|
HC GUIDE ANGLED .035"X150CM
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901602721
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$178.50 |
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.00
|
| Rate for Payer: EPIC Health Plan Senior |
$84.00
|
| Rate for Payer: Galaxy Health WC |
$178.50
|
| Rate for Payer: Global Benefits Group Commercial |
$126.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$140.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$129.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.40
|
| Rate for Payer: Multiplan Commercial |
$168.00
|
| Rate for Payer: Networks By Design Commercial |
$136.50
|
| Rate for Payer: Prime Health Services Commercial |
$178.50
|
|
|
HC GUIDE ANGLED .035"X150CM
|
Facility
|
OP
|
$210.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901602721
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$178.50 |
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$137.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$178.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$115.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$157.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$128.96
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cigna of CA HMO |
$134.40
|
| Rate for Payer: Cigna of CA PPO |
$155.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$178.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$178.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$178.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.00
|
| Rate for Payer: EPIC Health Plan Senior |
$84.00
|
| Rate for Payer: Galaxy Health WC |
$178.50
|
| Rate for Payer: Global Benefits Group Commercial |
$126.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$140.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$129.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$147.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$147.00
|
| Rate for Payer: Multiplan Commercial |
$168.00
|
| Rate for Payer: Networks By Design Commercial |
$136.50
|
| Rate for Payer: Prime Health Services Commercial |
$178.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$126.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$126.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$105.00
|
| Rate for Payer: United Healthcare All Other HMO |
$105.00
|
| Rate for Payer: United Healthcare HMO Rider |
$105.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$105.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$178.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$178.50
|
| Rate for Payer: Vantage Medical Group Senior |
$178.50
|
|
|
HC GUIDE ARROW .32X60CM SOFT TIP
|
Facility
|
IP
|
$91.20
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901606106
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.24 |
| Max. Negotiated Rate |
$77.52 |
| Rate for Payer: Adventist Health Commercial |
$18.24
|
| Rate for Payer: Cash Price |
$50.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.48
|
| Rate for Payer: EPIC Health Plan Senior |
$36.48
|
| Rate for Payer: Galaxy Health WC |
$77.52
|
| Rate for Payer: Global Benefits Group Commercial |
$54.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$60.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$56.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.89
|
| Rate for Payer: Multiplan Commercial |
$72.96
|
| Rate for Payer: Networks By Design Commercial |
$59.28
|
| Rate for Payer: Prime Health Services Commercial |
$77.52
|
|
|
HC GUIDE ARROW .32X60CM SOFT TIP
|
Facility
|
OP
|
$91.20
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901606106
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.24 |
| Max. Negotiated Rate |
$77.52 |
| Rate for Payer: Adventist Health Commercial |
$18.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$59.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$77.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$50.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$68.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$56.01
|
| Rate for Payer: Cash Price |
$50.16
|
| Rate for Payer: Cigna of CA HMO |
$58.37
|
| Rate for Payer: Cigna of CA PPO |
$67.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$77.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$77.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$77.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.48
|
| Rate for Payer: EPIC Health Plan Senior |
$36.48
|
| Rate for Payer: Galaxy Health WC |
$77.52
|
| Rate for Payer: Global Benefits Group Commercial |
$54.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$60.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$56.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$63.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$63.84
|
| Rate for Payer: Multiplan Commercial |
$72.96
|
| Rate for Payer: Networks By Design Commercial |
$59.28
|
| Rate for Payer: Prime Health Services Commercial |
$77.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$54.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$54.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$45.60
|
| Rate for Payer: United Healthcare All Other HMO |
$45.60
|
| Rate for Payer: United Healthcare HMO Rider |
$45.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$45.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$77.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$77.52
|
| Rate for Payer: Vantage Medical Group Senior |
$77.52
|
|
|
HC GUIDE BENTSON 035"X145CM
|
Facility
|
IP
|
$105.72
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901603846
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.14 |
| Max. Negotiated Rate |
$89.86 |
| Rate for Payer: Adventist Health Commercial |
$21.14
|
| Rate for Payer: Cash Price |
$58.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.29
|
| Rate for Payer: EPIC Health Plan Senior |
$42.29
|
| Rate for Payer: Galaxy Health WC |
$89.86
|
| Rate for Payer: Global Benefits Group Commercial |
