|
HC WIRE B/S ROTAWIRE ES
|
Facility
|
OP
|
$745.52
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812397
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$149.10 |
| Max. Negotiated Rate |
$670.97 |
| Rate for Payer: Adventist Health Commercial |
$149.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$452.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$633.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$410.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$559.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$360.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$437.84
|
| Rate for Payer: Blue Shield of California Commercial |
$455.51
|
| Rate for Payer: Blue Shield of California EPN |
$297.46
|
| Rate for Payer: Cash Price |
$410.04
|
| Rate for Payer: Central Health Plan Commercial |
$596.42
|
| Rate for Payer: Cigna of CA HMO |
$477.13
|
| Rate for Payer: Cigna of CA PPO |
$551.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$633.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$633.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$633.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$298.21
|
| Rate for Payer: EPIC Health Plan Senior |
$298.21
|
| Rate for Payer: Galaxy Health WC |
$633.69
|
| Rate for Payer: Global Benefits Group Commercial |
$447.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$670.97
|
| Rate for Payer: InnovAge PACE Commercial |
$372.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$497.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$284.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$461.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$521.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$521.86
|
| Rate for Payer: Multiplan Commercial |
$559.14
|
| Rate for Payer: Networks By Design Commercial |
$484.59
|
| Rate for Payer: Prime Health Services Commercial |
$633.69
|
| Rate for Payer: Riverside University Health System MISP |
$298.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$447.31
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$447.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$372.76
|
| Rate for Payer: United Healthcare All Other HMO |
$372.76
|
| Rate for Payer: United Healthcare HMO Rider |
$372.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$372.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$633.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$633.69
|
| Rate for Payer: Vantage Medical Group Senior |
$633.69
|
|
|
HC WIRE B/S ROTAWIRE ES
|
Facility
|
IP
|
$745.52
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812397
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$149.10 |
| Max. Negotiated Rate |
$670.97 |
| Rate for Payer: Adventist Health Commercial |
$149.10
|
| Rate for Payer: Cash Price |
$410.04
|
| Rate for Payer: Central Health Plan Commercial |
$596.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$298.21
|
| Rate for Payer: EPIC Health Plan Senior |
$298.21
|
| Rate for Payer: Galaxy Health WC |
$633.69
|
| Rate for Payer: Global Benefits Group Commercial |
$447.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$670.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$497.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$284.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$461.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.10
|
| Rate for Payer: Multiplan Commercial |
$559.14
|
| Rate for Payer: Networks By Design Commercial |
$484.59
|
| Rate for Payer: Prime Health Services Commercial |
$633.69
|
|
|
HC WIRE B/S SAFARI PRE-SHAPED
|
Facility
|
OP
|
$1,053.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812557
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$210.60 |
| Max. Negotiated Rate |
$947.70 |
| Rate for Payer: Adventist Health Commercial |
$210.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$639.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$895.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$579.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$789.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$509.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$618.43
|
| Rate for Payer: Blue Shield of California Commercial |
$643.38
|
| Rate for Payer: Blue Shield of California EPN |
$420.15
|
| Rate for Payer: Cash Price |
$579.15
|
| Rate for Payer: Central Health Plan Commercial |
$842.40
|
| Rate for Payer: Cigna of CA HMO |
$673.92
|
| Rate for Payer: Cigna of CA PPO |
$779.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$895.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$895.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$895.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$421.20
|
| Rate for Payer: EPIC Health Plan Senior |
$421.20
|
| Rate for Payer: Galaxy Health WC |
$895.05
|
| Rate for Payer: Global Benefits Group Commercial |
$631.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$947.70
|
| Rate for Payer: InnovAge PACE Commercial |
$526.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$702.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$401.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$651.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$210.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$737.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$737.10
|
| Rate for Payer: Multiplan Commercial |
$789.75
|
| Rate for Payer: Networks By Design Commercial |
$684.45
|
| Rate for Payer: Prime Health Services Commercial |
$895.05
|
| Rate for Payer: Riverside University Health System MISP |
$421.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$631.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$631.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$526.50
|
| Rate for Payer: United Healthcare All Other HMO |
$526.50
|
| Rate for Payer: United Healthcare HMO Rider |
$526.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$526.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$895.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$895.05
|
| Rate for Payer: Vantage Medical Group Senior |
$895.05
|
|
|
HC WIRE B/S SAFARI PRE-SHAPED
|
Facility
|
IP
|
$1,053.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812557
