|
HC WIRE ABBOTTCOMMAND ES
|
Facility
|
IP
|
$1,380.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812650
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$276.00 |
| Max. Negotiated Rate |
$1,173.00 |
| Rate for Payer: Adventist Health Commercial |
$276.00
|
| Rate for Payer: Cash Price |
$759.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$552.00
|
| Rate for Payer: EPIC Health Plan Senior |
$552.00
|
| Rate for Payer: Galaxy Health WC |
$1,173.00
|
| Rate for Payer: Global Benefits Group Commercial |
$828.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$920.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$525.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$854.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$331.20
|
| Rate for Payer: Multiplan Commercial |
$1,104.00
|
| Rate for Payer: Networks By Design Commercial |
$897.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,173.00
|
|
|
HC WIRE ABBOTT HI-TORQUE COMMAND
|
Facility
|
OP
|
$1,380.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812649
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$276.00 |
| Max. Negotiated Rate |
$1,173.00 |
| Rate for Payer: Adventist Health Commercial |
$276.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$905.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,173.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$759.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,035.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$847.46
|
| Rate for Payer: Cash Price |
$759.00
|
| Rate for Payer: Cigna of CA HMO |
$883.20
|
| Rate for Payer: Cigna of CA PPO |
$1,021.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,173.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,173.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,173.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$552.00
|
| Rate for Payer: EPIC Health Plan Senior |
$552.00
|
| Rate for Payer: Galaxy Health WC |
$1,173.00
|
| Rate for Payer: Global Benefits Group Commercial |
$828.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$920.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$525.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$854.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$331.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$966.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$966.00
|
| Rate for Payer: Multiplan Commercial |
$1,104.00
|
| Rate for Payer: Networks By Design Commercial |
$897.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,173.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$828.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$828.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$690.00
|
| Rate for Payer: United Healthcare All Other HMO |
$690.00
|
| Rate for Payer: United Healthcare HMO Rider |
$690.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$690.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,173.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,173.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,173.00
|
|
|
HC WIRE ABBOTT HI-TORQUE COMMAND
|
Facility
|
IP
|
$1,380.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812649
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$276.00 |
| Max. Negotiated Rate |
$1,173.00 |
| Rate for Payer: Adventist Health Commercial |
$276.00
|
| Rate for Payer: Cash Price |
$759.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$552.00
|
| Rate for Payer: EPIC Health Plan Senior |
$552.00
|
| Rate for Payer: Galaxy Health WC |
$1,173.00
|
| Rate for Payer: Global Benefits Group Commercial |
$828.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$920.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$525.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$854.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$331.20
|
| Rate for Payer: Multiplan Commercial |
$1,104.00
|
| Rate for Payer: Networks By Design Commercial |
$897.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,173.00
|
|
|
HC WIRE ABBOTT HI-TORQUE SPARTCOR
|
Facility
|
OP
|
$522.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812651
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$104.40 |
| Max. Negotiated Rate |
$443.70 |
| Rate for Payer: Adventist Health Commercial |
$104.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$342.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$443.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$287.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$391.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$320.56
|
| Rate for Payer: Cash Price |
$287.10
|
| Rate for Payer: Cigna of CA HMO |
$334.08
|
| Rate for Payer: Cigna of CA PPO |
$386.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$443.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$443.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$443.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$208.80
|
| Rate for Payer: EPIC Health Plan Senior |
$208.80
|
| Rate for Payer: Galaxy Health WC |
$443.70
|
| Rate for Payer: Global Benefits Group Commercial |
$313.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$348.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$198.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$323.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$125.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$365.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$365.40
|
| Rate for Payer: Multiplan Commercial |
$417.60
|
| Rate for Payer: Networks By Design Commercial |
$339.30
|
| Rate for Payer: Prime Health Services Commercial |
$443.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$313.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$313.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$261.00
|
| Rate for Payer: United Healthcare HMO Rider |
