|
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 WRIST EXT COCKUP PF
|
Facility
|
OP
|
$249.00
|
|
|
Service Code
|
CPT L3908
|
| Hospital Charge Code |
905109314
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$80.98 |
| Max. Negotiated Rate |
$224.10 |
| Rate for Payer: Adventist Health Commercial |
$102.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$211.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$136.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$186.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$146.24
|
| Rate for Payer: Blue Shield of California Commercial |
$192.48
|
| Rate for Payer: Blue Shield of California EPN |
$125.50
|
| Rate for Payer: Cash Price |
$136.95
|
| Rate for Payer: Cash Price |
$136.95
|
| Rate for Payer: Central Health Plan Commercial |
$199.20
|
| Rate for Payer: Cigna of CA HMO |
$174.30
|
| Rate for Payer: Cigna of CA PPO |
$174.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$211.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$211.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$211.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.60
|
| Rate for Payer: EPIC Health Plan Senior |
$99.60
|
| Rate for Payer: Galaxy Health WC |
$211.65
|
| Rate for Payer: Global Benefits Group Commercial |
$149.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$224.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$80.98
|
| Rate for Payer: InnovAge PACE Commercial |
$124.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$166.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$154.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$174.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$174.30
|
| Rate for Payer: Multiplan Commercial |
$186.75
|
| Rate for Payer: Networks By Design Commercial |
$124.50
|
| Rate for Payer: Prime Health Services Commercial |
$211.65
|
| Rate for Payer: Riverside University Health System MISP |
$99.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$149.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$149.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$93.45
|
| Rate for Payer: United Healthcare All Other HMO |
$90.96
|
| Rate for Payer: United Healthcare HMO Rider |
$88.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$81.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$211.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$211.65
|
| Rate for Payer: Vantage Medical Group Senior |
$211.65
|
|
|
HC WHFO WRIST EXT COCKUP PF
|
Facility
|
IP
|
$249.00
|
|
|
Service Code
|
CPT L3908
|
| Hospital Charge Code |
905109314
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$49.80 |
| Max. Negotiated Rate |
$224.10 |
| Rate for Payer: Adventist Health Commercial |
$49.80
|
| Rate for Payer: Blue Shield of California Commercial |
$192.48
|
| Rate for Payer: Blue Shield of California EPN |
$125.50
|
| Rate for Payer: Cash Price |
$136.95
|
| Rate for Payer: Central Health Plan Commercial |
$199.20
|
| Rate for Payer: Cigna of CA HMO |
$174.30
|
| Rate for Payer: Cigna of CA PPO |
$174.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.60
|
| Rate for Payer: EPIC Health Plan Senior |
$99.60
|
| Rate for Payer: Galaxy Health WC |
$211.65
|
| Rate for Payer: Global Benefits Group Commercial |
$149.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$224.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$166.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$94.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$154.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.80
|
| Rate for Payer: Multiplan Commercial |
$186.75
|
| Rate for Payer: Networks By Design Commercial |
$161.85
|
| Rate for Payer: Prime Health Services Commercial |
$211.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$93.45
|
| Rate for Payer: United Healthcare All Other HMO |
$90.96
|
| Rate for Payer: United Healthcare HMO Rider |
$88.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$81.55
|
|
|
HC WHFO WRIST EXT S/OUTRIGGER
|
Facility
|
IP
|
$196.00
|
|
|
Service Code
|
CPT L3931
|
| Hospital Charge Code |
905353916
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$176.40 |
| Rate for Payer: Adventist Health Commercial |
$39.20
|
| Rate for Payer: Blue Shield of California Commercial |
$151.51
|
| Rate for Payer: Blue Shield of California EPN |
$98.78
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Central Health Plan Commercial |
$156.80
|
| Rate for Payer: Cigna of CA HMO |
$137.20
|
| Rate for Payer: Cigna of CA PPO |
$137.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.40
|
| Rate for Payer: EPIC Health Plan Senior |
$78.40
|
| Rate for Payer: Galaxy Health WC |
$166.60
|
| Rate for Payer: Global Benefits Group Commercial |
$117.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$176.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$130.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$74.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$121.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.20
|
| Rate for Payer: Multiplan Commercial |
$147.00
|
| Rate for Payer: Networks By Design Commercial |
$127.40
|
| Rate for Payer: Prime Health Services Commercial |
$166.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$73.56
|
| Rate for Payer: United Healthcare All Other HMO |
$71.60
|
| Rate for Payer: United Healthcare HMO Rider |
