|
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 |
$32.40
|
| 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 |
$600.30
|
| 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: 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 |
$600.30
|
| 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: 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: 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 |
$119.92
|
| 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 |
$119.92
|
| 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 |
$194.40
|
| 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 |
$194.40
|
| 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
|
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 |
$170.43
|
| 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
|
|
|
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 |
$170.43
|
| 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 GUIDE WIRE M
|
Facility
|
OP
|
$900.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
900803803
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$180.00 |
| Max. Negotiated Rate |
$765.00 |
| Rate for Payer: Adventist Health Commercial |
$180.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$590.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$765.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$495.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$675.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$552.69
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cigna of CA HMO |
$576.00
|
| Rate for Payer: Cigna of CA PPO |
$666.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$765.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$765.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$765.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$360.00
|
| Rate for Payer: EPIC Health Plan Senior |
$360.00
|
| Rate for Payer: Galaxy Health WC |
$765.00
|
| Rate for Payer: Global Benefits Group Commercial |
$540.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$600.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$342.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$557.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$216.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$630.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$630.00
|
| Rate for Payer: Multiplan Commercial |
$720.00
|
| Rate for Payer: Networks By Design Commercial |
$585.00
|
| Rate for Payer: Prime Health Services Commercial |
$765.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$540.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$540.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$450.00
|
| Rate for Payer: United Healthcare All Other HMO |
$450.00
|
| Rate for Payer: United Healthcare HMO Rider |
$450.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$450.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$765.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$765.00
|
| Rate for Payer: Vantage Medical Group Senior |
$765.00
|
|
|
HC GUIDE WIRE M
|
Facility
|
IP
|
$900.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
900803803
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$180.00 |
| Max. Negotiated Rate |
$765.00 |
| Rate for Payer: Adventist Health Commercial |
$180.00
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$360.00
|
| Rate for Payer: EPIC Health Plan Senior |
$360.00
|
| Rate for Payer: Galaxy Health WC |
$765.00
|
| Rate for Payer: Global Benefits Group Commercial |
$540.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$600.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$342.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$557.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$216.00
|
| Rate for Payer: Multiplan Commercial |
$720.00
|
| Rate for Payer: Networks By Design Commercial |
$585.00
|
| Rate for Payer: Prime Health Services Commercial |
$765.00
|
|
|
HC GUIDEWIRE, PERSUADER
|
Facility
|
IP
|
$551.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909020116
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$110.20 |
| Max. Negotiated Rate |
$468.35 |
| Rate for Payer: Adventist Health Commercial |
$110.20
|
| Rate for Payer: Cash Price |
$247.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$220.40
|
| Rate for Payer: EPIC Health Plan Senior |
$220.40
|
| Rate for Payer: Galaxy Health WC |
$468.35
|
| Rate for Payer: Global Benefits Group Commercial |
$330.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$367.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$209.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$341.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$132.24
|
| Rate for Payer: Multiplan Commercial |
$440.80
|
| Rate for Payer: Networks By Design Commercial |
$358.15
|
| Rate for Payer: Prime Health Services Commercial |
$468.35
|
|
|
HC GUIDEWIRE, PERSUADER
|
Facility
|
OP
|
$551.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909020116
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$110.20 |
| Max. Negotiated Rate |
$468.35 |
| Rate for Payer: Adventist Health Commercial |
$110.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$361.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$468.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$303.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$413.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$338.37
|
| Rate for Payer: Cash Price |
$247.95
|
| Rate for Payer: Cigna of CA HMO |
$352.64
|
| Rate for Payer: Cigna of CA PPO |
$407.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$468.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$468.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$468.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$220.40
|
| Rate for Payer: EPIC Health Plan Senior |
$220.40
|
| Rate for Payer: Galaxy Health WC |
$468.35
|
| Rate for Payer: Global Benefits Group Commercial |
$330.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$367.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$209.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$341.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$132.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$385.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$385.70
|
| Rate for Payer: Multiplan Commercial |
$440.80
|
| Rate for Payer: Networks By Design Commercial |
$358.15
|
| Rate for Payer: Prime Health Services Commercial |
$468.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$330.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$330.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$275.50
|
| Rate for Payer: United Healthcare All Other HMO |
$275.50
|
| Rate for Payer: United Healthcare HMO Rider |
$275.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$275.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$468.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$468.35
|
| Rate for Payer: Vantage Medical Group Senior |
$468.35
|
|
|
HC GUIDEWIRE SEPARATOR
|
Facility
|
IP
|
$5,500.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909020026
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,100.00 |
| Max. Negotiated Rate |
$4,675.00 |
| Rate for Payer: Adventist Health Commercial |
$1,100.00
|
| Rate for Payer: Cash Price |
$2,475.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,200.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,200.00
|
| Rate for Payer: Galaxy Health WC |
$4,675.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,300.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,668.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,095.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,404.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,320.00