$261.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$261.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$443.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$443.70
|
| Rate for Payer: Vantage Medical Group Senior |
$443.70
|
|
|
HC WIRE ABBOTT HI-TORQUE SPARTCOR
|
Facility
|
IP
|
$522.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812651
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$104.40 |
| Max. Negotiated Rate |
$443.70 |
| Rate for Payer: Adventist Health Commercial |
$104.40
|
| Rate for Payer: Cash Price |
$287.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$208.80
|
| Rate for Payer: EPIC Health Plan Senior |
$208.80
|
| Rate for Payer: Galaxy Health WC |
$443.70
|
| Rate for Payer: Global Benefits Group Commercial |
$313.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$348.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$198.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$323.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$125.28
|
| Rate for Payer: Multiplan Commercial |
$417.60
|
| Rate for Payer: Networks By Design Commercial |
$339.30
|
| Rate for Payer: Prime Health Services Commercial |
$443.70
|
|
|
HC WIRE ABBOTT HI-TORQUE SUPRACOR
|
Facility
|
OP
|
$493.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812653
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$98.60 |
| Max. Negotiated Rate |
$419.05 |
| Rate for Payer: Adventist Health Commercial |
$98.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$323.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$419.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$271.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$369.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$302.75
|
| Rate for Payer: Cash Price |
$271.15
|
| Rate for Payer: Cigna of CA HMO |
$315.52
|
| Rate for Payer: Cigna of CA PPO |
$364.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$419.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$419.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$419.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$197.20
|
| Rate for Payer: EPIC Health Plan Senior |
$197.20
|
| Rate for Payer: Galaxy Health WC |
$419.05
|
| Rate for Payer: Global Benefits Group Commercial |
$295.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$328.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$187.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$305.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$118.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$345.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$345.10
|
| Rate for Payer: Multiplan Commercial |
$394.40
|
| Rate for Payer: Networks By Design Commercial |
$320.45
|
| Rate for Payer: Prime Health Services Commercial |
$419.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$295.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$295.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$246.50
|
| Rate for Payer: United Healthcare All Other HMO |
$246.50
|
| Rate for Payer: United Healthcare HMO Rider |
$246.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$246.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$419.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$419.05
|
| Rate for Payer: Vantage Medical Group Senior |
$419.05
|
|
|
HC WIRE ABBOTT HI-TORQUE SUPRACOR
|
Facility
|
IP
|
$493.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812653
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$98.60 |
| Max. Negotiated Rate |
$419.05 |
| Rate for Payer: Adventist Health Commercial |
$98.60
|
| Rate for Payer: Cash Price |
$271.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$197.20
|
| Rate for Payer: EPIC Health Plan Senior |
$197.20
|
| Rate for Payer: Galaxy Health WC |
$419.05
|
| Rate for Payer: Global Benefits Group Commercial |
$295.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$328.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$187.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$305.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$118.32
|
| Rate for Payer: Multiplan Commercial |
$394.40
|
| Rate for Payer: Networks By Design Commercial |
$320.45
|
| Rate for Payer: Prime Health Services Commercial |
$419.05
|
|
|
HC WIRE ABBOTT HI-TORQUE WINN
|
Facility
|
IP
|
$897.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812652
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$179.40 |
| Max. Negotiated Rate |
$762.45 |
| Rate for Payer: Adventist Health Commercial |
$179.40
|
| Rate for Payer: Cash Price |
$493.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$358.80
|
| Rate for Payer: EPIC Health Plan Senior |
$358.80
|
| Rate for Payer: Galaxy Health WC |
$762.45
|
| Rate for Payer: Global Benefits Group Commercial |
$538.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$598.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$341.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$555.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$215.28
|
| Rate for Payer: Multiplan Commercial |
$717.60
|
| Rate for Payer: Networks By Design Commercial |
$583.05
|
| Rate for Payer: Prime Health Services Commercial |
$762.45
|
|
|
HC WIRE ABBOTT HI-TORQUE WINN
|
Facility
|
OP
|
$897.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812652
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$179.40 |
| Max. Negotiated Rate |
$762.45 |
| Rate for Payer: Adventist Health Commercial |
$179.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$588.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$762.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$493.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$672.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$550.85
|
| Rate for Payer: Cash Price |
$493.35
|
| Rate for Payer: Cigna of CA HMO |
$574.08
|
| Rate for Payer: Cigna of CA PPO |