$70.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$64.19
|
|
|
HC WHFO WRIST EXT S/OUTRIGGER
|
Facility
|
OP
|
$196.00
|
|
|
Service Code
|
CPT L3931
|
| Hospital Charge Code |
905353916
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$64.19 |
| Max. Negotiated Rate |
$279.19 |
| Rate for Payer: Adventist Health Commercial |
$80.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$166.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$107.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$147.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$115.11
|
| Rate for Payer: Blue Shield of California Commercial |
$151.51
|
| Rate for Payer: Blue Shield of California EPN |
$98.78
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Central Health Plan Commercial |
$156.80
|
| Rate for Payer: Cigna of CA HMO |
$137.20
|
| Rate for Payer: Cigna of CA PPO |
$137.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$166.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$166.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$166.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.40
|
| Rate for Payer: EPIC Health Plan Senior |
$78.40
|
| Rate for Payer: Galaxy Health WC |
$166.60
|
| Rate for Payer: Global Benefits Group Commercial |
$117.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$176.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$252.74
|
| Rate for Payer: InnovAge PACE Commercial |
$98.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$130.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$279.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$121.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$137.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$137.20
|
| Rate for Payer: Multiplan Commercial |
$147.00
|
| Rate for Payer: Networks By Design Commercial |
$98.00
|
| Rate for Payer: Prime Health Services Commercial |
$166.60
|
| Rate for Payer: Riverside University Health System MISP |
$78.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$117.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$117.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$73.56
|
| Rate for Payer: United Healthcare All Other HMO |
$71.60
|
| Rate for Payer: United Healthcare HMO Rider |
$70.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$64.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$166.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$166.60
|
| Rate for Payer: Vantage Medical Group Senior |
$166.60
|
|
|
HC WHFO WRIST GAUNLET THUMB SPICA
|
Facility
|
IP
|
$891.00
|
|
|
Service Code
|
CPT L3808
|
| Hospital Charge Code |
915353907
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$178.20 |
| Max. Negotiated Rate |
$801.90 |
| Rate for Payer: Adventist Health Commercial |
$178.20
|
| Rate for Payer: Blue Shield of California Commercial |
$688.74
|
| Rate for Payer: Blue Shield of California EPN |
$449.06
|
| Rate for Payer: Cash Price |
$490.05
|
| Rate for Payer: Central Health Plan Commercial |
$712.80
|
| Rate for Payer: Cigna of CA HMO |
$623.70
|
| Rate for Payer: Cigna of CA PPO |
$623.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$356.40
|
| Rate for Payer: EPIC Health Plan Senior |
$356.40
|
| Rate for Payer: Galaxy Health WC |
$757.35
|
| Rate for Payer: Global Benefits Group Commercial |
$534.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$801.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$594.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$339.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$551.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$178.20
|
| Rate for Payer: Multiplan Commercial |
$668.25
|
| Rate for Payer: Networks By Design Commercial |
$579.15
|
| Rate for Payer: Prime Health Services Commercial |
$757.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$334.39
|
| Rate for Payer: United Healthcare All Other HMO |
$325.48
|
| Rate for Payer: United Healthcare HMO Rider |
$318.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$291.80
|
|
|
HC WHFO WRIST GAUNLET THUMB SPICA
|
Facility
|
OP
|
$891.00
|
|
|
Service Code
|
CPT L3808
|
| Hospital Charge Code |
915353907
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$289.67 |
| Max. Negotiated Rate |
$801.90 |
| Rate for Payer: Adventist Health Commercial |
$365.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$757.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$490.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$668.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$523.28
|
| Rate for Payer: Blue Shield of California Commercial |
$688.74
|
| Rate for Payer: Blue Shield of California EPN |
$449.06
|
| Rate for Payer: Cash Price |
$490.05
|
| Rate for Payer: Cash Price |
$490.05
|
| Rate for Payer: Central Health Plan Commercial |
$712.80
|
| Rate for Payer: Cigna of CA HMO |
$623.70
|
| Rate for Payer: Cigna of CA PPO |
$623.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$757.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$757.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$757.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$356.40
|
| Rate for Payer: EPIC Health Plan Senior |
$356.40
|
| Rate for Payer: Galaxy Health WC |
$757.35
|
| Rate for Payer: Global Benefits Group Commercial |
$534.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$801.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$289.67