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$210.60 |
| Max. Negotiated Rate |
$947.70 |
| Rate for Payer: Adventist Health Commercial |
$210.60
|
| Rate for Payer: Cash Price |
$579.15
|
| Rate for Payer: Central Health Plan Commercial |
$842.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$421.20
|
| Rate for Payer: EPIC Health Plan Senior |
$421.20
|
| Rate for Payer: Galaxy Health WC |
$895.05
|
| Rate for Payer: Global Benefits Group Commercial |
$631.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$947.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$702.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$401.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$651.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$210.60
|
| Rate for Payer: Multiplan Commercial |
$789.75
|
| Rate for Payer: Networks By Design Commercial |
$684.45
|
| Rate for Payer: Prime Health Services Commercial |
$895.05
|
|
|
HC WIRE BS STINGRAY
|
Facility
|
IP
|
$1,265.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812525
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$253.00 |
| Max. Negotiated Rate |
$1,138.50 |
| Rate for Payer: Adventist Health Commercial |
$253.00
|
| Rate for Payer: Cash Price |
$695.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,012.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.00
|
| Rate for Payer: EPIC Health Plan Senior |
$506.00
|
| Rate for Payer: Galaxy Health WC |
$1,075.25
|
| Rate for Payer: Global Benefits Group Commercial |
$759.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,138.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$843.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$481.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$783.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$253.00
|
| Rate for Payer: Multiplan Commercial |
$948.75
|
| Rate for Payer: Networks By Design Commercial |
$822.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,075.25
|
|
|
HC WIRE BS STINGRAY
|
Facility
|
OP
|
$1,265.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812525
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$253.00 |
| Max. Negotiated Rate |
$1,138.50 |
| Rate for Payer: Adventist Health Commercial |
$253.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$768.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,075.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$695.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$948.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$612.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$742.93
|
| Rate for Payer: Blue Shield of California Commercial |
$772.91
|
| Rate for Payer: Blue Shield of California EPN |
$504.74
|
| Rate for Payer: Cash Price |
$695.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,012.00
|
| Rate for Payer: Cigna of CA HMO |
$809.60
|
| Rate for Payer: Cigna of CA PPO |
$936.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,075.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,075.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,075.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.00
|
| Rate for Payer: EPIC Health Plan Senior |
$506.00
|
| Rate for Payer: Galaxy Health WC |
$1,075.25
|
| Rate for Payer: Global Benefits Group Commercial |
$759.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,138.50
|
| Rate for Payer: InnovAge PACE Commercial |
$632.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$843.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$481.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$783.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$253.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$885.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$885.50
|
| Rate for Payer: Multiplan Commercial |
$948.75
|
| Rate for Payer: Networks By Design Commercial |
$822.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,075.25
|
| Rate for Payer: Riverside University Health System MISP |
$506.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$759.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$759.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$632.50
|
| Rate for Payer: United Healthcare All Other HMO |
$632.50
|
| Rate for Payer: United Healthcare HMO Rider |
$632.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$632.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,075.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,075.25
|
| Rate for Payer: Vantage Medical Group Senior |
$1,075.25
|
|
|
HC WIRE BS STINGRAY EXTENSION
|
Facility
|
OP
|
$464.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812526
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$92.80 |
| Max. Negotiated Rate |
$417.60 |
| Rate for Payer: Adventist Health Commercial |
$92.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$281.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$394.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$255.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$348.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$224.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$272.51
|
| Rate for Payer: Blue Shield of California Commercial |
$283.50
|
| Rate for Payer: Blue Shield of California EPN |
$185.14
|
| Rate for Payer: Cash Price |
$255.20
|
| Rate for Payer: Central Health Plan Commercial |
$371.20
|
| Rate for Payer: Cigna of CA HMO |
$296.96
|
| Rate for Payer: Cigna of CA PPO |
$343.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$394.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$394.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$394.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.60
|
| Rate for Payer: EPIC Health Plan Senior |
$185.60
|
| Rate for Payer: Galaxy Health WC |
$394.40
|
| Rate for Payer: Global Benefits Group Commercial |
$278.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$417.60
|
| Rate for Payer: InnovAge PACE Commercial |
$232.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$309.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$176.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$287.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$324.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$324.80
|
