|
HC WIRE PTCA ASAHI MIRACLEBROS
|
Facility
|
IP
|
$621.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812390
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$124.20 |
| Max. Negotiated Rate |
$558.90 |
| Rate for Payer: Adventist Health Commercial |
$124.20
|
| Rate for Payer: Cash Price |
$341.55
|
| Rate for Payer: Central Health Plan Commercial |
$496.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$248.40
|
| Rate for Payer: EPIC Health Plan Senior |
$248.40
|
| Rate for Payer: Galaxy Health WC |
$527.85
|
| Rate for Payer: Global Benefits Group Commercial |
$372.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$558.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$414.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$236.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$384.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.20
|
| Rate for Payer: Multiplan Commercial |
$465.75
|
| Rate for Payer: Networks By Design Commercial |
$403.65
|
| Rate for Payer: Prime Health Services Commercial |
$527.85
|
|
|
HC WIRE PTCA ASAHI MIRACLEBROS
|
Facility
|
OP
|
$621.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812390
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$124.20 |
| Max. Negotiated Rate |
$558.90 |
| Rate for Payer: Adventist Health Commercial |
$124.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$377.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$527.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$341.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$465.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$300.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$364.71
|
| Rate for Payer: Blue Shield of California Commercial |
$379.43
|
| Rate for Payer: Blue Shield of California EPN |
$247.78
|
| Rate for Payer: Cash Price |
$341.55
|
| Rate for Payer: Central Health Plan Commercial |
$496.80
|
| Rate for Payer: Cigna of CA HMO |
$397.44
|
| Rate for Payer: Cigna of CA PPO |
$459.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$527.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$527.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$527.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$248.40
|
| Rate for Payer: EPIC Health Plan Senior |
$248.40
|
| Rate for Payer: Galaxy Health WC |
$527.85
|
| Rate for Payer: Global Benefits Group Commercial |
$372.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$558.90
|
| Rate for Payer: InnovAge PACE Commercial |
$310.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$414.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$236.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$384.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$434.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$434.70
|
| Rate for Payer: Multiplan Commercial |
$465.75
|
| Rate for Payer: Networks By Design Commercial |
$403.65
|
| Rate for Payer: Prime Health Services Commercial |
$527.85
|
| Rate for Payer: Riverside University Health System MISP |
$248.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$372.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$372.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$310.50
|
| Rate for Payer: United Healthcare All Other HMO |
$310.50
|
| Rate for Payer: United Healthcare HMO Rider |
$310.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$310.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$527.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$527.85
|
| Rate for Payer: Vantage Medical Group Senior |
$527.85
|
|
|
HC WIRE PTCA TERUMO RUNTHROUGH
|
Facility
|
OP
|
$493.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812379
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$98.60 |
| Max. Negotiated Rate |
$443.70 |
| Rate for Payer: Adventist Health Commercial |
$98.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$299.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$419.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$271.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$369.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$238.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$289.54
|
| Rate for Payer: Blue Shield of California Commercial |
$301.22
|
| Rate for Payer: Blue Shield of California EPN |
$196.71
|
| Rate for Payer: Cash Price |
$271.15
|
| Rate for Payer: Central Health Plan Commercial |
$394.40
|
| Rate for Payer: Cigna of CA HMO |
$315.52
|
| Rate for Payer: Cigna of CA PPO |
$364.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$419.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$419.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$419.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$197.20
|
| Rate for Payer: EPIC Health Plan Senior |
$197.20
|
| Rate for Payer: Galaxy Health WC |
$419.05
|
| Rate for Payer: Global Benefits Group Commercial |
$295.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$443.70
|
| Rate for Payer: InnovAge PACE Commercial |
$246.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$328.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$187.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$305.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$98.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$345.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$345.10
|
| Rate for Payer: Multiplan Commercial |
$369.75
|
| Rate for Payer: Networks By Design Commercial |
$320.45
|
| Rate for Payer: Prime Health Services Commercial |
$419.05
|
| Rate for Payer: Riverside University Health System MISP |
$197.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$295.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$295.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$246.50
|
| Rate for Payer: United Healthcare All Other HMO |
$246.50
|
| Rate for Payer: United Healthcare HMO Rider |
$246.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$246.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$419.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$419.05
|
| Rate for Payer: Vantage Medical Group Senior |
$419.05
|
|
|
HC WIRE PTCA TERUMO RUNTHROUGH
|
Facility
|
IP
|
$493.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812379
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$98.60 |
