|
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: Multiplan Commercial |
$66.88
|
| Rate for Payer: Networks By Design Commercial |
$54.34
|
| Rate for Payer: Adventist Health Commercial |
$16.72
|
| Rate for Payer: Cash Price |
$37.62
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$58.52
|
| 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 Foundation Hospitals Commercial/Self Funded |
$53.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$49.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.06
|
| Rate for Payer: Prime Health Services Commercial |
$71.06
|
|
|
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 |
$449.04 |
| Rate for Payer: Adventist Health Commercial |
$16.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$449.04
|
| 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 |
$53.65
|
| Rate for Payer: Cash Price |
$37.62
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$58.52
|
| 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 Foundation Hospitals Commercial/Self Funded |
$53.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$49.32
|
| 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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,030.70
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,842.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,711.59
|
| 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 |
$449.04 |
| Max. Negotiated Rate |
$2,465.85 |
| Rate for Payer: Adventist Health Commercial |
$580.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$449.04
|
| 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 |
$1,861.57
|
| Rate for Payer: Cash Price |
$1,305.45
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,030.70
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,842.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,053.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,711.59
|
| 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
|
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: Cash Price |
$32.44
|
| Rate for Payer: Adventist Health Commercial |
$14.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$50.46
|
| 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 Foundation Hospitals Commercial/Self Funded |
$45.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$42.53
|
| 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 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 |
$449.04 |
| Rate for Payer: Adventist Health Commercial |
$14.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$449.04
|
| 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 |
$46.25
|
| Rate for Payer: Cash Price |
$32.44
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$50.46
|
| 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 Foundation Hospitals Commercial/Self Funded |
$45.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$26.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$42.53
|
| 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, 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$776.02
|
| 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 Foundation Hospitals Commercial/Self Funded |
$703.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$654.07
|
| 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 |
$449.04
|
| 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 |
$711.39
|
| Rate for Payer: Cash Price |
$498.87
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$776.02
|
| 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 Foundation Hospitals Commercial/Self Funded |
$703.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$402.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$654.07
|
| 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 |
$449.04 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$449.04
|
| 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 |
$224.59
|
| Rate for Payer: Cash Price |
$157.50
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$245.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$222.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$127.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$206.50
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$245.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$222.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$206.50
|
| 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
|
OP
|
$149.87
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901698158
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$29.97 |
| Max. Negotiated Rate |
$449.04 |
| Rate for Payer: Adventist Health Commercial |
$29.97
|
| Rate for Payer: Aetna of CA HMO/PPO |
$449.04
|
| 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 |
$96.17
|
| Rate for Payer: Cash Price |
$67.44
|
| Rate for Payer: Cash Price |
$67.44
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$104.91
|
| 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 Foundation Hospitals Commercial/Self Funded |
$95.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$54.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$88.42
|
| 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, .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 |
$67.44
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$104.91
|
| 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 Foundation Hospitals Commercial/Self Funded |
$95.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$88.42
|
| 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,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 |
$449.04 |
| Rate for Payer: Adventist Health Commercial |
$49.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$449.04
|
| 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 |
$160.09
|
| Rate for Payer: Cash Price |
$112.27
|
| Rate for Payer: Cash Price |
$112.27
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$174.64
|
| 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 Foundation Hospitals Commercial/Self Funded |
$158.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$90.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$147.19
|
| 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 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 |
$112.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$174.64
|
| 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 Foundation Hospitals Commercial/Self Funded |
$158.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$147.19
|
