
$57.60
|
| Rate for Payer: Galaxy Health WC |
$122.40
|
| Rate for Payer: Global Benefits Group Commercial |
$86.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$129.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$96.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$89.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.80
|
| Rate for Payer: Multiplan Commercial |
$108.00
|
| Rate for Payer: Networks By Design Commercial |
$93.60
|
| Rate for Payer: Prime Health Services Commercial |
$122.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$54.04
|
| Rate for Payer: United Healthcare All Other HMO |
$52.60
|
| Rate for Payer: United Healthcare HMO Rider |
$51.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$47.16
|
|
|
HC WHFO SPREADING HAND
|
Facility
|
OP
|
$144.00
|
|
|
Service Code
|
CPT L3923
|
| Hospital Charge Code |
905353954
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$38.29 |
| Max. Negotiated Rate |
$129.60 |
| Rate for Payer: Adventist Health Commercial |
$59.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$122.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$79.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$108.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$84.57
|
| Rate for Payer: Blue Shield of California Commercial |
$111.31
|
| Rate for Payer: Blue Shield of California EPN |
$72.58
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Central Health Plan Commercial |
$115.20
|
| Rate for Payer: Cigna of CA HMO |
$100.80
|
| Rate for Payer: Cigna of CA PPO |
$100.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$122.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$122.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$122.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.60
|
| Rate for Payer: EPIC Health Plan Senior |
$57.60
|
| Rate for Payer: Galaxy Health WC |
$122.40
|
| Rate for Payer: Global Benefits Group Commercial |
$86.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$129.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$38.29
|
| Rate for Payer: InnovAge PACE Commercial |
$72.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$96.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$89.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$100.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$100.80
|
| Rate for Payer: Multiplan Commercial |
$108.00
|
| Rate for Payer: Networks By Design Commercial |
$72.00
|
| Rate for Payer: Prime Health Services Commercial |
$122.40
|
| Rate for Payer: Riverside University Health System MISP |
$57.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$86.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$86.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$54.04
|
| Rate for Payer: United Healthcare All Other HMO |
$52.60
|
| Rate for Payer: United Healthcare HMO Rider |
$51.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$47.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$122.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$122.40
|
| Rate for Payer: Vantage Medical Group Senior |
$122.40
|
|
|
HC WHFO SWANSON DESIGN
|
Facility
|
IP
|
$512.00
|
|
|
Service Code
|
CPT L3931
|
| Hospital Charge Code |
905353910
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$102.40 |
| Max. Negotiated Rate |
$460.80 |
| Rate for Payer: Adventist Health Commercial |
$102.40
|
| Rate for Payer: Blue Shield of California Commercial |
$395.78
|
| Rate for Payer: Blue Shield of California EPN |
$258.05
|
| Rate for Payer: Cash Price |
$281.60
|
| Rate for Payer: Central Health Plan Commercial |
$409.60
|
| Rate for Payer: Cigna of CA HMO |
$358.40
|
| Rate for Payer: Cigna of CA PPO |
$358.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$204.80
|
| Rate for Payer: EPIC Health Plan Senior |
$204.80
|
| Rate for Payer: Galaxy Health WC |
$435.20
|
| Rate for Payer: Global Benefits Group Commercial |
$307.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$460.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$341.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$195.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$316.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.40
|
| Rate for Payer: Multiplan Commercial |
$384.00
|
| Rate for Payer: Networks By Design Commercial |
$332.80
|
| Rate for Payer: Prime Health Services Commercial |
$435.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$192.15
|
| Rate for Payer: United Healthcare All Other HMO |
$187.03
|
| Rate for Payer: United Healthcare HMO Rider |
$182.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$167.68
|
|
|
HC WHFO SWANSON DESIGN
|
Facility
|
OP
|
$512.00
|
|
|
Service Code
|
CPT L3931
|
| Hospital Charge Code |
905353910
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$167.68 |
| Max. Negotiated Rate |
$460.80 |
| Rate for Payer: Adventist Health Commercial |
$209.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$435.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$281.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$384.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$300.70
|
| Rate for Payer: Blue Shield of California Commercial |
$395.78
|
| Rate for Payer: Blue Shield of California EPN |
$258.05
|
| Rate for Payer: Cash Price |