|
| Rate for Payer: Multiplan Commercial |
$4,400.00
|
| Rate for Payer: Networks By Design Commercial |
$3,575.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,675.00
|
|
|
HC GUIDEWIRE SEPARATOR
|
Facility
|
OP
|
$5,500.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909020026
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,100.00 |
| Max. Negotiated Rate |
$4,675.00 |
| Rate for Payer: Adventist Health Commercial |
$1,100.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,607.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,675.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,025.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,125.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,377.55
|
| Rate for Payer: Cash Price |
$2,475.00
|
| Rate for Payer: Cigna of CA HMO |
$3,520.00
|
| Rate for Payer: Cigna of CA PPO |
$4,070.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,675.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,675.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,675.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,200.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,200.00
|
| Rate for Payer: Galaxy Health WC |
$4,675.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,300.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,668.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,095.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,404.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,320.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,850.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,850.00
|
| Rate for Payer: Multiplan Commercial |
$4,400.00
|
| Rate for Payer: Networks By Design Commercial |
$3,575.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,675.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,300.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,300.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,750.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,750.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,750.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,750.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,675.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,675.00
|
| Rate for Payer: Vantage Medical Group Senior |
$4,675.00
|
|
|
HC GUIDEWIRE SPRING W/ARROW ADV
|
Facility
|
OP
|
$83.60
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901698840
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.72 |
| Max. Negotiated Rate |
$71.06 |
| Rate for Payer: Adventist Health Commercial |
$16.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$54.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$71.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$62.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$51.34
|
| Rate for Payer: Cash Price |
$37.62
|
| Rate for Payer: Cigna of CA HMO |
$53.50
|
| Rate for Payer: Cigna of CA PPO |
$61.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$71.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$71.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$71.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.44
|
| Rate for Payer: EPIC Health Plan Senior |
$33.44
|
| Rate for Payer: Galaxy Health WC |
$71.06
|
| Rate for Payer: Global Benefits Group Commercial |
$50.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$55.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$51.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$58.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$58.52
|
| Rate for Payer: Multiplan Commercial |
$66.88
|
| Rate for Payer: Networks By Design Commercial |
$54.34
|
| Rate for Payer: Prime Health Services Commercial |
$71.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$50.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$50.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.80
|
| Rate for Payer: United Healthcare All Other HMO |
$41.80
|
| Rate for Payer: United Healthcare HMO Rider |
$41.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$71.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$71.06
|
| Rate for Payer: Vantage Medical Group Senior |
$71.06
|
|
|
HC GUIDEWIRE SPRING W/ARROW ADV
|
Facility
|
IP
|
$83.60
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901698840
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.72 |
| Max. Negotiated Rate |
$71.06 |
| Rate for Payer: Adventist Health Commercial |
$16.72
|
| Rate for Payer: Cash Price |
$37.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.44
|
| Rate for Payer: EPIC Health Plan Senior |
$33.44
|
| Rate for Payer: Galaxy Health WC |
$71.06
|
| Rate for Payer: Global Benefits Group Commercial |
$50.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$55.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$51.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.06
|
| Rate for Payer: Multiplan Commercial |
$66.88
|
| Rate for Payer: Networks By Design Commercial |
$54.34
|
| Rate for Payer: Prime Health Services Commercial |
$71.06
|
|
|
HC GUIDEWIRE SYNCHRO
|
Facility
|
IP
|
$2,901.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909000003
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$580.20 |
| Max. Negotiated Rate |
$2,465.85 |
| Rate for Payer: Adventist Health Commercial |
$580.20
|
| Rate for Payer: Cash Price |
$1,305.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,160.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,160.40
|
| Rate for Payer: Galaxy Health WC |
$2,465.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,740.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,934.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,105.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,795.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$696.24
|
| Rate for Payer: Multiplan Commercial |
$2,320.80
|
| Rate for Payer: Networks By Design Commercial |
$1,885.65
|
| Rate for Payer: Prime Health Services Commercial |
$2,465.85
|
|
|
HC GUIDEWIRE SYNCHRO
|
Facility
|
OP
|
$2,901.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909000003
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$580.20 |
| Max. Negotiated Rate |
$2,465.85 |
| Rate for Payer: Adventist Health Commercial |
$580.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,902.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,465.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,595.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,175.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,781.50
|
| Rate for Payer: Cash Price |
$1,305.45
|
| Rate for Payer: Cigna of CA HMO |
$1,856.64
|
| Rate for Payer: Cigna of CA PPO |
$2,146.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,465.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,465.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,465.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,160.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,160.40
|
| Rate for Payer: Galaxy Health WC |
$2,465.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,740.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,934.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,105.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,795.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$696.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,030.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,030.70
|
| Rate for Payer: Multiplan Commercial |
$2,320.80
|
| Rate for Payer: Networks By Design Commercial |
$1,885.65
|
| Rate for Payer: Prime Health Services Commercial |
