|
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 |
$473.85
|
| 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 |
$473.85
|
| 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 |
$569.25
|
| 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: 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 |
$569.25
|
| 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
|
|
|
HC WIRE BS STINGRAY EXTENSION
|
Facility
|
IP
|
$464.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812526
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$92.80 |
| Max. Negotiated Rate |
$394.40 |
| Rate for Payer: Adventist Health Commercial |
$92.80
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.60
|
| Rate for Payer: EPIC Health Plan Senior |
$185.60
|
| Rate for Payer: Galaxy Health WC |
$394.40
|
| Rate for Payer: Global Benefits Group Commercial |
$278.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$309.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$176.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$287.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$111.36
|
| Rate for Payer: Multiplan Commercial |
$371.20
|
| Rate for Payer: Networks By Design Commercial |
$301.60
|
| Rate for Payer: Prime Health Services Commercial |
$394.40
|
|
|
HC WIRE BS STINGRAY EXTENSION
|
Facility
|
OP
|
$464.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812526
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$92.80 |
| Max. Negotiated Rate |
$394.40 |
| Rate for Payer: Adventist Health Commercial |
$92.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$304.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$394.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$255.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$348.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$284.94
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cigna of CA HMO |
$296.96
|
| Rate for Payer: Cigna of CA PPO |
$343.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$394.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$394.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$394.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.60
|
| Rate for Payer: EPIC Health Plan Senior |
$185.60
|
| Rate for Payer: Galaxy Health WC |
$394.40
|
| Rate for Payer: Global Benefits Group Commercial |
$278.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$309.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$176.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$287.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$111.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$324.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$324.80
|
| Rate for Payer: Multiplan Commercial |
$371.20
|
| Rate for Payer: Networks By Design Commercial |
$301.60
|
| Rate for Payer: Prime Health Services Commercial |
$394.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$278.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$278.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$232.00
|
| Rate for Payer: United Healthcare All Other HMO |
$232.00
|
| Rate for Payer: United Healthcare HMO Rider |
$232.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$232.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$394.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$394.40
|
| Rate for Payer: Vantage Medical Group Senior |
$394.40
|
|
|
HC WIRE B/S V-18
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812699
|
|
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 |
$261.00
|
| 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 V-18
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812699
|
|
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 |
$261.00
|
| 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 V-18 200CM
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812656
|
|
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 |
$261.00
|
| 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 V-18 200CM
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812656
|
|
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 |
$261.00
|
| 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 V-18 300CM
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812657
|
|
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 |
$261.00
|
| 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 V-18 300CM
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812657
|
|
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 |
$261.00
|
| 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 COOK 035 EXCHANGE J
|
Facility
|
OP
|
$152.25
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812440
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.45 |
| Max. Negotiated Rate |
$129.41 |
| Rate for Payer: Adventist Health Commercial |
$30.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$99.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$129.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$114.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$93.50
|
| Rate for Payer: Cash Price |
$68.51
|
| Rate for Payer: Cigna of CA HMO |
$97.44
|
| Rate for Payer: Cigna of CA PPO |
$112.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$129.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$129.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$129.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.90
|
| Rate for Payer: EPIC Health Plan Senior |
$60.90
|
| Rate for Payer: Galaxy Health WC |
$129.41
|
| Rate for Payer: Global Benefits Group Commercial |
$91.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$101.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$94.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$106.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$106.58
|
| Rate for Payer: Multiplan Commercial |
$121.80
|
| Rate for Payer: Networks By Design Commercial |
$98.96
|
| Rate for Payer: Prime Health Services Commercial |
$129.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$91.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$91.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$76.12
|
| Rate for Payer: United Healthcare All Other HMO |
$76.12
|
| Rate for Payer: United Healthcare HMO Rider |
$76.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$76.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$129.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$129.41
|
| Rate for Payer: Vantage Medical Group Senior |
$129.41
|
|
|
HC WIRE COOK 035 EXCHANGE J
|
Facility
|
IP
|
$152.25
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812440
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.45 |
| Max. Negotiated Rate |
$129.41 |
| Rate for Payer: Adventist Health Commercial |
$30.45
|
| Rate for Payer: Cash Price |
$68.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.90
|
| Rate for Payer: EPIC Health Plan Senior |
$60.90
|
| Rate for Payer: Galaxy Health WC |
