|
HC GUIDE CRVD TFE COAT .35"X145
|
Facility
|
OP
|
$192.50
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901604251
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.50 |
| Max. Negotiated Rate |
$449.04 |
| Rate for Payer: Adventist Health Commercial |
$38.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$449.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$163.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$105.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$144.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$123.53
|
| Rate for Payer: Cash Price |
$86.62
|
| Rate for Payer: Cash Price |
$86.62
|
| Rate for Payer: Cigna of CA HMO |
$123.20
|
| Rate for Payer: Cigna of CA PPO |
$142.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$163.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$163.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.62
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$134.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$77.00
|
| Rate for Payer: EPIC Health Plan Senior |
$77.00
|
| Rate for Payer: Galaxy Health WC |
$163.62
|
| Rate for Payer: Global Benefits Group Commercial |
$115.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$122.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$69.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$113.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$134.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$134.75
|
| Rate for Payer: Multiplan Commercial |
$154.00
|
| Rate for Payer: Networks By Design Commercial |
$125.12
|
| Rate for Payer: Prime Health Services Commercial |
$163.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$115.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$115.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$96.25
|
| Rate for Payer: United Healthcare All Other HMO |
$96.25
|
| Rate for Payer: United Healthcare HMO Rider |
$96.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$96.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$163.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$163.62
|
| Rate for Payer: Vantage Medical Group Senior |
$163.62
|
|
|
HC GUIDE CRVD TFE COAT .35"X145
|
Facility
|
IP
|
$192.50
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901604251
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.50 |
| Max. Negotiated Rate |
$163.62 |
| Rate for Payer: Adventist Health Commercial |
$38.50
|
| Rate for Payer: Cash Price |
$86.62
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$134.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$77.00
|
| Rate for Payer: EPIC Health Plan Senior |
$77.00
|
| Rate for Payer: Galaxy Health WC |
$163.62
|
| Rate for Payer: Global Benefits Group Commercial |
$115.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$122.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$113.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.20
|
| Rate for Payer: Multiplan Commercial |
$154.00
|
| Rate for Payer: Networks By Design Commercial |
$125.12
|
| Rate for Payer: Prime Health Services Commercial |
$163.62
|
|
|
HC GUIDE, CURVED .025"X80CM
|
Facility
|
OP
|
$192.71
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901600464
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.54 |
| Max. Negotiated Rate |
$449.04 |
| Rate for Payer: Adventist Health Commercial |
$38.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$449.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$163.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$105.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$144.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$123.66
|
| Rate for Payer: Cash Price |
$86.72
|
| Rate for Payer: Cash Price |
$86.72
|
| Rate for Payer: Cigna of CA HMO |
$123.33
|
| Rate for Payer: Cigna of CA PPO |
$142.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$163.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$163.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$134.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$77.08
|
| Rate for Payer: EPIC Health Plan Senior |
$77.08
|
| Rate for Payer: Galaxy Health WC |
$163.80
|
| Rate for Payer: Global Benefits Group Commercial |
$115.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$122.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$69.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$113.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$134.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$134.90
|
| Rate for Payer: Multiplan Commercial |
$154.17
|
| Rate for Payer: Networks By Design Commercial |
$125.26
|
| Rate for Payer: Prime Health Services Commercial |
$163.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$115.63
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$115.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$96.36
|
| Rate for Payer: United Healthcare All Other HMO |
$96.36
|
| Rate for Payer: United Healthcare HMO Rider |
$96.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$96.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$163.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$163.80
|
| Rate for Payer: Vantage Medical Group Senior |
$163.80
|
|
|
HC GUIDE, CURVED .025"X80CM
|
Facility
|
IP
|
$192.71
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901600464
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.54 |
| Max. Negotiated Rate |
$163.80 |
| Rate for Payer: Adventist Health Commercial |
$38.54
|
| Rate for Payer: Cash Price |
$86.72
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$134.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$77.08
|
| Rate for Payer: EPIC Health Plan Senior |
$77.08
|
| Rate for Payer: Galaxy Health WC |
$163.80
|
| Rate for Payer: Global Benefits Group Commercial |
$115.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$122.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$113.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.25
|
| Rate for Payer: Multiplan Commercial |
$154.17
|
| Rate for Payer: Networks By Design Commercial |
$125.26
|
| Rate for Payer: Prime Health Services Commercial |
$163.80
|
|
|
HC GUIDE DUOFLEX .018 45MM
|
Facility
|
OP
|
$80.11
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901603717
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.02 |
