|
HC HEP B LOW RISK ADMINISTRATION
|
Facility
|
OP
|
$23.00
|
|
| Hospital Charge Code |
902890239
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$4.60 |
| Max. Negotiated Rate |
$2,356.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$13.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$13.80
|
| Rate for Payer: Blue Shield of California Commercial |
$14.47
|
| Rate for Payer: Blue Shield of California EPN |
$11.25
|
| Rate for Payer: Cash Price |
$10.35
|
| Rate for Payer: Cash Price |
$10.35
|
| Rate for Payer: Central Health Plan Commercial |
$18.40
|
| Rate for Payer: Cigna of CA HMO |
$14.72
|
| Rate for Payer: Cigna of CA PPO |
$17.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.55
|
| Rate for Payer: Dignity Health Media |
$19.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$9.20
|
| Rate for Payer: Galaxy Health WC |
$19.55
|
| Rate for Payer: Global Benefits Group Commercial |
$13.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$17.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.60
|
| Rate for Payer: Multiplan Commercial |
$17.25
|
| Rate for Payer: Networks By Design Commercial |
$14.95
|
| Rate for Payer: Prime Health Services Commercial |
$19.55
|
| Rate for Payer: Riverside University Health System MISP |
$9.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.50
|
| Rate for Payer: United Healthcare All Other HMO |
$11.50
|
| Rate for Payer: United Healthcare HMO Rider |
$11.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.55
|
| Rate for Payer: Vantage Medical Group Senior |
$19.55
|
|
|
HC HERNIA REDUCTION
|
Facility
|
IP
|
$12,178.00
|
|
|
Service Code
|
CPT 49999
|
| Hospital Charge Code |
909020037
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,435.60 |
| Max. Negotiated Rate |
$10,960.20 |
| Rate for Payer: Cash Price |
$5,480.10
|
| Rate for Payer: Central Health Plan Commercial |
$9,742.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,871.20
|
| Rate for Payer: Galaxy Health WC |
$10,351.30
|
| Rate for Payer: Global Benefits Group Commercial |
$7,306.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,960.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,122.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,639.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,435.60
|
| Rate for Payer: Multiplan Commercial |
$9,133.50
|
| Rate for Payer: Networks By Design Commercial |
$7,915.70
|
| Rate for Payer: Prime Health Services Commercial |
$10,351.30
|
|
|
HC HERNIA REDUCTION
|
Facility
|
OP
|
$12,178.00
|
|
|
Service Code
|
CPT 49999
|
| Hospital Charge Code |
909020037
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$10,960.20 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,132.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$7,306.80
|
| Rate for Payer: Caremore Medicare Advantage |
$1,132.59
|
| Rate for Payer: Cash Price |
$5,480.10
|
| Rate for Payer: Cash Price |
$5,480.10
|
| Rate for Payer: Cash Price |
$5,480.10
|
| Rate for Payer: Cash Price |
$5,480.10
|
| Rate for Payer: Central Health Plan Commercial |
$9,742.40
|
| Rate for Payer: Cigna of CA PPO |
$9,011.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Dignity Health Media |
$1,132.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,245.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,529.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,132.59
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,132.59
|
| Rate for Payer: Galaxy Health WC |
$10,351.30
|
| Rate for Payer: Global Benefits Group Commercial |
$7,306.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,960.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9,133.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,857.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,132.59
|
| Rate for Payer: InnovAge PACE Commercial |
$1,698.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,122.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,132.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,435.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,517.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,517.67
|
| Rate for Payer: Multiplan Commercial |
$9,133.50
|
| Rate for Payer: Networks By Design Commercial |
$7,915.70
|
| Rate for Payer: Prime Health Services Commercial |
$10,351.30
|
| Rate for Payer: Prime Health Services Medicare |
$1,200.55
|
| Rate for Payer: Riverside University Health System MISP |
$1,245.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,306.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,089.00
|
| Rate for Payer: United Healthcare All Other HMO |
$6,089.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6,089.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,089.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,132.59
|
|
|
HC HERNIA REDUCTION
|
Facility
|
OP
|
$12,178.00
|
|
|
Service Code
|
CPT 49999
|
| Hospital Charge Code |
909020037
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,132.59 |