| Rate for Payer: Multiplan Commercial |
$348.00
|
| Rate for Payer: Networks By Design Commercial |
$301.60
|
| Rate for Payer: Prime Health Services Commercial |
$394.40
|
| Rate for Payer: Riverside University Health System MISP |
$185.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$278.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$278.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$232.00
|
| Rate for Payer: United Healthcare All Other HMO |
$232.00
|
| Rate for Payer: United Healthcare HMO Rider |
$232.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$232.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$394.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$394.40
|
| Rate for Payer: Vantage Medical Group Senior |
$394.40
|
|
|
HC WIRE BS STINGRAY EXTENSION
|
Facility
|
IP
|
$464.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812526
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$92.80 |
| Max. Negotiated Rate |
$417.60 |
| Rate for Payer: Adventist Health Commercial |
$92.80
|
| Rate for Payer: Cash Price |
$255.20
|
| Rate for Payer: Central Health Plan Commercial |
$371.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.60
|
| Rate for Payer: EPIC Health Plan Senior |
$185.60
|
| Rate for Payer: Galaxy Health WC |
$394.40
|
| Rate for Payer: Global Benefits Group Commercial |
$278.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$417.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$309.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$176.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$287.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.80
|
| Rate for Payer: Multiplan Commercial |
$348.00
|
| Rate for Payer: Networks By Design Commercial |
$301.60
|
| Rate for Payer: Prime Health Services Commercial |
$394.40
|
|
|
HC WIRE B/S V-18
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812699
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Cash Price |
$319.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
|
|
HC WIRE B/S V-18
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812699
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$352.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$319.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$435.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$280.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$340.63
|
| Rate for Payer: Blue Shield of California Commercial |
$354.38
|
| Rate for Payer: Blue Shield of California EPN |
$231.42
|
| Rate for Payer: Cash Price |
$319.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: Cigna of CA HMO |
$371.20
|
| Rate for Payer: Cigna of CA PPO |
$429.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$493.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$493.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: InnovAge PACE Commercial |
$290.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$406.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$406.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: Riverside University Health System MISP |
$232.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$348.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$348.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$290.00
|
| Rate for Payer: United Healthcare All Other HMO |
$290.00
|
| Rate for Payer: United Healthcare HMO Rider |
$290.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$290.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.00
|
| Rate for Payer: Vantage Medical Group Senior |
$493.00
|
|
|
HC WIRE B/S V-18 200CM
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812656
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Cash Price |
$319.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
|
|
HC WIRE B/S V-18 200CM
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812656
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$352.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$319.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$435.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$280.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$340.63
|
| Rate for Payer: Blue Shield of California Commercial |
$354.38
|
| Rate for Payer: Blue Shield of California EPN |
$231.42
|
| Rate for Payer: Cash Price |
$319.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: Cigna of CA HMO |
$371.20
|
| Rate for Payer: Cigna of CA PPO |
$429.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$493.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$493.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: InnovAge PACE Commercial |
$290.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$406.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$406.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: Riverside University Health System MISP |
$232.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$348.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$348.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$290.00
|
| Rate for Payer: United Healthcare All Other HMO |
$290.00
|
| Rate for Payer: United Healthcare HMO Rider |
$290.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$290.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.00
|
| Rate for Payer: Vantage Medical Group Senior |
$493.00
|
|
|
HC WIRE B/S V-18 300CM
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812657
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Cash Price |
$319.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
|
|
HC WIRE B/S V-18 300CM
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812657
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$352.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$319.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$435.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$280.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$340.63
|
| Rate for Payer: Blue Shield of California Commercial |
$354.38
|
| Rate for Payer: Blue Shield of California EPN |
$231.42
|
| Rate for Payer: Cash Price |
$319.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: Cigna of CA HMO |
$371.20
|
| Rate for Payer: Cigna of CA PPO |