| Max. Negotiated Rate |
$449.04 |
| Rate for Payer: Adventist Health Commercial |
$16.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$449.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$68.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$44.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$60.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$51.41
|
| Rate for Payer: Cash Price |
$36.05
|
| Rate for Payer: Cash Price |
$36.05
|
| Rate for Payer: Cigna of CA HMO |
$51.27
|
| Rate for Payer: Cigna of CA PPO |
$59.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$68.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$68.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$56.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.04
|
| Rate for Payer: EPIC Health Plan Senior |
$32.04
|
| Rate for Payer: Galaxy Health WC |
$68.09
|
| Rate for Payer: Global Benefits Group Commercial |
$48.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$50.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$29.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$47.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$56.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$56.08
|
| Rate for Payer: Multiplan Commercial |
$64.09
|
| Rate for Payer: Networks By Design Commercial |
$52.07
|
| Rate for Payer: Prime Health Services Commercial |
$68.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$48.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$48.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$40.05
|
| Rate for Payer: United Healthcare All Other HMO |
$40.05
|
| Rate for Payer: United Healthcare HMO Rider |
$40.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$40.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$68.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.09
|
| Rate for Payer: Vantage Medical Group Senior |
$68.09
|
|
|
HC GUIDE DUOFLEX .018 45MM
|
Facility
|
IP
|
$80.11
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901603717
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.02 |
| Max. Negotiated Rate |
$68.09 |
| Rate for Payer: Adventist Health Commercial |
$16.02
|
| Rate for Payer: Cash Price |
$36.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$56.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.04
|
| Rate for Payer: EPIC Health Plan Senior |
$32.04
|
| Rate for Payer: Galaxy Health WC |
$68.09
|
| Rate for Payer: Global Benefits Group Commercial |
$48.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$50.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$47.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.23
|
| Rate for Payer: Multiplan Commercial |
$64.09
|
| Rate for Payer: Networks By Design Commercial |
$52.07
|
| Rate for Payer: Prime Health Services Commercial |
$68.09
|
|
|
HC GUIDE, DUOFLEX 25 X 30
|
Facility
|
IP
|
$69.37
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901602056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.87 |
| Max. Negotiated Rate |
$58.96 |
| Rate for Payer: Adventist Health Commercial |
$13.87
|
| Rate for Payer: Cash Price |
$31.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$48.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.75
|
| Rate for Payer: EPIC Health Plan Senior |
$27.75
|
| Rate for Payer: Galaxy Health WC |
$58.96
|
| Rate for Payer: Global Benefits Group Commercial |
$41.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$44.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$40.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.65
|
| Rate for Payer: Multiplan Commercial |
$55.50
|
| Rate for Payer: Networks By Design Commercial |
$45.09
|
| Rate for Payer: Prime Health Services Commercial |
$58.96
|
|
|
HC GUIDE, DUOFLEX 25 X 30
|
Facility
|
OP
|
$69.37
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901602056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.87 |
| Max. Negotiated Rate |
$449.04 |
| Rate for Payer: Networks By Design Commercial |
$45.09
|
| Rate for Payer: Adventist Health Commercial |
$13.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$449.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$58.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$52.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$44.51
|
| Rate for Payer: Cash Price |
$31.22
|
| Rate for Payer: Cash Price |
$31.22
|
| Rate for Payer: Cigna of CA HMO |
$44.40
|
| Rate for Payer: Cigna of CA PPO |
$51.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$58.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$58.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$58.96
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$48.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.75
|
| Rate for Payer: EPIC Health Plan Senior |
$27.75
|
| Rate for Payer: Galaxy Health WC |
$58.96
|
| Rate for Payer: Global Benefits Group Commercial |
$41.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$44.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$40.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$48.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$48.56
|
| Rate for Payer: Multiplan Commercial |
$55.50
|
| Rate for Payer: Prime Health Services Commercial |
$58.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$41.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$41.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$34.69
|
| Rate for Payer: United Healthcare All Other HMO |
$34.69
|
| Rate for Payer: United Healthcare HMO Rider |
$34.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$58.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$58.96
|
| Rate for Payer: Vantage Medical Group Senior |
$58.96
|
|
|
HC GUIDE HYDROPHILIC 80CM X.018
|
Facility
|
IP
|
$303.52
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901607536
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$60.70 |
| Max. Negotiated Rate |
$257.99 |
| Rate for Payer: Adventist Health Commercial |
$60.70
|
| Rate for Payer: Cash Price |
$136.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$212.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$121.41
|
| Rate for Payer: EPIC Health Plan Senior |
$121.41
|
| Rate for Payer: Galaxy Health WC |
$257.99
|
| Rate for Payer: Global Benefits Group Commercial |