$63.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$70.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$65.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.37
|
| Rate for Payer: Multiplan Commercial |
$84.58
|
| Rate for Payer: Networks By Design Commercial |
$68.72
|
| Rate for Payer: Prime Health Services Commercial |
$89.86
|
|
|
HC GUIDE BENTSON 035"X145CM
|
Facility
|
OP
|
$105.72
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901603846
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.14 |
| Max. Negotiated Rate |
$89.86 |
| Rate for Payer: Adventist Health Commercial |
$21.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$69.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$89.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$58.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$79.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$64.92
|
| Rate for Payer: Cash Price |
$58.15
|
| Rate for Payer: Cigna of CA HMO |
$67.66
|
| Rate for Payer: Cigna of CA PPO |
$78.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$89.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$89.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$89.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.29
|
| Rate for Payer: EPIC Health Plan Senior |
$42.29
|
| Rate for Payer: Galaxy Health WC |
$89.86
|
| Rate for Payer: Global Benefits Group Commercial |
$63.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$70.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$65.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$74.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$74.00
|
| Rate for Payer: Multiplan Commercial |
$84.58
|
| Rate for Payer: Networks By Design Commercial |
$68.72
|
| Rate for Payer: Prime Health Services Commercial |
$89.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$63.43
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$63.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$52.86
|
| Rate for Payer: United Healthcare All Other HMO |
$52.86
|
| Rate for Payer: United Healthcare HMO Rider |
$52.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$52.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$89.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$89.86
|
| Rate for Payer: Vantage Medical Group Senior |
$89.86
|
|
|
HC GUIDE CRVD TFE COAT .35"X145
|
Facility
|
OP
|
$192.50
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901604251
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.50 |
| Max. Negotiated Rate |
$163.62 |
| Rate for Payer: Adventist Health Commercial |
$38.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$126.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$163.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$105.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$144.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$118.21
|
| Rate for Payer: Cash Price |
$105.88
|
| Rate for Payer: Cigna of CA HMO |
$123.20
|
| Rate for Payer: Cigna of CA PPO |
$142.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$163.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$163.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$77.00
|
| Rate for Payer: EPIC Health Plan Senior |
$77.00
|
| Rate for Payer: Galaxy Health WC |
$163.62
|
| Rate for Payer: Global Benefits Group Commercial |
$115.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$128.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$73.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$119.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$134.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$134.75
|
| Rate for Payer: Multiplan Commercial |
$154.00
|
| Rate for Payer: Networks By Design Commercial |
$125.12
|
| Rate for Payer: Prime Health Services Commercial |
$163.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$115.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$115.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$96.25
|
| Rate for Payer: United Healthcare All Other HMO |
$96.25
|
| Rate for Payer: United Healthcare HMO Rider |
$96.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$96.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$163.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$163.62
|
| Rate for Payer: Vantage Medical Group Senior |
$163.62
|
|
|
HC GUIDE CRVD TFE COAT .35"X145
|
Facility
|
IP
|
$192.50
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901604251
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.50 |
| Max. Negotiated Rate |
$163.62 |
| Rate for Payer: Adventist Health Commercial |
$38.50
|
| Rate for Payer: Cash Price |
$105.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$77.00
|
| Rate for Payer: EPIC Health Plan Senior |
$77.00
|
| Rate for Payer: Galaxy Health WC |
$163.62
|
| Rate for Payer: Global Benefits Group Commercial |
$115.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$128.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$73.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$119.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.20
|
| Rate for Payer: Multiplan Commercial |
$154.00
|
| Rate for Payer: Networks By Design Commercial |
$125.12
|
| Rate for Payer: Prime Health Services Commercial |
$163.62
|
|
|
HC GUIDE, CURVED .025"X80CM
|
Facility
|
IP
|
$192.71
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901600464
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.54 |
| Max. Negotiated Rate |
$163.80 |
| Rate for Payer: Adventist Health Commercial |
$38.54
|
| Rate for Payer: Cash Price |
$105.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$77.08
|
| Rate for Payer: EPIC Health Plan Senior |
$77.08
|
| Rate for Payer: Galaxy Health WC |
$163.80
|
| Rate for Payer: Global Benefits Group Commercial |
$115.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$128.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$73.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$119.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.25