| Max. Negotiated Rate |
$10,960.20 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,132.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,132.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,896.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,194.76
|
| Rate for Payer: Blue Distinction Transplant |
$7,306.80
|
| Rate for Payer: Blue Shield of California Commercial |
$4,710.35
|
| Rate for Payer: Blue Shield of California EPN |
$3,383.18
|
| Rate for Payer: Caremore Medicare Advantage |
$1,132.59
|
| Rate for Payer: Cash Price |
$5,480.10
|
| Rate for Payer: Cash Price |
$5,480.10
|
| Rate for Payer: Central Health Plan Commercial |
$9,742.40
|
| Rate for Payer: Cigna of CA PPO |
$9,011.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Dignity Health Media |
$1,132.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,245.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,529.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,132.59
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,132.59
|
| Rate for Payer: Galaxy Health WC |
$10,351.30
|
| Rate for Payer: Global Benefits Group Commercial |
$7,306.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,960.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9,133.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,857.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,868.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,132.59
|
| Rate for Payer: InnovAge PACE Commercial |
$1,698.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,122.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,132.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,435.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,517.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,517.67
|
| Rate for Payer: Multiplan Commercial |
$9,133.50
|
| Rate for Payer: Networks By Design Commercial |
$7,915.70
|
| Rate for Payer: Prime Health Services Commercial |
$10,351.30
|
| Rate for Payer: Prime Health Services Medicare |
$1,200.55
|
| Rate for Payer: Riverside University Health System MISP |
$1,245.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,306.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,132.59
|
|
|
HC HERNIA REDUCTION
|
Facility
|
IP
|
$12,178.00
|
|
|
Service Code
|
CPT 49999
|
| Hospital Charge Code |
909020037
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,435.60 |
| Max. Negotiated Rate |
$10,960.20 |
| Rate for Payer: Cash Price |
$5,480.10
|
| Rate for Payer: Central Health Plan Commercial |
$9,742.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,871.20
|
| Rate for Payer: Galaxy Health WC |
$10,351.30
|
| Rate for Payer: Global Benefits Group Commercial |
$7,306.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,960.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,122.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,639.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,435.60
|
| Rate for Payer: Multiplan Commercial |
$9,133.50
|
| Rate for Payer: Networks By Design Commercial |
$7,915.70
|
| Rate for Payer: Prime Health Services Commercial |
$10,351.30
|
|
|
HC HERPES SIMPLEX TYPE 1
|
Facility
|
IP
|
$58.00
|
|
|
Service Code
|
CPT 86695
|
| Hospital Charge Code |
900913660
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.60 |
| Max. Negotiated Rate |
$52.20 |
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Central Health Plan Commercial |
$46.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.20
|
| Rate for Payer: Galaxy Health WC |
$49.30
|
| Rate for Payer: Global Benefits Group Commercial |
$34.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$52.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$38.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.60
|
| Rate for Payer: Multiplan Commercial |
$43.50
|
| Rate for Payer: Networks By Design Commercial |
$37.70
|
| Rate for Payer: Prime Health Services Commercial |
$49.30
|
|
|
HC HERPES SIMPLEX TYPE 1
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
CPT 86695
|
| Hospital Charge Code |
900913660
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$117.03 |
| Rate for Payer: Adventist Health Medi-Cal |
$13.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$96.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$95.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$117.03
|
| Rate for Payer: Blue Distinction Transplant |
$23.40
|
| Rate for Payer: Blue Shield of California Commercial |
$24.10
|
| Rate for Payer: Blue Shield of California EPN |
$18.95
|
| Rate for Payer: Caremore Medicare Advantage |
$13.19
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Central Health Plan Commercial |
$31.20
|
| Rate for Payer: Cigna of CA HMO |
$24.96
|
| Rate for Payer: Cigna of CA PPO |
$28.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.78
|
| Rate for Payer: Dignity Health Media |
$13.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.81