$182.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$192.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$179.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.84
|
| Rate for Payer: Multiplan Commercial |
$242.82
|
| Rate for Payer: Networks By Design Commercial |
$197.29
|
| Rate for Payer: Prime Health Services Commercial |
$257.99
|
|
|
HC GUIDE HYDROPHILIC 80CM X.018
|
Facility
|
OP
|
$303.52
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901607536
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$60.70 |
| Max. Negotiated Rate |
$449.04 |
| Rate for Payer: Adventist Health Commercial |
$60.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$449.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$257.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$166.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$227.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$194.77
|
| Rate for Payer: Cash Price |
$136.58
|
| Rate for Payer: Cash Price |
$136.58
|
| Rate for Payer: Cigna of CA HMO |
$194.25
|
| Rate for Payer: Cigna of CA PPO |
$224.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$257.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$257.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$257.99
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$212.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$121.41
|
| Rate for Payer: EPIC Health Plan Senior |
$121.41
|
| Rate for Payer: Galaxy Health WC |
$257.99
|
| Rate for Payer: Global Benefits Group Commercial |
$182.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$192.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$110.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$179.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$212.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$212.46
|
| Rate for Payer: Multiplan Commercial |
$242.82
|
| Rate for Payer: Networks By Design Commercial |
$197.29
|
| Rate for Payer: Prime Health Services Commercial |
$257.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$182.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$182.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$151.76
|
| Rate for Payer: United Healthcare All Other HMO |
$151.76
|
| Rate for Payer: United Healthcare HMO Rider |
$151.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$151.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$257.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$257.99
|
| Rate for Payer: Vantage Medical Group Senior |
$257.99
|
|
|
HC GUIDE HYDROPHILLIC.008 COATED
|
Facility
|
IP
|
$261.59
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901605118
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$52.32 |
| Max. Negotiated Rate |
$222.35 |
| Rate for Payer: Adventist Health Commercial |
$52.32
|
| Rate for Payer: Cash Price |
$117.72
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$183.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$104.64
|
| Rate for Payer: EPIC Health Plan Senior |
$104.64
|
| Rate for Payer: Galaxy Health WC |
$222.35
|
| Rate for Payer: Global Benefits Group Commercial |
$156.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$166.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$154.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.78
|
| Rate for Payer: Multiplan Commercial |
$209.27
|
| Rate for Payer: Networks By Design Commercial |
$170.03
|
| Rate for Payer: Prime Health Services Commercial |
$222.35
|
|
|
HC GUIDE HYDROPHILLIC.008 COATED
|
Facility
|
OP
|
$261.59
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901605118
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$52.32 |
| Max. Negotiated Rate |
$449.04 |
| Rate for Payer: Adventist Health Commercial |
$52.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$449.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$222.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$143.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$196.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$167.86
|
| Rate for Payer: Cash Price |
$117.72
|
| Rate for Payer: Cash Price |
$117.72
|
| Rate for Payer: Cigna of CA HMO |
$167.42
|
| Rate for Payer: Cigna of CA PPO |
$193.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$222.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$222.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$222.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$183.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$104.64
|
| Rate for Payer: EPIC Health Plan Senior |
$104.64
|
| Rate for Payer: Galaxy Health WC |
$222.35
|
| Rate for Payer: Global Benefits Group Commercial |
$156.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$166.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$94.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$154.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$183.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$183.11
|
| Rate for Payer: Multiplan Commercial |
$209.27
|
| Rate for Payer: Networks By Design Commercial |
$170.03
|
| Rate for Payer: Prime Health Services Commercial |
$222.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$156.95
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$156.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$130.79
|
| Rate for Payer: United Healthcare All Other HMO |
$130.79
|
| Rate for Payer: United Healthcare HMO Rider |
$130.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$130.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$222.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$222.35
|
| Rate for Payer: Vantage Medical Group Senior |
$222.35
|
|
|
HC GUIDE NERV DESTR, ELEC STIM
|
Facility
|
IP
|
$294.00
|
|
|
Service Code
|
CPT 95873
|
| Hospital Charge Code |
900600242
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$58.80 |
| Max. Negotiated Rate |
$249.90 |
| Rate for Payer: Adventist Health Commercial |
$58.80
|
| Rate for Payer: Cash Price |
$132.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$205.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$117.60
|
| Rate for Payer: EPIC Health Plan Senior |
$117.60
|
| Rate for Payer: Galaxy Health WC |
$249.90
|
| Rate for Payer: Global Benefits Group Commercial |