$663.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$762.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$762.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$762.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$358.80
|
| Rate for Payer: EPIC Health Plan Senior |
$358.80
|
| Rate for Payer: Galaxy Health WC |
$762.45
|
| Rate for Payer: Global Benefits Group Commercial |
$538.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$598.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$341.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$555.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$215.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$627.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$627.90
|
| Rate for Payer: Multiplan Commercial |
$717.60
|
| Rate for Payer: Networks By Design Commercial |
$583.05
|
| Rate for Payer: Prime Health Services Commercial |
$762.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$538.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$538.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$448.50
|
| Rate for Payer: United Healthcare All Other HMO |
$448.50
|
| Rate for Payer: United Healthcare HMO Rider |
$448.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$448.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$762.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$762.45
|
| Rate for Payer: Vantage Medical Group Senior |
$762.45
|
|
|
HC WIRE ABBOTT PROWATER
|
Facility
|
OP
|
$435.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812631
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$87.00 |
| Max. Negotiated Rate |
$369.75 |
| Rate for Payer: Adventist Health Commercial |
$87.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$285.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$369.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$239.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$326.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$267.13
|
| Rate for Payer: Cash Price |
$239.25
|
| Rate for Payer: Cigna of CA HMO |
$278.40
|
| Rate for Payer: Cigna of CA PPO |
$321.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$369.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$369.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$369.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$174.00
|
| Rate for Payer: EPIC Health Plan Senior |
$174.00
|
| Rate for Payer: Galaxy Health WC |
$369.75
|
| Rate for Payer: Global Benefits Group Commercial |
$261.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$290.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$165.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$269.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$104.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$304.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$304.50
|
| Rate for Payer: Multiplan Commercial |
$348.00
|
| Rate for Payer: Networks By Design Commercial |
$282.75
|
| Rate for Payer: Prime Health Services Commercial |
$369.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$261.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$261.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$217.50
|
| Rate for Payer: United Healthcare All Other HMO |
$217.50
|
| Rate for Payer: United Healthcare HMO Rider |
$217.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$217.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$369.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$369.75
|
| Rate for Payer: Vantage Medical Group Senior |
$369.75
|
|
|
HC WIRE ABBOTT PROWATER
|
Facility
|
IP
|
$435.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812631
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$87.00 |
| Max. Negotiated Rate |
$369.75 |
| Rate for Payer: Adventist Health Commercial |
$87.00
|
| Rate for Payer: Cash Price |
$239.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$174.00
|
| Rate for Payer: EPIC Health Plan Senior |
$174.00
|
| Rate for Payer: Galaxy Health WC |
$369.75
|
| Rate for Payer: Global Benefits Group Commercial |
$261.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$290.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$165.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$269.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$104.40
|
| Rate for Payer: Multiplan Commercial |
$348.00
|
| Rate for Payer: Networks By Design Commercial |
$282.75
|
| Rate for Payer: Prime Health Services Commercial |
$369.75
|
|
|
HC WIRE BAYLIS NYKANEN RF
|
Facility
|
IP
|
$3,917.50
|
|
| Hospital Charge Code |
906812471
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$783.50 |
| Max. Negotiated Rate |
$3,329.88 |
| Rate for Payer: Adventist Health Commercial |
$783.50
|
| Rate for Payer: Cash Price |
$2,154.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,567.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,567.00
|
| Rate for Payer: Galaxy Health WC |
$3,329.88
|
| Rate for Payer: Global Benefits Group Commercial |
$2,350.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,612.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,492.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,424.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$940.20
|
| Rate for Payer: Multiplan Commercial |
$3,134.00
|
| Rate for Payer: Networks By Design Commercial |
$2,546.38
|
| Rate for Payer: Prime Health Services Commercial |
$3,329.88
|
|
|
HC WIRE BAYLIS NYKANEN RF
|
Facility
|
OP
|
$3,917.50
|
|
| Hospital Charge Code |
906812471
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$783.50 |
| Max. Negotiated Rate |
$3,329.88 |
| Rate for Payer: Adventist Health Commercial |
$783.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,569.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,329.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,154.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,938.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,405.74
|
| Rate for Payer: Cash Price |
