|
HC FX OX HUMERAL
|
Facility
|
IP
|
$1,100.00
|
|
|
Service Code
|
CPT L3980
|
| Hospital Charge Code |
915353980
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$220.00 |
| Max. Negotiated Rate |
$990.00 |
| Rate for Payer: Adventist Health Commercial |
$220.00
|
| Rate for Payer: Blue Shield of California Commercial |
$850.30
|
| Rate for Payer: Blue Shield of California EPN |
$554.40
|
| Rate for Payer: Cash Price |
$605.00
|
| Rate for Payer: Central Health Plan Commercial |
$880.00
|
| Rate for Payer: Cigna of CA HMO |
$770.00
|
| Rate for Payer: Cigna of CA PPO |
$770.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$440.00
|
| Rate for Payer: EPIC Health Plan Senior |
$440.00
|
| Rate for Payer: Galaxy Health WC |
$935.00
|
| Rate for Payer: Global Benefits Group Commercial |
$660.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$990.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$733.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$419.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$680.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$220.00
|
| Rate for Payer: Multiplan Commercial |
$825.00
|
| Rate for Payer: Networks By Design Commercial |
$715.00
|
| Rate for Payer: Prime Health Services Commercial |
$935.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$412.83
|
| Rate for Payer: United Healthcare All Other HMO |
$401.83
|
| Rate for Payer: United Healthcare HMO Rider |
$393.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$360.25
|
|
|
HC FX OX HUMERAL
|
Facility
|
OP
|
$1,100.00
|
|
|
Service Code
|
CPT L3980
|
| Hospital Charge Code |
915353980
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$360.25 |
| Max. Negotiated Rate |
$990.00 |
| Rate for Payer: Adventist Health Commercial |
$451.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$935.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$605.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$825.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$646.03
|
| Rate for Payer: Blue Shield of California Commercial |
$850.30
|
| Rate for Payer: Blue Shield of California EPN |
$554.40
|
| Rate for Payer: Cash Price |
$605.00
|
| Rate for Payer: Cash Price |
$605.00
|
| Rate for Payer: Central Health Plan Commercial |
$880.00
|
| Rate for Payer: Cigna of CA HMO |
$770.00
|
| Rate for Payer: Cigna of CA PPO |
$770.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$935.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$935.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$935.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$440.00
|
| Rate for Payer: EPIC Health Plan Senior |
$440.00
|
| Rate for Payer: Galaxy Health WC |
$935.00
|
| Rate for Payer: Global Benefits Group Commercial |
$660.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$990.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$417.79
|
| Rate for Payer: InnovAge PACE Commercial |
$550.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$733.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$461.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$680.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$451.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$770.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$770.00
|
| Rate for Payer: Multiplan Commercial |
$825.00
|
| Rate for Payer: Networks By Design Commercial |
$550.00
|
| Rate for Payer: Prime Health Services Commercial |
$935.00
|
| Rate for Payer: Riverside University Health System MISP |
$440.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$660.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$660.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$412.83
|
| Rate for Payer: United Healthcare All Other HMO |
$401.83
|
| Rate for Payer: United Healthcare HMO Rider |
$393.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$360.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$935.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$935.00
|
| Rate for Payer: Vantage Medical Group Senior |
$935.00
|
|
|
HC FX OX HUMERAL
|
Facility
|
IP
|
$1,100.00
|
|
|
Service Code
|
CPT L3980
|
| Hospital Charge Code |
905353980
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$220.00 |
| Max. Negotiated Rate |
$990.00 |
| Rate for Payer: Adventist Health Commercial |
$220.00
|
| Rate for Payer: Blue Shield of California Commercial |
$850.30
|
| Rate for Payer: Blue Shield of California EPN |
$554.40
|
| Rate for Payer: Cash Price |
$605.00
|
| Rate for Payer: Central Health Plan Commercial |
$880.00
|
| Rate for Payer: Cigna of CA HMO |
$770.00
|
| Rate for Payer: Cigna of CA PPO |
$770.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$440.00
|
| Rate for Payer: EPIC Health Plan Senior |
$440.00
|
| Rate for Payer: Galaxy Health WC |
$935.00
|
| Rate for Payer: Global Benefits Group Commercial |
$660.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$990.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$733.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$419.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$680.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$220.00
|
| Rate for Payer: Multiplan Commercial |
$825.00
|
| Rate for Payer: Networks By Design Commercial |