$176.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$186.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$173.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.56
|
| Rate for Payer: Multiplan Commercial |
$235.20
|
| Rate for Payer: Networks By Design Commercial |
$191.10
|
| Rate for Payer: Prime Health Services Commercial |
$249.90
|
|
|
HC GUIDE NERV DESTR, ELEC STIM
|
Facility
|
OP
|
$294.00
|
|
|
Service Code
|
CPT 95873
|
| Hospital Charge Code |
900600242
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$41.14 |
| Max. Negotiated Rate |
$1,297.00 |
| Rate for Payer: Adventist Health Commercial |
$58.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$282.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$249.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$161.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$220.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$188.66
|
| Rate for Payer: Blue Shield of California Commercial |
$187.57
|
| Rate for Payer: Blue Shield of California Commercial |
$123.77
|
| Rate for Payer: Cash Price |
$132.30
|
| Rate for Payer: Cash Price |
$132.30
|
| Rate for Payer: Cash Price |
$132.30
|
| Rate for Payer: Cigna of CA HMO |
$188.16
|
| Rate for Payer: Cigna of CA PPO |
$217.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$249.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$249.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$249.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$205.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$117.60
|
| Rate for Payer: EPIC Health Plan Senior |
$117.60
|
| Rate for Payer: Galaxy Health WC |
$249.90
|
| Rate for Payer: Global Benefits Group Commercial |
$176.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$41.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$186.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$46.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$173.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$205.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$205.80
|
| Rate for Payer: Multiplan Commercial |
$235.20
|
| Rate for Payer: Networks By Design Commercial |
$191.10
|
| Rate for Payer: Prime Health Services Commercial |
$249.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$176.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$176.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,297.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,024.00
|
| Rate for Payer: United Healthcare HMO Rider |
$776.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$711.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$249.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$249.90
|
| Rate for Payer: Vantage Medical Group Senior |
$249.90
|
|
|
HC GUIDE NERV DESTR NEEDLE EMG
|
Facility
|
OP
|
$298.00
|
|
|
Service Code
|
CPT 95874
|
| Hospital Charge Code |
900600243
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$41.71 |
| Max. Negotiated Rate |
$1,297.00 |
| Rate for Payer: Adventist Health Commercial |
$59.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$267.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$253.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$163.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$223.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$191.23
|
| Rate for Payer: Blue Shield of California Commercial |
$190.12
|
| Rate for Payer: Blue Shield of California Commercial |
$125.46
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cigna of CA HMO |
$190.72
|
| Rate for Payer: Cigna of CA PPO |
$220.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$253.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$253.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$253.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$208.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$119.20
|
| Rate for Payer: EPIC Health Plan Senior |
$119.20
|
| Rate for Payer: Galaxy Health WC |
$253.30
|
| Rate for Payer: Global Benefits Group Commercial |
$178.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$41.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$189.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$47.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$175.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$208.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$208.60
|
| Rate for Payer: Multiplan Commercial |
$238.40
|
| Rate for Payer: Networks By Design Commercial |
$193.70
|
| Rate for Payer: Prime Health Services Commercial |
$253.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$178.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$178.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,297.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,024.00
|
| Rate for Payer: United Healthcare HMO Rider |
$776.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$711.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$253.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$253.30
|
| Rate for Payer: Vantage Medical Group Senior |
$253.30
|
|
|
HC GUIDE NERV DESTR NEEDLE EMG
|
Facility
|
IP
|
$298.00
|
|
|
Service Code
|
CPT 95874
|
| Hospital Charge Code |
900600243
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$59.60 |
| Max. Negotiated Rate |
$253.30 |
| Rate for Payer: Adventist Health Commercial |
$59.60
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$208.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$119.20
|
| Rate for Payer: EPIC Health Plan Senior |
$119.20
|
| Rate for Payer: Galaxy Health WC |
$253.30
|
| Rate for Payer: Global Benefits Group Commercial |
$178.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$189.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$175.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.52
|
| Rate for Payer: Multiplan Commercial |
$238.40
|
| Rate for Payer: Networks By Design Commercial |
$193.70
|
| Rate for Payer: Prime Health Services Commercial |
$253.30
|
|
|
HC GUIDE NITINOL MANDREL 40CM .014"
|
Facility
|
IP
|
$154.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901698137
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.80 |
| Max. Negotiated Rate |
$130.90 |
| Rate for Payer: Galaxy Health WC |
$130.90
|
| Rate for Payer: Adventist Health Commercial |
$30.80
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$107.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.60
