|
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
|
|
|
HC WIRE EV3 NITREX 300CM
|
Facility
|
OP
|
$622.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812590
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$124.40 |
| Max. Negotiated Rate |
$559.80 |
| Rate for Payer: Adventist Health Commercial |
$124.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$377.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$528.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$342.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$466.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$301.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$365.30
|
| Rate for Payer: Blue Shield of California Commercial |
$380.04
|
| Rate for Payer: Blue Shield of California EPN |
$248.18
|
| Rate for Payer: Cash Price |
$342.10
|
| Rate for Payer: Central Health Plan Commercial |
$497.60
|
| Rate for Payer: Cigna of CA HMO |
$398.08
|
| Rate for Payer: Cigna of CA PPO |
$460.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$528.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$528.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$528.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$248.80
|
| Rate for Payer: EPIC Health Plan Senior |
$248.80
|
| Rate for Payer: Galaxy Health WC |
$528.70
|
| Rate for Payer: Global Benefits Group Commercial |
$373.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$559.80
|
| Rate for Payer: InnovAge PACE Commercial |
$311.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$414.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$236.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$385.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$435.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$435.40
|
| Rate for Payer: Multiplan Commercial |
$466.50
|
| Rate for Payer: Networks By Design Commercial |
$404.30
|
| Rate for Payer: Prime Health Services Commercial |
$528.70
|
| Rate for Payer: Riverside University Health System MISP |
$248.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$373.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$373.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$311.00
|
| Rate for Payer: United Healthcare All Other HMO |
$311.00
|
| Rate for Payer: United Healthcare HMO Rider |
$311.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$311.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$528.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$528.70
|
| Rate for Payer: Vantage Medical Group Senior |
$528.70
|
|
|
HC WIRE EV3 NITREX 300CM
|
Facility
|
IP
|
$622.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812590
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$124.40 |
| Max. Negotiated Rate |
$559.80 |
| Rate for Payer: Adventist Health Commercial |
$124.40
|
| Rate for Payer: Cash Price |
$342.10
|
| Rate for Payer: Central Health Plan Commercial |
$497.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$248.80
|
| Rate for Payer: EPIC Health Plan Senior |
$248.80
|
| Rate for Payer: Galaxy Health WC |
$528.70
|
| Rate for Payer: Global Benefits Group Commercial |
$373.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$559.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$414.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$236.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$385.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.40
|
| Rate for Payer: Multiplan Commercial |
$466.50
|
| Rate for Payer: Networks By Design Commercial |
$404.30
|
| Rate for Payer: Prime Health Services Commercial |
$528.70
|
|
|
HC WIRE EV3 NITREX 80CM
|
Facility
|
IP
|
$412.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812068
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$82.40 |
| Max. Negotiated Rate |
$370.80 |
| Rate for Payer: Adventist Health Commercial |
$82.40
|
| Rate for Payer: Cash Price |
$226.60
|
| Rate for Payer: Central Health Plan Commercial |
$329.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$164.80
|
| Rate for Payer: EPIC Health Plan Senior |
$164.80
|
| Rate for Payer: Galaxy Health WC |
$350.20
|
| Rate for Payer: Global Benefits Group Commercial |
$247.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$370.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$274.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$156.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$255.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.40
|
| Rate for Payer: Multiplan Commercial |
$309.00
|
| Rate for Payer: Networks By Design Commercial |
$267.80
|
| Rate for Payer: Prime Health Services Commercial |
$350.20
|
|
|
HC WIRE EV3 NITREX 80CM
|
Facility
|
OP
|
$412.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812068
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$82.40 |
| Max. Negotiated Rate |
$370.80 |
| Rate for Payer: Adventist Health Commercial |
$82.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$250.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$350.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$226.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$309.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$199.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$241.97
|
| Rate for Payer: Blue Shield of California Commercial |
$251.73
|
| Rate for Payer: Blue Shield of California EPN |
$164.39
|
| Rate for Payer: Cash Price |
$226.60
|
| Rate for Payer: Central Health Plan Commercial |
$329.60
|
| Rate for Payer: Cigna of CA HMO |
$263.68
|
| Rate for Payer: Cigna of CA PPO |
$304.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$350.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$350.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$350.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$164.80
|
| Rate for Payer: EPIC Health Plan Senior |
$164.80
|
| Rate for Payer: Galaxy Health WC |
$350.20
|
| Rate for Payer: Global Benefits Group Commercial |
$247.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$370.80
|
