|
HC WIRE TERUMO ADVANTAGE 180CM
|
Facility
|
OP
|
$920.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812577
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$184.00 |
| Max. Negotiated Rate |
$782.00 |
| Rate for Payer: Adventist Health Commercial |
$184.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$603.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$782.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$506.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$690.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$564.97
|
| Rate for Payer: Cash Price |
$506.00
|
| Rate for Payer: Cigna of CA HMO |
$588.80
|
| Rate for Payer: Cigna of CA PPO |
$680.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$782.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$782.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$782.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$368.00
|
| Rate for Payer: EPIC Health Plan Senior |
$368.00
|
| Rate for Payer: Galaxy Health WC |
$782.00
|
| Rate for Payer: Global Benefits Group Commercial |
$552.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$613.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$350.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$569.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$220.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$644.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$644.00
|
| Rate for Payer: Multiplan Commercial |
$736.00
|
| Rate for Payer: Networks By Design Commercial |
$598.00
|
| Rate for Payer: Prime Health Services Commercial |
$782.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$552.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$552.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$460.00
|
| Rate for Payer: United Healthcare All Other HMO |
$460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$460.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$460.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$782.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$782.00
|
| Rate for Payer: Vantage Medical Group Senior |
$782.00
|
|
|
HC WIRE TERUMO ADVANTAGE 180CM
|
Facility
|
IP
|
$920.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812577
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$184.00 |
| Max. Negotiated Rate |
$782.00 |
| Rate for Payer: Adventist Health Commercial |
$184.00
|
| Rate for Payer: Cash Price |
$506.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$368.00
|
| Rate for Payer: EPIC Health Plan Senior |
$368.00
|
| Rate for Payer: Galaxy Health WC |
$782.00
|
| Rate for Payer: Global Benefits Group Commercial |
$552.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$613.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$350.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$569.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$220.80
|
| Rate for Payer: Multiplan Commercial |
$736.00
|
| Rate for Payer: Networks By Design Commercial |
$598.00
|
| Rate for Payer: Prime Health Services Commercial |
$782.00
|
|
|
HC WIRE TERUMO ADVANTAGE 300CM
|
Facility
|
IP
|
$1,035.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812578
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$207.00 |
| Max. Negotiated Rate |
$879.75 |
| Rate for Payer: Adventist Health Commercial |
$207.00
|
| Rate for Payer: Cash Price |
$569.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$414.00
|
| Rate for Payer: EPIC Health Plan Senior |
$414.00
|
| Rate for Payer: Galaxy Health WC |
$879.75
|
| Rate for Payer: Global Benefits Group Commercial |
$621.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$690.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$394.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$640.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$248.40
|
| Rate for Payer: Multiplan Commercial |
$828.00
|
| Rate for Payer: Networks By Design Commercial |
$672.75
|
| Rate for Payer: Prime Health Services Commercial |
$879.75
|
|
|
HC WIRE TERUMO ADVANTAGE 300CM
|
Facility
|
OP
|
$1,035.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812578
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$207.00 |
| Max. Negotiated Rate |
$879.75 |
| Rate for Payer: Adventist Health Commercial |
$207.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$678.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$879.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$569.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$776.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$635.59
|
| Rate for Payer: Cash Price |
$569.25
|
| Rate for Payer: Cigna of CA HMO |
$662.40
|
| Rate for Payer: Cigna of CA PPO |
$765.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$879.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$879.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$879.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$414.00
|
| Rate for Payer: EPIC Health Plan Senior |
$414.00
|
| Rate for Payer: Galaxy Health WC |
$879.75
|
| Rate for Payer: Global Benefits Group Commercial |
$621.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$690.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$394.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$640.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$248.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$724.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$724.50
|
| Rate for Payer: Multiplan Commercial |
$828.00
|
| Rate for Payer: Networks By Design Commercial |
$672.75
|
| Rate for Payer: Prime Health Services Commercial |
$879.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$621.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$621.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$517.50
|
| Rate for Payer: United Healthcare All Other HMO |
$517.50
|
| Rate for Payer: United Healthcare HMO Rider |
$517.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$517.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$879.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$879.75
|
| Rate for Payer: Vantage Medical Group Senior |
$879.75
|
|
|
HC WIRE TERUMO ADVANTAGED ANG 260
|
Facility
|
IP
|
$828.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812576
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$165.60 |
| Max. Negotiated Rate |
$703.80 |
| Rate for Payer: Adventist Health Commercial |
$165.60
|
| Rate for Payer: Cash Price |
$455.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$331.20
|
| Rate for Payer: EPIC Health Plan Senior |
$331.20
|
| Rate for Payer: Galaxy Health WC |
$703.80
|
| Rate for Payer: Global Benefits Group Commercial |