| 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 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$43.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Cigna of CA HMO |
$152.60
|
| Rate for Payer: Cigna of CA PPO |
$152.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$138.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$128.62
|
| 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 |
$141.70
|
| 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
|
IP
|
$218.00
|
|
|
Service Code
|
CPT L3100
|
| Hospital Charge Code |
915353100
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$43.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$43.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Cigna of CA HMO |
$152.60
|
| Rate for Payer: Cigna of CA PPO |
$152.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$138.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$128.62
|
| 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 |
$141.70
|
| 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 |
$131.96
|
| Rate for Payer: Blue Shield of California Commercial |
$167.64
|
| Rate for Payer: Blue Shield of California Commercial |
$110.53
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Cash Price |
$98.10
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$28.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$138.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$128.62
|
| 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
|
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 |
$131.96
|
| Rate for Payer: Blue Shield of California Commercial |
$167.64
|
| Rate for Payer: Blue Shield of California Commercial |
$110.53
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Cash Price |
$98.10
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$28.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$138.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$128.62
|
| 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 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$586.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$1,319.85
|
| Rate for Payer: Cash Price |
$1,319.85
|
| Rate for Payer: Cigna of CA HMO |
$2,053.10
|
| Rate for Payer: Cigna of CA PPO |
$2,053.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$1,862.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,730.47
|
| 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 |
$1,906.45
|
| 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
|
|
|
HC HALO ADDITION MRI COMPATIBLE
|
Facility
|
OP
|
$2,933.00
|
|
|
Service Code
|
CPT L0859
|
| Hospital Charge Code |
905350860
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$703.92 |
| Max. Negotiated Rate |
$2,493.05 |
| Rate for Payer: Adventist Health Commercial |
$1,202.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,493.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,613.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,199.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,775.34
|
| Rate for Payer: Blue Shield of California Commercial |
$2,255.48
|
| Rate for Payer: Blue Shield of California Commercial |
$1,487.03
|
| Rate for Payer: Cash Price |
$1,319.85
|
| Rate for Payer: Cash Price |
$1,319.85
|
| Rate for Payer: Cigna of CA HMO |
$2,053.10
|
| Rate for Payer: Cigna of CA PPO |
$2,053.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,493.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,493.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,493.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,232.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,862.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,393.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,730.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$703.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,053.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,053.10
|
| 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: Temecula Valley Physicians Medical Group Commercial |
$1,759.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,759.80
|
| 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
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,493.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,493.05
|
| Rate for Payer: Vantage Medical Group Senior |
$2,493.05
|
|
|
HC HALO ADDITION MRI COMPATIBLE SYSTEM
|
Facility
|
OP
|
$2,210.00
|
|
|
Service Code
|
CPT L0859
|
| Hospital Charge Code |
905350859
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$530.40 |
| Max. Negotiated Rate |
$1,878.50 |
| Rate for Payer: Adventist Health Commercial |
$906.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,878.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,215.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,657.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,337.71
|
| Rate for Payer: Blue Shield of California Commercial |
$1,699.49
|
| Rate for Payer: Blue Shield of California Commercial |
$1,120.47
|
| Rate for Payer: Cash Price |
$994.50
|
| Rate for Payer: Cash Price |
$994.50
|
| Rate for Payer: Cigna of CA HMO |
$1,547.00
|
| Rate for Payer: Cigna of CA PPO |
$1,547.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,878.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,878.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,878.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,547.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$884.00
|
| Rate for Payer: EPIC Health Plan Senior |
$884.00
|
| Rate for Payer: Galaxy Health WC |
$1,878.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,326.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,232.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,403.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,393.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,303.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$530.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,547.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,547.00
|
| Rate for Payer: Multiplan Commercial |
$1,768.00
|
| Rate for Payer: Networks By Design Commercial |
$1,105.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,878.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,326.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,326.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$829.41
|
| Rate for Payer: United Healthcare All Other HMO |
$807.31
|
| Rate for Payer: United Healthcare HMO Rider |