|
| Rate for Payer: Multiplan Commercial |
$154.17
|
| Rate for Payer: Networks By Design Commercial |
$125.26
|
| Rate for Payer: Prime Health Services Commercial |
$163.80
|
|
|
HC GUIDE, CURVED .025"X80CM
|
Facility
|
OP
|
$192.71
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901600464
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.54 |
| Max. Negotiated Rate |
$163.80 |
| Rate for Payer: Adventist Health Commercial |
$38.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$126.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$163.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$105.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$144.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$118.34
|
| Rate for Payer: Cash Price |
$105.99
|
| Rate for Payer: Cigna of CA HMO |
$123.33
|
| Rate for Payer: Cigna of CA PPO |
$142.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$163.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$163.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$77.08
|
| Rate for Payer: EPIC Health Plan Senior |
$77.08
|
| Rate for Payer: Galaxy Health WC |
$163.80
|
| Rate for Payer: Global Benefits Group Commercial |
$115.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$128.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$73.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$119.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$134.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$134.90
|
| Rate for Payer: Multiplan Commercial |
$154.17
|
| Rate for Payer: Networks By Design Commercial |
$125.26
|
| Rate for Payer: Prime Health Services Commercial |
$163.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$115.63
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$115.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$96.36
|
| Rate for Payer: United Healthcare All Other HMO |
$96.36
|
| Rate for Payer: United Healthcare HMO Rider |
$96.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$96.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$163.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$163.80
|
| Rate for Payer: Vantage Medical Group Senior |
$163.80
|
|
|
HC GUIDE DUOFLEX .018 45MM
|
Facility
|
OP
|
$80.11
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901603717
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.02 |
| Max. Negotiated Rate |
$68.09 |
| Rate for Payer: Adventist Health Commercial |
$16.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$52.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$68.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$44.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$60.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$49.20
|
| Rate for Payer: Cash Price |
$44.06
|
| Rate for Payer: Cigna of CA HMO |
$51.27
|
| Rate for Payer: Cigna of CA PPO |
$59.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$68.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$68.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.04
|
| Rate for Payer: EPIC Health Plan Senior |
$32.04
|
| Rate for Payer: Galaxy Health WC |
$68.09
|
| Rate for Payer: Global Benefits Group Commercial |
$48.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$53.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$49.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$56.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$56.08
|
| Rate for Payer: Multiplan Commercial |
$64.09
|
| Rate for Payer: Networks By Design Commercial |
$52.07
|
| Rate for Payer: Prime Health Services Commercial |
$68.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$48.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$48.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$40.05
|
| Rate for Payer: United Healthcare All Other HMO |
$40.05
|
| Rate for Payer: United Healthcare HMO Rider |
$40.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$40.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$68.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.09
|
| Rate for Payer: Vantage Medical Group Senior |
$68.09
|
|
|
HC GUIDE DUOFLEX .018 45MM
|
Facility
|
IP
|
$80.11
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901603717
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.02 |
| Max. Negotiated Rate |
$68.09 |
| Rate for Payer: Adventist Health Commercial |
$16.02
|
| Rate for Payer: Cash Price |
$44.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.04
|
| Rate for Payer: EPIC Health Plan Senior |
$32.04
|
| Rate for Payer: Galaxy Health WC |
$68.09
|
| Rate for Payer: Global Benefits Group Commercial |
$48.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$53.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$49.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.23
|
| Rate for Payer: Multiplan Commercial |
$64.09
|
| Rate for Payer: Networks By Design Commercial |
$52.07
|
| Rate for Payer: Prime Health Services Commercial |
$68.09
|
|
|
HC GUIDE, DUOFLEX 25 X 30
|
Facility
|
OP
|
$69.37
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901602056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.87 |
| Max. Negotiated Rate |
$58.96 |
| Rate for Payer: Adventist Health Commercial |
$13.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$45.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$58.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$52.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$42.60
|
| Rate for Payer: Cash Price |
$38.15
|
| Rate for Payer: Cigna of CA HMO |
$44.40
|
| Rate for Payer: Cigna of CA PPO |
$51.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$58.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$58.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$58.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.75
|
| Rate for Payer: EPIC Health Plan Senior |
$27.75
|
| Rate for Payer: Galaxy Health WC |
$58.96
|