$2,154.62
|
| Rate for Payer: Cigna of CA HMO |
$2,507.20
|
| Rate for Payer: Cigna of CA PPO |
$2,898.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,329.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,329.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,329.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,567.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,567.00
|
| Rate for Payer: Galaxy Health WC |
$3,329.88
|
| Rate for Payer: Global Benefits Group Commercial |
$2,350.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,612.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,492.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,424.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$940.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,742.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,742.25
|
| Rate for Payer: Multiplan Commercial |
$3,134.00
|
| Rate for Payer: Networks By Design Commercial |
$2,546.38
|
| Rate for Payer: Prime Health Services Commercial |
$3,329.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,350.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,350.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,958.75
|
| Rate for Payer: United Healthcare All Other HMO |
$1,958.75
|
| Rate for Payer: United Healthcare HMO Rider |
$1,958.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,958.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,329.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,329.88
|
| Rate for Payer: Vantage Medical Group Senior |
$3,329.88
|
|
|
HC WIRE BP STINGRAY
|
Facility
|
OP
|
$1,150.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812475
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$230.00 |
| Max. Negotiated Rate |
$977.50 |
| Rate for Payer: Adventist Health Commercial |
$230.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$977.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$632.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$862.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$666.08
|
| Rate for Payer: Blue Shield of California Commercial |
$848.70
|
| Rate for Payer: Blue Shield of California EPN |
$558.90
|
| Rate for Payer: Cash Price |
$632.50
|
| Rate for Payer: Cigna of CA HMO |
$805.00
|
| Rate for Payer: Cigna of CA PPO |
$805.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$977.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$977.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$977.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$460.00
|
| Rate for Payer: EPIC Health Plan Senior |
$460.00
|
| Rate for Payer: Galaxy Health WC |
$977.50
|
| Rate for Payer: Global Benefits Group Commercial |
$690.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$767.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$438.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$711.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$276.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$805.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$805.00
|
| Rate for Payer: Multiplan Commercial |
$920.00
|
| Rate for Payer: Networks By Design Commercial |
$575.00
|
| Rate for Payer: Prime Health Services Commercial |
$977.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$690.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$690.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$431.60
|
| Rate for Payer: United Healthcare All Other HMO |
$420.10
|
| Rate for Payer: United Healthcare HMO Rider |
$411.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$376.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$977.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$977.50
|
| Rate for Payer: Vantage Medical Group Senior |
$977.50
|
|
|
HC WIRE BP STINGRAY
|
Facility
|
IP
|
$1,150.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812475
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$230.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$230.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$632.50
|
| Rate for Payer: Cash Price |
$632.50
|
| Rate for Payer: Cigna of CA HMO |
$805.00
|
| Rate for Payer: Cigna of CA PPO |
$805.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$460.00
|
| Rate for Payer: EPIC Health Plan Senior |
$460.00
|
| Rate for Payer: Galaxy Health WC |
$977.50
|
| Rate for Payer: Global Benefits Group Commercial |
$690.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$767.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$438.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$711.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$276.00
|
| Rate for Payer: Multiplan Commercial |
$920.00
|
| Rate for Payer: Networks By Design Commercial |
$575.00
|
| Rate for Payer: Prime Health Services Commercial |
$977.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$431.60
|
| Rate for Payer: United Healthcare All Other HMO |
$420.10
|
| Rate for Payer: United Healthcare HMO Rider |
$411.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$376.62
|
|
|
HC WIRE B/S CONTROLWIRE
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812579
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$493.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$380.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$319.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$435.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$356.18
|
| Rate for Payer: Cash Price |
$319.00
|
| Rate for Payer: Cigna of CA HMO |
$371.20
|
| Rate for Payer: Cigna of CA PPO |
$429.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$493.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$493.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$406.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$406.00
|
| Rate for Payer: Multiplan Commercial |