|
| Rate for Payer: InnovAge PACE Commercial |
$445.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$594.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$319.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$551.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$365.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$623.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$623.70
|
| Rate for Payer: Multiplan Commercial |
$668.25
|
| Rate for Payer: Networks By Design Commercial |
$445.50
|
| Rate for Payer: Prime Health Services Commercial |
$757.35
|
| Rate for Payer: Riverside University Health System MISP |
$356.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$534.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$534.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$334.39
|
| Rate for Payer: United Healthcare All Other HMO |
$325.48
|
| Rate for Payer: United Healthcare HMO Rider |
$318.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$291.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$757.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$757.35
|
| Rate for Payer: Vantage Medical Group Senior |
$757.35
|
|
|
HC WHFO WRIST GAUNLET THUMB SPICA
|
Facility
|
IP
|
$891.00
|
|
|
Service Code
|
CPT L3808
|
| Hospital Charge Code |
905353907
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$178.20 |
| Max. Negotiated Rate |
$801.90 |
| Rate for Payer: Adventist Health Commercial |
$178.20
|
| Rate for Payer: Blue Shield of California Commercial |
$688.74
|
| Rate for Payer: Blue Shield of California EPN |
$449.06
|
| Rate for Payer: Cash Price |
$490.05
|
| Rate for Payer: Central Health Plan Commercial |
$712.80
|
| Rate for Payer: Cigna of CA HMO |
$623.70
|
| Rate for Payer: Cigna of CA PPO |
$623.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$356.40
|
| Rate for Payer: EPIC Health Plan Senior |
$356.40
|
| Rate for Payer: Galaxy Health WC |
$757.35
|
| Rate for Payer: Global Benefits Group Commercial |
$534.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$801.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$594.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$339.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$551.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$178.20
|
| Rate for Payer: Multiplan Commercial |
$668.25
|
| Rate for Payer: Networks By Design Commercial |
$579.15
|
| Rate for Payer: Prime Health Services Commercial |
$757.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$334.39
|
| Rate for Payer: United Healthcare All Other HMO |
$325.48
|
| Rate for Payer: United Healthcare HMO Rider |
$318.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$291.80
|
|
|
HC WHFO WRIST GAUNLET THUMB SPICA
|
Facility
|
OP
|
$891.00
|
|
|
Service Code
|
CPT L3808
|
| Hospital Charge Code |
905353907
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$289.67 |
| Max. Negotiated Rate |
$801.90 |
| Rate for Payer: Adventist Health Commercial |
$365.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$757.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$490.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$668.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$523.28
|
| Rate for Payer: Blue Shield of California Commercial |
$688.74
|
| Rate for Payer: Blue Shield of California EPN |
$449.06
|
| Rate for Payer: Cash Price |
$490.05
|
| Rate for Payer: Cash Price |
$490.05
|
| Rate for Payer: Central Health Plan Commercial |
$712.80
|
| Rate for Payer: Cigna of CA HMO |
$623.70
|
| Rate for Payer: Cigna of CA PPO |
$623.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$757.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$757.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$757.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$356.40
|
| Rate for Payer: EPIC Health Plan Senior |
$356.40
|
| Rate for Payer: Galaxy Health WC |
$757.35
|
| Rate for Payer: Global Benefits Group Commercial |
$534.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$801.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$289.67
|
| Rate for Payer: InnovAge PACE Commercial |
$445.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$594.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$319.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$551.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$365.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$623.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$623.70
|
| Rate for Payer: Multiplan Commercial |
$668.25
|
| Rate for Payer: Networks By Design Commercial |
$445.50
|
| Rate for Payer: Prime Health Services Commercial |
$757.35
|
| Rate for Payer: Riverside University Health System MISP |
$356.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$534.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$534.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$334.39
|
| Rate for Payer: United Healthcare All Other HMO |
$325.48
|
| Rate for Payer: United Healthcare HMO Rider |
$318.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$291.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$757.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$757.35
|
| Rate for Payer: Vantage Medical Group Senior |
$757.35
|
|
|
HC WHFO WRIST GAUNTLET MOLDED
|
Facility
|
OP
|
$760.00