| Rate for Payer: InnovAge PACE Commercial |
$206.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$274.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$156.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$255.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$288.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$288.40
|
| Rate for Payer: Multiplan Commercial |
$309.00
|
| Rate for Payer: Networks By Design Commercial |
$267.80
|
| Rate for Payer: Prime Health Services Commercial |
$350.20
|
| Rate for Payer: Riverside University Health System MISP |
$164.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$247.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$247.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$206.00
|
| Rate for Payer: United Healthcare All Other HMO |
$206.00
|
| Rate for Payer: United Healthcare HMO Rider |
$206.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$350.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$350.20
|
| Rate for Payer: Vantage Medical Group Senior |
$350.20
|
|
|
HC WIRE INDIGO SEPERATOR
|
Facility
|
OP
|
$2,913.00
|
|
|
Service Code
|
CPT C1759
|
| Hospital Charge Code |
909000017
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$582.60 |
| Max. Negotiated Rate |
$2,621.70 |
| Rate for Payer: Adventist Health Commercial |
$582.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,476.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,602.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,184.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,330.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,612.93
|
| Rate for Payer: Blue Shield of California Commercial |
$2,251.75
|
| Rate for Payer: Blue Shield of California EPN |
$1,468.15
|
| Rate for Payer: Cash Price |
$1,602.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,330.40
|
| Rate for Payer: Cigna of CA HMO |
$2,039.10
|
| Rate for Payer: Cigna of CA PPO |
$2,039.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,476.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,476.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,476.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,165.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,165.20
|
| Rate for Payer: Galaxy Health WC |
$2,476.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,747.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,621.70
|
| Rate for Payer: InnovAge PACE Commercial |
$1,456.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,942.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,109.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,803.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$582.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,039.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,039.10
|
| Rate for Payer: Multiplan Commercial |
$2,184.75
|
| Rate for Payer: Networks By Design Commercial |
$1,456.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,476.05
|
| Rate for Payer: Riverside University Health System MISP |
$1,165.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,747.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,747.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,093.25
|
| Rate for Payer: United Healthcare All Other HMO |
$1,064.12
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$954.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,476.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,476.05
|
| Rate for Payer: Vantage Medical Group Senior |
$2,476.05
|
|
|
HC WIRE INDIGO SEPERATOR
|
Facility
|
IP
|
$2,913.00
|
|
|
Service Code
|
CPT C1759
|
| Hospital Charge Code |
909000017
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$582.60 |
| Max. Negotiated Rate |
$2,621.70 |
| Rate for Payer: Adventist Health Commercial |
$582.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,251.75
|
| Rate for Payer: Blue Shield of California EPN |
$1,468.15
|
| Rate for Payer: Cash Price |
$1,602.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,330.40
|
| Rate for Payer: Cigna of CA HMO |
$2,039.10
|
| Rate for Payer: Cigna of CA PPO |
$2,039.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,165.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,165.20
|
| Rate for Payer: Galaxy Health WC |
$2,476.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,747.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,621.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,942.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,109.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,803.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$582.60
|
| Rate for Payer: Multiplan Commercial |
$2,184.75
|
| Rate for Payer: Networks By Design Commercial |
$1,456.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,476.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,093.25
|
| Rate for Payer: United Healthcare All Other HMO |
$1,064.12
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$954.01
|
|
|
HC WIRE MALLINCKRODT LOC
|
Facility
|
OP
|
$310.10
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812450
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$62.02 |
| Max. Negotiated Rate |
$279.09 |
| Rate for Payer: Adventist Health Commercial |
$62.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$188.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$263.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$170.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$232.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$150.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$182.12
|
| Rate for Payer: Blue Shield of California Commercial |
$189.47
|
| Rate for Payer: Blue Shield of California EPN |
$123.73
|
| Rate for Payer: Cash Price |
$170.56
|
| Rate for Payer: Central Health Plan Commercial |
$248.08
|
| Rate for Payer: Cigna of CA HMO |
$198.46
|
| Rate for Payer: Cigna of CA PPO |
$229.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$263.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$263.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$263.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$124.04
