|
HC GUIDE NITINOL MANDREL 60CM .018"
|
Facility
|
OP
|
$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: Aetna of CA HMO/PPO |
$119.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$154.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$100.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$136.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$111.77
|
| Rate for Payer: Cash Price |
$100.10
|
| Rate for Payer: Cigna of CA HMO |
$116.48
|
| Rate for Payer: Cigna of CA PPO |
$134.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$154.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$154.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$154.70
|
| 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: Molina Healthcare of CA Medi-Cal |
$127.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$127.40
|
| 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
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$109.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$109.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$91.00
|
| Rate for Payer: United Healthcare All Other HMO |
$91.00
|
| Rate for Payer: United Healthcare HMO Rider |
$91.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$91.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$154.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$154.70
|
| Rate for Payer: Vantage Medical Group Senior |
$154.70
|
|
|
HC GUIDE STR 0.021IN X 50CM
|
Facility
|
IP
|
$79.62
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901605558
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.92 |
| Max. Negotiated Rate |
$67.68 |
| Rate for Payer: Adventist Health Commercial |
$15.92
|
| Rate for Payer: Cash Price |
$43.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.85
|
| Rate for Payer: EPIC Health Plan Senior |
$31.85
|
| Rate for Payer: Galaxy Health WC |
$67.68
|
| Rate for Payer: Global Benefits Group Commercial |
$47.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$53.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$49.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.11
|
| Rate for Payer: Multiplan Commercial |
$63.70
|
| Rate for Payer: Networks By Design Commercial |
$51.75
|
| Rate for Payer: Prime Health Services Commercial |
$67.68
|
|
|
HC GUIDE STR 0.021IN X 50CM
|
Facility
|
OP
|
$79.62
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901605558
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.92 |
| Max. Negotiated Rate |
$67.68 |
| Rate for Payer: Adventist Health Commercial |
$15.92
|
| Rate for Payer: Aetna of CA HMO/PPO |
$52.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$67.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$43.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$59.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48.89
|
| Rate for Payer: Cash Price |
$43.79
|
| Rate for Payer: Cigna of CA HMO |
$50.96
|
| Rate for Payer: Cigna of CA PPO |
$58.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$67.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$67.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$67.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.85
|
| Rate for Payer: EPIC Health Plan Senior |
$31.85
|
| Rate for Payer: Galaxy Health WC |
$67.68
|
| Rate for Payer: Global Benefits Group Commercial |
$47.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$53.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$49.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$55.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$55.73
|
| Rate for Payer: Multiplan Commercial |
$63.70
|
| Rate for Payer: Networks By Design Commercial |
$51.75
|
| Rate for Payer: Prime Health Services Commercial |
$67.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$47.77
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$47.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$39.81
|
| Rate for Payer: United Healthcare All Other HMO |
$39.81
|
| Rate for Payer: United Healthcare HMO Rider |
$39.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$39.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$67.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$67.68
|
| Rate for Payer: Vantage Medical Group Senior |
$67.68
|
|
|
HC GUIDE STRAIGHT .038"X145C
|
Facility
|
OP
|
$64.53
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901603847
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.91 |
| Max. Negotiated Rate |
$54.85 |
| Rate for Payer: Adventist Health Commercial |
$12.91
|
| Rate for Payer: Aetna of CA HMO/PPO |
$42.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$54.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$35.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$48.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$39.63
|
| Rate for Payer: Cash Price |
$35.49
|
| Rate for Payer: Cigna of CA HMO |
$41.30
|
| Rate for Payer: Cigna of CA PPO |
$47.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$54.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$54.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$54.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.81
|
| Rate for Payer: EPIC Health Plan Senior |
$25.81
|
| Rate for Payer: Galaxy Health WC |
$54.85
|
| Rate for Payer: Global Benefits Group Commercial |
$38.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$43.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$39.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$45.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$45.17
|
| Rate for Payer: Multiplan Commercial |
$51.62
|
| Rate for Payer: Networks By Design Commercial |
$41.94
|
| Rate for Payer: Prime Health Services Commercial |
$54.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$38.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$38.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$32.27
|
| Rate for Payer: United Healthcare All Other HMO |
$32.27
|
| Rate for Payer: United Healthcare HMO Rider |