|
|
|
Service Code
|
CPT L3906
|
| Hospital Charge Code |
901309100
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$248.90 |
| Max. Negotiated Rate |
$684.00 |
| Rate for Payer: Adventist Health Commercial |
$311.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$646.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$418.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$570.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$446.35
|
| Rate for Payer: Blue Shield of California Commercial |
$587.48
|
| Rate for Payer: Blue Shield of California EPN |
$383.04
|
| Rate for Payer: Cash Price |
$418.00
|
| Rate for Payer: Cash Price |
$418.00
|
| Rate for Payer: Central Health Plan Commercial |
$608.00
|
| Rate for Payer: Cigna of CA HMO |
$532.00
|
| Rate for Payer: Cigna of CA PPO |
$532.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$646.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$646.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$646.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$304.00
|
| Rate for Payer: EPIC Health Plan Senior |
$304.00
|
| Rate for Payer: Galaxy Health WC |
$646.00
|
| Rate for Payer: Global Benefits Group Commercial |
$456.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$684.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$533.99
|
| Rate for Payer: InnovAge PACE Commercial |
$380.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$506.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$589.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$470.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$311.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$532.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$532.00
|
| Rate for Payer: Multiplan Commercial |
$570.00
|
| Rate for Payer: Networks By Design Commercial |
$380.00
|
| Rate for Payer: Prime Health Services Commercial |
$646.00
|
| Rate for Payer: Riverside University Health System MISP |
$304.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$456.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$456.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$285.23
|
| Rate for Payer: United Healthcare All Other HMO |
$277.63
|
| Rate for Payer: United Healthcare HMO Rider |
$271.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$248.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$646.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$646.00
|
| Rate for Payer: Vantage Medical Group Senior |
$646.00
|
|
|
HC WHFO WRIST GAUNTLET MOLDED
|
Facility
|
IP
|
$760.00
|
|
|
Service Code
|
CPT L3906
|
| Hospital Charge Code |
901309100
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$152.00 |
| Max. Negotiated Rate |
$684.00 |
| Rate for Payer: Adventist Health Commercial |
$152.00
|
| Rate for Payer: Blue Shield of California Commercial |
$587.48
|
| Rate for Payer: Blue Shield of California EPN |
$383.04
|
| Rate for Payer: Cash Price |
$418.00
|
| Rate for Payer: Central Health Plan Commercial |
$608.00
|
| Rate for Payer: Cigna of CA HMO |
$532.00
|
| Rate for Payer: Cigna of CA PPO |
$532.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$304.00
|
| Rate for Payer: EPIC Health Plan Senior |
$304.00
|
| Rate for Payer: Galaxy Health WC |
$646.00
|
| Rate for Payer: Global Benefits Group Commercial |
$456.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$684.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$506.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$289.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$470.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$152.00
|
| Rate for Payer: Multiplan Commercial |
$570.00
|
| Rate for Payer: Networks By Design Commercial |
$494.00
|
| Rate for Payer: Prime Health Services Commercial |
$646.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$285.23
|
| Rate for Payer: United Healthcare All Other HMO |
$277.63
|
| Rate for Payer: United Healthcare HMO Rider |
$271.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$248.90
|
|
|
HC WHFO WRIST GAUNT W/THUMB SPIC
|
Facility
|
OP
|
$936.00
|
|
|
Service Code
|
CPT L3808
|
| Hospital Charge Code |
901309101
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$206.00 |
| Max. Negotiated Rate |
$842.40 |
| Rate for Payer: Adventist Health Commercial |
$383.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$568.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$795.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$514.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$702.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$514.80
|
| Rate for Payer: Cash Price |
$514.80
|
| Rate for Payer: Cash Price |
$514.80
|
| Rate for Payer: Cash Price |
$514.80
|
| Rate for Payer: Central Health Plan Commercial |
$748.80
|
| Rate for Payer: Cigna of CA HMO |
$599.04
|
| Rate for Payer: Cigna of CA PPO |
$692.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$795.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$795.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$795.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$374.40
|
| Rate for Payer: EPIC Health Plan Senior |
$374.40
|
| Rate for Payer: Galaxy Health WC |
$795.60
|
| Rate for Payer: Global Benefits Group Commercial |
$561.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$842.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$289.67