|
| Rate for Payer: EPIC Health Plan Senior |
$124.04
|
| Rate for Payer: Galaxy Health WC |
$263.58
|
| Rate for Payer: Global Benefits Group Commercial |
$186.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$279.09
|
| Rate for Payer: InnovAge PACE Commercial |
$155.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$206.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$118.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$191.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$217.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$217.07
|
| Rate for Payer: Multiplan Commercial |
$232.57
|
| Rate for Payer: Networks By Design Commercial |
$201.56
|
| Rate for Payer: Prime Health Services Commercial |
$263.58
|
| Rate for Payer: Riverside University Health System MISP |
$124.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$186.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$186.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$155.05
|
| Rate for Payer: United Healthcare All Other HMO |
$155.05
|
| Rate for Payer: United Healthcare HMO Rider |
$155.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$155.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$263.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$263.58
|
| Rate for Payer: Vantage Medical Group Senior |
$263.58
|
|
|
HC WIRE MALLINCKRODT LOC
|
Facility
|
IP
|
$310.10
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812450
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$62.02 |
| Max. Negotiated Rate |
$279.09 |
| Rate for Payer: Adventist Health Commercial |
$62.02
|
| Rate for Payer: Cash Price |
$170.56
|
| Rate for Payer: Central Health Plan Commercial |
$248.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$124.04
|
| Rate for Payer: EPIC Health Plan Senior |
$124.04
|
| Rate for Payer: Galaxy Health WC |
$263.58
|
| Rate for Payer: Global Benefits Group Commercial |
$186.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$279.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$206.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$118.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$191.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.02
|
| Rate for Payer: Multiplan Commercial |
$232.57
|
| Rate for Payer: Networks By Design Commercial |
$201.56
|
| Rate for Payer: Prime Health Services Commercial |
$263.58
|
|
|
HC WIRE MED ATTAIN GWR
|
Facility
|
OP
|
$782.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812494
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$156.40 |
| Max. Negotiated Rate |
$703.80 |
| Rate for Payer: Adventist Health Commercial |
$156.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$474.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$664.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$430.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$586.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$378.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$459.27
|
| Rate for Payer: Blue Shield of California Commercial |
$477.80
|
| Rate for Payer: Blue Shield of California EPN |
$312.02
|
| Rate for Payer: Cash Price |
$430.10
|
| Rate for Payer: Central Health Plan Commercial |
$625.60
|
| Rate for Payer: Cigna of CA HMO |
$500.48
|
| Rate for Payer: Cigna of CA PPO |
$578.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$664.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$664.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$664.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$312.80
|
| Rate for Payer: EPIC Health Plan Senior |
$312.80
|
| Rate for Payer: Galaxy Health WC |
$664.70
|
| Rate for Payer: Global Benefits Group Commercial |
$469.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$703.80
|
| Rate for Payer: InnovAge PACE Commercial |
$391.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$521.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$297.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$484.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$156.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$547.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$547.40
|
| Rate for Payer: Multiplan Commercial |
$586.50
|
| Rate for Payer: Networks By Design Commercial |
$508.30
|
| Rate for Payer: Prime Health Services Commercial |
$664.70
|
| Rate for Payer: Riverside University Health System MISP |
$312.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$469.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$469.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$391.00
|
| Rate for Payer: United Healthcare All Other HMO |
$391.00
|
| Rate for Payer: United Healthcare HMO Rider |
$391.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$391.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$664.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$664.70
|
| Rate for Payer: Vantage Medical Group Senior |
$664.70
|
|
|
HC WIRE MED ATTAIN GWR
|
Facility
|
IP
|
$782.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812494
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$156.40 |
| Max. Negotiated Rate |
$703.80 |
| Rate for Payer: Adventist Health Commercial |
$156.40
|
| Rate for Payer: Cash Price |
$430.10
|
| Rate for Payer: Central Health Plan Commercial |
$625.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$312.80
|
| Rate for Payer: EPIC Health Plan Senior |
$312.80
|
| Rate for Payer: Galaxy Health WC |
$664.70
|
| Rate for Payer: Global Benefits Group Commercial |
$469.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$703.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$521.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$297.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$484.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$156.40
|
| Rate for Payer: Multiplan Commercial |
$586.50
|
| Rate for Payer: Networks By Design Commercial |