| Max. Negotiated Rate |
$443.70 |
| Rate for Payer: Adventist Health Commercial |
$98.60
|
| Rate for Payer: Cash Price |
$271.15
|
| Rate for Payer: Central Health Plan Commercial |
$394.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$197.20
|
| Rate for Payer: EPIC Health Plan Senior |
$197.20
|
| Rate for Payer: Galaxy Health WC |
$419.05
|
| Rate for Payer: Global Benefits Group Commercial |
$295.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$443.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$328.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$187.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$305.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$98.60
|
| Rate for Payer: Multiplan Commercial |
$369.75
|
| Rate for Payer: Networks By Design Commercial |
$320.45
|
| Rate for Payer: Prime Health Services Commercial |
$419.05
|
|
|
HC WIRE SPECT BRIDGE ACC KIT
|
Facility
|
IP
|
$1,219.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812686
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$243.80 |
| Max. Negotiated Rate |
$1,097.10 |
| Rate for Payer: Adventist Health Commercial |
$243.80
|
| Rate for Payer: Cash Price |
$670.45
|
| Rate for Payer: Central Health Plan Commercial |
$975.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$487.60
|
| Rate for Payer: EPIC Health Plan Senior |
$487.60
|
| Rate for Payer: Galaxy Health WC |
$1,036.15
|
| Rate for Payer: Global Benefits Group Commercial |
$731.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,097.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$813.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$464.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$754.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$243.80
|
| Rate for Payer: Multiplan Commercial |
$914.25
|
| Rate for Payer: Networks By Design Commercial |
$792.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,036.15
|
|
|
HC WIRE SPECT BRIDGE ACC KIT
|
Facility
|
OP
|
$1,219.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812686
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$243.80 |
| Max. Negotiated Rate |
$1,097.10 |
| Rate for Payer: Adventist Health Commercial |
$243.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$740.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,036.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$670.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$914.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$590.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$715.92
|
| Rate for Payer: Blue Shield of California Commercial |
$744.81
|
| Rate for Payer: Blue Shield of California EPN |
$486.38
|
| Rate for Payer: Cash Price |
$670.45
|
| Rate for Payer: Central Health Plan Commercial |
$975.20
|
| Rate for Payer: Cigna of CA HMO |
$780.16
|
| Rate for Payer: Cigna of CA PPO |
$902.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,036.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,036.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,036.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$487.60
|
| Rate for Payer: EPIC Health Plan Senior |
$487.60
|
| Rate for Payer: Galaxy Health WC |
$1,036.15
|
| Rate for Payer: Global Benefits Group Commercial |
$731.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,097.10
|
| Rate for Payer: InnovAge PACE Commercial |
$609.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$813.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$464.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$754.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$243.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$853.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$853.30
|
| Rate for Payer: Multiplan Commercial |
$914.25
|
| Rate for Payer: Networks By Design Commercial |
$792.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,036.15
|
| Rate for Payer: Riverside University Health System MISP |
$487.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$731.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$731.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$609.50
|
| Rate for Payer: United Healthcare All Other HMO |
$609.50
|
| Rate for Payer: United Healthcare HMO Rider |
$609.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$609.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,036.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,036.15
|
| Rate for Payer: Vantage Medical Group Senior |
$1,036.15
|
|
|
HC WIRE TERUMO ADVANTAGE 180CM
|
Facility
|
OP
|
$920.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812577
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$184.00 |
| Max. Negotiated Rate |
$828.00 |
| Rate for Payer: Adventist Health Commercial |
$184.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$558.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$782.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$506.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$690.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$445.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$540.32
|
| Rate for Payer: Blue Shield of California Commercial |
$562.12
|
| Rate for Payer: Blue Shield of California EPN |
$367.08
|
| Rate for Payer: Cash Price |
$506.00
|
| Rate for Payer: Central Health Plan Commercial |
$736.00
|
| Rate for Payer: Cigna of CA HMO |
$588.80
|
| Rate for Payer: Cigna of CA PPO |
$680.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$782.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$782.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$782.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$368.00
|
| Rate for Payer: EPIC Health Plan Senior |
$368.00
|
| Rate for Payer: Galaxy Health WC |
$782.00
|
| Rate for Payer: Global Benefits Group Commercial |
$552.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$828.00
|
| Rate for Payer: InnovAge PACE Commercial |
$460.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$613.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$350.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$569.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$184.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$644.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$644.00