$464.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$348.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$348.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$290.00
|
| Rate for Payer: United Healthcare All Other HMO |
$290.00
|
| Rate for Payer: United Healthcare HMO Rider |
$290.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$290.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.00
|
| Rate for Payer: Vantage Medical Group Senior |
$493.00
|
|
|
HC WIRE B/S CONTROLWIRE
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812579
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$493.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Cash Price |
$319.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.20
|
| Rate for Payer: Multiplan Commercial |
$464.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
|
|
HC WIRE B/S EMBOLIC FILTERWIRE
|
Facility
|
IP
|
$3,900.00
|
|
|
Service Code
|
CPT C1884
|
| Hospital Charge Code |
906812230
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,315.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Cash Price |
$2,145.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$936.00
|
| Rate for Payer: Multiplan Commercial |
$3,120.00
|
| Rate for Payer: Networks By Design Commercial |
$2,535.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
|
|
HC WIRE B/S EMBOLIC FILTERWIRE
|
Facility
|
OP
|
$3,900.00
|
|
|
Service Code
|
CPT C1884
|
| Hospital Charge Code |
906812230
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,315.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,558.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,145.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,925.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,394.99
|
| Rate for Payer: Cash Price |
$2,145.00
|
| Rate for Payer: Cigna of CA HMO |
$2,496.00
|
| Rate for Payer: Cigna of CA PPO |
$2,886.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,315.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,315.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$936.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,730.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,730.00
|
| Rate for Payer: Multiplan Commercial |
$3,120.00
|
| Rate for Payer: Networks By Design Commercial |
$2,535.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,340.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,340.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,950.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,950.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,950.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,950.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,315.00
|
|
|
HC WIRE B/S ROTAWIRE ES
|
Facility
|
IP
|
$745.52
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812397
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$149.10 |
| Max. Negotiated Rate |
$633.69 |
| Rate for Payer: Adventist Health Commercial |
$149.10
|
| Rate for Payer: Cash Price |
$410.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$298.21
|
| Rate for Payer: EPIC Health Plan Senior |
$298.21
|
| Rate for Payer: Galaxy Health WC |
$633.69
|
| Rate for Payer: Global Benefits Group Commercial |
$447.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$497.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$284.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$461.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$178.92
|
| Rate for Payer: Multiplan Commercial |
$596.42
|
| Rate for Payer: Networks By Design Commercial |
$484.59
|
| Rate for Payer: Prime Health Services Commercial |
$633.69
|
|
|
HC WIRE B/S ROTAWIRE ES
|
Facility
|
OP
|
$745.52
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812397
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$149.10 |
| Max. Negotiated Rate |
$633.69 |
| Rate for Payer: Adventist Health Commercial |
$149.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$488.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$633.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$410.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$559.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.82
|
| Rate for Payer: Cash Price |
$410.04
|
| Rate for Payer: Cigna of CA HMO |
$477.13
|
| Rate for Payer: Cigna of CA PPO |
$551.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$633.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$633.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$633.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$298.21
|
| Rate for Payer: EPIC Health Plan Senior |
$298.21
|
| Rate for Payer: Galaxy Health WC |
$633.69
|
| Rate for Payer: Global Benefits Group Commercial |
$447.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$497.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$284.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$461.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$178.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$521.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$521.86
|
| Rate for Payer: Multiplan Commercial |
$596.42
|
| Rate for Payer: Networks By Design Commercial |
$484.59
|
| Rate for Payer: Prime Health Services Commercial |
$633.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$447.31
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$447.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$372.76
|
| Rate for Payer: United Healthcare All Other HMO |
$372.76
|
| Rate for Payer: United Healthcare HMO Rider |
$372.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$372.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$633.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$633.69
|
| Rate for Payer: Vantage Medical Group Senior |
$633.69
|
|
|
HC WIRE B/S SAFARI PRE-SHAPED
|
Facility
|
OP
|
$1,053.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812557
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$210.60 |
| Max. Negotiated Rate |
$895.05 |