$789.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$723.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,878.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,878.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,878.50
|
|
|
HC HALO ADDITION MRI COMPATIBLE SYSTEM
|
Facility
|
OP
|
$2,210.00
|
|
|
Service Code
|
CPT L0859
|
| Hospital Charge Code |
915350859
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$530.40 |
| Max. Negotiated Rate |
$1,878.50 |
| Rate for Payer: Adventist Health Commercial |
$906.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,878.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,215.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,657.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,337.71
|
| Rate for Payer: Blue Shield of California Commercial |
$1,699.49
|
| Rate for Payer: Blue Shield of California Commercial |
$1,120.47
|
| Rate for Payer: Cash Price |
$994.50
|
| Rate for Payer: Cash Price |
$994.50
|
| Rate for Payer: Cigna of CA HMO |
$1,547.00
|
| Rate for Payer: Cigna of CA PPO |
$1,547.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,878.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,878.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,878.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,547.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$884.00
|
| Rate for Payer: EPIC Health Plan Senior |
$884.00
|
| Rate for Payer: Galaxy Health WC |
$1,878.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,326.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,232.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,403.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,393.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,303.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$530.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,547.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,547.00
|
| Rate for Payer: Multiplan Commercial |
$1,768.00
|
| Rate for Payer: Networks By Design Commercial |
$1,105.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,878.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,326.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,326.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$829.41
|
| Rate for Payer: United Healthcare All Other HMO |
$807.31
|
| Rate for Payer: United Healthcare HMO Rider |
$789.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$723.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,878.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,878.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,878.50
|
|
|
HC HALO ADDITION MRI COMPATIBLE SYSTEM
|
Facility
|
IP
|
$2,210.00
|
|
|
Service Code
|
CPT L0859
|
| Hospital Charge Code |
915350859
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$442.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$442.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$994.50
|
| Rate for Payer: Cash Price |
$994.50
|
| Rate for Payer: Cigna of CA HMO |
$1,547.00
|
| Rate for Payer: Cigna of CA PPO |
$1,547.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,547.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$884.00
|
| Rate for Payer: EPIC Health Plan Senior |
$884.00
|
| Rate for Payer: Galaxy Health WC |
$1,878.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,326.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,403.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,303.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$530.40
|
| Rate for Payer: Multiplan Commercial |
$1,768.00
|
| Rate for Payer: Networks By Design Commercial |
$1,436.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,878.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$829.41
|
| Rate for Payer: United Healthcare All Other HMO |
$807.31
|
| Rate for Payer: United Healthcare HMO Rider |
$789.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$723.77
|
|
|
HC HALO ADDITION MRI COMPATIBLE SYSTEM
|
Facility
|
IP
|
$2,210.00
|
|
|
Service Code
|
CPT L0859
|
| Hospital Charge Code |
905350859
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$442.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$442.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$994.50
|
| Rate for Payer: Cash Price |
$994.50
|
| Rate for Payer: Cigna of CA HMO |
$1,547.00
|
| Rate for Payer: Cigna of CA PPO |
$1,547.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,547.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$884.00
|
| Rate for Payer: EPIC Health Plan Senior |
$884.00
|
| Rate for Payer: Galaxy Health WC |
$1,878.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,326.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,403.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,303.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$530.40
|
| Rate for Payer: Multiplan Commercial |
$1,768.00
|
| Rate for Payer: Networks By Design Commercial |
$1,436.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,878.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$829.41
|
| Rate for Payer: United Healthcare All Other HMO |
$807.31
|
| Rate for Payer: United Healthcare HMO Rider |
$789.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$723.77
|
|
|
HC HALO PROCEDURE W/MILWAUKEE
|
Facility
|
IP
|
$9,346.00
|
|
|
Service Code
|
CPT L0830
|
| Hospital Charge Code |
915350830
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,869.20 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$1,869.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$4,205.70
|
| Rate for Payer: Cash Price |
$4,205.70
|
| Rate for Payer: Cigna of CA HMO |
$6,542.20
|
| Rate for Payer: Cigna of CA PPO |
$6,542.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,542.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,738.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,738.40
|
| Rate for Payer: Galaxy Health WC |
$7,944.10
|
| Rate for Payer: Global Benefits Group Commercial |
$5,607.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,934.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,514.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,243.04
|
| Rate for Payer: Multiplan Commercial |
$7,476.80
|
| Rate for Payer: Networks By Design Commercial |
$6,074.90
|
| Rate for Payer: Prime Health Services Commercial |
$7,944.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,507.55
|
| Rate for Payer: United Healthcare All Other HMO |
$3,414.09
|
| Rate for Payer: United Healthcare HMO Rider |
$3,340.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,060.82
|
|