$508.30
|
| Rate for Payer: Prime Health Services Commercial |
$664.70
|
|
|
HC WIRE MED CINFIDA
|
Facility
|
IP
|
$897.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812550
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$179.40 |
| Max. Negotiated Rate |
$807.30 |
| Rate for Payer: Adventist Health Commercial |
$179.40
|
| Rate for Payer: Cash Price |
$493.35
|
| Rate for Payer: Central Health Plan Commercial |
$717.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$358.80
|
| Rate for Payer: EPIC Health Plan Senior |
$358.80
|
| Rate for Payer: Galaxy Health WC |
$762.45
|
| Rate for Payer: Global Benefits Group Commercial |
$538.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$807.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$598.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$341.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$555.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$179.40
|
| Rate for Payer: Multiplan Commercial |
$672.75
|
| Rate for Payer: Networks By Design Commercial |
$583.05
|
| Rate for Payer: Prime Health Services Commercial |
$762.45
|
|
|
HC WIRE MED CINFIDA
|
Facility
|
OP
|
$897.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812550
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$179.40 |
| Max. Negotiated Rate |
$807.30 |
| Rate for Payer: Adventist Health Commercial |
$179.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$544.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$762.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$493.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$672.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$434.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$526.81
|
| Rate for Payer: Blue Shield of California Commercial |
$548.07
|
| Rate for Payer: Blue Shield of California EPN |
$357.90
|
| Rate for Payer: Cash Price |
$493.35
|
| Rate for Payer: Central Health Plan Commercial |
$717.60
|
| Rate for Payer: Cigna of CA HMO |
$574.08
|
| Rate for Payer: Cigna of CA PPO |
$663.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$762.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$762.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$762.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$358.80
|
| Rate for Payer: EPIC Health Plan Senior |
$358.80
|
| Rate for Payer: Galaxy Health WC |
$762.45
|
| Rate for Payer: Global Benefits Group Commercial |
$538.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$807.30
|
| Rate for Payer: InnovAge PACE Commercial |
$448.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$598.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$341.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$555.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$179.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$627.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$627.90
|
| Rate for Payer: Multiplan Commercial |
$672.75
|
| Rate for Payer: Networks By Design Commercial |
$583.05
|
| Rate for Payer: Prime Health Services Commercial |
$762.45
|
| Rate for Payer: Riverside University Health System MISP |
$358.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$538.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$538.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$448.50
|
| Rate for Payer: United Healthcare All Other HMO |
$448.50
|
| Rate for Payer: United Healthcare HMO Rider |
$448.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$448.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$762.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$762.45
|
| Rate for Payer: Vantage Medical Group Senior |
$762.45
|
|
|
HC WIRE MED SPIDER FX EMBOLIC FW
|
Facility
|
OP
|
$3,900.00
|
|
|
Service Code
|
CPT C1884
|
| Hospital Charge Code |
906812661
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,510.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,368.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,145.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,925.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,888.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,290.47
|
| Rate for Payer: Blue Shield of California Commercial |
$2,382.90
|
| Rate for Payer: Blue Shield of California EPN |
$1,556.10
|
| Rate for Payer: Cash Price |
$2,145.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.00
|
| Rate for Payer: Cigna of CA HMO |
$2,496.00
|
| Rate for Payer: Cigna of CA PPO |
$2,886.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,315.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,315.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,510.00
|
| Rate for Payer: InnovAge PACE Commercial |
$1,950.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$780.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,730.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,730.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: Networks By Design Commercial |
$2,535.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| Rate for Payer: Riverside University Health System MISP |
$1,560.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,340.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,340.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,950.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,950.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,950.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,950.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,315.00
|
|
|
HC WIRE MED SPIDER FX EMBOLIC FW
|
Facility
|
IP
|
$3,900.00
|
|
|
Service Code
|
CPT C1884
|
| Hospital Charge Code |
906812661
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,510.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Cash Price |
$2,145.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,510.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$780.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: Networks By Design Commercial |
$2,535.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
|
|