|
| Rate for Payer: Multiplan Commercial |
$690.00
|
| Rate for Payer: Networks By Design Commercial |
$598.00
|
| Rate for Payer: Prime Health Services Commercial |
$782.00
|
| Rate for Payer: Riverside University Health System MISP |
$368.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$552.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$552.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$460.00
|
| Rate for Payer: United Healthcare All Other HMO |
$460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$460.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$460.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$782.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$782.00
|
| Rate for Payer: Vantage Medical Group Senior |
$782.00
|
|
|
HC WIRE TERUMO ADVANTAGE 180CM
|
Facility
|
IP
|
$920.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812577
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$184.00 |
| Max. Negotiated Rate |
$828.00 |
| Rate for Payer: Adventist Health Commercial |
$184.00
|
| Rate for Payer: Cash Price |
$506.00
|
| Rate for Payer: Central Health Plan Commercial |
$736.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$368.00
|
| Rate for Payer: EPIC Health Plan Senior |
$368.00
|
| Rate for Payer: Galaxy Health WC |
$782.00
|
| Rate for Payer: Global Benefits Group Commercial |
$552.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$828.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$613.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$350.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$569.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$184.00
|
| Rate for Payer: Multiplan Commercial |
$690.00
|
| Rate for Payer: Networks By Design Commercial |
$598.00
|
| Rate for Payer: Prime Health Services Commercial |
$782.00
|
|
|
HC WIRE TERUMO ADVANTAGE 300CM
|
Facility
|
IP
|
$1,035.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812578
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$207.00 |
| Max. Negotiated Rate |
$931.50 |
| Rate for Payer: Adventist Health Commercial |
$207.00
|
| Rate for Payer: Cash Price |
$569.25
|
| Rate for Payer: Central Health Plan Commercial |
$828.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$414.00
|
| Rate for Payer: EPIC Health Plan Senior |
$414.00
|
| Rate for Payer: Galaxy Health WC |
$879.75
|
| Rate for Payer: Global Benefits Group Commercial |
$621.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$931.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$690.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$394.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$640.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$207.00
|
| Rate for Payer: Multiplan Commercial |
$776.25
|
| Rate for Payer: Networks By Design Commercial |
$672.75
|
| Rate for Payer: Prime Health Services Commercial |
$879.75
|
|
|
HC WIRE TERUMO ADVANTAGE 300CM
|
Facility
|
OP
|
$1,035.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812578
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$207.00 |
| Max. Negotiated Rate |
$931.50 |
| Rate for Payer: Adventist Health Commercial |
$207.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$628.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$879.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$569.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$776.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$501.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$607.86
|
| Rate for Payer: Blue Shield of California Commercial |
$632.38
|
| Rate for Payer: Blue Shield of California EPN |
$412.96
|
| Rate for Payer: Cash Price |
$569.25
|
| Rate for Payer: Central Health Plan Commercial |
$828.00
|
| Rate for Payer: Cigna of CA HMO |
$662.40
|
| Rate for Payer: Cigna of CA PPO |
$765.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$879.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$879.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$879.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$414.00
|
| Rate for Payer: EPIC Health Plan Senior |
$414.00
|
| Rate for Payer: Galaxy Health WC |
$879.75
|
| Rate for Payer: Global Benefits Group Commercial |
$621.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$931.50
|
| Rate for Payer: InnovAge PACE Commercial |
$517.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$690.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$394.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$640.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$207.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$724.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$724.50
|
| Rate for Payer: Multiplan Commercial |
$776.25
|
| Rate for Payer: Networks By Design Commercial |
$672.75
|
| Rate for Payer: Prime Health Services Commercial |
$879.75
|
| Rate for Payer: Riverside University Health System MISP |
$414.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$621.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$621.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$517.50
|
| Rate for Payer: United Healthcare All Other HMO |
$517.50
|
| Rate for Payer: United Healthcare HMO Rider |
$517.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$517.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$879.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$879.75
|
| Rate for Payer: Vantage Medical Group Senior |
$879.75
|
|
|
HC WIRE TERUMO ADVANTAGED ANG 260
|
Facility
|
OP
|
$828.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812576
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$165.60 |
| Max. Negotiated Rate |
$745.20 |
| Rate for Payer: Adventist Health Commercial |
$165.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$502.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$703.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$455.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$621.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$400.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$486.28
|
| Rate for Payer: Blue Shield of California Commercial |
$505.91
|
| Rate for Payer: Blue Shield of California EPN |
$330.37
|
| Rate for Payer: Cash Price |
$455.40