$281.60
|
| Rate for Payer: Cash Price |
$281.60
|
| Rate for Payer: Central Health Plan Commercial |
$409.60
|
| Rate for Payer: Cigna of CA HMO |
$358.40
|
| Rate for Payer: Cigna of CA PPO |
$358.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$435.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$435.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$435.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$204.80
|
| Rate for Payer: EPIC Health Plan Senior |
$204.80
|
| Rate for Payer: Galaxy Health WC |
$435.20
|
| Rate for Payer: Global Benefits Group Commercial |
$307.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$460.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$252.74
|
| Rate for Payer: InnovAge PACE Commercial |
$256.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$341.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$279.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$316.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$209.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$358.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$358.40
|
| Rate for Payer: Multiplan Commercial |
$384.00
|
| Rate for Payer: Networks By Design Commercial |
$256.00
|
| Rate for Payer: Prime Health Services Commercial |
$435.20
|
| Rate for Payer: Riverside University Health System MISP |
$204.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$307.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$307.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$192.15
|
| Rate for Payer: United Healthcare All Other HMO |
$187.03
|
| Rate for Payer: United Healthcare HMO Rider |
$182.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$167.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$435.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$435.20
|
| Rate for Payer: Vantage Medical Group Senior |
$435.20
|
|
|
HC WHFO THOMAS SUSPENSION
|
Facility
|
IP
|
$339.00
|
|
|
Service Code
|
CPT L3931
|
| Hospital Charge Code |
905353926
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$67.80 |
| Max. Negotiated Rate |
$305.10 |
| Rate for Payer: Adventist Health Commercial |
$67.80
|
| Rate for Payer: Blue Shield of California Commercial |
$262.05
|
| Rate for Payer: Blue Shield of California EPN |
$170.86
|
| Rate for Payer: Cash Price |
$186.45
|
| Rate for Payer: Central Health Plan Commercial |
$271.20
|
| Rate for Payer: Cigna of CA HMO |
$237.30
|
| Rate for Payer: Cigna of CA PPO |
$237.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$135.60
|
| Rate for Payer: EPIC Health Plan Senior |
$135.60
|
| Rate for Payer: Galaxy Health WC |
$288.15
|
| Rate for Payer: Global Benefits Group Commercial |
$203.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$305.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$226.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$129.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$209.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.80
|
| Rate for Payer: Multiplan Commercial |
$254.25
|
| Rate for Payer: Networks By Design Commercial |
$220.35
|
| Rate for Payer: Prime Health Services Commercial |
$288.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$127.23
|
| Rate for Payer: United Healthcare All Other HMO |
$123.84
|
| Rate for Payer: United Healthcare HMO Rider |
$121.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$111.02
|
|
|
HC WHFO THOMAS SUSPENSION
|
Facility
|
OP
|
$339.00
|
|
|
Service Code
|
CPT L3931
|
| Hospital Charge Code |
905353926
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$111.02 |
| Max. Negotiated Rate |
$305.10 |
| Rate for Payer: Adventist Health Commercial |
$138.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$288.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$186.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$254.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$199.09
|
| Rate for Payer: Blue Shield of California Commercial |
$262.05
|
| Rate for Payer: Blue Shield of California EPN |
$170.86
|
| Rate for Payer: Cash Price |
$186.45
|
| Rate for Payer: Cash Price |
$186.45
|
| Rate for Payer: Central Health Plan Commercial |
$271.20
|
| Rate for Payer: Cigna of CA HMO |
$237.30
|
| Rate for Payer: Cigna of CA PPO |
$237.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$288.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$288.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$288.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$135.60
|
| Rate for Payer: EPIC Health Plan Senior |
$135.60
|
| Rate for Payer: Galaxy Health WC |
$288.15
|
| Rate for Payer: Global Benefits Group Commercial |
$203.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$305.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$252.74
|
| Rate for Payer: InnovAge PACE Commercial |
$169.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$226.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$279.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$209.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$138.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$237.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$237.30
|
| Rate for Payer: Multiplan Commercial |
$254.25
|
| Rate for Payer: Networks By Design Commercial |