$715.00
|
| Rate for Payer: Prime Health Services Commercial |
$935.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$412.83
|
| Rate for Payer: United Healthcare All Other HMO |
$401.83
|
| Rate for Payer: United Healthcare HMO Rider |
$393.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$360.25
|
|
|
HC FX OX LIMIT MOTION KNEE JT
|
Facility
|
IP
|
$560.00
|
|
|
Service Code
|
CPT L2184
|
| Hospital Charge Code |
915352184
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$112.00 |
| Max. Negotiated Rate |
$504.00 |
| Rate for Payer: Adventist Health Commercial |
$112.00
|
| Rate for Payer: Blue Shield of California Commercial |
$432.88
|
| Rate for Payer: Blue Shield of California EPN |
$282.24
|
| Rate for Payer: Cash Price |
$308.00
|
| Rate for Payer: Central Health Plan Commercial |
$448.00
|
| Rate for Payer: Cigna of CA HMO |
$392.00
|
| Rate for Payer: Cigna of CA PPO |
$392.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$224.00
|
| Rate for Payer: EPIC Health Plan Senior |
$224.00
|
| Rate for Payer: Galaxy Health WC |
$476.00
|
| Rate for Payer: Global Benefits Group Commercial |
$336.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$504.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$373.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$213.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$346.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.00
|
| Rate for Payer: Multiplan Commercial |
$420.00
|
| Rate for Payer: Networks By Design Commercial |
$364.00
|
| Rate for Payer: Prime Health Services Commercial |
$476.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$210.17
|
| Rate for Payer: United Healthcare All Other HMO |
$204.57
|
| Rate for Payer: United Healthcare HMO Rider |
$200.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$183.40
|
|
|
HC FX OX LIMIT MOTION KNEE JT
|
Facility
|
IP
|
$560.00
|
|
|
Service Code
|
CPT L2184
|
| Hospital Charge Code |
905352184
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$112.00 |
| Max. Negotiated Rate |
$504.00 |
| Rate for Payer: Adventist Health Commercial |
$112.00
|
| Rate for Payer: Blue Shield of California Commercial |
$432.88
|
| Rate for Payer: Blue Shield of California EPN |
$282.24
|
| Rate for Payer: Cash Price |
$308.00
|
| Rate for Payer: Central Health Plan Commercial |
$448.00
|
| Rate for Payer: Cigna of CA HMO |
$392.00
|
| Rate for Payer: Cigna of CA PPO |
$392.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$224.00
|
| Rate for Payer: EPIC Health Plan Senior |
$224.00
|
| Rate for Payer: Galaxy Health WC |
$476.00
|
| Rate for Payer: Global Benefits Group Commercial |
$336.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$504.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$373.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$213.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$346.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.00
|
| Rate for Payer: Multiplan Commercial |
$420.00
|
| Rate for Payer: Networks By Design Commercial |
$364.00
|
| Rate for Payer: Prime Health Services Commercial |
$476.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$210.17
|
| Rate for Payer: United Healthcare All Other HMO |
$204.57
|
| Rate for Payer: United Healthcare HMO Rider |
$200.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$183.40
|
|
|
HC FX OX LIMIT MOTION KNEE JT
|
Facility
|
OP
|
$560.00
|
|
|
Service Code
|
CPT L2184
|
| Hospital Charge Code |
915352184
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$68.94 |
| Max. Negotiated Rate |
$504.00 |
| Rate for Payer: Adventist Health Commercial |
$229.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$476.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$308.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$420.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$328.89
|
| Rate for Payer: Blue Shield of California Commercial |
$432.88
|
| Rate for Payer: Blue Shield of California EPN |
$282.24
|
| Rate for Payer: Cash Price |
$308.00
|
| Rate for Payer: Cash Price |
$308.00
|
| Rate for Payer: Central Health Plan Commercial |
$448.00
|
| Rate for Payer: Cigna of CA HMO |
$392.00
|
| Rate for Payer: Cigna of CA PPO |
$392.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$476.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$476.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$476.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$224.00
|
| Rate for Payer: EPIC Health Plan Senior |
$224.00
|
| Rate for Payer: Galaxy Health WC |
$476.00
|
| Rate for Payer: Global Benefits Group Commercial |
$336.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$504.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$68.94
|
| Rate for Payer: InnovAge PACE Commercial |
$280.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$373.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$76.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$346.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$229.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$392.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$392.00
|
| Rate for Payer: Multiplan Commercial |
$420.00
|
| Rate for Payer: Networks By Design Commercial |
$280.00
|