|
| Rate for Payer: Central Health Plan Commercial |
$662.40
|
| Rate for Payer: Cigna of CA HMO |
$529.92
|
| Rate for Payer: Cigna of CA PPO |
$612.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$703.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$703.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$703.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$331.20
|
| Rate for Payer: EPIC Health Plan Senior |
$331.20
|
| Rate for Payer: Galaxy Health WC |
$703.80
|
| Rate for Payer: Global Benefits Group Commercial |
$496.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$745.20
|
| Rate for Payer: InnovAge PACE Commercial |
$414.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$552.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$315.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$512.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$165.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$579.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$579.60
|
| Rate for Payer: Multiplan Commercial |
$621.00
|
| Rate for Payer: Networks By Design Commercial |
$538.20
|
| Rate for Payer: Prime Health Services Commercial |
$703.80
|
| Rate for Payer: Riverside University Health System MISP |
$331.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$496.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$496.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$414.00
|
| Rate for Payer: United Healthcare All Other HMO |
$414.00
|
| Rate for Payer: United Healthcare HMO Rider |
$414.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$414.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$703.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$703.80
|
| Rate for Payer: Vantage Medical Group Senior |
$703.80
|
|
|
HC WIRE TERUMO ADVANTAGED ANG 260
|
Facility
|
IP
|
$828.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812576
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$165.60 |
| Max. Negotiated Rate |
$745.20 |
| Rate for Payer: Adventist Health Commercial |
$165.60
|
| Rate for Payer: Cash Price |
$455.40
|
| Rate for Payer: Central Health Plan Commercial |
$662.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$331.20
|
| Rate for Payer: EPIC Health Plan Senior |
$331.20
|
| Rate for Payer: Galaxy Health WC |
$703.80
|
| Rate for Payer: Global Benefits Group Commercial |
$496.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$745.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$552.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$315.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$512.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$165.60
|
| Rate for Payer: Multiplan Commercial |
$621.00
|
| Rate for Payer: Networks By Design Commercial |
$538.20
|
| Rate for Payer: Prime Health Services Commercial |
$703.80
|
|
|
HC WIRE TERUMO GLIDEWIRE ST/AN260
|
Facility
|
IP
|
$308.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812654
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$61.60 |
| Max. Negotiated Rate |
$277.20 |
| Rate for Payer: Adventist Health Commercial |
$61.60
|
| Rate for Payer: Cash Price |
$169.40
|
| Rate for Payer: Central Health Plan Commercial |
$246.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$123.20
|
| Rate for Payer: EPIC Health Plan Senior |
$123.20
|
| Rate for Payer: Galaxy Health WC |
$261.80
|
| Rate for Payer: Global Benefits Group Commercial |
$184.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$277.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$205.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$117.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$190.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.60
|
| Rate for Payer: Multiplan Commercial |
$231.00
|
| Rate for Payer: Networks By Design Commercial |
$200.20
|
| Rate for Payer: Prime Health Services Commercial |
$261.80
|
|
|
HC WIRE TERUMO GLIDEWIRE ST/AN260
|
Facility
|
OP
|
$308.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812654
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$61.60 |
| Max. Negotiated Rate |
$277.20 |
| Rate for Payer: Adventist Health Commercial |
$61.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$187.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$261.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$169.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$231.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$149.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$180.89
|
| Rate for Payer: Blue Shield of California Commercial |
$188.19
|
| Rate for Payer: Blue Shield of California EPN |
$122.89
|
| Rate for Payer: Cash Price |
$169.40
|
| Rate for Payer: Central Health Plan Commercial |
$246.40
|
| Rate for Payer: Cigna of CA HMO |
$197.12
|
| Rate for Payer: Cigna of CA PPO |
$227.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$261.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$261.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$261.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$123.20
|
| Rate for Payer: EPIC Health Plan Senior |
$123.20
|
| Rate for Payer: Galaxy Health WC |
$261.80
|
| Rate for Payer: Global Benefits Group Commercial |
$184.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$277.20
|
| Rate for Payer: InnovAge PACE Commercial |
$154.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$205.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$117.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$190.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$215.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$215.60
|
| Rate for Payer: Multiplan Commercial |
$231.00
|
| Rate for Payer: Networks By Design Commercial |
$200.20
|
| Rate for Payer: Prime Health Services Commercial |
$261.80
|
| Rate for Payer: Riverside University Health System MISP |
$123.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$184.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$184.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$154.00
|
| Rate for Payer: United Healthcare All Other HMO |
$154.00
|
| Rate for Payer: United Healthcare HMO Rider |
$154.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$154.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$261.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$261.80
