|
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 |
$495.00
|
| 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 |
$495.00
|
| 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 |
$303.05
|
| 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 |
$303.05
|
| 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
|
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 |
$3,025.00
|
| 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 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 |
$3,025.00
|
| 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 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: Vantage Medical Group Medi-Cal |
$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 |
$45.98
|
| 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 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 |
$45.98
|
| 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 |
$1,595.55
|
| 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 |
$1,595.55
|
| 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 |
$39.64
|
| 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 |
$39.64
|
| 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
|
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 |
$609.73
|
| 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, 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 |
$609.73
|
| 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 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 |
$192.50
|
| 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 |
$192.50
|
| 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
|
|
|
HC GUIDEWR, .015",20CM STRT FLXBL
|
Facility
|
IP
|
$149.87
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901698158
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$29.97 |
| Max. Negotiated Rate |
$127.39 |
| Rate for Payer: Adventist Health Commercial |
$29.97
|
| Rate for Payer: Cash Price |
$82.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$59.95
|
| Rate for Payer: EPIC Health Plan Senior |
$59.95
|
| Rate for Payer: Galaxy Health WC |
$127.39
|
| Rate for Payer: Global Benefits Group Commercial |
$89.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$99.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$92.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.97
|
| Rate for Payer: Multiplan Commercial |
$119.90
|
| Rate for Payer: Networks By Design Commercial |
$97.42
|
| Rate for Payer: Prime Health Services Commercial |
$127.39
|
|
|
HC GUIDEWR, .015",20CM STRT FLXBL
|
Facility
|
OP
|
$149.87
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901698158
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$29.97 |
| Max. Negotiated Rate |
$127.39 |
| Rate for Payer: Adventist Health Commercial |
$29.97
|
| Rate for Payer: Aetna of CA HMO/PPO |
$98.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$127.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$82.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$112.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$92.04
|
| Rate for Payer: Cash Price |
$82.43
|
| Rate for Payer: Cigna of CA HMO |
$95.92
|
| Rate for Payer: Cigna of CA PPO |
$110.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$127.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$127.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$127.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$59.95
|
| Rate for Payer: EPIC Health Plan Senior |
$59.95
|
| Rate for Payer: Galaxy Health WC |
$127.39
|
| Rate for Payer: Global Benefits Group Commercial |
$89.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$99.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$92.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$104.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$104.91
|
| Rate for Payer: Multiplan Commercial |
$119.90
|
| Rate for Payer: Networks By Design Commercial |
$97.42
|
| Rate for Payer: Prime Health Services Commercial |
$127.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$89.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$89.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$74.94
|
| Rate for Payer: United Healthcare All Other HMO |
$74.94
|
| Rate for Payer: United Healthcare HMO Rider |
$74.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$74.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$127.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$127.39
|
| Rate for Payer: Vantage Medical Group Senior |
$127.39
|
|
|
HC GUIDEWR,STRT CURVED .025"X50CM
|
Facility
|
IP
|
$249.48
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901698270
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.90 |
| Max. Negotiated Rate |
$212.06 |
| Rate for Payer: Adventist Health Commercial |
$49.90
|
| Rate for Payer: Cash Price |
$137.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.79
|
| Rate for Payer: EPIC Health Plan Senior |
$99.79
|
| Rate for Payer: Galaxy Health WC |
$212.06
|
| Rate for Payer: Global Benefits Group Commercial |
$149.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$166.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$95.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$154.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.88
|
| Rate for Payer: Multiplan Commercial |
$199.58
|
| Rate for Payer: Networks By Design Commercial |
$162.16
|
| Rate for Payer: Prime Health Services Commercial |
$212.06
|
|
|
HC GUIDEWR,STRT CURVED .025"X50CM
|
Facility
|
OP
|
$249.48
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901698270
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.90 |
| Max. Negotiated Rate |
$212.06 |
| Rate for Payer: Adventist Health Commercial |
$49.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$163.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$212.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$137.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$187.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$153.21
|
| Rate for Payer: Cash Price |
$137.21
|
| Rate for Payer: Cigna of CA HMO |
$159.67
|
| Rate for Payer: Cigna of CA PPO |
$184.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$212.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$212.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$212.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.79
|
| Rate for Payer: EPIC Health Plan Senior |
$99.79
|
| Rate for Payer: Galaxy Health WC |
$212.06
|
| Rate for Payer: Global Benefits Group Commercial |
$149.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$166.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$95.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$154.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$174.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$174.64
|
| Rate for Payer: Multiplan Commercial |
$199.58
|
| Rate for Payer: Networks By Design Commercial |
$162.16
|
| Rate for Payer: Prime Health Services Commercial |
$212.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$149.69
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$149.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$124.74
|
| Rate for Payer: United Healthcare All Other HMO |
$124.74
|
| Rate for Payer: United Healthcare HMO Rider |
$124.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$124.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$212.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$212.06
|
| Rate for Payer: Vantage Medical Group Senior |
$212.06
|
|
|
HC HALLUS-VALGUS SPLINT EA
|
Facility
|
OP
|
$218.00
|
|
|
Service Code
|
CPT L3100
|
| Hospital Charge Code |
905353100
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$28.11 |
| Max. Negotiated Rate |
$185.30 |
| Rate for Payer: Adventist Health Commercial |