$169.50
|
| Rate for Payer: Prime Health Services Commercial |
$288.15
|
| Rate for Payer: Riverside University Health System MISP |
$135.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$203.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$203.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$127.23
|
| Rate for Payer: United Healthcare All Other HMO |
$123.84
|
| Rate for Payer: United Healthcare HMO Rider |
$121.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$111.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$288.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$288.15
|
| Rate for Payer: Vantage Medical Group Senior |
$288.15
|
|
|
HC WHFO VOLAR COCK-UP W/FLEX OUTRIGGER
|
Facility
|
IP
|
$214.00
|
|
|
Service Code
|
CPT L3931
|
| Hospital Charge Code |
901301038
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$42.80 |
| Max. Negotiated Rate |
$192.60 |
| Rate for Payer: Adventist Health Commercial |
$42.80
|
| Rate for Payer: Blue Shield of California Commercial |
$165.42
|
| Rate for Payer: Blue Shield of California EPN |
$107.86
|
| Rate for Payer: Cash Price |
$117.70
|
| Rate for Payer: Central Health Plan Commercial |
$171.20
|
| Rate for Payer: Cigna of CA HMO |
$149.80
|
| Rate for Payer: Cigna of CA PPO |
$149.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$85.60
|
| Rate for Payer: EPIC Health Plan Senior |
$85.60
|
| Rate for Payer: Galaxy Health WC |
$181.90
|
| Rate for Payer: Global Benefits Group Commercial |
$128.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$192.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$142.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$81.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$132.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.80
|
| Rate for Payer: Multiplan Commercial |
$160.50
|
| Rate for Payer: Networks By Design Commercial |
$139.10
|
| Rate for Payer: Prime Health Services Commercial |
$181.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$80.31
|
| Rate for Payer: United Healthcare All Other HMO |
$78.17
|
| Rate for Payer: United Healthcare HMO Rider |
$76.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$70.08
|
|
|
HC WHFO VOLAR COCK-UP W/FLEX OUTRIGGER
|
Facility
|
OP
|
$214.00
|
|
|
Service Code
|
CPT L3931
|
| Hospital Charge Code |
901301038
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$70.08 |
| Max. Negotiated Rate |
$279.19 |
| Rate for Payer: Adventist Health Commercial |
$87.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$181.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$117.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$160.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$125.68
|
| Rate for Payer: Blue Shield of California Commercial |
$165.42
|
| Rate for Payer: Blue Shield of California EPN |
$107.86
|
| Rate for Payer: Cash Price |
$117.70
|
| Rate for Payer: Cash Price |
$117.70
|
| Rate for Payer: Central Health Plan Commercial |
$171.20
|
| Rate for Payer: Cigna of CA HMO |
$149.80
|
| Rate for Payer: Cigna of CA PPO |
$149.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$181.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$181.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$181.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$85.60
|
| Rate for Payer: EPIC Health Plan Senior |
$85.60
|
| Rate for Payer: Galaxy Health WC |
$181.90
|
| Rate for Payer: Global Benefits Group Commercial |
$128.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$192.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$252.74
|
| Rate for Payer: InnovAge PACE Commercial |
$107.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$142.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$279.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$132.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$149.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.80
|
| Rate for Payer: Multiplan Commercial |
$160.50
|
| Rate for Payer: Networks By Design Commercial |
$107.00
|
| Rate for Payer: Prime Health Services Commercial |
$181.90
|
| Rate for Payer: Riverside University Health System MISP |
$85.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$128.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$128.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$80.31
|
| Rate for Payer: United Healthcare All Other HMO |
$78.17
|
| Rate for Payer: United Healthcare HMO Rider |
$76.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$70.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$181.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$181.90
|
| Rate for Payer: Vantage Medical Group Senior |
$181.90
|
|
|
HC WHFO W/JOINT(S) CUSTOM FABRCTD
|
Facility
|
IP
|
$670.00
|
|
|
Service Code
|
CPT L3806
|
| Hospital Charge Code |
905353806
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$134.00 |
| Max. Negotiated Rate |
$603.00 |
| Rate for Payer: Adventist Health Commercial |
$134.00
|
| Rate for Payer: Blue Shield of California Commercial |
$517.91
|
| Rate for Payer: Blue Shield of California EPN |
$337.68
|
| Rate for Payer: Cash Price |
$368.50
|
| Rate for Payer: Central Health Plan Commercial |
$536.00
|
| Rate for Payer: Cigna of CA HMO |
$469.00
|
| Rate for Payer: Cigna of CA PPO |