$429.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$493.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$493.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: InnovAge PACE Commercial |
$290.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$406.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$406.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: Riverside University Health System MISP |
$232.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$348.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$348.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$290.00
|
| Rate for Payer: United Healthcare All Other HMO |
$290.00
|
| Rate for Payer: United Healthcare HMO Rider |
$290.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$290.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.00
|
| Rate for Payer: Vantage Medical Group Senior |
$493.00
|
|
|
HC WIRE COOK 035 EXCHANGE J
|
Facility
|
OP
|
$152.25
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812440
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.45 |
| Max. Negotiated Rate |
$137.03 |
| Rate for Payer: Adventist Health Commercial |
$30.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$92.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$129.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$114.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$73.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$89.42
|
| Rate for Payer: Blue Shield of California Commercial |
$93.02
|
| Rate for Payer: Blue Shield of California EPN |
$60.75
|
| Rate for Payer: Cash Price |
$83.74
|
| Rate for Payer: Central Health Plan Commercial |
$121.80
|
| Rate for Payer: Cigna of CA HMO |
$97.44
|
| Rate for Payer: Cigna of CA PPO |
$112.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$129.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$129.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$129.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.90
|
| Rate for Payer: EPIC Health Plan Senior |
$60.90
|
| Rate for Payer: Galaxy Health WC |
$129.41
|
| Rate for Payer: Global Benefits Group Commercial |
$91.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$137.03
|
| Rate for Payer: InnovAge PACE Commercial |
$76.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$101.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$94.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$106.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$106.58
|
| Rate for Payer: Multiplan Commercial |
$114.19
|
| Rate for Payer: Networks By Design Commercial |
$98.96
|
| Rate for Payer: Prime Health Services Commercial |
$129.41
|
| Rate for Payer: Riverside University Health System MISP |
$60.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$91.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$91.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$76.12
|
| Rate for Payer: United Healthcare All Other HMO |
$76.12
|
| Rate for Payer: United Healthcare HMO Rider |
$76.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$76.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$129.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$129.41
|
| Rate for Payer: Vantage Medical Group Senior |
$129.41
|
|
|
HC WIRE COOK 035 EXCHANGE J
|
Facility
|
IP
|
$152.25
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812440
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.45 |
| Max. Negotiated Rate |
$137.03 |
| Rate for Payer: Adventist Health Commercial |
$30.45
|
| Rate for Payer: Cash Price |
$83.74
|
| Rate for Payer: Central Health Plan Commercial |
$121.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.90
|
| Rate for Payer: EPIC Health Plan Senior |
$60.90
|
| Rate for Payer: Galaxy Health WC |
$129.41
|
| Rate for Payer: Global Benefits Group Commercial |
$91.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$137.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$101.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$94.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.45
|
| Rate for Payer: Multiplan Commercial |
$114.19
|
| Rate for Payer: Networks By Design Commercial |
$98.96
|
| Rate for Payer: Prime Health Services Commercial |
$129.41
|
|
|
HC WIRE COOK AMPLATZ EXTRA STIFF
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812509
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$30.40 |
| Max. Negotiated Rate |
$136.80 |
| Rate for Payer: Adventist Health Commercial |
$30.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$129.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$114.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$69.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$84.16
|
| Rate for Payer: Blue Shield of California Commercial |
$117.50
|
| Rate for Payer: Blue Shield of California EPN |
$76.61
|
| Rate for Payer: Cash Price |
$83.60
|
| Rate for Payer: Central Health Plan Commercial |
$121.60
|
| Rate for Payer: Cigna of CA HMO |
$106.40
|
| Rate for Payer: Cigna of CA PPO |
$106.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$129.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$129.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$129.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.80
|
| Rate for Payer: EPIC Health Plan Senior |
$60.80
|
| Rate for Payer: Galaxy Health WC |
$129.20
|
| Rate for Payer: Global Benefits Group Commercial |
$91.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$136.80
|
| Rate for Payer: InnovAge PACE Commercial |
$76.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$101.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$94.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$106.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$106.40
|
| Rate for Payer: Multiplan Commercial |
$114.00
|
| Rate for Payer: Networks By Design Commercial |
$76.00
|
| Rate for Payer: Prime Health Services Commercial |
$129.20
|
| Rate for Payer: Riverside University Health System MISP |
$60.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$91.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$91.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$57.05
|
| Rate for Payer: United Healthcare All Other HMO |
$55.53
|
| Rate for Payer: United Healthcare HMO Rider |