$32.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$54.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$54.85
|
| Rate for Payer: Vantage Medical Group Senior |
$54.85
|
|
|
HC GUIDE STRAIGHT .038"X145C
|
Facility
|
IP
|
$64.53
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901603847
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.91 |
| Max. Negotiated Rate |
$54.85 |
| Rate for Payer: Adventist Health Commercial |
$12.91
|
| Rate for Payer: Cash Price |
$35.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.81
|
| Rate for Payer: EPIC Health Plan Senior |
$25.81
|
| Rate for Payer: Galaxy Health WC |
$54.85
|
| Rate for Payer: Global Benefits Group Commercial |
$38.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$43.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$39.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.49
|
| Rate for Payer: Multiplan Commercial |
$51.62
|
| Rate for Payer: Networks By Design Commercial |
$41.94
|
| Rate for Payer: Prime Health Services Commercial |
$54.85
|
|
|
HC GUIDE VASONOVA VPS
|
Facility
|
OP
|
$586.55
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901606278
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$117.31 |
| Max. Negotiated Rate |
$498.57 |
| Rate for Payer: Adventist Health Commercial |
$117.31
|
| Rate for Payer: Aetna of CA HMO/PPO |
$384.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$498.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$322.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$439.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$360.20
|
| Rate for Payer: Cash Price |
$322.60
|
| Rate for Payer: Cigna of CA HMO |
$375.39
|
| Rate for Payer: Cigna of CA PPO |
$434.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$498.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$498.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$498.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$234.62
|
| Rate for Payer: EPIC Health Plan Senior |
$234.62
|
| Rate for Payer: Galaxy Health WC |
$498.57
|
| Rate for Payer: Global Benefits Group Commercial |
$351.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$391.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$223.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$363.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$410.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$410.58
|
| Rate for Payer: Multiplan Commercial |
$469.24
|
| Rate for Payer: Networks By Design Commercial |
$381.26
|
| Rate for Payer: Prime Health Services Commercial |
$498.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$351.93
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$351.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$293.27
|
| Rate for Payer: United Healthcare All Other HMO |
$293.27
|
| Rate for Payer: United Healthcare HMO Rider |
$293.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$293.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$498.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$498.57
|
| Rate for Payer: Vantage Medical Group Senior |
$498.57
|
|
|
HC GUIDE VASONOVA VPS
|
Facility
|
IP
|
$586.55
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901606278
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$117.31 |
| Max. Negotiated Rate |
$498.57 |
| Rate for Payer: Adventist Health Commercial |
$117.31
|
| Rate for Payer: Cash Price |
$322.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$234.62
|
| Rate for Payer: EPIC Health Plan Senior |
$234.62
|
| Rate for Payer: Galaxy Health WC |
$498.57
|
| Rate for Payer: Global Benefits Group Commercial |
$351.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$391.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$223.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$363.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.77
|
| Rate for Payer: Multiplan Commercial |
$469.24
|
| Rate for Payer: Networks By Design Commercial |
$381.26
|
| Rate for Payer: Prime Health Services Commercial |
$498.57
|
|
|
HC GUIDEWIRE ASAHI CHAKAI
|
Facility
|
OP
|
$2,070.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909000019
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$414.00 |
| Max. Negotiated Rate |
$1,759.50 |
| Rate for Payer: Adventist Health Commercial |
$414.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,357.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,759.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,138.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,552.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,271.19
|
| Rate for Payer: Cash Price |
$1,138.50
|
| Rate for Payer: Cigna of CA HMO |
$1,324.80
|
| Rate for Payer: Cigna of CA PPO |
$1,531.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,759.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,759.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,759.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$828.00
|
| Rate for Payer: EPIC Health Plan Senior |
$828.00
|
| Rate for Payer: Galaxy Health WC |
$1,759.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,242.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,380.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$788.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,281.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$496.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,449.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,449.00
|
| Rate for Payer: Multiplan Commercial |
$1,656.00
|
| Rate for Payer: Networks By Design Commercial |
$1,345.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,759.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,242.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,242.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,035.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,035.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,035.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,035.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,759.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,759.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,759.50