$469.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$268.00
|
| Rate for Payer: EPIC Health Plan Senior |
$268.00
|
| Rate for Payer: Galaxy Health WC |
$569.50
|
| Rate for Payer: Global Benefits Group Commercial |
$402.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$603.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$446.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$255.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$414.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$134.00
|
| Rate for Payer: Multiplan Commercial |
$502.50
|
| Rate for Payer: Networks By Design Commercial |
$435.50
|
| Rate for Payer: Prime Health Services Commercial |
$569.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$251.45
|
| Rate for Payer: United Healthcare All Other HMO |
$244.75
|
| Rate for Payer: United Healthcare HMO Rider |
$239.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$219.43
|
|
|
HC WHFO W/JOINT(S) CUSTOM FABRCTD
|
Facility
|
IP
|
$670.00
|
|
|
Service Code
|
CPT L3806
|
| Hospital Charge Code |
915353806
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$134.00 |
| Max. Negotiated Rate |
$603.00 |
| Rate for Payer: Adventist Health Commercial |
$134.00
|
| Rate for Payer: Blue Shield of California Commercial |
$517.91
|
| Rate for Payer: Blue Shield of California EPN |
$337.68
|
| Rate for Payer: Cash Price |
$368.50
|
| Rate for Payer: Central Health Plan Commercial |
$536.00
|
| Rate for Payer: Cigna of CA HMO |
$469.00
|
| Rate for Payer: Cigna of CA PPO |
$469.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$268.00
|
| Rate for Payer: EPIC Health Plan Senior |
$268.00
|
| Rate for Payer: Galaxy Health WC |
$569.50
|
| Rate for Payer: Global Benefits Group Commercial |
$402.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$603.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$446.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$255.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$414.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$134.00
|
| Rate for Payer: Multiplan Commercial |
$502.50
|
| Rate for Payer: Networks By Design Commercial |
$435.50
|
| Rate for Payer: Prime Health Services Commercial |
$569.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$251.45
|
| Rate for Payer: United Healthcare All Other HMO |
$244.75
|
| Rate for Payer: United Healthcare HMO Rider |
$239.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$219.43
|
|
|
HC WHFO W/JOINT(S) CUSTOM FABRCTD
|
Facility
|
OP
|
$670.00
|
|
|
Service Code
|
CPT L3806
|
| Hospital Charge Code |
915353806
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$219.43 |
| Max. Negotiated Rate |
$603.00 |
| Rate for Payer: Adventist Health Commercial |
$274.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$569.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$368.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$502.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$393.49
|
| Rate for Payer: Blue Shield of California Commercial |
$517.91
|
| Rate for Payer: Blue Shield of California EPN |
$337.68
|
| Rate for Payer: Cash Price |
$368.50
|
| Rate for Payer: Cash Price |
$368.50
|
| Rate for Payer: Central Health Plan Commercial |
$536.00
|
| Rate for Payer: Cigna of CA HMO |
$469.00
|
| Rate for Payer: Cigna of CA PPO |
$469.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$569.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$569.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$569.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$268.00
|
| Rate for Payer: EPIC Health Plan Senior |
$268.00
|
| Rate for Payer: Galaxy Health WC |
$569.50
|
| Rate for Payer: Global Benefits Group Commercial |
$402.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$603.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$502.72
|
| Rate for Payer: InnovAge PACE Commercial |
$335.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$446.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$555.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$414.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$274.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$469.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$469.00
|
| Rate for Payer: Multiplan Commercial |
$502.50
|
| Rate for Payer: Networks By Design Commercial |
$335.00
|
| Rate for Payer: Prime Health Services Commercial |
$569.50
|
| Rate for Payer: Riverside University Health System MISP |
$268.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$402.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$402.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$251.45
|
| Rate for Payer: United Healthcare All Other HMO |
$244.75
|
| Rate for Payer: United Healthcare HMO Rider |
$239.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$219.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$569.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$569.50
|
| Rate for Payer: Vantage Medical Group Senior |
$569.50
|
|
|
HC WHFO W/JOINT(S) CUSTOM FABRCTD
|
Facility
|
OP
|
$670.00
|
|
|
Service Code
|
CPT L3806
|
| Hospital Charge Code |
905353806
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$219.43 |
| Max. Negotiated Rate |
$603.00 |
| Rate for Payer: Adventist Health Commercial |