|
| Rate for Payer: InnovAge PACE Commercial |
$468.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$624.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$319.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$579.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$383.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$655.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$655.20
|
| Rate for Payer: Multiplan Commercial |
$702.00
|
| Rate for Payer: Networks By Design Commercial |
$608.40
|
| Rate for Payer: Prime Health Services Commercial |
$795.60
|
| Rate for Payer: Riverside University Health System MISP |
$374.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$561.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$561.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$795.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$795.60
|
| Rate for Payer: Vantage Medical Group Senior |
$795.60
|
|
|
HC WHFO WRIST GAUNT W/THUMB SPIC
|
Facility
|
IP
|
$936.00
|
|
|
Service Code
|
CPT L3808
|
| Hospital Charge Code |
901309101
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$187.20 |
| Max. Negotiated Rate |
$842.40 |
| Rate for Payer: Adventist Health Commercial |
$187.20
|
| Rate for Payer: Cash Price |
$514.80
|
| Rate for Payer: Central Health Plan Commercial |
$748.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$374.40
|
| Rate for Payer: EPIC Health Plan Senior |
$374.40
|
| Rate for Payer: Galaxy Health WC |
$795.60
|
| Rate for Payer: Global Benefits Group Commercial |
$561.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$842.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$624.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$356.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$579.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$187.20
|
| Rate for Payer: Multiplan Commercial |
$702.00
|
| Rate for Payer: Networks By Design Commercial |
$608.40
|
| Rate for Payer: Prime Health Services Commercial |
$795.60
|
|
|
HC WHIRLPOOL MCAL
|
Facility
|
OP
|
$217.00
|
|
|
Service Code
|
CPT 97022
|
| Hospital Charge Code |
901300045
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$19.16 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$88.97
|
| Rate for Payer: Aetna of CA HMO/PPO |
$131.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$184.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$119.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$162.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$119.35
|
| Rate for Payer: Cash Price |
$119.35
|
| Rate for Payer: Cash Price |
$119.35
|
| Rate for Payer: Cash Price |
$119.35
|
| Rate for Payer: Central Health Plan Commercial |
$173.60
|
| Rate for Payer: Cigna of CA HMO |
$138.88
|
| Rate for Payer: Cigna of CA PPO |
$160.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$184.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$184.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$184.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.80
|
| Rate for Payer: EPIC Health Plan Senior |
$86.80
|
| Rate for Payer: Galaxy Health WC |
$184.45
|
| Rate for Payer: Global Benefits Group Commercial |
$130.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$195.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.16
|
| Rate for Payer: InnovAge PACE Commercial |
$108.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$144.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$134.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$151.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$151.90
|
| Rate for Payer: Multiplan Commercial |
$162.75
|
| Rate for Payer: Networks By Design Commercial |
$141.05
|
| Rate for Payer: Prime Health Services Commercial |
$184.45
|
| Rate for Payer: Riverside University Health System MISP |
$86.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$130.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$130.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$184.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$184.45
|
| Rate for Payer: Vantage Medical Group Senior |
$184.45
|
|
|
HC WHIRLPOOL MCAL
|
Facility
|
IP
|
$217.00
|
|
|
Service Code
|
CPT 97022
|
| Hospital Charge Code |
901300045
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$43.40 |
| Max. Negotiated Rate |
$195.30 |
| Rate for Payer: Adventist Health Commercial |
$43.40
|
| Rate for Payer: Cash Price |
$119.35
|
| Rate for Payer: Central Health Plan Commercial |
$173.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.80
|
| Rate for Payer: EPIC Health Plan Senior |
$86.80
|
| Rate for Payer: Galaxy Health WC |
$184.45
|
| Rate for Payer: Global Benefits Group Commercial |
$130.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$195.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$144.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$82.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$134.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.40
|
| Rate for Payer: Multiplan Commercial |
$162.75
|
| Rate for Payer: Networks By Design Commercial |
$141.05
|
| Rate for Payer: Prime Health Services Commercial |
$184.45
|
|
|
HC WHIRLPOOL MCARE COM
|
Facility
|
IP
|
$217.00
|
|
|
Service Code
|
CPT 97022
|
| Hospital Charge Code |
900407040
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$43.40 |