|
|
|
HC GUIDEWIRE ASAHI CHAKAI
|
Facility
|
IP
|
$2,070.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909000019
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$414.00 |
| Max. Negotiated Rate |
$1,759.50 |
| Rate for Payer: Adventist Health Commercial |
$414.00
|
| Rate for Payer: Cash Price |
$1,138.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$828.00
|
| Rate for Payer: EPIC Health Plan Senior |
$828.00
|
| Rate for Payer: Galaxy Health WC |
$1,759.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,242.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,380.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$788.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,281.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$496.80
|
| Rate for Payer: Multiplan Commercial |
$1,656.00
|
| Rate for Payer: Networks By Design Commercial |
$1,345.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,759.50
|
|
|
HC GUIDEWIRE/DIAG STARTER
|
Facility
|
OP
|
$106.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909081225
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.20 |
| Max. Negotiated Rate |
$90.10 |
| Rate for Payer: Adventist Health Commercial |
$21.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$69.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$90.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$58.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$79.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$65.09
|
| Rate for Payer: Cash Price |
$58.30
|
| Rate for Payer: Cigna of CA HMO |
$67.84
|
| Rate for Payer: Cigna of CA PPO |
$78.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$90.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$90.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$90.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.40
|
| Rate for Payer: EPIC Health Plan Senior |
$42.40
|
| Rate for Payer: Galaxy Health WC |
$90.10
|
| Rate for Payer: Global Benefits Group Commercial |
$63.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$70.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$65.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$74.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$74.20
|
| Rate for Payer: Multiplan Commercial |
$84.80
|
| Rate for Payer: Networks By Design Commercial |
$68.90
|
| Rate for Payer: Prime Health Services Commercial |
$90.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$63.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$63.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$53.00
|
| Rate for Payer: United Healthcare All Other HMO |
$53.00
|
| Rate for Payer: United Healthcare HMO Rider |
$53.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$53.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$90.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$90.10
|
| Rate for Payer: Vantage Medical Group Senior |
$90.10
|
|
|
HC GUIDEWIRE/DIAG STARTER
|
Facility
|
IP
|
$106.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909081225
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.20 |
| Max. Negotiated Rate |
$90.10 |
| Rate for Payer: Adventist Health Commercial |
$21.20
|
| Rate for Payer: Cash Price |
$58.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.40
|
| Rate for Payer: EPIC Health Plan Senior |
$42.40
|
| Rate for Payer: Galaxy Health WC |
$90.10
|
| Rate for Payer: Global Benefits Group Commercial |
$63.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$70.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$65.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.44
|
| Rate for Payer: Multiplan Commercial |
$84.80
|
| Rate for Payer: Networks By Design Commercial |
$68.90
|
| Rate for Payer: Prime Health Services Commercial |
$90.10
|
|
|
HC GUIDEWIRE EXCELSIOR 18
|
Facility
|
IP
|
$3,842.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909000021
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$768.40 |
| Max. Negotiated Rate |
$3,265.70 |
| Rate for Payer: Adventist Health Commercial |
$768.40
|
| Rate for Payer: Cash Price |
$2,113.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,536.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,536.80
|
| Rate for Payer: Galaxy Health WC |
$3,265.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,305.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,562.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,463.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,378.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$922.08
|
| Rate for Payer: Multiplan Commercial |
$3,073.60
|
| Rate for Payer: Networks By Design Commercial |
$2,497.30
|
| Rate for Payer: Prime Health Services Commercial |
$3,265.70
|
|
|
HC GUIDEWIRE EXCELSIOR 18
|
Facility
|
OP
|
$3,842.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909000021
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$768.40 |
| Max. Negotiated Rate |
$3,265.70 |
| Rate for Payer: Adventist Health Commercial |
$768.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,519.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,265.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,113.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,881.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,359.37
|
| Rate for Payer: Cash Price |
$2,113.10
|
| Rate for Payer: Cigna of CA HMO |
$2,458.88
|
| Rate for Payer: Cigna of CA PPO |
$2,843.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,265.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,265.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,265.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,536.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,536.80
|
| Rate for Payer: Galaxy Health WC |
$3,265.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,305.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,562.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,463.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,378.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$922.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,689.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,689.40