$2,465.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,740.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,740.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,450.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,450.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,450.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,450.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,465.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,465.85
|
| Rate for Payer: Vantage Medical Group Senior |
$2,465.85
|
|
|
HC GUIDEWIRE TEFLON STRAIGHT 80CM
|
Facility
|
OP
|
$72.08
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901698837
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.42 |
| Max. Negotiated Rate |
$61.27 |
| Rate for Payer: Adventist Health Commercial |
$14.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$47.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$61.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$39.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$54.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$44.26
|
| Rate for Payer: Cash Price |
$32.44
|
| Rate for Payer: Cigna of CA HMO |
$46.13
|
| Rate for Payer: Cigna of CA PPO |
$53.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$61.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$61.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$61.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.83
|
| Rate for Payer: EPIC Health Plan Senior |
$28.83
|
| Rate for Payer: Galaxy Health WC |
$61.27
|
| Rate for Payer: Global Benefits Group Commercial |
$43.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$48.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$44.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$50.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$50.46
|
| Rate for Payer: Multiplan Commercial |
$57.66
|
| Rate for Payer: Networks By Design Commercial |
$46.85
|
| Rate for Payer: Prime Health Services Commercial |
$61.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$43.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$43.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$36.04
|
| Rate for Payer: United Healthcare All Other HMO |
$36.04
|
| Rate for Payer: United Healthcare HMO Rider |
$36.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$61.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$61.27
|
| Rate for Payer: Vantage Medical Group Senior |
$61.27
|
|
|
HC GUIDEWIRE TEFLON STRAIGHT 80CM
|
Facility
|
IP
|
$72.08
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901698837
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.42 |
| Max. Negotiated Rate |
$61.27 |
| Rate for Payer: Adventist Health Commercial |
$14.42
|
| Rate for Payer: Cash Price |
$32.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.83
|
| Rate for Payer: EPIC Health Plan Senior |
$28.83
|
| Rate for Payer: Galaxy Health WC |
$61.27
|
| Rate for Payer: Global Benefits Group Commercial |
$43.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$48.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$44.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.30
|
| Rate for Payer: Multiplan Commercial |
$57.66
|
| Rate for Payer: Networks By Design Commercial |
$46.85
|
| Rate for Payer: Prime Health Services Commercial |
$61.27
|
|
|
HC GUIDEWIRE, TRANSEND
|
Facility
|
OP
|
$1,108.60
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909020096
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$221.72 |
| Max. Negotiated Rate |
$942.31 |
| Rate for Payer: Adventist Health Commercial |
$221.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$727.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$942.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$609.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$831.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$680.79
|
| Rate for Payer: Cash Price |
$498.87
|
| Rate for Payer: Cigna of CA HMO |
$709.50
|
| Rate for Payer: Cigna of CA PPO |
$820.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$942.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$942.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$942.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$443.44
|
| Rate for Payer: EPIC Health Plan Senior |
$443.44
|
| Rate for Payer: Galaxy Health WC |
$942.31
|
| Rate for Payer: Global Benefits Group Commercial |
$665.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$739.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$422.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$686.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$266.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$776.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$776.02
|
| Rate for Payer: Multiplan Commercial |
$886.88
|
| Rate for Payer: Networks By Design Commercial |
$720.59
|
| Rate for Payer: Prime Health Services Commercial |
$942.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$665.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$665.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$554.30
|
| Rate for Payer: United Healthcare All Other HMO |
$554.30
|
| Rate for Payer: United Healthcare HMO Rider |
$554.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$554.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$942.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$942.31
|
| Rate for Payer: Vantage Medical Group Senior |
$942.31
|
|
|
HC GUIDEWIRE, TRANSEND
|
Facility
|
IP
|
$1,108.60
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909020096
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$221.72 |
| Max. Negotiated Rate |
$942.31 |
| Rate for Payer: Adventist Health Commercial |
$221.72
|
| Rate for Payer: Cash Price |
$498.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$443.44
|
| Rate for Payer: EPIC Health Plan Senior |
$443.44
|
| Rate for Payer: Galaxy Health WC |
$942.31
|
| Rate for Payer: Global Benefits Group Commercial |
$665.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$739.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$422.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$686.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$266.06
|
| Rate for Payer: Multiplan Commercial |
$886.88
|
| Rate for Payer: Networks By Design Commercial |
$720.59
|
| Rate for Payer: Prime Health Services Commercial |
$942.31
|
|
|
HC GUIDEWIRE VASC T-J FXD CORE
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901698184
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$297.50 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$229.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$262.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$214.94
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna of CA HMO |
$224.00
|
| Rate for Payer: Cigna of CA PPO |
$259.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$297.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$245.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$245.00
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$210.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$210.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$175.00
|
| Rate for Payer: United Healthcare All Other HMO |
$175.00
|
| Rate for Payer: United Healthcare HMO Rider |
$175.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$175.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
|
HC GUIDEWIRE VASC T-J FXD CORE
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901698184
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$297.50 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
|