$54.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$49.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$129.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$129.20
|
| Rate for Payer: Vantage Medical Group Senior |
$129.20
|
|
|
HC WIRE COOK AMPLATZ EXTRA STIFF
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812509
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$30.40 |
| Max. Negotiated Rate |
$136.80 |
| Rate for Payer: Adventist Health Commercial |
$30.40
|
| Rate for Payer: Blue Shield of California Commercial |
$117.50
|
| Rate for Payer: Blue Shield of California EPN |
$76.61
|
| Rate for Payer: Cash Price |
$83.60
|
| Rate for Payer: Central Health Plan Commercial |
$121.60
|
| Rate for Payer: Cigna of CA HMO |
$106.40
|
| Rate for Payer: Cigna of CA PPO |
$106.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.80
|
| Rate for Payer: EPIC Health Plan Senior |
$60.80
|
| Rate for Payer: Galaxy Health WC |
$129.20
|
| Rate for Payer: Global Benefits Group Commercial |
$91.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$136.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$101.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$94.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.40
|
| Rate for Payer: Multiplan Commercial |
$114.00
|
| Rate for Payer: Networks By Design Commercial |
$76.00
|
| Rate for Payer: Prime Health Services Commercial |
$129.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$57.05
|
| Rate for Payer: United Healthcare All Other HMO |
$55.53
|
| Rate for Payer: United Healthcare HMO Rider |
$54.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$49.78
|
|
|
HC WIRE COOK LUNDERQUIST
|
Facility
|
OP
|
$574.20
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812436
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$114.84 |
| Max. Negotiated Rate |
$516.78 |
| Rate for Payer: Adventist Health Commercial |
$114.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$348.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$488.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$315.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$430.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$278.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$337.23
|
| Rate for Payer: Blue Shield of California Commercial |
$350.84
|
| Rate for Payer: Blue Shield of California EPN |
$229.11
|
| Rate for Payer: Cash Price |
$315.81
|
| Rate for Payer: Central Health Plan Commercial |
$459.36
|
| Rate for Payer: Cigna of CA HMO |
$367.49
|
| Rate for Payer: Cigna of CA PPO |
$424.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$488.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$488.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$488.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$229.68
|
| Rate for Payer: EPIC Health Plan Senior |
$229.68
|
| Rate for Payer: Galaxy Health WC |
$488.07
|
| Rate for Payer: Global Benefits Group Commercial |
$344.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$516.78
|
| Rate for Payer: InnovAge PACE Commercial |
$287.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$382.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$218.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$355.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$114.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$401.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$401.94
|
| Rate for Payer: Multiplan Commercial |
$430.65
|
| Rate for Payer: Networks By Design Commercial |
$373.23
|
| Rate for Payer: Prime Health Services Commercial |
$488.07
|
| Rate for Payer: Riverside University Health System MISP |
$229.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$344.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$344.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$287.10
|
| Rate for Payer: United Healthcare All Other HMO |
$287.10
|
| Rate for Payer: United Healthcare HMO Rider |
$287.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$287.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$488.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$488.07
|
| Rate for Payer: Vantage Medical Group Senior |
$488.07
|
|
|
HC WIRE COOK LUNDERQUIST
|
Facility
|
IP
|
$574.20
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812436
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$114.84 |
| Max. Negotiated Rate |
$516.78 |
| Rate for Payer: Adventist Health Commercial |
$114.84
|
| Rate for Payer: Cash Price |
$315.81
|
| Rate for Payer: Central Health Plan Commercial |
$459.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$229.68
|
| Rate for Payer: EPIC Health Plan Senior |
$229.68
|
| Rate for Payer: Galaxy Health WC |
$488.07
|
| Rate for Payer: Global Benefits Group Commercial |
$344.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$516.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$382.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$218.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$355.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$114.84
|
| Rate for Payer: Multiplan Commercial |
$430.65
|
| Rate for Payer: Networks By Design Commercial |
$373.23
|
| Rate for Payer: Prime Health Services Commercial |
$488.07
|
|
|
HC WIRE COOK ROSEN
|
Facility
|
IP
|
$100.70
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812459
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20.14 |
| Max. Negotiated Rate |
$90.63 |
| Rate for Payer: Adventist Health Commercial |
$20.14
|
| Rate for Payer: Blue Shield of California Commercial |
$77.84
|
| Rate for Payer: Blue Shield of California EPN |
$50.75
|
| Rate for Payer: Cash Price |
$55.39
|
| Rate for Payer: Central Health Plan Commercial |
$80.56
|
| Rate for Payer: Cigna of CA HMO |
$70.49
|
| Rate for Payer: Cigna of CA PPO |
$70.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.28
|
| Rate for Payer: EPIC Health Plan Senior |
$40.28
|
| Rate for Payer: Galaxy Health WC |
$85.59
|
| Rate for Payer: Global Benefits Group Commercial |
$60.42
|
| Rate for Payer: Health Management Network EPO/PPO |
$90.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$67.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$62.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.14
|