|
| Rate for Payer: Multiplan Commercial |
$3,073.60
|
| Rate for Payer: Networks By Design Commercial |
$2,497.30
|
| Rate for Payer: Prime Health Services Commercial |
$3,265.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,305.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,305.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,921.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,921.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,921.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,921.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,265.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,265.70
|
| Rate for Payer: Vantage Medical Group Senior |
$3,265.70
|
|
|
HC GUIDEWIRE FIX CORE STRT 180CM
|
Facility
|
OP
|
$81.92
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901698839
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.38 |
| Max. Negotiated Rate |
$69.63 |
| Rate for Payer: Adventist Health Commercial |
$16.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$53.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$69.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$61.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$50.31
|
| Rate for Payer: Cash Price |
$45.06
|
| Rate for Payer: Cigna of CA HMO |
$52.43
|
| Rate for Payer: Cigna of CA PPO |
$60.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$69.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$69.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$69.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.77
|
| Rate for Payer: EPIC Health Plan Senior |
$32.77
|
| Rate for Payer: Galaxy Health WC |
$69.63
|
| Rate for Payer: Global Benefits Group Commercial |
$49.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$57.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$57.34
|
| Rate for Payer: Multiplan Commercial |
$65.54
|
| Rate for Payer: Networks By Design Commercial |
$53.25
|
| Rate for Payer: Prime Health Services Commercial |
$69.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$40.96
|
| Rate for Payer: United Healthcare All Other HMO |
$40.96
|
| Rate for Payer: United Healthcare HMO Rider |
$40.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$40.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$69.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$69.63
|
| Rate for Payer: Vantage Medical Group Senior |
$69.63
|
|
|
HC GUIDEWIRE FIX CORE STRT 180CM
|
Facility
|
IP
|
$81.92
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901698839
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.38 |
| Max. Negotiated Rate |
$69.63 |
| Rate for Payer: Adventist Health Commercial |
$16.38
|
| Rate for Payer: Cash Price |
$45.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.77
|
| Rate for Payer: EPIC Health Plan Senior |
$32.77
|
| Rate for Payer: Galaxy Health WC |
$69.63
|
| Rate for Payer: Global Benefits Group Commercial |
$49.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.66
|
| Rate for Payer: Multiplan Commercial |
$65.54
|
| Rate for Payer: Networks By Design Commercial |
$53.25
|
| Rate for Payer: Prime Health Services Commercial |
$69.63
|
|
|
HC GUIDEWIRE/GLIDE/AMPLATZ
|
Facility
|
IP
|
$72.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909081288
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$61.20 |
| Rate for Payer: Adventist Health Commercial |
$14.40
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.80
|
| Rate for Payer: EPIC Health Plan Senior |
$28.80
|
| Rate for Payer: Galaxy Health WC |
$61.20
|
| Rate for Payer: Global Benefits Group Commercial |
$43.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$48.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$44.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.28
|
| Rate for Payer: Multiplan Commercial |
$57.60
|
| Rate for Payer: Networks By Design Commercial |
$46.80
|
| Rate for Payer: Prime Health Services Commercial |
$61.20
|
|
|
HC GUIDEWIRE/GLIDE/AMPLATZ
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909081288
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$61.20 |
| Rate for Payer: Adventist Health Commercial |
$14.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$47.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$61.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$39.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$54.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$44.22
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cigna of CA HMO |
$46.08
|
| Rate for Payer: Cigna of CA PPO |
$53.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$61.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$61.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$61.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.80
|
| Rate for Payer: EPIC Health Plan Senior |
$28.80
|
| Rate for Payer: Galaxy Health WC |
$61.20
|
| Rate for Payer: Global Benefits Group Commercial |
$43.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$48.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$44.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$50.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$50.40
|
| Rate for Payer: Multiplan Commercial |
$57.60
|
| Rate for Payer: Networks By Design Commercial |
$46.80
|
| Rate for Payer: Prime Health Services Commercial |
$61.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$43.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$43.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$36.00
|
| Rate for Payer: United Healthcare All Other HMO |
$36.00
|
| Rate for Payer: United Healthcare HMO Rider |
$36.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$61.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$61.20
|
| Rate for Payer: Vantage Medical Group Senior |
$61.20
|
|
|
HC GUIDEWIRE GOLD TIP
|
Facility
|
IP
|