| Max. Negotiated Rate |
$195.30 |
| Rate for Payer: Adventist Health Commercial |
$43.40
|
| Rate for Payer: Cash Price |
$119.35
|
| Rate for Payer: Central Health Plan Commercial |
$173.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.80
|
| Rate for Payer: EPIC Health Plan Senior |
$86.80
|
| Rate for Payer: Galaxy Health WC |
$184.45
|
| Rate for Payer: Global Benefits Group Commercial |
$130.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$195.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$144.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$82.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$134.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.40
|
| Rate for Payer: Multiplan Commercial |
$162.75
|
| Rate for Payer: Networks By Design Commercial |
$141.05
|
| Rate for Payer: Prime Health Services Commercial |
$184.45
|
|
|
HC WHIRLPOOL MCARE COM
|
Facility
|
OP
|
$217.00
|
|
|
Service Code
|
CPT 97022
|
| Hospital Charge Code |
900407040
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$19.16 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$88.97
|
| Rate for Payer: Aetna of CA HMO/PPO |
$131.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$184.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$119.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$162.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$119.35
|
| Rate for Payer: Cash Price |
$119.35
|
| Rate for Payer: Cash Price |
$119.35
|
| Rate for Payer: Cash Price |
$119.35
|
| Rate for Payer: Central Health Plan Commercial |
$173.60
|
| Rate for Payer: Cigna of CA HMO |
$138.88
|
| Rate for Payer: Cigna of CA PPO |
$160.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$184.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$184.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$184.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.80
|
| Rate for Payer: EPIC Health Plan Senior |
$86.80
|
| Rate for Payer: Galaxy Health WC |
$184.45
|
| Rate for Payer: Global Benefits Group Commercial |
$130.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$195.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.16
|
| Rate for Payer: InnovAge PACE Commercial |
$108.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$144.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$134.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$151.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$151.90
|
| Rate for Payer: Multiplan Commercial |
$162.75
|
| Rate for Payer: Networks By Design Commercial |
$141.05
|
| Rate for Payer: Prime Health Services Commercial |
$184.45
|
| Rate for Payer: Riverside University Health System MISP |
$86.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$130.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$130.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$184.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$184.45
|
| Rate for Payer: Vantage Medical Group Senior |
$184.45
|
|
|
HC WHIRLPOOL OT
|
Facility
|
IP
|
$217.00
|
|
|
Service Code
|
CPT 97022
|
| Hospital Charge Code |
903207022
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$43.40 |
| Max. Negotiated Rate |
$195.30 |
| Rate for Payer: Adventist Health Commercial |
$43.40
|
| Rate for Payer: Cash Price |
$119.35
|
| Rate for Payer: Central Health Plan Commercial |
$173.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.80
|
| Rate for Payer: EPIC Health Plan Senior |
$86.80
|
| Rate for Payer: Galaxy Health WC |
$184.45
|
| Rate for Payer: Global Benefits Group Commercial |
$130.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$195.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$144.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$82.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$134.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.40
|
| Rate for Payer: Multiplan Commercial |
$162.75
|
| Rate for Payer: Networks By Design Commercial |
$141.05
|
| Rate for Payer: Prime Health Services Commercial |
$184.45
|
|
|
HC WHIRLPOOL OT
|
Facility
|
OP
|
$217.00
|
|
|
Service Code
|
CPT 97022
|
| Hospital Charge Code |
903207022
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$19.16 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$88.97
|
| Rate for Payer: Aetna of CA HMO/PPO |
$131.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$184.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$119.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$162.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$119.35
|
| Rate for Payer: Cash Price |
$119.35
|
| Rate for Payer: Cash Price |
$119.35
|
| Rate for Payer: Cash Price |
$119.35
|
| Rate for Payer: Central Health Plan Commercial |
$173.60
|
| Rate for Payer: Cigna of CA HMO |
$138.88
|
| Rate for Payer: Cigna of CA PPO |
$160.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$184.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$184.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$184.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.80
|
| Rate for Payer: EPIC Health Plan Senior |
$86.80
|
| Rate for Payer: Galaxy Health WC |
$184.45
|
| Rate for Payer: Global Benefits Group Commercial |
$130.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$195.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.16
|
| Rate for Payer: InnovAge PACE Commercial |