$89.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$185.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$119.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$126.27
|
| Rate for Payer: Blue Shield of California Commercial |
$160.88
|
| Rate for Payer: Blue Shield of California EPN |
$105.95
|
| Rate for Payer: Cash Price |
$119.90
|
| Rate for Payer: Cash Price |
$119.90
|
| Rate for Payer: Cigna of CA HMO |
$152.60
|
| Rate for Payer: Cigna of CA PPO |
$152.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$185.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$185.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$185.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$87.20
|
| Rate for Payer: EPIC Health Plan Senior |
$87.20
|
| Rate for Payer: Galaxy Health WC |
$185.30
|
| Rate for Payer: Global Benefits Group Commercial |
$130.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$28.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$145.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$134.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$152.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$152.60
|
| Rate for Payer: Multiplan Commercial |
$174.40
|
| Rate for Payer: Networks By Design Commercial |
$109.00
|
| Rate for Payer: Prime Health Services Commercial |
$185.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$130.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$130.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$81.82
|
| Rate for Payer: United Healthcare All Other HMO |
$79.64
|
| Rate for Payer: United Healthcare HMO Rider |
$77.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$71.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$185.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$185.30
|
| Rate for Payer: Vantage Medical Group Senior |
$185.30
|
|
|
HC HALLUS-VALGUS SPLINT EA
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
CPT L3100
|
| Hospital Charge Code |
915353100
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$43.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$43.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$119.90
|
| Rate for Payer: Cash Price |
$119.90
|
| Rate for Payer: Cigna of CA HMO |
$152.60
|
| Rate for Payer: Cigna of CA PPO |
$152.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$87.20
|
| Rate for Payer: EPIC Health Plan Senior |
$87.20
|
| Rate for Payer: Galaxy Health WC |
$185.30
|
| Rate for Payer: Global Benefits Group Commercial |
$130.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$145.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$83.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$134.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.32
|
| Rate for Payer: Multiplan Commercial |
$174.40
|
| Rate for Payer: Networks By Design Commercial |
$109.00
|
| Rate for Payer: Prime Health Services Commercial |
$185.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$81.82
|
| Rate for Payer: United Healthcare All Other HMO |
$79.64
|
| Rate for Payer: United Healthcare HMO Rider |
$77.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$71.39
|
|
|
HC HALLUS-VALGUS SPLINT EA
|
Facility
|
OP
|
$218.00
|
|
|
Service Code
|
CPT L3100
|
| Hospital Charge Code |
915353100
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$28.11 |
| Max. Negotiated Rate |
$185.30 |
| Rate for Payer: Adventist Health Commercial |
$89.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$185.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$119.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$126.27
|
| Rate for Payer: Blue Shield of California Commercial |
$160.88
|
| Rate for Payer: Blue Shield of California EPN |
$105.95
|
| Rate for Payer: Cash Price |
$119.90
|
| Rate for Payer: Cash Price |
$119.90
|
| Rate for Payer: Cigna of CA HMO |
$152.60
|
| Rate for Payer: Cigna of CA PPO |
$152.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$185.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$185.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$185.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$87.20
|
| Rate for Payer: EPIC Health Plan Senior |
$87.20
|
| Rate for Payer: Galaxy Health WC |
$185.30
|
| Rate for Payer: Global Benefits Group Commercial |
$130.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$28.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$145.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$134.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$152.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$152.60
|
| Rate for Payer: Multiplan Commercial |
$174.40
|
| Rate for Payer: Networks By Design Commercial |
$109.00
|
| Rate for Payer: Prime Health Services Commercial |
$185.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$130.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$130.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$81.82
|
| Rate for Payer: United Healthcare All Other HMO |
$79.64
|
| Rate for Payer: United Healthcare HMO Rider |
$77.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$71.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$185.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$185.30
|
| Rate for Payer: Vantage Medical Group Senior |
$185.30
|
|
|
HC HALLUS-VALGUS SPLINT EA
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
CPT L3100
|
| Hospital Charge Code |
905353100
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$43.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$43.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$119.90
|
| Rate for Payer: Cash Price |
$119.90
|
| Rate for Payer: Cigna of CA HMO |
$152.60
|
| Rate for Payer: Cigna of CA PPO |
$152.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$87.20
|
| Rate for Payer: EPIC Health Plan Senior |
$87.20
|
| Rate for Payer: Galaxy Health WC |
$185.30
|
| Rate for Payer: Global Benefits Group Commercial |
$130.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$145.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$83.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$134.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.32
|
| Rate for Payer: Multiplan Commercial |
$174.40
|
| Rate for Payer: Networks By Design Commercial |
$109.00
|
| Rate for Payer: Prime Health Services Commercial |
$185.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$81.82
|
| Rate for Payer: United Healthcare All Other HMO |
$79.64
|
| Rate for Payer: United Healthcare HMO Rider |
$77.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$71.39
|
|
|
HC HALO ADDITION MRI COMPATIBLE
|
Facility
|
IP
|
$2,933.00
|
|
|
Service Code
|
CPT L0859
|
| Hospital Charge Code |
905350860
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$586.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$586.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,613.15
|
| Rate for Payer: Cash Price |
$1,613.15
|
| Rate for Payer: Cigna of CA HMO |
$2,053.10
|
| Rate for Payer: Cigna of CA PPO |
$2,053.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,173.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,173.20
|
| Rate for Payer: Galaxy Health WC |
$2,493.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,759.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,956.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,117.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,815.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$703.92
|
| Rate for Payer: Multiplan Commercial |
$2,346.40
|
| Rate for Payer: Networks By Design Commercial |
$1,466.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,493.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,100.75
|
| Rate for Payer: United Healthcare All Other HMO |
$1,071.42
|
| Rate for Payer: United Healthcare HMO Rider |
$1,048.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$960.56
|
|