$129.41
|
| Rate for Payer: Global Benefits Group Commercial |
$91.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$101.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$94.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.54
|
| Rate for Payer: Multiplan Commercial |
$121.80
|
| Rate for Payer: Networks By Design Commercial |
$98.96
|
| Rate for Payer: Prime Health Services Commercial |
$129.41
|
|
|
HC WIRE COOK AMPLATZ EXTRA STIFF
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812509
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$30.40 |
| Max. Negotiated Rate |
$129.20 |
| Rate for Payer: Adventist Health Commercial |
$30.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$129.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$114.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$88.04
|
| Rate for Payer: Blue Shield of California Commercial |
$112.18
|
| Rate for Payer: Blue Shield of California EPN |
$73.87
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cigna of CA HMO |
$106.40
|
| Rate for Payer: Cigna of CA PPO |
$106.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$129.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$129.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$129.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.80
|
| Rate for Payer: EPIC Health Plan Senior |
$60.80
|
| Rate for Payer: Galaxy Health WC |
$129.20
|
| Rate for Payer: Global Benefits Group Commercial |
$91.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$101.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$94.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$106.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$106.40
|
| Rate for Payer: Multiplan Commercial |
$121.60
|
| Rate for Payer: Networks By Design Commercial |
$76.00
|
| Rate for Payer: Prime Health Services Commercial |
$129.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$91.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$91.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$57.05
|
| Rate for Payer: United Healthcare All Other HMO |
$55.53
|
| Rate for Payer: United Healthcare HMO Rider |
$54.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$49.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$129.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$129.20
|
| Rate for Payer: Vantage Medical Group Senior |
$129.20
|
|
|
HC WIRE COOK AMPLATZ EXTRA STIFF
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812509
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$30.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$30.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cigna of CA HMO |
$106.40
|
| Rate for Payer: Cigna of CA PPO |
$106.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.80
|
| Rate for Payer: EPIC Health Plan Senior |
$60.80
|
| Rate for Payer: Galaxy Health WC |
$129.20
|
| Rate for Payer: Global Benefits Group Commercial |
$91.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$101.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$94.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.48
|
| Rate for Payer: Multiplan Commercial |
$121.60
|
| Rate for Payer: Networks By Design Commercial |
$76.00
|
| Rate for Payer: Prime Health Services Commercial |
$129.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$57.05
|
| Rate for Payer: United Healthcare All Other HMO |
$55.53
|
| Rate for Payer: United Healthcare HMO Rider |
$54.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$49.78
|
|
|
HC WIRE COOK LUNDERQUIST
|
Facility
|
OP
|
$574.20
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812436
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$114.84 |
| Max. Negotiated Rate |
$488.07 |
| Rate for Payer: Adventist Health Commercial |
$114.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$376.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$488.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$315.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$430.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$352.62
|
| Rate for Payer: Cash Price |
$258.39
|
| Rate for Payer: Cigna of CA HMO |
$367.49
|
| Rate for Payer: Cigna of CA PPO |
$424.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$488.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$488.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$488.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$229.68
|
| Rate for Payer: EPIC Health Plan Senior |
$229.68
|
| Rate for Payer: Galaxy Health WC |
$488.07
|
| Rate for Payer: Global Benefits Group Commercial |
$344.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$382.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$218.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$355.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$137.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$401.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$401.94
|
| Rate for Payer: Multiplan Commercial |
$459.36
|
| Rate for Payer: Networks By Design Commercial |
$373.23
|
| Rate for Payer: Prime Health Services Commercial |
$488.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$344.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$344.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$287.10
|
| Rate for Payer: United Healthcare All Other HMO |
$287.10
|
| Rate for Payer: United Healthcare HMO Rider |
$287.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$287.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$488.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$488.07
|
| Rate for Payer: Vantage Medical Group Senior |
$488.07
|
|
|
HC WIRE COOK LUNDERQUIST
|
Facility
|
IP
|
$574.20
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812436
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$114.84 |
| Max. Negotiated Rate |
$488.07 |
| Rate for Payer: Adventist Health Commercial |
$114.84
|
| Rate for Payer: Cash Price |
$258.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$229.68
|
| Rate for Payer: EPIC Health Plan Senior |
$229.68
|
| Rate for Payer: Galaxy Health WC |
$488.07
|
| Rate for Payer: Global Benefits Group Commercial |
$344.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$382.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$218.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$355.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$137.81
|
| Rate for Payer: Multiplan Commercial |
$459.36
|
| Rate for Payer: Networks By Design Commercial |
$373.23
|
| Rate for Payer: Prime Health Services Commercial |
$488.07
|
|
|
HC WIRE COOK ROSEN
|
Facility
|
IP
|
$100.70
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812459
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20.14 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$20.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$45.32
|
| Rate for Payer: Cash Price |
$45.32
|
| Rate for Payer: Cigna of CA HMO |
$70.49
|