| Rate for Payer: Prime Health Services Commercial |
$476.00
|
| Rate for Payer: Riverside University Health System MISP |
$224.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$336.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$336.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$210.17
|
| Rate for Payer: United Healthcare All Other HMO |
$204.57
|
| Rate for Payer: United Healthcare HMO Rider |
$200.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$183.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$476.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$476.00
|
| Rate for Payer: Vantage Medical Group Senior |
$476.00
|
|
|
HC FX OX LIMIT MOTION KNEE JT
|
Facility
|
OP
|
$560.00
|
|
|
Service Code
|
CPT L2184
|
| Hospital Charge Code |
905352184
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$68.94 |
| Max. Negotiated Rate |
$504.00 |
| Rate for Payer: Adventist Health Commercial |
$229.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$476.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$308.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$420.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$328.89
|
| Rate for Payer: Blue Shield of California Commercial |
$432.88
|
| Rate for Payer: Blue Shield of California EPN |
$282.24
|
| Rate for Payer: Cash Price |
$308.00
|
| Rate for Payer: Cash Price |
$308.00
|
| Rate for Payer: Central Health Plan Commercial |
$448.00
|
| Rate for Payer: Cigna of CA HMO |
$392.00
|
| Rate for Payer: Cigna of CA PPO |
$392.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$476.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$476.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$476.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$224.00
|
| Rate for Payer: EPIC Health Plan Senior |
$224.00
|
| Rate for Payer: Galaxy Health WC |
$476.00
|
| Rate for Payer: Global Benefits Group Commercial |
$336.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$504.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$68.94
|
| Rate for Payer: InnovAge PACE Commercial |
$280.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$373.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$76.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$346.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$229.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$392.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$392.00
|
| Rate for Payer: Multiplan Commercial |
$420.00
|
| Rate for Payer: Networks By Design Commercial |
$280.00
|
| Rate for Payer: Prime Health Services Commercial |
$476.00
|
| Rate for Payer: Riverside University Health System MISP |
$224.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$336.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$336.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$210.17
|
| Rate for Payer: United Healthcare All Other HMO |
$204.57
|
| Rate for Payer: United Healthcare HMO Rider |
$200.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$183.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$476.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$476.00
|
| Rate for Payer: Vantage Medical Group Senior |
$476.00
|
|
|
HC FX OX QUAD BRIM
|
Facility
|
IP
|
$905.00
|
|
|
Service Code
|
CPT L2188
|
| Hospital Charge Code |
905352188
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$181.00 |
| Max. Negotiated Rate |
$814.50 |
| Rate for Payer: Adventist Health Commercial |
$181.00
|
| Rate for Payer: Blue Shield of California Commercial |
$699.57
|
| Rate for Payer: Blue Shield of California EPN |
$456.12
|
| Rate for Payer: Cash Price |
$497.75
|
| Rate for Payer: Central Health Plan Commercial |
$724.00
|
| Rate for Payer: Cigna of CA HMO |
$633.50
|
| Rate for Payer: Cigna of CA PPO |
$633.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$362.00
|
| Rate for Payer: EPIC Health Plan Senior |
$362.00
|
| Rate for Payer: Galaxy Health WC |
$769.25
|
| Rate for Payer: Global Benefits Group Commercial |
$543.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$814.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$603.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$344.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$560.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$181.00
|
| Rate for Payer: Multiplan Commercial |
$678.75
|
| Rate for Payer: Networks By Design Commercial |
$588.25
|
| Rate for Payer: Prime Health Services Commercial |
$769.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$339.65
|
| Rate for Payer: United Healthcare All Other HMO |
$330.60
|
| Rate for Payer: United Healthcare HMO Rider |
$323.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$296.39
|
|
|
HC FX OX QUAD BRIM
|
Facility
|
OP
|
$905.00
|
|
|
Service Code
|
CPT L2188
|
| Hospital Charge Code |
905352188
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$67.06 |
| Max. Negotiated Rate |
$814.50 |
| Rate for Payer: Adventist Health Commercial |
$371.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$769.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$497.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$678.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$531.51
|
| Rate for Payer: Blue Shield of California Commercial |