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$13.19
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.19
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$29.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.19
|
| Rate for Payer: InnovAge PACE Commercial |
$19.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.67
|
| Rate for Payer: Multiplan Commercial |
$29.25
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
| Rate for Payer: Prime Health Services Medicare |
$13.98
|
| Rate for Payer: Riverside University Health System MISP |
$14.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.68
|
| Rate for Payer: United Healthcare All Other HMO |
$10.68
|
| Rate for Payer: United Healthcare HMO Rider |
$10.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.51
|
| Rate for Payer: Vantage Medical Group Senior |
$13.19
|
|
|
HC HERPES SIMPLEX TYPE 2
|
Facility
|
IP
|
$58.00
|
|
|
Service Code
|
CPT 86696
|
| Hospital Charge Code |
900913661
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.60 |
| Max. Negotiated Rate |
$52.20 |
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Central Health Plan Commercial |
$46.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.20
|
| Rate for Payer: Galaxy Health WC |
$49.30
|
| Rate for Payer: Global Benefits Group Commercial |
$34.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$52.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$38.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.60
|
| Rate for Payer: Multiplan Commercial |
$43.50
|
| Rate for Payer: Networks By Design Commercial |
$37.70
|
| Rate for Payer: Prime Health Services Commercial |
$49.30
|
|
|
HC HERPES SIMPLEX TYPE 2
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
CPT 86696
|
| Hospital Charge Code |
900913661
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$171.63 |
| Rate for Payer: Adventist Health Medi-Cal |
$19.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$142.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$140.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$171.63
|
| Rate for Payer: Blue Distinction Transplant |
$23.40
|
| Rate for Payer: Blue Shield of California Commercial |
$24.10
|
| Rate for Payer: Blue Shield of California EPN |
$18.95
|
| Rate for Payer: Caremore Medicare Advantage |
$19.35
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Central Health Plan Commercial |
$31.20
|
| Rate for Payer: Cigna of CA HMO |
$24.96
|
| Rate for Payer: Cigna of CA PPO |
$28.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.02
|
| Rate for Payer: Dignity Health Media |
$19.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.12
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$19.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$19.35
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$29.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$31.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$31.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$19.35
|
| Rate for Payer: InnovAge PACE Commercial |
$29.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.93
|
| Rate for Payer: Multiplan Commercial |
$29.25
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
| Rate for Payer: Prime Health Services Medicare |
$20.51
|
| Rate for Payer: Riverside University Health System MISP |
$21.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.68
|
| Rate for Payer: United Healthcare All Other HMO |
$15.68
|
| Rate for Payer: United Healthcare HMO Rider |
$15.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.28
|
| Rate for Payer: Vantage Medical Group Senior |
$19.35
|
|
|
HC HFO FINGER EXT W/CLOCK SPRING
|
Facility
|
IP
|
$113.00
|
|
|
Service Code
|
CPT L3929
|
| Hospital Charge Code |
903203928
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$22.60 |
| Max. Negotiated Rate |
$101.70 |
| Rate for Payer: Blue Shield of California EPN |
$60.34
|
| Rate for Payer: Cash Price |
$50.85
|
| Rate for Payer: Central Health Plan Commercial |
$90.40
|
| Rate for Payer: Cigna of CA HMO |
$79.10
|
| Rate for Payer: Cigna of CA PPO |
$79.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$45.20
|
| Rate for Payer: Galaxy Health WC |
$96.05
|
| Rate for Payer: Global Benefits Group Commercial |
$67.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$101.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$75.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.60
|
| Rate for Payer: Multiplan Commercial |
$84.75
|
| Rate for Payer: Networks By Design Commercial |
$56.50
|
| Rate for Payer: Prime Health Services Commercial |
$96.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$42.67
|
| Rate for Payer: United Healthcare All Other HMO |
$41.67
|
| Rate for Payer: United Healthcare HMO Rider |
$40.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$37.29
|
|
|
HC HFO FINGER EXT W/CLOCK SPRING
|
Facility
|
OP
|
$113.00
|
|
|
Service Code
|
CPT L3929
|
| Hospital Charge Code |
903203928