$108.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$144.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$134.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$151.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$151.90
|
| Rate for Payer: Multiplan Commercial |
$162.75
|
| Rate for Payer: Networks By Design Commercial |
$141.05
|
| Rate for Payer: Prime Health Services Commercial |
$184.45
|
| Rate for Payer: Riverside University Health System MISP |
$86.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$130.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$130.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$184.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$184.45
|
| Rate for Payer: Vantage Medical Group Senior |
$184.45
|
|
|
HC WHIRLPOOL PT
|
Facility
|
IP
|
$217.00
|
|
|
Service Code
|
CPT 97022
|
| Hospital Charge Code |
905103118
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$43.40 |
| Max. Negotiated Rate |
$195.30 |
| Rate for Payer: Adventist Health Commercial |
$43.40
|
| Rate for Payer: Cash Price |
$119.35
|
| Rate for Payer: Central Health Plan Commercial |
$173.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.80
|
| Rate for Payer: EPIC Health Plan Senior |
$86.80
|
| Rate for Payer: Galaxy Health WC |
$184.45
|
| Rate for Payer: Global Benefits Group Commercial |
$130.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$195.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$144.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$82.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$134.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.40
|
| Rate for Payer: Multiplan Commercial |
$162.75
|
| Rate for Payer: Networks By Design Commercial |
$141.05
|
| Rate for Payer: Prime Health Services Commercial |
$184.45
|
|
|
HC WHIRLPOOL PT
|
Facility
|
OP
|
$217.00
|
|
|
Service Code
|
CPT 97022
|
| Hospital Charge Code |
900419063
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$19.16 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$88.97
|
| Rate for Payer: Aetna of CA HMO/PPO |
$131.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$184.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$119.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$162.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$119.35
|
| Rate for Payer: Cash Price |
$119.35
|
| Rate for Payer: Cash Price |
$119.35
|
| Rate for Payer: Cash Price |
$119.35
|
| Rate for Payer: Central Health Plan Commercial |
$173.60
|
| Rate for Payer: Cigna of CA HMO |
$138.88
|
| Rate for Payer: Cigna of CA PPO |
$160.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$184.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$184.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$184.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.80
|
| Rate for Payer: EPIC Health Plan Senior |
$86.80
|
| Rate for Payer: Galaxy Health WC |
$184.45
|
| Rate for Payer: Global Benefits Group Commercial |
$130.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$195.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.16
|
| Rate for Payer: InnovAge PACE Commercial |
$108.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$144.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$134.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$151.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$151.90
|
| Rate for Payer: Multiplan Commercial |
$162.75
|
| Rate for Payer: Networks By Design Commercial |
$141.05
|
| Rate for Payer: Prime Health Services Commercial |
$184.45
|
| Rate for Payer: Riverside University Health System MISP |
$86.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$130.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$130.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$184.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$184.45
|
| Rate for Payer: Vantage Medical Group Senior |
$184.45
|
|
|
HC WHIRLPOOL PT
|
Facility
|
IP
|
$217.00
|
|
|
Service Code
|
CPT 97022
|
| Hospital Charge Code |
900419063
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$43.40 |
| Max. Negotiated Rate |
$195.30 |
| Rate for Payer: Adventist Health Commercial |
$43.40
|
| Rate for Payer: Cash Price |
$119.35
|
| Rate for Payer: Central Health Plan Commercial |
$173.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.80
|
| Rate for Payer: EPIC Health Plan Senior |
$86.80
|
| Rate for Payer: Galaxy Health WC |
$184.45
|
| Rate for Payer: Global Benefits Group Commercial |
$130.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$195.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$144.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$82.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$134.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.40
|
| Rate for Payer: Multiplan Commercial |
$162.75
|
| Rate for Payer: Networks By Design Commercial |
$141.05
|
| Rate for Payer: Prime Health Services Commercial |
$184.45
|
|
|
HC WHIRLPOOL PT
|
Facility
|
OP
|
$217.00
|
|
|
Service Code
|
CPT 97022
|
| Hospital Charge Code |
905103118
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$19.16 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$88.97
|
| Rate for Payer: Aetna of CA HMO/PPO |
$131.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$184.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$119.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$162.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$119.35