| Rate for Payer: Adventist Health Commercial |
$210.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$690.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$895.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$579.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$789.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$646.65
|
| Rate for Payer: Cash Price |
$579.15
|
| Rate for Payer: Cigna of CA HMO |
$673.92
|
| Rate for Payer: Cigna of CA PPO |
$779.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$895.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$895.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$895.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$421.20
|
| Rate for Payer: EPIC Health Plan Senior |
$421.20
|
| Rate for Payer: Galaxy Health WC |
$895.05
|
| Rate for Payer: Global Benefits Group Commercial |
$631.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$702.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$401.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$651.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$252.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$737.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$737.10
|
| Rate for Payer: Multiplan Commercial |
$842.40
|
| Rate for Payer: Networks By Design Commercial |
$684.45
|
| Rate for Payer: Prime Health Services Commercial |
$895.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$631.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$631.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$526.50
|
| Rate for Payer: United Healthcare All Other HMO |
$526.50
|
| Rate for Payer: United Healthcare HMO Rider |
$526.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$526.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$895.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$895.05
|
| Rate for Payer: Vantage Medical Group Senior |
$895.05
|
|
|
HC WIRE B/S SAFARI PRE-SHAPED
|
Facility
|
IP
|
$1,053.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812557
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$210.60 |
| Max. Negotiated Rate |
$895.05 |
| Rate for Payer: Adventist Health Commercial |
$210.60
|
| Rate for Payer: Cash Price |
$579.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$421.20
|
| Rate for Payer: EPIC Health Plan Senior |
$421.20
|
| Rate for Payer: Galaxy Health WC |
$895.05
|
| Rate for Payer: Global Benefits Group Commercial |
$631.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$702.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$401.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$651.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$252.72
|
| Rate for Payer: Multiplan Commercial |
$842.40
|
| Rate for Payer: Networks By Design Commercial |
$684.45
|
| Rate for Payer: Prime Health Services Commercial |
$895.05
|
|
|
HC WIRE BS STINGRAY
|
Facility
|
IP
|
$1,265.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812525
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$253.00 |
| Max. Negotiated Rate |
$1,075.25 |
| Rate for Payer: Adventist Health Commercial |
$253.00
|
| Rate for Payer: Cash Price |
$695.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.00
|
| Rate for Payer: EPIC Health Plan Senior |
$506.00
|
| Rate for Payer: Galaxy Health WC |
$1,075.25
|
| Rate for Payer: Global Benefits Group Commercial |
$759.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$843.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$481.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$783.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$303.60
|
| Rate for Payer: Multiplan Commercial |
$1,012.00
|
| Rate for Payer: Networks By Design Commercial |
$822.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,075.25
|
|
|
HC WIRE BS STINGRAY
|
Facility
|
OP
|
$1,265.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812525
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$253.00 |
| Max. Negotiated Rate |
$1,075.25 |
| Rate for Payer: Adventist Health Commercial |
$253.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$829.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,075.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$695.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$948.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$776.84
|
| Rate for Payer: Cash Price |
$695.75
|
| Rate for Payer: Cigna of CA HMO |
$809.60
|
| Rate for Payer: Cigna of CA PPO |
$936.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,075.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,075.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,075.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.00
|
| Rate for Payer: EPIC Health Plan Senior |
$506.00
|
| Rate for Payer: Galaxy Health WC |
$1,075.25
|
| Rate for Payer: Global Benefits Group Commercial |
$759.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$843.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$481.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$783.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$303.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$885.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$885.50
|
| Rate for Payer: Multiplan Commercial |
$1,012.00
|
| Rate for Payer: Networks By Design Commercial |
$822.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,075.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$759.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$759.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$632.50
|
| Rate for Payer: United Healthcare All Other HMO |
$632.50
|
| Rate for Payer: United Healthcare HMO Rider |
$632.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$632.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,075.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,075.25
|
| Rate for Payer: Vantage Medical Group Senior |
$1,075.25
|
|