$1,334.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909000011
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$266.80 |
| Max. Negotiated Rate |
$1,133.90 |
| Rate for Payer: Adventist Health Commercial |
$266.80
|
| Rate for Payer: Cash Price |
$733.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$533.60
|
| Rate for Payer: EPIC Health Plan Senior |
$533.60
|
| Rate for Payer: Galaxy Health WC |
$1,133.90
|
| Rate for Payer: Global Benefits Group Commercial |
$800.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$889.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$508.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$825.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$320.16
|
| Rate for Payer: Multiplan Commercial |
$1,067.20
|
| Rate for Payer: Networks By Design Commercial |
$867.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,133.90
|
|
|
HC GUIDEWIRE GOLD TIP
|
Facility
|
OP
|
$1,334.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909000011
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$266.80 |
| Max. Negotiated Rate |
$1,133.90 |
| Rate for Payer: Galaxy Health WC |
$1,133.90
|
| Rate for Payer: Adventist Health Commercial |
$266.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$874.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,133.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$733.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,000.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$819.21
|
| Rate for Payer: Cash Price |
$733.70
|
| Rate for Payer: Cigna of CA HMO |
$853.76
|
| Rate for Payer: Cigna of CA PPO |
$987.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,133.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,133.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,133.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$533.60
|
| Rate for Payer: EPIC Health Plan Senior |
$533.60
|
| Rate for Payer: Global Benefits Group Commercial |
$800.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$889.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$508.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$825.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$320.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$933.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$933.80
|
| Rate for Payer: Multiplan Commercial |
$1,067.20
|
| Rate for Payer: Networks By Design Commercial |
$867.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,133.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$800.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$800.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$667.00
|
| Rate for Payer: United Healthcare All Other HMO |
$667.00
|
| Rate for Payer: United Healthcare HMO Rider |
$667.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$667.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,133.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,133.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1,133.90
|
|
|
HC GUIDEWIRE HYDROPHILIC SS 80CM
|
Facility
|
OP
|
$266.49
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901698648
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$53.30 |
| Max. Negotiated Rate |
$226.52 |
| Rate for Payer: Adventist Health Commercial |
$53.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$174.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$226.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$146.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$199.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$163.65
|
| Rate for Payer: Cash Price |
$146.57
|
| Rate for Payer: Cigna of CA HMO |
$170.55
|
| Rate for Payer: Cigna of CA PPO |
$197.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$226.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$226.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$226.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.60
|
| Rate for Payer: EPIC Health Plan Senior |
$106.60
|
| Rate for Payer: Galaxy Health WC |
$226.52
|
| Rate for Payer: Global Benefits Group Commercial |
$159.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$177.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$101.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$164.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$186.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$186.54
|
| Rate for Payer: Multiplan Commercial |
$213.19
|
| Rate for Payer: Networks By Design Commercial |
$173.22
|
| Rate for Payer: Prime Health Services Commercial |
$226.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$159.89
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$159.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$133.25
|
| Rate for Payer: United Healthcare All Other HMO |
$133.25
|
| Rate for Payer: United Healthcare HMO Rider |
$133.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$133.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$226.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$226.52
|
| Rate for Payer: Vantage Medical Group Senior |
$226.52
|
|
|
HC GUIDEWIRE HYDROPHILIC SS 80CM
|
Facility
|
IP
|
$266.49
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901698648
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$53.30 |
| Max. Negotiated Rate |
$226.52 |
| Rate for Payer: Adventist Health Commercial |
$53.30
|
| Rate for Payer: Cash Price |
$146.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.60
|
| Rate for Payer: EPIC Health Plan Senior |
$106.60
|
| Rate for Payer: Galaxy Health WC |
$226.52
|
| Rate for Payer: Global Benefits Group Commercial |
$159.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$177.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$101.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$164.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.96
|
| Rate for Payer: Multiplan Commercial |
$213.19
|
| Rate for Payer: Networks By Design Commercial |
$173.22
|
| Rate for Payer: Prime Health Services Commercial |
$226.52
|
|
|
HC GUIDEWIRE, JINDO TAPERED