|
| Rate for Payer: Cash Price |
$119.35
|
| Rate for Payer: Cash Price |
$119.35
|
| Rate for Payer: Cash Price |
$119.35
|
| Rate for Payer: Central Health Plan Commercial |
$173.60
|
| Rate for Payer: Cigna of CA HMO |
$138.88
|
| Rate for Payer: Cigna of CA PPO |
$160.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$184.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$184.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$184.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.80
|
| Rate for Payer: EPIC Health Plan Senior |
$86.80
|
| Rate for Payer: Galaxy Health WC |
$184.45
|
| Rate for Payer: Global Benefits Group Commercial |
$130.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$195.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.16
|
| Rate for Payer: InnovAge PACE Commercial |
$108.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$144.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$134.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$151.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$151.90
|
| Rate for Payer: Multiplan Commercial |
$162.75
|
| Rate for Payer: Networks By Design Commercial |
$141.05
|
| Rate for Payer: Prime Health Services Commercial |
$184.45
|
| Rate for Payer: Riverside University Health System MISP |
$86.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$130.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$130.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$184.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$184.45
|
| Rate for Payer: Vantage Medical Group Senior |
$184.45
|
|
|
HC WHITAKER TEST
|
Facility
|
IP
|
$1,694.00
|
|
|
Service Code
|
CPT 50396
|
| Hospital Charge Code |
909000169
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$338.80 |
| Max. Negotiated Rate |
$1,524.60 |
| Rate for Payer: Adventist Health Commercial |
$338.80
|
| Rate for Payer: Cash Price |
$931.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,355.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$677.60
|
| Rate for Payer: EPIC Health Plan Senior |
$677.60
|
| Rate for Payer: Galaxy Health WC |
$1,439.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,016.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,524.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,129.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$645.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,048.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$338.80
|
| Rate for Payer: Multiplan Commercial |
$1,270.50
|
| Rate for Payer: Networks By Design Commercial |
$1,101.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,439.90
|
|
|
HC WHITAKER TEST
|
Facility
|
OP
|
$1,694.00
|
|
|
Service Code
|
CPT 50396
|
| Hospital Charge Code |
909000169
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$78.76 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$338.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$848.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,272.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$932.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$848.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,351.26
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$931.70
|
| Rate for Payer: Cash Price |
$931.70
|
| Rate for Payer: Cash Price |
$931.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,355.20
|
| Rate for Payer: Cigna of CA HMO |
$1,084.16
|
| Rate for Payer: Cigna of CA PPO |
$1,253.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,272.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$932.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$848.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,144.92
|
| Rate for Payer: EPIC Health Plan Senior |
$848.09
|
| Rate for Payer: Galaxy Health WC |
$1,439.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,016.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,524.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,390.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$78.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$848.09
|
| Rate for Payer: InnovAge PACE Commercial |
$1,272.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,129.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$848.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$338.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,136.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,136.44
|
| Rate for Payer: Multiplan Commercial |
$1,270.50
|
| Rate for Payer: Multiplan WC |
$1,351.26
|
| Rate for Payer: Networks By Design Commercial |
$1,101.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$848.09
|
| Rate for Payer: Preferred Health Network WC |
$1,378.84
|
| Rate for Payer: Prime Health Services Commercial |
$1,439.90
|
| Rate for Payer: Prime Health Services Medicare |
$898.98
|
| Rate for Payer: Prime Health Services WC |
$1,337.47
|
| Rate for Payer: Riverside University Health System MISP |
$932.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,016.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$848.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,272.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$932.90
|
| Rate for Payer: Vantage Medical Group Senior |
$848.09
|
|