| Rate for Payer: Global Benefits Group Commercial |
$41.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$46.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$42.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$48.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$48.56
|
| Rate for Payer: Multiplan Commercial |
$55.50
|
| Rate for Payer: Networks By Design Commercial |
$45.09
|
| Rate for Payer: Prime Health Services Commercial |
$58.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$41.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$41.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$34.69
|
| Rate for Payer: United Healthcare All Other HMO |
$34.69
|
| Rate for Payer: United Healthcare HMO Rider |
$34.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$58.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$58.96
|
| Rate for Payer: Vantage Medical Group Senior |
$58.96
|
|
|
HC GUIDE, DUOFLEX 25 X 30
|
Facility
|
IP
|
$69.37
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901602056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.87 |
| Max. Negotiated Rate |
$58.96 |
| Rate for Payer: Adventist Health Commercial |
$13.87
|
| Rate for Payer: Cash Price |
$38.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.75
|
| Rate for Payer: EPIC Health Plan Senior |
$27.75
|
| Rate for Payer: Galaxy Health WC |
$58.96
|
| Rate for Payer: Global Benefits Group Commercial |
$41.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$46.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$42.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.65
|
| Rate for Payer: Multiplan Commercial |
$55.50
|
| Rate for Payer: Networks By Design Commercial |
$45.09
|
| Rate for Payer: Prime Health Services Commercial |
$58.96
|
|
|
HC GUIDE HYDROPHILIC 80CM X.018
|
Facility
|
OP
|
$303.52
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901607536
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$60.70 |
| Max. Negotiated Rate |
$257.99 |
| Rate for Payer: Adventist Health Commercial |
$60.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$199.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$257.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$166.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$227.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$186.39
|
| Rate for Payer: Cash Price |
$166.94
|
| Rate for Payer: Cigna of CA HMO |
$194.25
|
| Rate for Payer: Cigna of CA PPO |
$224.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$257.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$257.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$257.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$121.41
|
| Rate for Payer: EPIC Health Plan Senior |
$121.41
|
| Rate for Payer: Galaxy Health WC |
$257.99
|
| Rate for Payer: Global Benefits Group Commercial |
$182.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$202.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$187.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$212.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$212.46
|
| Rate for Payer: Multiplan Commercial |
$242.82
|
| Rate for Payer: Networks By Design Commercial |
$197.29
|
| Rate for Payer: Prime Health Services Commercial |
$257.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$182.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$182.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$151.76
|
| Rate for Payer: United Healthcare All Other HMO |
$151.76
|
| Rate for Payer: United Healthcare HMO Rider |
$151.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$151.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$257.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$257.99
|
| Rate for Payer: Vantage Medical Group Senior |
$257.99
|
|
|
HC GUIDE HYDROPHILIC 80CM X.018
|
Facility
|
IP
|
$303.52
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901607536
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$60.70 |
| Max. Negotiated Rate |
$257.99 |
| Rate for Payer: Adventist Health Commercial |
$60.70
|
| Rate for Payer: Cash Price |
$166.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$121.41
|
| Rate for Payer: EPIC Health Plan Senior |
$121.41
|
| Rate for Payer: Galaxy Health WC |
$257.99
|
| Rate for Payer: Global Benefits Group Commercial |
$182.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$202.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$187.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.84
|
| Rate for Payer: Multiplan Commercial |
$242.82
|
| Rate for Payer: Networks By Design Commercial |
$197.29
|
| Rate for Payer: Prime Health Services Commercial |
$257.99
|
|
|
HC GUIDE HYDROPHILLIC.008 COATED
|
Facility
|
IP
|
$261.59
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901605118
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$52.32 |
| Max. Negotiated Rate |
$222.35 |
| Rate for Payer: Adventist Health Commercial |
$52.32
|
| Rate for Payer: Cash Price |
$143.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$104.64
|
| Rate for Payer: EPIC Health Plan Senior |
$104.64
|
| Rate for Payer: Galaxy Health WC |
$222.35
|
| Rate for Payer: Global Benefits Group Commercial |
$156.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$174.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$99.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$161.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.78
|
| Rate for Payer: Multiplan Commercial |
$209.27
|
| Rate for Payer: Networks By Design Commercial |
$170.03
|
| Rate for Payer: Prime Health Services Commercial |
$222.35
|
|
|
HC GUIDE HYDROPHILLIC.008 COATED
|
Facility
|
OP
|
$261.59
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901605118
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$52.32 |
| Max. Negotiated Rate |
$222.35 |
| Rate for Payer: Adventist Health Commercial |