$699.57
|
| Rate for Payer: Blue Shield of California EPN |
$456.12
|
| Rate for Payer: Cash Price |
$497.75
|
| Rate for Payer: Cash Price |
$497.75
|
| Rate for Payer: Central Health Plan Commercial |
$724.00
|
| Rate for Payer: Cigna of CA HMO |
$633.50
|
| Rate for Payer: Cigna of CA PPO |
$633.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$769.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$769.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$769.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$362.00
|
| Rate for Payer: EPIC Health Plan Senior |
$362.00
|
| Rate for Payer: Galaxy Health WC |
$769.25
|
| Rate for Payer: Global Benefits Group Commercial |
$543.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$814.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$67.06
|
| Rate for Payer: InnovAge PACE Commercial |
$452.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$603.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$74.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$560.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$371.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$633.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$633.50
|
| Rate for Payer: Multiplan Commercial |
$678.75
|
| Rate for Payer: Networks By Design Commercial |
$452.50
|
| Rate for Payer: Prime Health Services Commercial |
$769.25
|
| Rate for Payer: Riverside University Health System MISP |
$362.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$543.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$543.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$339.65
|
| Rate for Payer: United Healthcare All Other HMO |
$330.60
|
| Rate for Payer: United Healthcare HMO Rider |
$323.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$296.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$769.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$769.25
|
| Rate for Payer: Vantage Medical Group Senior |
$769.25
|
|
|
HC FX OX QUAD BRIM
|
Facility
|
OP
|
$905.00
|
|
|
Service Code
|
CPT L2188
|
| Hospital Charge Code |
915352188
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$67.06 |
| Max. Negotiated Rate |
$814.50 |
| Rate for Payer: Adventist Health Commercial |
$371.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$769.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$497.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$678.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$531.51
|
| Rate for Payer: Blue Shield of California Commercial |
$699.57
|
| Rate for Payer: Blue Shield of California EPN |
$456.12
|
| Rate for Payer: Cash Price |
$497.75
|
| Rate for Payer: Cash Price |
$497.75
|
| Rate for Payer: Central Health Plan Commercial |
$724.00
|
| Rate for Payer: Cigna of CA HMO |
$633.50
|
| Rate for Payer: Cigna of CA PPO |
$633.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$769.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$769.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$769.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$362.00
|
| Rate for Payer: EPIC Health Plan Senior |
$362.00
|
| Rate for Payer: Galaxy Health WC |
$769.25
|
| Rate for Payer: Global Benefits Group Commercial |
$543.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$814.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$67.06
|
| Rate for Payer: InnovAge PACE Commercial |
$452.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$603.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$74.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$560.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$371.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$633.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$633.50
|
| Rate for Payer: Multiplan Commercial |
$678.75
|
| Rate for Payer: Networks By Design Commercial |
$452.50
|
| Rate for Payer: Prime Health Services Commercial |
$769.25
|
| Rate for Payer: Riverside University Health System MISP |
$362.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$543.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$543.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$339.65
|
| Rate for Payer: United Healthcare All Other HMO |
$330.60
|
| Rate for Payer: United Healthcare HMO Rider |
$323.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$296.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$769.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$769.25
|
| Rate for Payer: Vantage Medical Group Senior |
$769.25
|
|
|
HC FX OX QUAD BRIM
|
Facility
|
IP
|
$905.00
|
|
|
Service Code
|
CPT L2188
|
| Hospital Charge Code |
915352188
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$181.00 |
| Max. Negotiated Rate |
$814.50 |
| Rate for Payer: Adventist Health Commercial |
$181.00
|
| Rate for Payer: Blue Shield of California Commercial |
$699.57
|
| Rate for Payer: Blue Shield of California EPN |
$456.12
|
| Rate for Payer: Cash Price |
$497.75
|
| Rate for Payer: Central Health Plan Commercial |
$724.00
|
| Rate for Payer: Cigna of CA HMO |
$633.50
|
| Rate for Payer: Cigna of CA PPO |
$633.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$362.00
|
| Rate for Payer: EPIC Health Plan Senior |
$362.00
|
| Rate for Payer: Galaxy Health WC |