HC WIRE MED SPIDER FX FILER WIRE
|
Facility
|
IP
|
$3,900.00
|
|
|
Service Code
|
CPT C1884
|
| Hospital Charge Code |
906812644
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,510.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Cash Price |
$2,145.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,510.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$780.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: Networks By Design Commercial |
$2,535.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
|
|
HC WIRE MED SPIDER FX FILER WIRE
|
Facility
|
OP
|
$3,900.00
|
|
|
Service Code
|
CPT C1884
|
| Hospital Charge Code |
906812644
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,510.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,368.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,145.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,925.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,888.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,290.47
|
| Rate for Payer: Blue Shield of California Commercial |
$2,382.90
|
| Rate for Payer: Blue Shield of California EPN |
$1,556.10
|
| Rate for Payer: Cash Price |
$2,145.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.00
|
| Rate for Payer: Cigna of CA HMO |
$2,496.00
|
| Rate for Payer: Cigna of CA PPO |
$2,886.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,315.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,315.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,510.00
|
| Rate for Payer: InnovAge PACE Commercial |
$1,950.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$780.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,730.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,730.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: Networks By Design Commercial |
$2,535.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| Rate for Payer: Riverside University Health System MISP |
$1,560.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,340.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,340.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,950.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,950.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,950.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,950.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,315.00
|
|
|
HC WIRE MED WHOLEY 175CM
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812676
|
|
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 MED WHOLEY 175CM
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812676
|
|
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 MED WHOLEY 300CM
|
Facility
|
OP
|
$627.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812677
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$125.40 |
| Max. Negotiated Rate |
$564.30 |
| Rate for Payer: Adventist Health Commercial |
$125.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$380.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$532.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$344.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$470.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$303.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$368.24
|
| Rate for Payer: Blue Shield of California Commercial |
$383.10
|
| Rate for Payer: Blue Shield of California EPN |
$250.17
|
| Rate for Payer: Cash Price |
$344.85
|
| Rate for Payer: Central Health Plan Commercial |
$501.60
|
| Rate for Payer: Cigna of CA HMO |
$401.28
|
| Rate for Payer: Cigna of CA PPO |
$463.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$532.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$532.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$532.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$250.80
|
| Rate for Payer: EPIC Health Plan Senior |
$250.80
|
| Rate for Payer: Galaxy Health WC |
$532.95
|
| Rate for Payer: Global Benefits Group Commercial |
$376.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$564.30
|
| Rate for Payer: InnovAge PACE Commercial |
$313.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$418.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$238.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$388.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$125.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$438.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$438.90
|
| Rate for Payer: Multiplan Commercial |
$470.25
|
| Rate for Payer: Networks By Design Commercial |
$407.55
|
| Rate for Payer: Prime Health Services Commercial |
$532.95
|
| Rate for Payer: Riverside University Health System MISP |
$250.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$376.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$376.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$313.50
|
| Rate for Payer: United Healthcare All Other HMO |
$313.50
|
| Rate for Payer: United Healthcare HMO Rider |
$313.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$313.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$532.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$532.95
|
| Rate for Payer: Vantage Medical Group Senior |
$532.95
|
|
|
HC WIRE MED WHOLEY 300CM
|
Facility
|
IP
|
$627.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812677
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$125.40 |
| Max. Negotiated Rate |
$564.30 |
| Rate for Payer: Adventist Health Commercial |
$125.40
|
| Rate for Payer: Cash Price |
$344.85
|
| Rate for Payer: Central Health Plan Commercial |
$501.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$250.80
|
| Rate for Payer: EPIC Health Plan Senior |
$250.80
|
| Rate for Payer: Galaxy Health WC |
$532.95
|
| Rate for Payer: Global Benefits Group Commercial |
$376.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$564.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$418.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$238.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$388.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$125.40