$496.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$552.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$315.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$512.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$198.72
|
| Rate for Payer: Multiplan Commercial |
$662.40
|
| Rate for Payer: Networks By Design Commercial |
$538.20
|
| Rate for Payer: Prime Health Services Commercial |
$703.80
|
|
|
HC WIRE TERUMO ADVANTAGED ANG 260
|
Facility
|
OP
|
$828.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812576
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$165.60 |
| Max. Negotiated Rate |
$703.80 |
| Rate for Payer: Adventist Health Commercial |
$165.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$543.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$703.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$455.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$621.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$508.47
|
| Rate for Payer: Cash Price |
$455.40
|
| Rate for Payer: Cigna of CA HMO |
$529.92
|
| Rate for Payer: Cigna of CA PPO |
$612.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$703.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$703.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$703.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$331.20
|
| Rate for Payer: EPIC Health Plan Senior |
$331.20
|
| Rate for Payer: Galaxy Health WC |
$703.80
|
| Rate for Payer: Global Benefits Group Commercial |
$496.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$552.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$315.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$512.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$198.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$579.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$579.60
|
| Rate for Payer: Multiplan Commercial |
$662.40
|
| Rate for Payer: Networks By Design Commercial |
$538.20
|
| Rate for Payer: Prime Health Services Commercial |
$703.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$496.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$496.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$414.00
|
| Rate for Payer: United Healthcare All Other HMO |
$414.00
|
| Rate for Payer: United Healthcare HMO Rider |
$414.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$414.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$703.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$703.80
|
| Rate for Payer: Vantage Medical Group Senior |
$703.80
|
|
|
HC WIRE TERUMO GLIDEWIRE ST/AN260
|
Facility
|
OP
|
$308.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812654
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$61.60 |
| Max. Negotiated Rate |
$261.80 |
| Rate for Payer: Adventist Health Commercial |
$61.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$202.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$261.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$169.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$231.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$189.14
|
| Rate for Payer: Cash Price |
$169.40
|
| Rate for Payer: Cigna of CA HMO |
$197.12
|
| Rate for Payer: Cigna of CA PPO |
$227.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$261.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$261.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$261.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$123.20
|
| Rate for Payer: EPIC Health Plan Senior |
$123.20
|
| Rate for Payer: Galaxy Health WC |
$261.80
|
| Rate for Payer: Global Benefits Group Commercial |
$184.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$205.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$117.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$190.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$215.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$215.60
|
| Rate for Payer: Multiplan Commercial |
$246.40
|
| Rate for Payer: Networks By Design Commercial |
$200.20
|
| Rate for Payer: Prime Health Services Commercial |
$261.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$184.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$184.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$154.00
|
| Rate for Payer: United Healthcare All Other HMO |
$154.00
|
| Rate for Payer: United Healthcare HMO Rider |
$154.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$154.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$261.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$261.80
|
| Rate for Payer: Vantage Medical Group Senior |
$261.80
|
|
|
HC WIRE TERUMO GLIDEWIRE ST/AN260
|
Facility
|
IP
|
$308.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812654
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$61.60 |
| Max. Negotiated Rate |
$261.80 |
| Rate for Payer: Adventist Health Commercial |
$61.60
|
| Rate for Payer: Cash Price |
$169.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$123.20
|
| Rate for Payer: EPIC Health Plan Senior |
$123.20
|
| Rate for Payer: Galaxy Health WC |
$261.80
|
| Rate for Payer: Global Benefits Group Commercial |
$184.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$205.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$117.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$190.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.92
|
| Rate for Payer: Multiplan Commercial |
$246.40
|
| Rate for Payer: Networks By Design Commercial |
$200.20
|
| Rate for Payer: Prime Health Services Commercial |
$261.80
|
|
|
HC WIRE THRUWAY SHORT
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812580
|
|
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 THRUWAY SHORT
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812580
|
|
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 TORAY, 230CM
|
Facility
|
IP
|
$805.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812409
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$161.00 |
| Max. Negotiated Rate |
$684.25 |
| Rate for Payer: Adventist Health Commercial |
$161.00
|
| Rate for Payer: Cash Price |
$442.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$322.00
|
| Rate for Payer: EPIC Health Plan Senior |
$322.00
|
| Rate for Payer: Galaxy Health WC |
$684.25
|
| Rate for Payer: Global Benefits Group Commercial |
$483.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$536.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$306.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$498.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$193.20
|
| Rate for Payer: Multiplan Commercial |
$644.00
|
| Rate for Payer: Networks By Design Commercial |
$523.25
|
| Rate for Payer: Prime Health Services Commercial |