|
| Rate for Payer: EPIC Health Plan Senior |
$61.60
|
| Rate for Payer: Global Benefits Group Commercial |
$92.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$97.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$90.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.96
|
| Rate for Payer: Multiplan Commercial |
$123.20
|
| Rate for Payer: Networks By Design Commercial |
$100.10
|
| Rate for Payer: Prime Health Services Commercial |
$130.90
|
|
|
HC GUIDE NITINOL MANDREL 40CM .014"
|
Facility
|
OP
|
$154.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901698137
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.80 |
| Max. Negotiated Rate |
$449.04 |
| Rate for Payer: Adventist Health Commercial |
$30.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$449.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$130.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$84.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$115.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$98.82
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cigna of CA HMO |
$98.56
|
| Rate for Payer: Cigna of CA PPO |
$113.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$130.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$130.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$130.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$107.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.60
|
| Rate for Payer: EPIC Health Plan Senior |
$61.60
|
| Rate for Payer: Galaxy Health WC |
$130.90
|
| Rate for Payer: Global Benefits Group Commercial |
$92.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$97.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$55.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$90.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$107.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$107.80
|
| Rate for Payer: Multiplan Commercial |
$123.20
|
| Rate for Payer: Networks By Design Commercial |
$100.10
|
| Rate for Payer: Prime Health Services Commercial |
$130.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$92.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$92.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$77.00
|
| Rate for Payer: United Healthcare All Other HMO |
$77.00
|
| Rate for Payer: United Healthcare HMO Rider |
$77.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$77.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$130.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$130.90
|
| Rate for Payer: Vantage Medical Group Senior |
$130.90
|
|
|
HC GUIDE NITINOL MANDREL 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 |
$449.04 |
| Rate for Payer: Adventist Health Commercial |
$36.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$449.04
|
| 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 |
$116.79
|
| Rate for Payer: Cash Price |
$81.90
|
| Rate for Payer: Cash Price |
$81.90
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$127.40
|
| 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 Foundation Hospitals Commercial/Self Funded |
$115.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$66.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$107.38
|
| 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 NITINOL MANDREL 60CM .018"
|
Facility
|
IP
|
$182.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901698136
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.40 |
| Max. Negotiated Rate |
$154.70 |
| Rate for Payer: Adventist Health Commercial |
$36.40
|
| Rate for Payer: Cash Price |
$81.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$127.40
|
| 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 Foundation Hospitals Commercial/Self Funded |
$115.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$107.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.68
|
| Rate for Payer: Multiplan Commercial |
$145.60
|
| Rate for Payer: Networks By Design Commercial |
$118.30
|
| Rate for Payer: Prime Health Services Commercial |
$154.70
|
|
|
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 |
$449.04 |
| Rate for Payer: Adventist Health Commercial |
$15.92
|
| Rate for Payer: Aetna of CA HMO/PPO |
$449.04
|
| 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 |
$51.09
|
| Rate for Payer: Cash Price |
$35.83
|
| Rate for Payer: Cash Price |
$35.83
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$55.73
|
| 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 Foundation Hospitals Commercial/Self Funded |
$50.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$46.98
|
| 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 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 |
$35.83
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$55.73
|
| 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 Foundation Hospitals Commercial/Self Funded |
$50.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$46.98
|
| 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 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 |
$29.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$45.17
|
| 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 Foundation Hospitals Commercial/Self Funded |
$40.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$38.07
|
| 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 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 |
$449.04 |
| Rate for Payer: Adventist Health Commercial |
$12.91
|
| Rate for Payer: Aetna of CA HMO/PPO |
$449.04
|
| 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 |
$41.41
|
| Rate for Payer: Cash Price |
$29.04
|
| Rate for Payer: Cash Price |
$29.04
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$45.17
|
| 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 Foundation Hospitals Commercial/Self Funded |
$40.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$38.07
|
| 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 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 |
$263.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$410.58
|
| 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 Foundation Hospitals Commercial/Self Funded |
$372.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$346.06
|
| 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
|
|