$274.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$569.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$368.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$502.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$393.49
|
| Rate for Payer: Blue Shield of California Commercial |
$517.91
|
| Rate for Payer: Blue Shield of California EPN |
$337.68
|
| Rate for Payer: Cash Price |
$368.50
|
| Rate for Payer: Cash Price |
$368.50
|
| Rate for Payer: Central Health Plan Commercial |
$536.00
|
| Rate for Payer: Cigna of CA HMO |
$469.00
|
| Rate for Payer: Cigna of CA PPO |
$469.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$569.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$569.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$569.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$268.00
|
| Rate for Payer: EPIC Health Plan Senior |
$268.00
|
| Rate for Payer: Galaxy Health WC |
$569.50
|
| Rate for Payer: Global Benefits Group Commercial |
$402.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$603.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$502.72
|
| Rate for Payer: InnovAge PACE Commercial |
$335.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$446.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$555.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$414.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$274.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$469.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$469.00
|
| Rate for Payer: Multiplan Commercial |
$502.50
|
| Rate for Payer: Networks By Design Commercial |
$335.00
|
| Rate for Payer: Prime Health Services Commercial |
$569.50
|
| Rate for Payer: Riverside University Health System MISP |
$268.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$402.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$402.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$251.45
|
| Rate for Payer: United Healthcare All Other HMO |
$244.75
|
| Rate for Payer: United Healthcare HMO Rider |
$239.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$219.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$569.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$569.50
|
| Rate for Payer: Vantage Medical Group Senior |
$569.50
|
|
|
HC WHFO WO JOINTS GAUNTLET CF
|
Facility
|
IP
|
$1,004.00
|
|
|
Service Code
|
CPT L3906
|
| Hospital Charge Code |
915353906
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$200.80 |
| Max. Negotiated Rate |
$903.60 |
| Rate for Payer: Adventist Health Commercial |
$200.80
|
| Rate for Payer: Blue Shield of California Commercial |
$776.09
|
| Rate for Payer: Blue Shield of California EPN |
$506.02
|
| Rate for Payer: Cash Price |
$552.20
|
| Rate for Payer: Central Health Plan Commercial |
$803.20
|
| Rate for Payer: Cigna of CA HMO |
$702.80
|
| Rate for Payer: Cigna of CA PPO |
$702.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$401.60
|
| Rate for Payer: EPIC Health Plan Senior |
$401.60
|
| Rate for Payer: Galaxy Health WC |
$853.40
|
| Rate for Payer: Global Benefits Group Commercial |
$602.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$903.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$669.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$382.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$621.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$200.80
|
| Rate for Payer: Multiplan Commercial |
$753.00
|
| Rate for Payer: Networks By Design Commercial |
$652.60
|
| Rate for Payer: Prime Health Services Commercial |
$853.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$376.80
|
| Rate for Payer: United Healthcare All Other HMO |
$366.76
|
| Rate for Payer: United Healthcare HMO Rider |
$358.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$328.81
|
|
|
HC WHFO WO JOINTS GAUNTLET CF
|
Facility
|
OP
|
$1,004.00
|
|
|
Service Code
|
CPT L3906
|
| Hospital Charge Code |
905353906
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$328.81 |
| Max. Negotiated Rate |
$903.60 |
| Rate for Payer: Adventist Health Commercial |
$411.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$853.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$552.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$753.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$589.65
|
| Rate for Payer: Blue Shield of California Commercial |
$776.09
|
| Rate for Payer: Blue Shield of California EPN |
$506.02
|
| Rate for Payer: Cash Price |
$552.20
|
| Rate for Payer: Cash Price |
$552.20
|
| Rate for Payer: Central Health Plan Commercial |
$803.20
|
| Rate for Payer: Cigna of CA HMO |
$702.80
|
| Rate for Payer: Cigna of CA PPO |
$702.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$853.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$853.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$853.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$401.60
|
| Rate for Payer: EPIC Health Plan Senior |
$401.60
|
| Rate for Payer: Galaxy Health WC |
$853.40
|
| Rate for Payer: Global Benefits Group Commercial |
$602.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$903.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$533.99
|
| Rate for Payer: InnovAge PACE Commercial |