$684.25
|
|
|
HC WIRE TORAY, 230CM
|
Facility
|
OP
|
$805.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812409
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$161.00 |
| Max. Negotiated Rate |
$684.25 |
| Rate for Payer: Adventist Health Commercial |
$161.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$528.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$684.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$442.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$603.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$494.35
|
| Rate for Payer: Cash Price |
$442.75
|
| Rate for Payer: Cigna of CA HMO |
$515.20
|
| Rate for Payer: Cigna of CA PPO |
$595.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$684.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$684.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$684.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$322.00
|
| Rate for Payer: EPIC Health Plan Senior |
$322.00
|
| Rate for Payer: Galaxy Health WC |
$684.25
|
| Rate for Payer: Global Benefits Group Commercial |
$483.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$536.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$306.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$498.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$193.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$563.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$563.50
|
| Rate for Payer: Multiplan Commercial |
$644.00
|
| Rate for Payer: Networks By Design Commercial |
$523.25
|
| Rate for Payer: Prime Health Services Commercial |
$684.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$483.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$483.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$402.50
|
| Rate for Payer: United Healthcare All Other HMO |
$402.50
|
| Rate for Payer: United Healthcare HMO Rider |
$402.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$402.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$684.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$684.25
|
| Rate for Payer: Vantage Medical Group Senior |
$684.25
|
|
|
HC WIRE VASC R350
|
Facility
|
IP
|
$823.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812523
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$164.60 |
| Max. Negotiated Rate |
$699.55 |
| Rate for Payer: Adventist Health Commercial |
$164.60
|
| Rate for Payer: Cash Price |
$452.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$329.20
|
| Rate for Payer: EPIC Health Plan Senior |
$329.20
|
| Rate for Payer: Galaxy Health WC |
$699.55
|
| Rate for Payer: Global Benefits Group Commercial |
$493.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$548.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$313.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$509.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$197.52
|
| Rate for Payer: Multiplan Commercial |
$658.40
|
| Rate for Payer: Networks By Design Commercial |
$534.95
|
| Rate for Payer: Prime Health Services Commercial |
$699.55
|
|
|
HC WIRE VASC R350
|
Facility
|
OP
|
$823.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812523
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$164.60 |
| Max. Negotiated Rate |
$699.55 |
| Rate for Payer: Adventist Health Commercial |
$164.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$539.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$699.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$452.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$617.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$505.40
|
| Rate for Payer: Cash Price |
$452.65
|
| Rate for Payer: Cigna of CA HMO |
$526.72
|
| Rate for Payer: Cigna of CA PPO |
$609.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$699.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$699.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$699.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$329.20
|
| Rate for Payer: EPIC Health Plan Senior |
$329.20
|
| Rate for Payer: Galaxy Health WC |
$699.55
|
| Rate for Payer: Global Benefits Group Commercial |
$493.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$548.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$313.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$509.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$197.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$576.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$576.10
|
| Rate for Payer: Multiplan Commercial |
$658.40
|
| Rate for Payer: Networks By Design Commercial |
$534.95
|
| Rate for Payer: Prime Health Services Commercial |
$699.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$493.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$493.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$411.50
|
| Rate for Payer: United Healthcare All Other HMO |
$411.50
|
| Rate for Payer: United Healthcare HMO Rider |
$411.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$411.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$699.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$699.55
|
| Rate for Payer: Vantage Medical Group Senior |
$699.55
|
|
|
HC WIRE VASCULAR SOL PIGGYBACK
|
Facility
|
OP
|
$3,881.00
|
|
| Hospital Charge Code |
906812755
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$776.20 |
| Max. Negotiated Rate |
$3,298.85 |
| Rate for Payer: Adventist Health Commercial |
$776.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,545.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,298.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,134.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,910.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,383.32
|
| Rate for Payer: Cash Price |
$2,134.55
|
| Rate for Payer: Cigna of CA HMO |
$2,483.84
|
| Rate for Payer: Cigna of CA PPO |
$2,871.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,298.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,298.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,298.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,552.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,552.40
|
| Rate for Payer: Galaxy Health WC |
$3,298.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,328.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,588.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,478.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,402.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$931.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,716.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,716.70
|
| Rate for Payer: Multiplan Commercial |
$3,104.80
|
| Rate for Payer: Networks By Design Commercial |