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$39.55 |
| Max. Negotiated Rate |
$125.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$96.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$62.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$62.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$54.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$66.76
|
| Rate for Payer: Blue Distinction Transplant |
$67.80
|
| Rate for Payer: Blue Shield of California Commercial |
$84.75
|
| Rate for Payer: Blue Shield of California EPN |
$61.47
|
| Rate for Payer: Cash Price |
$50.85
|
| Rate for Payer: Cash Price |
$50.85
|
| Rate for Payer: Central Health Plan Commercial |
$90.40
|
| Rate for Payer: Cigna of CA HMO |
$79.10
|
| Rate for Payer: Cigna of CA PPO |
$79.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$96.05
|
| Rate for Payer: Dignity Health Media |
$96.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$96.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$45.20
|
| Rate for Payer: Galaxy Health WC |
$96.05
|
| Rate for Payer: Global Benefits Group Commercial |
$67.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$101.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$84.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$39.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$75.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$125.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.33
|
| Rate for Payer: Multiplan Commercial |
$84.75
|
| Rate for Payer: Networks By Design Commercial |
$56.50
|
| Rate for Payer: Prime Health Services Commercial |
$96.05
|
| Rate for Payer: Riverside University Health System MISP |
$45.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$67.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$67.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$56.50
|
| Rate for Payer: United Healthcare All Other HMO |
$56.50
|
| Rate for Payer: United Healthcare HMO Rider |
$56.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$56.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$96.05
|
| Rate for Payer: Vantage Medical Group Senior |
$96.05
|
|
|
HC HFO FINGER EXT W/WRIST SUPPORT
|
Facility
|
IP
|
$264.00
|
|
|
Service Code
|
CPT L3931
|
| Hospital Charge Code |
903203930
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$52.80 |
| Max. Negotiated Rate |
$237.60 |
| Rate for Payer: Blue Shield of California EPN |
$140.98
|
| Rate for Payer: Cash Price |
$118.80
|
| 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 Transplant |
$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: LLUH Dept of Risk Management WC |
$52.80
|
| 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: United Healthcare All Other Commercial |
$99.69
|
| Rate for Payer: United Healthcare All Other HMO |
$97.36
|
| Rate for Payer: United Healthcare HMO Rider |
$95.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$87.12
|
|
|
HC HFO FINGER EXT W/WRIST SUPPORT
|
Facility
|
OP
|
$264.00
|
|
|
Service Code
|
CPT L3931
|
| Hospital Charge Code |
903203930
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$92.40 |
| Max. Negotiated Rate |
$279.19 |
| 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 |
$145.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$127.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$155.97
|
| Rate for Payer: Blue Distinction Transplant |
$158.40
|
| Rate for Payer: Blue Shield of California Commercial |
$198.00
|
| Rate for Payer: Blue Shield of California EPN |
$143.62
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cash Price |
$118.80
|
| 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 Media |
$224.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$224.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$105.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$198.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$92.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$176.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$279.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.24
|
| 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 |
$132.00
|
| Rate for Payer: United Healthcare All Other HMO |
$132.00
|
| Rate for Payer: United Healthcare HMO Rider |
$132.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$132.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$224.40
|
| Rate for Payer: Vantage Medical Group Senior |
$224.40
|
|
|
HC HFO KNUCKLE BENDER OUTRIGGER
|
Facility
|
OP
|
$424.00
|
|
|
Service Code
|
CPT L3929
|
| Hospital Charge Code |
903200603
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$125.00 |
| Max. Negotiated Rate |
$381.60 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$360.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$233.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$233.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$205.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$250.50
|
| Rate for Payer: Blue Distinction Transplant |