|
| Rate for Payer: Multiplan Commercial |
$470.25
|
| Rate for Payer: Networks By Design Commercial |
$407.55
|
| Rate for Payer: Prime Health Services Commercial |
$532.95
|
|
|
HC WIRE PEDIAVASC SPRING
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
906812464
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: Cash Price |
$22.00
|
| Rate for Payer: Central Health Plan Commercial |
$32.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.00
|
| Rate for Payer: EPIC Health Plan Senior |
$16.00
|
| Rate for Payer: Galaxy Health WC |
$34.00
|
| Rate for Payer: Global Benefits Group Commercial |
$24.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$36.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.00
|
| Rate for Payer: Multiplan Commercial |
$30.00
|
| Rate for Payer: Networks By Design Commercial |
$26.00
|
| Rate for Payer: Prime Health Services Commercial |
$34.00
|
|
|
HC WIRE PEDIAVASC SPRING
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
906812464
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$24.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$30.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$19.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.49
|
| Rate for Payer: Blue Shield of California Commercial |
$24.44
|
| Rate for Payer: Blue Shield of California EPN |
$15.96
|
| Rate for Payer: Cash Price |
$22.00
|
| Rate for Payer: Central Health Plan Commercial |
$32.00
|
| Rate for Payer: Cigna of CA HMO |
$25.60
|
| Rate for Payer: Cigna of CA PPO |
$29.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$34.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.00
|
| Rate for Payer: EPIC Health Plan Senior |
$16.00
|
| Rate for Payer: Galaxy Health WC |
$34.00
|
| Rate for Payer: Global Benefits Group Commercial |
$24.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$36.00
|
| Rate for Payer: InnovAge PACE Commercial |
$20.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28.00
|
| Rate for Payer: Multiplan Commercial |
$30.00
|
| Rate for Payer: Networks By Design Commercial |
$26.00
|
| Rate for Payer: Prime Health Services Commercial |
$34.00
|
| Rate for Payer: Riverside University Health System MISP |
$16.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20.00
|
| Rate for Payer: United Healthcare HMO Rider |
$20.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.00
|
| Rate for Payer: Vantage Medical Group Senior |
$34.00
|
|
|
HC WIRE PP SAFESEPT TRANSSEPTAL
|
Facility
|
OP
|
$805.00
|
|
| Hospital Charge Code |
906812388
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$161.00 |
| Max. Negotiated Rate |
$724.50 |
| Rate for Payer: Adventist Health Commercial |
$161.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$488.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$684.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$442.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$603.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$389.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$472.78
|
| Rate for Payer: Blue Shield of California Commercial |
$491.86
|
| Rate for Payer: Blue Shield of California EPN |
$321.19
|
| Rate for Payer: Cash Price |
$442.75
|
| Rate for Payer: Central Health Plan Commercial |
$644.00
|
| Rate for Payer: Cigna of CA HMO |
$515.20
|
| Rate for Payer: Cigna of CA PPO |
$595.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$684.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$684.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$684.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$322.00
|
| Rate for Payer: EPIC Health Plan Senior |
$322.00
|
| Rate for Payer: Galaxy Health WC |
$684.25
|
| Rate for Payer: Global Benefits Group Commercial |
$483.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$724.50
|
| Rate for Payer: InnovAge PACE Commercial |
$402.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$536.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$306.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$498.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$161.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$563.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$563.50
|
| Rate for Payer: Multiplan Commercial |
$603.75
|
| Rate for Payer: Networks By Design Commercial |
$523.25
|
| Rate for Payer: Prime Health Services Commercial |
$684.25
|
| Rate for Payer: Riverside University Health System MISP |
$322.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$483.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$483.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$402.50
|
| Rate for Payer: United Healthcare All Other HMO |
$402.50
|
| Rate for Payer: United Healthcare HMO Rider |
$402.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$402.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$684.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$684.25
|
| Rate for Payer: Vantage Medical Group Senior |
$684.25
|
|
|
HC WIRE PP SAFESEPT TRANSSEPTAL
|
Facility
|
IP
|
$805.00
|
|
| Hospital Charge Code |
906812388
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$161.00 |
| Max. Negotiated Rate |
$724.50 |
| Rate for Payer: Adventist Health Commercial |
$161.00
|
| Rate for Payer: Cash Price |
$442.75
|
| Rate for Payer: Central Health Plan Commercial |
$644.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$322.00
|
| Rate for Payer: EPIC Health Plan Senior |
$322.00
|
| Rate for Payer: Galaxy Health WC |
$684.25
|
| Rate for Payer: Global Benefits Group Commercial |
$483.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$724.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$536.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$306.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$498.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$161.00
|
| Rate for Payer: Multiplan Commercial |
$603.75
|
| Rate for Payer: Networks By Design Commercial |
$523.25
|
| Rate for Payer: Prime Health Services Commercial |
$684.25
|
|