$502.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$669.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$589.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$621.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$411.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$702.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$702.80
|
| Rate for Payer: Multiplan Commercial |
$753.00
|
| Rate for Payer: Networks By Design Commercial |
$502.00
|
| Rate for Payer: Prime Health Services Commercial |
$853.40
|
| Rate for Payer: Riverside University Health System MISP |
$401.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$602.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$602.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$376.80
|
| Rate for Payer: United Healthcare All Other HMO |
$366.76
|
| Rate for Payer: United Healthcare HMO Rider |
$358.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$328.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$853.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$853.40
|
| Rate for Payer: Vantage Medical Group Senior |
$853.40
|
|
|
HC WHFO WO JOINTS GAUNTLET CF
|
Facility
|
IP
|
$1,004.00
|
|
|
Service Code
|
CPT L3906
|
| Hospital Charge Code |
905353906
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$200.80 |
| Max. Negotiated Rate |
$903.60 |
| Rate for Payer: Adventist Health Commercial |
$200.80
|
| Rate for Payer: Blue Shield of California Commercial |
$776.09
|
| Rate for Payer: Blue Shield of California EPN |
$506.02
|
| Rate for Payer: Cash Price |
$552.20
|
| Rate for Payer: Central Health Plan Commercial |
$803.20
|
| Rate for Payer: Cigna of CA HMO |
$702.80
|
| Rate for Payer: Cigna of CA PPO |
$702.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$401.60
|
| Rate for Payer: EPIC Health Plan Senior |
$401.60
|
| Rate for Payer: Galaxy Health WC |
$853.40
|
| Rate for Payer: Global Benefits Group Commercial |
$602.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$903.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$669.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$382.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$621.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$200.80
|
| Rate for Payer: Multiplan Commercial |
$753.00
|
| Rate for Payer: Networks By Design Commercial |
$652.60
|
| Rate for Payer: Prime Health Services Commercial |
$853.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$376.80
|
| Rate for Payer: United Healthcare All Other HMO |
$366.76
|
| Rate for Payer: United Healthcare HMO Rider |
$358.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$328.81
|
|
|
HC WHFO WO JOINTS GAUNTLET CF
|
Facility
|
OP
|
$1,004.00
|
|
|
Service Code
|
CPT L3906
|
| Hospital Charge Code |
915353906
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$328.81 |
| Max. Negotiated Rate |
$903.60 |
| Rate for Payer: Adventist Health Commercial |
$411.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$853.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$552.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$753.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$589.65
|
| Rate for Payer: Blue Shield of California Commercial |
$776.09
|
| Rate for Payer: Blue Shield of California EPN |
$506.02
|
| Rate for Payer: Cash Price |
$552.20
|
| Rate for Payer: Cash Price |
$552.20
|
| Rate for Payer: Central Health Plan Commercial |
$803.20
|
| Rate for Payer: Cigna of CA HMO |
$702.80
|
| Rate for Payer: Cigna of CA PPO |
$702.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$853.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$853.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$853.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$401.60
|
| Rate for Payer: EPIC Health Plan Senior |
$401.60
|
| Rate for Payer: Galaxy Health WC |
$853.40
|
| Rate for Payer: Global Benefits Group Commercial |
$602.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$903.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$533.99
|
| Rate for Payer: InnovAge PACE Commercial |
$502.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$669.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$589.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$621.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$411.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$702.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$702.80
|
| Rate for Payer: Multiplan Commercial |
$753.00
|
| Rate for Payer: Networks By Design Commercial |
$502.00
|
| Rate for Payer: Prime Health Services Commercial |
$853.40
|
| Rate for Payer: Riverside University Health System MISP |
$401.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$602.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$602.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$376.80
|
| Rate for Payer: United Healthcare All Other HMO |
$366.76
|
| Rate for Payer: United Healthcare HMO Rider |
$358.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$328.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$853.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$853.40
|
| Rate for Payer: Vantage Medical Group Senior |
$853.40
|
|
|
HC WHFO W/O JOINT(S) PF
|
Facility
|
IP
|
$383.00
|
|
|
Service Code
|
CPT L3807
|
| Hospital Charge Code |
905353807