$2,522.65
|
| Rate for Payer: Prime Health Services Commercial |
$3,298.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,328.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,328.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,940.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,940.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,940.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,940.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,298.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,298.85
|
| Rate for Payer: Vantage Medical Group Senior |
$3,298.85
|
|
|
HC WIRE VASCULAR SOL PIGGYBACK
|
Facility
|
IP
|
$3,881.00
|
|
| Hospital Charge Code |
906812755
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$776.20 |
| Max. Negotiated Rate |
$3,298.85 |
| Rate for Payer: Adventist Health Commercial |
$776.20
|
| Rate for Payer: Cash Price |
$2,134.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,552.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,552.40
|
| Rate for Payer: Galaxy Health WC |
$3,298.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,328.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,588.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,478.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,402.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$931.44
|
| Rate for Payer: Multiplan Commercial |
$3,104.80
|
| Rate for Payer: Networks By Design Commercial |
$2,522.65
|
| Rate for Payer: Prime Health Services Commercial |
$3,298.85
|
|
|
HC WIRE VLCNO PRIMEWIRE
|
Facility
|
OP
|
$2,711.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812377
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$542.20 |
| Max. Negotiated Rate |
$2,304.35 |
| Rate for Payer: Adventist Health Commercial |
$542.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,778.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,304.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,491.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,033.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,664.83
|
| Rate for Payer: Cash Price |
$1,491.05
|
| Rate for Payer: Cigna of CA HMO |
$1,735.04
|
| Rate for Payer: Cigna of CA PPO |
$2,006.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,304.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,304.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,304.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,084.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,084.40
|
| Rate for Payer: Galaxy Health WC |
$2,304.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,626.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,808.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,032.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,678.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$650.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,897.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,897.70
|
| Rate for Payer: Multiplan Commercial |
$2,168.80
|
| Rate for Payer: Networks By Design Commercial |
$1,762.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,304.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,626.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,626.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,355.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,355.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,355.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,355.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,304.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,304.35
|
| Rate for Payer: Vantage Medical Group Senior |
$2,304.35
|
|
|
HC WIRE VLCNO PRIMEWIRE
|
Facility
|
IP
|
$2,711.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812377
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$542.20 |
| Max. Negotiated Rate |
$2,304.35 |
| Rate for Payer: Adventist Health Commercial |
$542.20
|
| Rate for Payer: Cash Price |
$1,491.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,084.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,084.40
|
| Rate for Payer: Galaxy Health WC |
$2,304.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,626.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,808.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,032.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,678.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$650.64
|
| Rate for Payer: Multiplan Commercial |
$2,168.80
|
| Rate for Payer: Networks By Design Commercial |
$1,762.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,304.35
|
|
|
HC WIRE VLCNO PRIMEWIRE PRESTIGE
|
Facility
|
IP
|
$3,003.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812419
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$600.60 |
| Max. Negotiated Rate |
$2,552.55 |
| Rate for Payer: Adventist Health Commercial |
$600.60
|
| Rate for Payer: Cash Price |
$1,651.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,201.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,201.20
|
| Rate for Payer: Galaxy Health WC |
$2,552.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,801.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,003.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,144.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,858.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$720.72
|
| Rate for Payer: Multiplan Commercial |
$2,402.40
|
| Rate for Payer: Networks By Design Commercial |
$1,951.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,552.55
|
|
|
HC WIRE VLCNO PRIMEWIRE PRESTIGE
|
Facility
|
OP
|
$3,003.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812419
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$600.60 |
| Max. Negotiated Rate |
$2,552.55 |
| Rate for Payer: Adventist Health Commercial |
$600.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,969.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,552.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,651.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,252.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,844.14
|
| Rate for Payer: Cash Price |
$1,651.65
|
| Rate for Payer: Cigna of CA HMO |
$1,921.92
|
| Rate for Payer: Cigna of CA PPO |
$2,222.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,552.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,552.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,552.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,201.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,201.20
|
| Rate for Payer: Galaxy Health WC |