$52.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$171.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$222.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$143.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$196.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$160.64
|
| Rate for Payer: Cash Price |
$143.87
|
| Rate for Payer: Cigna of CA HMO |
$167.42
|
| Rate for Payer: Cigna of CA PPO |
$193.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$222.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$222.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$222.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$104.64
|
| Rate for Payer: EPIC Health Plan Senior |
$104.64
|
| Rate for Payer: Galaxy Health WC |
$222.35
|
| Rate for Payer: Global Benefits Group Commercial |
$156.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$174.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$99.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$161.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$183.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$183.11
|
| Rate for Payer: Multiplan Commercial |
$209.27
|
| Rate for Payer: Networks By Design Commercial |
$170.03
|
| Rate for Payer: Prime Health Services Commercial |
$222.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$156.95
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$156.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$130.79
|
| Rate for Payer: United Healthcare All Other HMO |
$130.79
|
| Rate for Payer: United Healthcare HMO Rider |
$130.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$130.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$222.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$222.35
|
| Rate for Payer: Vantage Medical Group Senior |
$222.35
|
|
|
HC GUIDE NERV DESTR, ELEC STIM
|
Facility
|
IP
|
$294.00
|
|
|
Service Code
|
CPT 95873
|
| Hospital Charge Code |
900600242
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$58.80 |
| Max. Negotiated Rate |
$249.90 |
| Rate for Payer: Adventist Health Commercial |
$58.80
|
| Rate for Payer: Cash Price |
$161.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$117.60
|
| Rate for Payer: EPIC Health Plan Senior |
$117.60
|
| Rate for Payer: Galaxy Health WC |
$249.90
|
| Rate for Payer: Global Benefits Group Commercial |
$176.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$196.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$112.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$181.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.56
|
| Rate for Payer: Multiplan Commercial |
$235.20
|
| Rate for Payer: Networks By Design Commercial |
$191.10
|
| Rate for Payer: Prime Health Services Commercial |
$249.90
|
|
|
HC GUIDE NERV DESTR, ELEC STIM
|
Facility
|
OP
|
$294.00
|
|
|
Service Code
|
CPT 95873
|
| Hospital Charge Code |
900600242
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$41.14 |
| Max. Negotiated Rate |
$1,297.00 |
| Rate for Payer: Adventist Health Commercial |
$58.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$192.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$249.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$161.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$220.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$180.55
|
| Rate for Payer: Blue Shield of California Commercial |
$179.93
|
| Rate for Payer: Blue Shield of California EPN |
$118.78
|
| Rate for Payer: Cash Price |
$161.70
|
| Rate for Payer: Cash Price |
$161.70
|
| Rate for Payer: Cash Price |
$161.70
|
| Rate for Payer: Cigna of CA HMO |
$188.16
|
| Rate for Payer: Cigna of CA PPO |
$217.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$249.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$249.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$249.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$117.60
|
| Rate for Payer: EPIC Health Plan Senior |
$117.60
|
| Rate for Payer: Galaxy Health WC |
$249.90
|
| Rate for Payer: Global Benefits Group Commercial |
$176.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$41.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$196.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$181.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$205.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$205.80
|
| Rate for Payer: Multiplan Commercial |
$235.20
|
| Rate for Payer: Networks By Design Commercial |
$191.10
|
| Rate for Payer: Prime Health Services Commercial |
$249.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$176.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$176.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,297.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,024.00
|
| Rate for Payer: United Healthcare HMO Rider |
$776.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$711.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$249.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$249.90
|
| Rate for Payer: Vantage Medical Group Senior |
$249.90
|
|
|
HC GUIDE NERV DESTR NEEDLE EMG
|
Facility
|
OP
|
$298.00
|
|
|
Service Code
|
CPT 95874
|
| Hospital Charge Code |
900600243
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$41.71 |
| Max. Negotiated Rate |
$1,297.00 |
| Rate for Payer: Adventist Health Commercial |
$59.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$195.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$253.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$163.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$223.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$183.00
|
| Rate for Payer: Blue Shield of California Commercial |
$182.38
|
| Rate for Payer: Blue Shield of California EPN |
$120.39
|
| Rate for Payer: Cash Price |
$163.90
|
| Rate for Payer: Cash Price |
$163.90
|
| Rate for Payer: Cash Price |
$163.90
|
| Rate for Payer: Cigna of CA HMO |
$190.72
|
| Rate for Payer: Cigna of CA PPO |
$220.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$253.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$253.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$253.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$119.20