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$76.60 |
| Max. Negotiated Rate |
$344.70 |
| Rate for Payer: Adventist Health Commercial |
$76.60
|
| Rate for Payer: Blue Shield of California Commercial |
$296.06
|
| Rate for Payer: Blue Shield of California EPN |
$193.03
|
| Rate for Payer: Cash Price |
$210.65
|
| Rate for Payer: Central Health Plan Commercial |
$306.40
|
| Rate for Payer: Cigna of CA HMO |
$268.10
|
| Rate for Payer: Cigna of CA PPO |
$268.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.20
|
| Rate for Payer: EPIC Health Plan Senior |
$153.20
|
| Rate for Payer: Galaxy Health WC |
$325.55
|
| Rate for Payer: Global Benefits Group Commercial |
$229.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$344.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$255.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$145.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$237.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.60
|
| Rate for Payer: Multiplan Commercial |
$287.25
|
| Rate for Payer: Networks By Design Commercial |
$248.95
|
| Rate for Payer: Prime Health Services Commercial |
$325.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$143.74
|
| Rate for Payer: United Healthcare All Other HMO |
$139.91
|
| Rate for Payer: United Healthcare HMO Rider |
$136.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$125.43
|
|
|
HC WHFO W/O JOINT(S) PF
|
Facility
|
OP
|
$383.00
|
|
|
Service Code
|
CPT L3807
|
| Hospital Charge Code |
905353807
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$125.43 |
| Max. Negotiated Rate |
$344.70 |
| Rate for Payer: Adventist Health Commercial |
$157.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$325.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$210.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$287.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$224.94
|
| Rate for Payer: Blue Shield of California Commercial |
$296.06
|
| Rate for Payer: Blue Shield of California EPN |
$193.03
|
| Rate for Payer: Cash Price |
$210.65
|
| Rate for Payer: Central Health Plan Commercial |
$306.40
|
| Rate for Payer: Cigna of CA HMO |
$268.10
|
| Rate for Payer: Cigna of CA PPO |
$268.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$325.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$325.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$325.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.20
|
| Rate for Payer: EPIC Health Plan Senior |
$153.20
|
| Rate for Payer: Galaxy Health WC |
$325.55
|
| Rate for Payer: Global Benefits Group Commercial |
$229.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$344.70
|
| Rate for Payer: InnovAge PACE Commercial |
$191.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$255.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$237.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$157.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$268.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$268.10
|
| Rate for Payer: Multiplan Commercial |
$287.25
|
| Rate for Payer: Networks By Design Commercial |
$191.50
|
| Rate for Payer: Prime Health Services Commercial |
$325.55
|
| Rate for Payer: Riverside University Health System MISP |
$153.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$229.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$229.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$143.74
|
| Rate for Payer: United Healthcare All Other HMO |
$139.91
|
| Rate for Payer: United Healthcare HMO Rider |
$136.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$125.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$325.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$325.55
|
| Rate for Payer: Vantage Medical Group Senior |
$325.55
|
|
|
HC WHFO W/O JOINT(S) PF
|
Facility
|
IP
|
$383.00
|
|
|
Service Code
|
CPT L3807
|
| Hospital Charge Code |
915353807
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$76.60 |
| Max. Negotiated Rate |
$344.70 |
| Rate for Payer: Adventist Health Commercial |
$76.60
|
| Rate for Payer: Blue Shield of California Commercial |
$296.06
|
| Rate for Payer: Blue Shield of California EPN |
$193.03
|
| Rate for Payer: Cash Price |
$210.65
|
| Rate for Payer: Central Health Plan Commercial |
$306.40
|
| Rate for Payer: Cigna of CA HMO |
$268.10
|
| Rate for Payer: Cigna of CA PPO |
$268.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.20
|
| Rate for Payer: EPIC Health Plan Senior |
$153.20
|
| Rate for Payer: Galaxy Health WC |
$325.55
|
| Rate for Payer: Global Benefits Group Commercial |
$229.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$344.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$255.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$145.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$237.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.60
|
| Rate for Payer: Multiplan Commercial |
$287.25
|
| Rate for Payer: Networks By Design Commercial |
$248.95
|
| Rate for Payer: Prime Health Services Commercial |
$325.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$143.74
|
| Rate for Payer: United Healthcare All Other HMO |
$139.91
|
| Rate for Payer: United Healthcare HMO Rider |
$136.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$125.43
|
|