$254.40
|
| Rate for Payer: Blue Shield of California Commercial |
$318.00
|
| Rate for Payer: Blue Shield of California EPN |
$230.66
|
| Rate for Payer: Cash Price |
$190.80
|
| Rate for Payer: Cash Price |
$190.80
|
| Rate for Payer: Central Health Plan Commercial |
$339.20
|
| Rate for Payer: Cigna of CA HMO |
$296.80
|
| Rate for Payer: Cigna of CA PPO |
$296.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$360.40
|
| Rate for Payer: Dignity Health Media |
$360.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$360.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$169.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$169.60
|
| Rate for Payer: Galaxy Health WC |
$360.40
|
| Rate for Payer: Global Benefits Group Commercial |
$254.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$381.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$318.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$148.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$282.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$125.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$173.84
|
| Rate for Payer: Multiplan Commercial |
$318.00
|
| Rate for Payer: Networks By Design Commercial |
$212.00
|
| Rate for Payer: Prime Health Services Commercial |
$360.40
|
| Rate for Payer: Riverside University Health System MISP |
$169.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$254.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$254.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$212.00
|
| Rate for Payer: United Healthcare All Other HMO |
$212.00
|
| Rate for Payer: United Healthcare HMO Rider |
$212.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$212.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$360.40
|
| Rate for Payer: Vantage Medical Group Senior |
$360.40
|
|
|
HC HFO KNUCKLE BENDER OUTRIGGER
|
Facility
|
IP
|
$424.00
|
|
|
Service Code
|
CPT L3929
|
| Hospital Charge Code |
903200603
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$84.80 |
| Max. Negotiated Rate |
$381.60 |
| Rate for Payer: Blue Shield of California EPN |
$226.42
|
| Rate for Payer: Cash Price |
$190.80
|
| Rate for Payer: Central Health Plan Commercial |
$339.20
|
| Rate for Payer: Cigna of CA HMO |
$296.80
|
| Rate for Payer: Cigna of CA PPO |
$296.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$169.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$169.60
|
| Rate for Payer: Galaxy Health WC |
$360.40
|
| Rate for Payer: Global Benefits Group Commercial |
$254.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$381.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$282.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$161.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.80
|
| Rate for Payer: Multiplan Commercial |
$318.00
|
| Rate for Payer: Networks By Design Commercial |
$212.00
|
| Rate for Payer: Prime Health Services Commercial |
$360.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$160.10
|
| Rate for Payer: United Healthcare All Other HMO |
$156.37
|
| Rate for Payer: United Healthcare HMO Rider |
$152.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$139.92
|
|
|
HC HFO,NO JOINT,PREFABRICATED
|
Facility
|
IP
|
$137.00
|
|
|
Service Code
|
CPT L3923
|
| Hospital Charge Code |
905353923
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$27.40 |
| Max. Negotiated Rate |
$123.30 |
| Rate for Payer: Blue Shield of California EPN |
$73.16
|
| Rate for Payer: Cash Price |
$61.65
|
| Rate for Payer: Central Health Plan Commercial |
$109.60
|
| Rate for Payer: Cigna of CA HMO |
$95.90
|
| Rate for Payer: Cigna of CA PPO |
$95.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$54.80
|
| Rate for Payer: Galaxy Health WC |
$116.45
|
| Rate for Payer: Global Benefits Group Commercial |
$82.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$123.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$91.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.40
|
| Rate for Payer: Multiplan Commercial |
$102.75
|
| Rate for Payer: Networks By Design Commercial |
$68.50
|
| Rate for Payer: Prime Health Services Commercial |
$116.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$51.73
|
| Rate for Payer: United Healthcare All Other HMO |
$50.53
|
| Rate for Payer: United Healthcare HMO Rider |
$49.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$45.21
|
|
|
HC HFO,NO JOINT,PREFABRICATED
|
Facility
|
OP
|
$137.00
|
|
|
Service Code
|
CPT L3923
|
| Hospital Charge Code |
905353923
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$42.29 |
| Max. Negotiated Rate |
$123.30 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$116.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$75.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$66.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$80.94
|
| Rate for Payer: Blue Distinction Transplant |
$82.20
|
| Rate for Payer: Blue Shield of California Commercial |
$102.75