$769.25
|
| Rate for Payer: Global Benefits Group Commercial |
$543.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$814.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$603.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$344.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$560.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$181.00
|
| Rate for Payer: Multiplan Commercial |
$678.75
|
| Rate for Payer: Networks By Design Commercial |
$588.25
|
| Rate for Payer: Prime Health Services Commercial |
$769.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$339.65
|
| Rate for Payer: United Healthcare All Other HMO |
$330.60
|
| Rate for Payer: United Healthcare HMO Rider |
$323.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$296.39
|
|
|
HC FX OX RADIUS ULNAR
|
Facility
|
OP
|
$264.00
|
|
| Hospital Charge Code |
905353982
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$86.46 |
| Max. Negotiated Rate |
$237.60 |
| Rate for Payer: Adventist Health Commercial |
$108.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$224.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$145.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$155.05
|
| Rate for Payer: Blue Shield of California Commercial |
$204.07
|
| Rate for Payer: Blue Shield of California EPN |
$133.06
|
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Central Health Plan Commercial |
$211.20
|
| Rate for Payer: Cigna of CA HMO |
$184.80
|
| Rate for Payer: Cigna of CA PPO |
$184.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$224.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$224.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$224.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$105.60
|
| Rate for Payer: EPIC Health Plan Senior |
$105.60
|
| Rate for Payer: Galaxy Health WC |
$224.40
|
| Rate for Payer: Global Benefits Group Commercial |
$158.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$237.60
|
| Rate for Payer: InnovAge PACE Commercial |
$132.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$176.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$184.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.80
|
| Rate for Payer: Multiplan Commercial |
$198.00
|
| Rate for Payer: Networks By Design Commercial |
$132.00
|
| Rate for Payer: Prime Health Services Commercial |
$224.40
|
| Rate for Payer: Riverside University Health System MISP |
$105.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$158.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$158.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$99.08
|
| Rate for Payer: United Healthcare All Other HMO |
$96.44
|
| Rate for Payer: United Healthcare HMO Rider |
$94.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$86.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$224.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$224.40
|
| Rate for Payer: Vantage Medical Group Senior |
$224.40
|
|
|
HC FX OX RADIUS ULNAR
|
Facility
|
IP
|
$264.00
|
|
| Hospital Charge Code |
905353982
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$52.80 |
| Max. Negotiated Rate |
$237.60 |
| Rate for Payer: Adventist Health Commercial |
$52.80
|
| Rate for Payer: Blue Shield of California Commercial |
$204.07
|
| Rate for Payer: Blue Shield of California EPN |
$133.06
|
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Central Health Plan Commercial |
$211.20
|
| Rate for Payer: Cigna of CA HMO |
$184.80
|
| Rate for Payer: Cigna of CA PPO |
$184.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$105.60
|
| Rate for Payer: EPIC Health Plan Senior |
$105.60
|
| Rate for Payer: Galaxy Health WC |
$224.40
|
| Rate for Payer: Global Benefits Group Commercial |
$158.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$237.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$176.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.80
|
| Rate for Payer: Multiplan Commercial |
$198.00
|
| Rate for Payer: Networks By Design Commercial |
$171.60
|
| Rate for Payer: Prime Health Services Commercial |
$224.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$99.08
|
| Rate for Payer: United Healthcare All Other HMO |
$96.44
|
| Rate for Payer: United Healthcare HMO Rider |
$94.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$86.46
|
|
|
HC FX OX RADIUS ULNAR
|
Facility
|
OP
|
$720.00
|
|
|
Service Code
|
CPT L3982
|
| Hospital Charge Code |
915353982
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$235.80 |
| Max. Negotiated Rate |
$648.00 |
| Rate for Payer: Adventist Health Commercial |
$295.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$612.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$396.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$540.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$422.86
|
| Rate for Payer: Blue Shield of California Commercial |
$556.56
|
| Rate for Payer: Blue Shield of California EPN |
$362.88
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Central Health Plan Commercial |
$576.00
|
| Rate for Payer: Cigna of CA HMO |
$504.00
|
| Rate for Payer: Cigna of CA PPO |
$504.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$612.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$612.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$612.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$288.00