$2,552.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,801.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,003.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,144.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,858.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$720.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,102.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,102.10
|
| Rate for Payer: Multiplan Commercial |
$2,402.40
|
| Rate for Payer: Networks By Design Commercial |
$1,951.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,552.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,801.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,801.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,501.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,501.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,501.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,501.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,552.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,552.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2,552.55
|
|
|
HC WIRE VLCNO PRIMEWIRE VERRATA
|
Facility
|
OP
|
$3,003.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812518
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$600.60 |
| Max. Negotiated Rate |
$2,552.55 |
| Rate for Payer: Adventist Health Commercial |
$600.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,969.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,552.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,651.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,252.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,844.14
|
| Rate for Payer: Cash Price |
$1,651.65
|
| Rate for Payer: Cigna of CA HMO |
$1,921.92
|
| Rate for Payer: Cigna of CA PPO |
$2,222.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,552.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,552.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,552.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,201.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,201.20
|
| Rate for Payer: Galaxy Health WC |
$2,552.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,801.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,003.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,144.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,858.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$720.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,102.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,102.10
|
| Rate for Payer: Multiplan Commercial |
$2,402.40
|
| Rate for Payer: Networks By Design Commercial |
$1,951.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,552.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,801.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,801.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,501.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,501.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,501.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,501.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,552.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,552.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2,552.55
|
|
|
HC WIRE VLCNO PRIMEWIRE VERRATA
|
Facility
|
IP
|
$3,003.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812518
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$600.60 |
| Max. Negotiated Rate |
$2,552.55 |
| Rate for Payer: Adventist Health Commercial |
$600.60
|
| Rate for Payer: Cash Price |
$1,651.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,201.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,201.20
|
| Rate for Payer: Galaxy Health WC |
$2,552.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,801.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,003.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,144.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,858.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$720.72
|
| Rate for Payer: Multiplan Commercial |
$2,402.40
|
| Rate for Payer: Networks By Design Commercial |
$1,951.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,552.55
|
|
|
HC WOUND CLOSURE 4IN X 0.25IN
|
Facility
|
OP
|
$6.31
|
|
| Hospital Charge Code |
901698165
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$5.36 |
| Rate for Payer: Adventist Health Commercial |
$1.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.87
|
| Rate for Payer: Cash Price |
$3.47
|
| Rate for Payer: Cigna of CA HMO |
$4.04
|
| Rate for Payer: Cigna of CA PPO |
$4.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.52
|
| Rate for Payer: EPIC Health Plan Senior |
$2.52
|
| Rate for Payer: Galaxy Health WC |
$5.36
|
| Rate for Payer: Global Benefits Group Commercial |
$3.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.42
|
| Rate for Payer: Multiplan Commercial |
$5.05
|
| Rate for Payer: Networks By Design Commercial |
$4.10
|
| Rate for Payer: Prime Health Services Commercial |
$5.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.79
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.79
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.15
|
| Rate for Payer: United Healthcare All Other HMO |
$3.15
|
| Rate for Payer: United Healthcare HMO Rider |
$3.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.36
|
| Rate for Payer: Vantage Medical Group Senior |
$5.36
|
|
|
HC WOUND CLOSURE 4IN X 0.25IN
|
Facility
|
IP
|
$6.31
|
|
| Hospital Charge Code |
901698165
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$5.36 |
| Rate for Payer: Adventist Health Commercial |
$1.26
|
| Rate for Payer: Cash Price |
$3.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.52
|
| Rate for Payer: EPIC Health Plan Senior |
$2.52
|
| Rate for Payer: Galaxy Health WC |
$5.36
|
| Rate for Payer: Global Benefits Group Commercial |
$3.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.51
|
| Rate for Payer: Multiplan Commercial |
$5.05
|
| Rate for Payer: Networks By Design Commercial |
$4.10
|
| Rate for Payer: Prime Health Services Commercial |
$5.36
|
|
|
HC WOUND CLOSURE STRIP .5X4IN
|
Facility
|
IP
|
$6.15
|
|
| Hospital Charge Code |
901698703
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.23 |
| Max. Negotiated Rate |
$5.23 |
| Rate for Payer: Adventist Health Commercial |
$1.23
|
| Rate for Payer: Cash Price |
$3.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.46
|
| Rate for Payer: EPIC Health Plan Senior |
$2.46
|
| Rate for Payer: Galaxy Health WC |
$5.23
|
| Rate for Payer: Global Benefits Group Commercial |
$3.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.48
|
| Rate for Payer: Multiplan Commercial |
$4.92
|
| Rate for Payer: Networks By Design Commercial |
$4.00
|
| Rate for Payer: Prime Health Services Commercial |
$5.23
|
|