|
| Rate for Payer: Blue Shield of California EPN |
$74.53
|
| Rate for Payer: Cash Price |
$61.65
|
| Rate for Payer: Cash Price |
$61.65
|
| Rate for Payer: Central Health Plan Commercial |
$109.60
|
| Rate for Payer: Cigna of CA HMO |
$95.90
|
| Rate for Payer: Cigna of CA PPO |
$95.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$116.45
|
| Rate for Payer: Dignity Health Media |
$116.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$116.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$54.80
|
| Rate for Payer: Galaxy Health WC |
$116.45
|
| Rate for Payer: Global Benefits Group Commercial |
$82.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$123.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$102.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$47.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$91.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.17
|
| Rate for Payer: Multiplan Commercial |
$102.75
|
| Rate for Payer: Networks By Design Commercial |
$68.50
|
| Rate for Payer: Prime Health Services Commercial |
$116.45
|
| Rate for Payer: Riverside University Health System MISP |
$54.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$82.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$82.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$68.50
|
| Rate for Payer: United Healthcare All Other HMO |
$68.50
|
| Rate for Payer: United Healthcare HMO Rider |
$68.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$68.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$116.45
|
| Rate for Payer: Vantage Medical Group Senior |
$116.45
|
|
|
HC HFO W/JOINT(S) CF
|
Facility
|
OP
|
$480.00
|
|
|
Service Code
|
CPT L3921
|
| Hospital Charge Code |
905353921
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$168.00 |
| Max. Negotiated Rate |
$432.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$408.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$264.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$264.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$232.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$283.58
|
| Rate for Payer: Blue Distinction Transplant |
$288.00
|
| Rate for Payer: Blue Shield of California Commercial |
$360.00
|
| Rate for Payer: Blue Shield of California EPN |
$261.12
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Central Health Plan Commercial |
$384.00
|
| Rate for Payer: Cigna of CA HMO |
$336.00
|
| Rate for Payer: Cigna of CA PPO |
$336.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$408.00
|
| Rate for Payer: Dignity Health Media |
$408.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$408.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$192.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$192.00
|
| Rate for Payer: Galaxy Health WC |
$408.00
|
| Rate for Payer: Global Benefits Group Commercial |
$288.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$432.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$360.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$168.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$320.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$349.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$196.80
|
| Rate for Payer: Multiplan Commercial |
$360.00
|
| Rate for Payer: Networks By Design Commercial |
$240.00
|
| Rate for Payer: Prime Health Services Commercial |
$408.00
|
| Rate for Payer: Riverside University Health System MISP |
$192.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$288.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$288.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$240.00
|
| Rate for Payer: United Healthcare All Other HMO |
$240.00
|
| Rate for Payer: United Healthcare HMO Rider |
$240.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$240.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$408.00
|
| Rate for Payer: Vantage Medical Group Senior |
$408.00
|
|
|
HC HFO W/JOINT(S) CF
|
Facility
|
IP
|
$480.00
|
|
|
Service Code
|
CPT L3921
|
| Hospital Charge Code |
905353921
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$96.00 |
| Max. Negotiated Rate |
$432.00 |
| Rate for Payer: Blue Shield of California EPN |
$256.32
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Central Health Plan Commercial |
$384.00
|
| Rate for Payer: Cigna of CA HMO |
$336.00
|
| Rate for Payer: Cigna of CA PPO |
$336.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$192.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$192.00
|
| Rate for Payer: Galaxy Health WC |
$408.00
|
| Rate for Payer: Global Benefits Group Commercial |
$288.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$432.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$320.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$182.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.00
|
| Rate for Payer: Multiplan Commercial |
$360.00
|
| Rate for Payer: Networks By Design Commercial |
$240.00
|