|
| Rate for Payer: EPIC Health Plan Senior |
$288.00
|
| Rate for Payer: Galaxy Health WC |
$612.00
|
| Rate for Payer: Global Benefits Group Commercial |
$432.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$648.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$504.51
|
| Rate for Payer: InnovAge PACE Commercial |
$360.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$480.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$557.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$445.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$295.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$504.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$504.00
|
| Rate for Payer: Multiplan Commercial |
$540.00
|
| Rate for Payer: Networks By Design Commercial |
$360.00
|
| Rate for Payer: Prime Health Services Commercial |
$612.00
|
| Rate for Payer: Riverside University Health System MISP |
$288.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$432.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$432.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$270.22
|
| Rate for Payer: United Healthcare All Other HMO |
$263.02
|
| Rate for Payer: United Healthcare HMO Rider |
$257.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$235.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$612.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$612.00
|
| Rate for Payer: Vantage Medical Group Senior |
$612.00
|
|
|
HC FX OX RADIUS ULNAR
|
Facility
|
IP
|
$720.00
|
|
|
Service Code
|
CPT L3982
|
| Hospital Charge Code |
915353982
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$144.00 |
| Max. Negotiated Rate |
$648.00 |
| Rate for Payer: Adventist Health Commercial |
$144.00
|
| Rate for Payer: Blue Shield of California Commercial |
$556.56
|
| Rate for Payer: Blue Shield of California EPN |
$362.88
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Central Health Plan Commercial |
$576.00
|
| Rate for Payer: Cigna of CA HMO |
$504.00
|
| Rate for Payer: Cigna of CA PPO |
$504.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$288.00
|
| Rate for Payer: EPIC Health Plan Senior |
$288.00
|
| Rate for Payer: Galaxy Health WC |
$612.00
|
| Rate for Payer: Global Benefits Group Commercial |
$432.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$648.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$480.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$274.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$445.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$144.00
|
| Rate for Payer: Multiplan Commercial |
$540.00
|
| Rate for Payer: Networks By Design Commercial |
$468.00
|
| Rate for Payer: Prime Health Services Commercial |
$612.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$270.22
|
| Rate for Payer: United Healthcare All Other HMO |
$263.02
|
| Rate for Payer: United Healthcare HMO Rider |
$257.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$235.80
|
|
|
HC FX OX SHOE INSERT
|
Facility
|
IP
|
$222.00
|
|
|
Service Code
|
CPT L2180
|
| Hospital Charge Code |
905352180
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$44.40 |
| Max. Negotiated Rate |
$199.80 |
| Rate for Payer: Adventist Health Commercial |
$44.40
|
| Rate for Payer: Blue Shield of California Commercial |
$171.61
|
| Rate for Payer: Blue Shield of California EPN |
$111.89
|
| Rate for Payer: Cash Price |
$122.10
|
| Rate for Payer: Central Health Plan Commercial |
$177.60
|
| Rate for Payer: Cigna of CA HMO |
$155.40
|
| Rate for Payer: Cigna of CA PPO |
$155.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$88.80
|
| Rate for Payer: EPIC Health Plan Senior |
$88.80
|
| Rate for Payer: Galaxy Health WC |
$188.70
|
| Rate for Payer: Global Benefits Group Commercial |
$133.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$199.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$148.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$84.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.40
|
| Rate for Payer: Multiplan Commercial |
$166.50
|
| Rate for Payer: Networks By Design Commercial |
$144.30
|
| Rate for Payer: Prime Health Services Commercial |
$188.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$83.32
|
| Rate for Payer: United Healthcare All Other HMO |
$81.10
|
| Rate for Payer: United Healthcare HMO Rider |
$79.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$72.70
|
|
|
HC FX OX SHOE INSERT
|
Facility
|
OP
|
$222.00
|
|
|
Service Code
|
CPT L2180
|
| Hospital Charge Code |
905352180
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$72.70 |
| Max. Negotiated Rate |
$199.80 |
| Rate for Payer: Adventist Health Commercial |
$91.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$188.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$122.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$166.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$130.38
|
| Rate for Payer: Blue Shield of California Commercial |
$171.61
|
| Rate for Payer: Blue Shield of California EPN |
$111.89
|
| Rate for Payer: Cash Price |
$122.10
|
| Rate for Payer: Cash Price |
$122.10
|
| Rate for Payer: Central Health Plan Commercial |