| Rate for Payer: Multiplan Commercial |
$75.53
|
| Rate for Payer: Networks By Design Commercial |
$50.35
|
| Rate for Payer: Prime Health Services Commercial |
$85.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$37.79
|
| Rate for Payer: United Healthcare All Other HMO |
$36.79
|
| Rate for Payer: United Healthcare HMO Rider |
$35.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.98
|
|
|
HC WIRE COOK ROSEN
|
Facility
|
OP
|
$100.70
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812459
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20.14 |
| Max. Negotiated Rate |
$90.63 |
| Rate for Payer: Adventist Health Commercial |
$20.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$85.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$55.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$45.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$55.76
|
| Rate for Payer: Blue Shield of California Commercial |
$77.84
|
| Rate for Payer: Blue Shield of California EPN |
$50.75
|
| Rate for Payer: Cash Price |
$55.39
|
| Rate for Payer: Central Health Plan Commercial |
$80.56
|
| Rate for Payer: Cigna of CA HMO |
$70.49
|
| Rate for Payer: Cigna of CA PPO |
$70.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$85.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$85.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$85.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.28
|
| Rate for Payer: EPIC Health Plan Senior |
$40.28
|
| Rate for Payer: Galaxy Health WC |
$85.59
|
| Rate for Payer: Global Benefits Group Commercial |
$60.42
|
| Rate for Payer: Health Management Network EPO/PPO |
$90.63
|
| Rate for Payer: InnovAge PACE Commercial |
$50.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$67.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$62.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$70.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$70.49
|
| Rate for Payer: Multiplan Commercial |
$75.53
|
| Rate for Payer: Networks By Design Commercial |
$50.35
|
| Rate for Payer: Prime Health Services Commercial |
$85.59
|
| Rate for Payer: Riverside University Health System MISP |
$40.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$60.42
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$60.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$37.79
|
| Rate for Payer: United Healthcare All Other HMO |
$36.79
|
| Rate for Payer: United Healthcare HMO Rider |
$35.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$85.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$85.59
|
| Rate for Payer: Vantage Medical Group Senior |
$85.59
|
|
|
HC WIRE CORDIS PTCA
|
Facility
|
IP
|
$456.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812258
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$91.20 |
| Max. Negotiated Rate |
$410.40 |
| Rate for Payer: Adventist Health Commercial |
$91.20
|
| Rate for Payer: Cash Price |
$250.80
|
| Rate for Payer: Central Health Plan Commercial |
$364.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.40
|
| Rate for Payer: EPIC Health Plan Senior |
$182.40
|
| Rate for Payer: Galaxy Health WC |
$387.60
|
| Rate for Payer: Global Benefits Group Commercial |
$273.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$410.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$304.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$173.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$282.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$91.20
|
| Rate for Payer: Multiplan Commercial |
$342.00
|
| Rate for Payer: Networks By Design Commercial |
$296.40
|
| Rate for Payer: Prime Health Services Commercial |
$387.60
|
|
|
HC WIRE CORDIS PTCA
|
Facility
|
OP
|
$456.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812258
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$91.20 |
| Max. Negotiated Rate |
$410.40 |
| Rate for Payer: Adventist Health Commercial |
$91.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$276.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$250.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$342.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$220.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$267.81
|
| Rate for Payer: Blue Shield of California Commercial |
$278.62
|
| Rate for Payer: Blue Shield of California EPN |
$181.94
|
| Rate for Payer: Cash Price |
$250.80
|
| Rate for Payer: Central Health Plan Commercial |
$364.80
|
| Rate for Payer: Cigna of CA HMO |
$291.84
|
| Rate for Payer: Cigna of CA PPO |
$337.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$387.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$387.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.40
|
| Rate for Payer: EPIC Health Plan Senior |
$182.40
|
| Rate for Payer: Galaxy Health WC |
$387.60
|
| Rate for Payer: Global Benefits Group Commercial |
$273.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$410.40
|
| Rate for Payer: InnovAge PACE Commercial |
$228.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$304.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$173.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$282.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$91.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$319.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$319.20
|
| Rate for Payer: Multiplan Commercial |
$342.00
|
| Rate for Payer: Networks By Design Commercial |
$296.40
|
| Rate for Payer: Prime Health Services Commercial |
$387.60
|
| Rate for Payer: Riverside University Health System MISP |
$182.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$273.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$273.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$228.00
|
| Rate for Payer: United Healthcare All Other HMO |
$228.00
|
| Rate for Payer: United Healthcare HMO Rider |
$228.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$228.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$387.60
|
| Rate for Payer: Vantage Medical Group Senior |
$387.60
|
|
|
HC WIRE EV3 NITREX 180CM
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812589
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Cash Price |
$319.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
|