| Rate for Payer: Prime Health Services Commercial |
$408.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$181.25
|
| Rate for Payer: United Healthcare All Other HMO |
$177.02
|
| Rate for Payer: United Healthcare HMO Rider |
$173.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$158.40
|
|
|
HC HFO WO JOINT PF
|
Facility
|
OP
|
$264.00
|
|
|
Service Code
|
CPT L3923
|
| Hospital Charge Code |
903203954
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$42.29 |
| Max. Negotiated Rate |
$237.60 |
| 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 |
$145.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$127.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$155.97
|
| Rate for Payer: Blue Distinction Transplant |
$158.40
|
| Rate for Payer: Blue Shield of California Commercial |
$198.00
|
| Rate for Payer: Blue Shield of California EPN |
$143.62
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cash Price |
$118.80
|
| 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 Media |
$224.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$224.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$105.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$198.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$92.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$176.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.24
|
| 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 |
$132.00
|
| Rate for Payer: United Healthcare All Other HMO |
$132.00
|
| Rate for Payer: United Healthcare HMO Rider |
$132.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$132.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$224.40
|
| Rate for Payer: Vantage Medical Group Senior |
$224.40
|
|
|
HC HFO WO JOINT PF
|
Facility
|
IP
|
$264.00
|
|
|
Service Code
|
CPT L3923
|
| Hospital Charge Code |
903203954
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$52.80 |
| Max. Negotiated Rate |
$237.60 |
| Rate for Payer: Blue Shield of California EPN |
$140.98
|
| Rate for Payer: Cash Price |
$118.80
|
| 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 Transplant |
$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: LLUH Dept of Risk Management WC |
$52.80
|
| 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: United Healthcare All Other Commercial |
$99.69
|
| Rate for Payer: United Healthcare All Other HMO |
$97.36
|
| Rate for Payer: United Healthcare HMO Rider |
$95.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$87.12
|
|
|
HC HFO W/O JOINTS CF
|
Facility
|
IP
|
$405.00
|
|
|
Service Code
|
CPT L3913
|
| Hospital Charge Code |
905353913
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$81.00 |
| Max. Negotiated Rate |
$364.50 |
| Rate for Payer: Blue Shield of California EPN |
$216.27
|
| Rate for Payer: Cash Price |
$182.25
|
| Rate for Payer: Central Health Plan Commercial |
$324.00
|
| Rate for Payer: Cigna of CA HMO |
$283.50
|
| Rate for Payer: Cigna of CA PPO |
$283.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$162.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$162.00
|
| Rate for Payer: Galaxy Health WC |
$344.25
|
| Rate for Payer: Global Benefits Group Commercial |
$243.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$364.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$270.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$154.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.00
|
| Rate for Payer: Multiplan Commercial |
$303.75
|
| Rate for Payer: Networks By Design Commercial |
$202.50
|
| Rate for Payer: Prime Health Services Commercial |
$344.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$152.93
|
| Rate for Payer: United Healthcare All Other HMO |
$149.36
|
| Rate for Payer: United Healthcare HMO Rider |
$146.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$133.65
|
|
|
HC HFO W/O JOINTS CF
|
Facility
|
OP
|
$405.00
|
|
|
Service Code
|
CPT L3913
|
| Hospital Charge Code |
905353913
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$141.75 |
| Max. Negotiated Rate |
$364.50 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$344.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$222.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$222.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$196.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$239.27
|
| Rate for Payer: Blue Distinction Transplant |
$243.00
|
| Rate for Payer: Blue Shield of California Commercial |
$303.75
|
| Rate for Payer: Blue Shield of California EPN |
$220.32
|
| Rate for Payer: Cash Price |
$182.25
|
| Rate for Payer: Cash Price |
$182.25
|
| Rate for Payer: Central Health Plan Commercial |
$324.00
|
| Rate for Payer: Cigna of CA HMO |
$283.50
|
| Rate for Payer: Cigna of CA PPO |
$283.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$344.25
|
| Rate for Payer: Dignity Health Media |
$344.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$344.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$162.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$162.00