$177.60
|
| Rate for Payer: Cigna of CA HMO |
$155.40
|
| Rate for Payer: Cigna of CA PPO |
$155.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$188.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$188.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$88.80
|
| Rate for Payer: EPIC Health Plan Senior |
$88.80
|
| Rate for Payer: Galaxy Health WC |
$188.70
|
| Rate for Payer: Global Benefits Group Commercial |
$133.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$199.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$161.71
|
| Rate for Payer: InnovAge PACE Commercial |
$111.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$148.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$178.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$91.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$155.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$155.40
|
| Rate for Payer: Multiplan Commercial |
$166.50
|
| Rate for Payer: Networks By Design Commercial |
$111.00
|
| Rate for Payer: Prime Health Services Commercial |
$188.70
|
| Rate for Payer: Riverside University Health System MISP |
$88.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$133.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$133.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$83.32
|
| Rate for Payer: United Healthcare All Other HMO |
$81.10
|
| Rate for Payer: United Healthcare HMO Rider |
$79.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$72.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$188.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.70
|
| Rate for Payer: Vantage Medical Group Senior |
$188.70
|
|
|
HC FX OX SHOE INSERT
|
Facility
|
IP
|
$222.00
|
|
|
Service Code
|
CPT L2180
|
| Hospital Charge Code |
915352180
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$44.40 |
| Max. Negotiated Rate |
$199.80 |
| Rate for Payer: Adventist Health Commercial |
$44.40
|
| Rate for Payer: Blue Shield of California Commercial |
$171.61
|
| Rate for Payer: Blue Shield of California EPN |
$111.89
|
| Rate for Payer: Cash Price |
$122.10
|
| Rate for Payer: Central Health Plan Commercial |
$177.60
|
| Rate for Payer: Cigna of CA HMO |
$155.40
|
| Rate for Payer: Cigna of CA PPO |
$155.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$88.80
|
| Rate for Payer: EPIC Health Plan Senior |
$88.80
|
| Rate for Payer: Galaxy Health WC |
$188.70
|
| Rate for Payer: Global Benefits Group Commercial |
$133.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$199.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$148.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$84.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.40
|
| Rate for Payer: Multiplan Commercial |
$166.50
|
| Rate for Payer: Networks By Design Commercial |
$144.30
|
| Rate for Payer: Prime Health Services Commercial |
$188.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$83.32
|
| Rate for Payer: United Healthcare All Other HMO |
$81.10
|
| Rate for Payer: United Healthcare HMO Rider |
$79.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$72.70
|
|
|
HC FX OX SHOE INSERT
|
Facility
|
OP
|
$222.00
|
|
|
Service Code
|
CPT L2180
|
| Hospital Charge Code |
915352180
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$72.70 |
| Max. Negotiated Rate |
$199.80 |
| Rate for Payer: Adventist Health Commercial |
$91.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$188.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$122.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$166.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$130.38
|
| Rate for Payer: Blue Shield of California Commercial |
$171.61
|
| Rate for Payer: Blue Shield of California EPN |
$111.89
|
| Rate for Payer: Cash Price |
$122.10
|
| Rate for Payer: Cash Price |
$122.10
|
| Rate for Payer: Central Health Plan Commercial |
$177.60
|
| Rate for Payer: Cigna of CA HMO |
$155.40
|
| Rate for Payer: Cigna of CA PPO |
$155.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$188.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$188.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$88.80
|
| Rate for Payer: EPIC Health Plan Senior |
$88.80
|
| Rate for Payer: Galaxy Health WC |
$188.70
|
| Rate for Payer: Global Benefits Group Commercial |
$133.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$199.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$161.71
|
| Rate for Payer: InnovAge PACE Commercial |
$111.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$148.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$178.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$91.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$155.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$155.40
|
| Rate for Payer: Multiplan Commercial |
$166.50
|
| Rate for Payer: Networks By Design Commercial |
$111.00
|
| Rate for Payer: Prime Health Services Commercial |
$188.70
|
| Rate for Payer: Riverside University Health System MISP |
$88.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$133.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$133.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$83.32
|
| Rate for Payer: United Healthcare All Other HMO |
$81.10
|