| Rate for Payer: Cigna of CA PPO |
$70.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.28
|
| Rate for Payer: EPIC Health Plan Senior |
$40.28
|
| Rate for Payer: Galaxy Health WC |
$85.59
|
| Rate for Payer: Global Benefits Group Commercial |
$60.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$67.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$62.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.17
|
| Rate for Payer: Multiplan Commercial |
$80.56
|
| Rate for Payer: Networks By Design Commercial |
$50.35
|
| Rate for Payer: Prime Health Services Commercial |
$85.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$37.79
|
| Rate for Payer: United Healthcare All Other HMO |
$36.79
|
| Rate for Payer: United Healthcare HMO Rider |
$35.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.98
|
|
|
HC WIRE COOK ROSEN
|
Facility
|
OP
|
$100.70
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812459
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20.14 |
| Max. Negotiated Rate |
$85.59 |
| Rate for Payer: Adventist Health Commercial |
$20.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$85.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$55.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$58.33
|
| Rate for Payer: Blue Shield of California Commercial |
$74.32
|
| Rate for Payer: Blue Shield of California EPN |
$48.94
|
| Rate for Payer: Cash Price |
$45.32
|
| Rate for Payer: Cigna of CA HMO |
$70.49
|
| Rate for Payer: Cigna of CA PPO |
$70.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$85.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$85.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$85.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.28
|
| Rate for Payer: EPIC Health Plan Senior |
$40.28
|
| Rate for Payer: Galaxy Health WC |
$85.59
|
| Rate for Payer: Global Benefits Group Commercial |
$60.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$67.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$62.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$70.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$70.49
|
| Rate for Payer: Multiplan Commercial |
$80.56
|
| Rate for Payer: Networks By Design Commercial |
$50.35
|
| Rate for Payer: Prime Health Services Commercial |
$85.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$60.42
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$60.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$37.79
|
| Rate for Payer: United Healthcare All Other HMO |
$36.79
|
| Rate for Payer: United Healthcare HMO Rider |
$35.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$85.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$85.59
|
| Rate for Payer: Vantage Medical Group Senior |
$85.59
|
|
|
HC WIRE CORDIS PTCA
|
Facility
|
IP
|
$456.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812258
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$91.20 |
| Max. Negotiated Rate |
$387.60 |
| Rate for Payer: Adventist Health Commercial |
$91.20
|
| Rate for Payer: Cash Price |
$205.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.40
|
| Rate for Payer: EPIC Health Plan Senior |
$182.40
|
| Rate for Payer: Galaxy Health WC |
$387.60
|
| Rate for Payer: Global Benefits Group Commercial |
$273.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$304.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$173.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$282.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$109.44
|
| Rate for Payer: Multiplan Commercial |
$364.80
|
| Rate for Payer: Networks By Design Commercial |
$296.40
|
| Rate for Payer: Prime Health Services Commercial |
$387.60
|
|
|
HC WIRE CORDIS PTCA
|
Facility
|
OP
|
$456.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812258
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$91.20 |
| Max. Negotiated Rate |
$387.60 |
| Rate for Payer: Adventist Health Commercial |
$91.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$299.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$250.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$342.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$280.03
|
| Rate for Payer: Cash Price |
$205.20
|
| Rate for Payer: Cigna of CA HMO |
$291.84
|
| Rate for Payer: Cigna of CA PPO |
$337.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$387.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$387.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.40
|
| Rate for Payer: EPIC Health Plan Senior |
$182.40
|
| Rate for Payer: Galaxy Health WC |
$387.60
|
| Rate for Payer: Global Benefits Group Commercial |
$273.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$304.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$173.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$282.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$109.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$319.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$319.20
|
| Rate for Payer: Multiplan Commercial |
$364.80
|
| Rate for Payer: Networks By Design Commercial |
$296.40
|
| Rate for Payer: Prime Health Services Commercial |
$387.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$273.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$273.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$228.00
|
| Rate for Payer: United Healthcare All Other HMO |
$228.00
|
| Rate for Payer: United Healthcare HMO Rider |
$228.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$228.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$387.60
|
| Rate for Payer: Vantage Medical Group Senior |
$387.60
|
|
|
HC WIRE EV3 NITREX 180CM
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812589
|
|
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 |
$261.00
|
| 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 EV3 NITREX 180CM
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812589
|
|
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 |
$261.00
|
| 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 EV3 NITREX 300CM
|
Facility
|
IP
|
$622.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812590
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$124.40 |
| Max. Negotiated Rate |
$528.70 |
| Rate for Payer: Adventist Health Commercial |
$124.40
|
| Rate for Payer: Cash Price |
$279.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$248.80
|
| Rate for Payer: EPIC Health Plan Senior |
$248.80
|
| Rate for Payer: Galaxy Health WC |
$528.70
|
| Rate for Payer: Global Benefits Group Commercial |
$373.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$414.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$236.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$385.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.28
|
| Rate for Payer: Multiplan Commercial |
$497.60
|
| Rate for Payer: Networks By Design Commercial |
$404.30
|
| Rate for Payer: Prime Health Services Commercial |
$528.70
|
|