|
| Rate for Payer: Galaxy Health WC |
$344.25
|
| Rate for Payer: Global Benefits Group Commercial |
$243.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$364.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$303.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$141.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$270.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$294.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.05
|
| Rate for Payer: Multiplan Commercial |
$303.75
|
| Rate for Payer: Networks By Design Commercial |
$202.50
|
| Rate for Payer: Prime Health Services Commercial |
$344.25
|
| Rate for Payer: Riverside University Health System MISP |
$162.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$243.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$243.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$202.50
|
| Rate for Payer: United Healthcare All Other HMO |
$202.50
|
| Rate for Payer: United Healthcare HMO Rider |
$202.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$202.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$344.25
|
| Rate for Payer: Vantage Medical Group Senior |
$344.25
|
|
|
HC HIGH ACTIVITY KNEE CNTRL FRAME
|
Facility
|
IP
|
$12,792.00
|
|
|
Service Code
|
CPT L5930
|
| Hospital Charge Code |
905355930
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,558.40 |
| Max. Negotiated Rate |
$11,512.80 |
| Rate for Payer: Blue Shield of California EPN |
$6,830.93
|
| Rate for Payer: Cash Price |
$5,756.40
|
| Rate for Payer: Central Health Plan Commercial |
$10,233.60
|
| Rate for Payer: Cigna of CA HMO |
$8,954.40
|
| Rate for Payer: Cigna of CA PPO |
$8,954.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,116.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$5,116.80
|
| Rate for Payer: Galaxy Health WC |
$10,873.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7,675.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,512.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,532.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,873.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,558.40
|
| Rate for Payer: Multiplan Commercial |
$9,594.00
|
| Rate for Payer: Networks By Design Commercial |
$6,396.00
|
| Rate for Payer: Prime Health Services Commercial |
$10,873.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,830.26
|
| Rate for Payer: United Healthcare All Other HMO |
$4,717.69
|
| Rate for Payer: United Healthcare HMO Rider |
$4,615.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,221.36
|
|
|
HC HIGH ACTIVITY KNEE CNTRL FRAME
|
Facility
|
OP
|
$12,792.00
|
|
|
Service Code
|
CPT L5930
|
| Hospital Charge Code |
905355930
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,794.18 |
| Max. Negotiated Rate |
$11,512.80 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,873.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,035.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,035.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,193.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,557.51
|
| Rate for Payer: Blue Distinction Transplant |
$7,675.20
|
| Rate for Payer: Blue Shield of California Commercial |
$9,594.00
|
| Rate for Payer: Blue Shield of California EPN |
$6,958.85
|
| Rate for Payer: Cash Price |
$5,756.40
|
| Rate for Payer: Cash Price |
$5,756.40
|
| Rate for Payer: Central Health Plan Commercial |
$10,233.60
|
| Rate for Payer: Cigna of CA HMO |
$8,954.40
|
| Rate for Payer: Cigna of CA PPO |
$8,954.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,873.20
|
| Rate for Payer: Dignity Health Media |
$10,873.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,873.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,116.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$5,116.80
|
| Rate for Payer: Galaxy Health WC |
$10,873.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7,675.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,512.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9,594.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4,477.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,532.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,794.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,244.72
|
| Rate for Payer: Multiplan Commercial |
$9,594.00
|
| Rate for Payer: Networks By Design Commercial |
$6,396.00
|
| Rate for Payer: Prime Health Services Commercial |
$10,873.20
|
| Rate for Payer: Riverside University Health System MISP |
$5,116.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,675.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,675.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$6,396.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6,396.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,396.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,873.20
|
| Rate for Payer: Vantage Medical Group Senior |
$10,873.20
|
|