|
| Rate for Payer: EPIC Health Plan Senior |
$119.20
|
| Rate for Payer: Galaxy Health WC |
$253.30
|
| Rate for Payer: Global Benefits Group Commercial |
$178.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$41.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$198.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$184.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$208.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$208.60
|
| Rate for Payer: Multiplan Commercial |
$238.40
|
| Rate for Payer: Networks By Design Commercial |
$193.70
|
| Rate for Payer: Prime Health Services Commercial |
$253.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$178.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$178.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,297.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,024.00
|
| Rate for Payer: United Healthcare HMO Rider |
$776.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$711.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$253.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$253.30
|
| Rate for Payer: Vantage Medical Group Senior |
$253.30
|
|
|
HC GUIDE NERV DESTR NEEDLE EMG
|
Facility
|
IP
|
$298.00
|
|
|
Service Code
|
CPT 95874
|
| Hospital Charge Code |
900600243
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$59.60 |
| Max. Negotiated Rate |
$253.30 |
| Rate for Payer: Adventist Health Commercial |
$59.60
|
| Rate for Payer: Cash Price |
$163.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$119.20
|
| Rate for Payer: EPIC Health Plan Senior |
$119.20
|
| Rate for Payer: Galaxy Health WC |
$253.30
|
| Rate for Payer: Global Benefits Group Commercial |
$178.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$198.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$113.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$184.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.52
|
| Rate for Payer: Multiplan Commercial |
$238.40
|
| Rate for Payer: Networks By Design Commercial |
$193.70
|
| Rate for Payer: Prime Health Services Commercial |
$253.30
|
|
|
HC GUIDE NITINOL MANDREL 40CM .014"
|
Facility
|
OP
|
$154.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901698137
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.80 |
| Max. Negotiated Rate |
$130.90 |
| Rate for Payer: Adventist Health Commercial |
$30.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$101.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$130.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$84.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$115.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$94.57
|
| Rate for Payer: Cash Price |
$84.70
|
| Rate for Payer: Cigna of CA HMO |
$98.56
|
| Rate for Payer: Cigna of CA PPO |
$113.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$130.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$130.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$130.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.60
|
| Rate for Payer: EPIC Health Plan Senior |
$61.60
|
| Rate for Payer: Galaxy Health WC |
$130.90
|
| Rate for Payer: Global Benefits Group Commercial |
$92.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$102.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$95.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$107.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$107.80
|
| Rate for Payer: Multiplan Commercial |
$123.20
|
| Rate for Payer: Networks By Design Commercial |
$100.10
|
| Rate for Payer: Prime Health Services Commercial |
$130.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$92.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$92.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$77.00
|
| Rate for Payer: United Healthcare All Other HMO |
$77.00
|
| Rate for Payer: United Healthcare HMO Rider |
$77.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$77.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$130.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$130.90
|
| Rate for Payer: Vantage Medical Group Senior |
$130.90
|
|
|
HC GUIDE NITINOL MANDREL 40CM .014"
|
Facility
|
IP
|
$154.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901698137
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.80 |
| Max. Negotiated Rate |
$130.90 |
| Rate for Payer: Adventist Health Commercial |
$30.80
|
| Rate for Payer: Cash Price |
$84.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.60
|
| Rate for Payer: EPIC Health Plan Senior |
$61.60
|
| Rate for Payer: Galaxy Health WC |
$130.90
|
| Rate for Payer: Global Benefits Group Commercial |
$92.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$102.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$95.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.96
|
| Rate for Payer: Multiplan Commercial |
$123.20
|
| Rate for Payer: Networks By Design Commercial |
$100.10
|
| Rate for Payer: Prime Health Services Commercial |
$130.90
|
|
|
HC GUIDE NITINOL MANDREL 60CM .018"
|
Facility
|
IP
|
$182.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901698136
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.40 |
| Max. Negotiated Rate |
$154.70 |
| Rate for Payer: Adventist Health Commercial |
$36.40
|
| Rate for Payer: Cash Price |
$100.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.80
|
| Rate for Payer: EPIC Health Plan Senior |
$72.80
|
| Rate for Payer: Galaxy Health WC |
$154.70
|
| Rate for Payer: Global Benefits Group Commercial |
$109.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$121.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$69.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$112.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.68
|
| Rate for Payer: Multiplan Commercial |
$145.60
|
| Rate for Payer: Networks By Design Commercial |
$118.30
|
| Rate for Payer: Prime Health Services Commercial |
$154.70
|
|