|
Facility
|
OP
|
$432.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909081418
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$86.40 |
| Max. Negotiated Rate |
$367.20 |
| Rate for Payer: Adventist Health Commercial |
$86.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$283.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$367.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$237.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$324.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$265.29
|
| Rate for Payer: Cash Price |
$237.60
|
| Rate for Payer: Cigna of CA HMO |
$276.48
|
| Rate for Payer: Cigna of CA PPO |
$319.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$367.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$367.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$367.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$172.80
|
| Rate for Payer: EPIC Health Plan Senior |
$172.80
|
| Rate for Payer: Galaxy Health WC |
$367.20
|
| Rate for Payer: Global Benefits Group Commercial |
$259.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$288.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$164.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$267.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$103.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$302.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$302.40
|
| Rate for Payer: Multiplan Commercial |
$345.60
|
| Rate for Payer: Networks By Design Commercial |
$280.80
|
| Rate for Payer: Prime Health Services Commercial |
$367.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$259.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$259.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$216.00
|
| Rate for Payer: United Healthcare All Other HMO |
$216.00
|
| Rate for Payer: United Healthcare HMO Rider |
$216.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$216.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$367.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$367.20
|
| Rate for Payer: Vantage Medical Group Senior |
$367.20
|
|
|
HC GUIDEWIRE, JINDO TAPERED
|
Facility
|
IP
|
$432.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909081418
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$86.40 |
| Max. Negotiated Rate |
$367.20 |
| Rate for Payer: Adventist Health Commercial |
$86.40
|
| Rate for Payer: Cash Price |
$237.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$172.80
|
| Rate for Payer: EPIC Health Plan Senior |
$172.80
|
| Rate for Payer: Galaxy Health WC |
$367.20
|
| Rate for Payer: Global Benefits Group Commercial |
$259.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$288.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$164.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$267.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$103.68
|
| Rate for Payer: Multiplan Commercial |
$345.60
|
| Rate for Payer: Networks By Design Commercial |
$280.80
|
| Rate for Payer: Prime Health Services Commercial |
$367.20
|
|
|
HC GUIDEWIRE, LUNDERQUIST
|
Facility
|
OP
|
$378.74
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909020084
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$75.75 |
| Max. Negotiated Rate |
$321.93 |
| Rate for Payer: Adventist Health Commercial |
$75.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$248.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$321.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$208.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$284.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$232.58
|
| Rate for Payer: Cash Price |
$208.31
|
| Rate for Payer: Cigna of CA HMO |
$242.39
|
| Rate for Payer: Cigna of CA PPO |
$280.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$321.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$321.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$321.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.50
|
| Rate for Payer: EPIC Health Plan Senior |
$151.50
|
| Rate for Payer: Galaxy Health WC |
$321.93
|
| Rate for Payer: Global Benefits Group Commercial |
$227.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$252.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$144.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$234.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$265.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$265.12
|
| Rate for Payer: Multiplan Commercial |
$302.99
|
| Rate for Payer: Networks By Design Commercial |
$246.18
|
| Rate for Payer: Prime Health Services Commercial |
$321.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$227.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$227.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$189.37
|
| Rate for Payer: United Healthcare All Other HMO |
$189.37
|
| Rate for Payer: United Healthcare HMO Rider |
$189.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$189.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$321.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$321.93
|
| Rate for Payer: Vantage Medical Group Senior |
$321.93
|
|
|
HC GUIDEWIRE, LUNDERQUIST
|
Facility
|
IP
|
$378.74
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909020084
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$75.75 |
| Max. Negotiated Rate |
$321.93 |
| Rate for Payer: Adventist Health Commercial |
$75.75
|
| Rate for Payer: Cash Price |
$208.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.50
|
| Rate for Payer: EPIC Health Plan Senior |
$151.50
|
| Rate for Payer: Galaxy Health WC |
$321.93
|
| Rate for Payer: Global Benefits Group Commercial |
$227.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$252.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$144.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$234.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.90
|
| Rate for Payer: Multiplan Commercial |
$302.99
|
| Rate for Payer: Networks By Design Commercial |
$246.18
|
| Rate for Payer: Prime Health Services Commercial |
$321.93
|
|