| Rate for Payer: United Healthcare HMO Rider |
$79.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$72.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$188.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.70
|
| Rate for Payer: Vantage Medical Group Senior |
$188.70
|
|
|
HC FX OX WAIST BELT
|
Facility
|
IP
|
$132.00
|
|
|
Service Code
|
CPT L2190
|
| Hospital Charge Code |
915352190
|
|
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 FX OX WAIST BELT
|
Facility
|
OP
|
$132.00
|
|
|
Service Code
|
CPT L2190
|
| Hospital Charge Code |
915352190
|
|
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 |
$76.09
|
| 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 |
$84.06
|
| 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 FX OX WAIST BELT
|
Facility
|
IP
|
$132.00
|
|
|
Service Code
|
CPT L2190
|
| Hospital Charge Code |
905352190
|
|
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 FX OX WAIST BELT
|
Facility
|
OP
|
$132.00
|
|
|
Service Code
|
CPT L2190
|
| Hospital Charge Code |
905352190
|
|
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 |
$76.09
|
| 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 |
$84.06
|
| 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 FX OX WRIST
|
Facility
|
OP
|
$724.00
|
|
|
Service Code
|
CPT L3984
|
| Hospital Charge Code |
905353984
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$237.11 |
| Max. Negotiated Rate |
$651.60 |
| Rate for Payer: Adventist Health Commercial |
$296.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$615.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$398.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$543.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$425.21
|
| Rate for Payer: Blue Shield of California Commercial |
$559.65
|
| Rate for Payer: Blue Shield of California EPN |
$364.90
|
| Rate for Payer: Cash Price |
$398.20
|
| Rate for Payer: Cash Price |
$398.20
|
| Rate for Payer: Central Health Plan Commercial |
$579.20
|
| Rate for Payer: Cigna of CA HMO |
$506.80
|
| Rate for Payer: Cigna of CA PPO |
$506.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$615.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$615.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$615.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$289.60
|
| Rate for Payer: EPIC Health Plan Senior |
$289.60
|
| Rate for Payer: Galaxy Health WC |
$615.40
|
| Rate for Payer: Global Benefits Group Commercial |
$434.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$651.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$290.49
|
| Rate for Payer: InnovAge PACE Commercial |
$362.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$482.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$320.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$448.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$296.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$506.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$506.80
|
| Rate for Payer: Multiplan Commercial |
$543.00
|
| Rate for Payer: Networks By Design Commercial |
$362.00
|
| Rate for Payer: Prime Health Services Commercial |
$615.40
|
| Rate for Payer: Riverside University Health System MISP |
$289.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$434.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$434.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$271.72
|
| Rate for Payer: United Healthcare All Other HMO |
$264.48
|
| Rate for Payer: United Healthcare HMO Rider |
$258.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$237.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$615.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$615.40
|
| Rate for Payer: Vantage Medical Group Senior |
$615.40
|
|
|
HC FX OX WRIST
|
Facility
|
IP
|
$724.00
|
|
|
Service Code
|
CPT L3984
|
| Hospital Charge Code |
905353984
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$144.80 |
| Max. Negotiated Rate |
$651.60 |
| Rate for Payer: Adventist Health Commercial |
$144.80
|
| Rate for Payer: Blue Shield of California Commercial |
$559.65
|
| Rate for Payer: Blue Shield of California EPN |
$364.90
|
| Rate for Payer: Cash Price |
$398.20
|
| Rate for Payer: Central Health Plan Commercial |
$579.20
|
| Rate for Payer: Cigna of CA HMO |
$506.80
|
| Rate for Payer: Cigna of CA PPO |
$506.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$289.60
|
| Rate for Payer: EPIC Health Plan Senior |
$289.60
|
| Rate for Payer: Galaxy Health WC |
$615.40
|
| Rate for Payer: Global Benefits Group Commercial |
$434.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$651.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$482.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$275.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$448.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$144.80
|
| Rate for Payer: Multiplan Commercial |
$543.00
|
| Rate for Payer: Networks By Design Commercial |
$470.60
|
| Rate for Payer: Prime Health Services Commercial |
$615.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$271.72
|
| Rate for Payer: United Healthcare All Other HMO |
$264.48
|
| Rate for Payer: United Healthcare HMO Rider |
$258.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$237.11
|
|