|
| Rate for Payer: Vantage Medical Group Senior |
$261.80
|
|
|
HC WIRE THRUWAY SHORT
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812580
|
|
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 THRUWAY SHORT
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812580
|
|
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 TORAY, 230CM
|
Facility
|
IP
|
$805.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812409
|
|
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
|
|
|
HC WIRE TORAY, 230CM
|
Facility
|
OP
|
$805.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812409
|
|
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 VASC R350
|
Facility
|
IP
|
$823.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812523
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$164.60 |
| Max. Negotiated Rate |
$740.70 |
| Rate for Payer: Adventist Health Commercial |
$164.60
|
| Rate for Payer: Cash Price |
$452.65
|
| Rate for Payer: Central Health Plan Commercial |
$658.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$329.20
|
| Rate for Payer: EPIC Health Plan Senior |
$329.20
|
| Rate for Payer: Galaxy Health WC |
$699.55
|
| Rate for Payer: Global Benefits Group Commercial |
$493.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$740.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$548.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$313.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$509.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$164.60
|
| Rate for Payer: Multiplan Commercial |
$617.25
|
| Rate for Payer: Networks By Design Commercial |
$534.95
|
| Rate for Payer: Prime Health Services Commercial |
$699.55
|
|
|
HC WIRE VASC R350
|
Facility
|
OP
|
$823.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812523
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$164.60 |
| Max. Negotiated Rate |
$740.70 |
| Rate for Payer: Adventist Health Commercial |
$164.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$499.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$699.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$452.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$617.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$398.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$483.35
|
| Rate for Payer: Blue Shield of California Commercial |
$502.85
|
| Rate for Payer: Blue Shield of California EPN |
$328.38
|
| Rate for Payer: Cash Price |
$452.65
|
| Rate for Payer: Central Health Plan Commercial |
$658.40
|
| Rate for Payer: Cigna of CA HMO |
$526.72
|
| Rate for Payer: Cigna of CA PPO |
$609.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$699.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$699.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$699.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$329.20
|
| Rate for Payer: EPIC Health Plan Senior |
$329.20
|
| Rate for Payer: Galaxy Health WC |
$699.55
|
| Rate for Payer: Global Benefits Group Commercial |
$493.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$740.70
|
| Rate for Payer: InnovAge PACE Commercial |
$411.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$548.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$313.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$509.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$164.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$576.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$576.10
|
| Rate for Payer: Multiplan Commercial |
$617.25
|
| Rate for Payer: Networks By Design Commercial |
$534.95
|
| Rate for Payer: Prime Health Services Commercial |
$699.55
|
| Rate for Payer: Riverside University Health System MISP |
$329.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$493.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$493.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$411.50
|
| Rate for Payer: United Healthcare All Other HMO |
$411.50
|
| Rate for Payer: United Healthcare HMO Rider |
$411.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$411.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$699.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$699.55
|
| Rate for Payer: Vantage Medical Group Senior |
$699.55
|
|
|
HC WIRE VASCULAR SOL PIGGYBACK
|
Facility
|
IP
|
$3,881.00
|
|
| Hospital Charge Code |
906812755
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$776.20 |
| Max. Negotiated Rate |
$3,492.90 |
| Rate for Payer: Adventist Health Commercial |
$776.20
|
| Rate for Payer: Cash Price |
$2,134.55
|
| Rate for Payer: Central Health Plan Commercial |
$3,104.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,552.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,552.40
|
| Rate for Payer: Galaxy Health WC |
$3,298.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,328.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,492.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,588.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,478.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,402.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$776.20
|
| Rate for Payer: Multiplan Commercial |
$2,910.75
|
| Rate for Payer: Networks By Design Commercial |
$2,522.65
|
| Rate for Payer: Prime Health Services Commercial |
$3,298.85
|
|
|
HC WIRE VASCULAR SOL PIGGYBACK
|
Facility
|
OP
|
$3,881.00
|
|
| Hospital Charge Code |
906812755
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$776.20 |
| Max. Negotiated Rate |
$3,492.90 |
| Rate for Payer: Adventist Health Commercial |
$776.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,356.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,298.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,134.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,910.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,879.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,279.31
|
| Rate for Payer: Blue Shield of California Commercial |
$2,371.29
|
| Rate for Payer: Blue Shield of California EPN |
$1,548.52
|
| Rate for Payer: Cash Price |
$2,134.55
|
| Rate for Payer: Central Health Plan Commercial |
$3,104.80
|
| Rate for Payer: Cigna of CA HMO |
$2,483.84
|
| Rate for Payer: Cigna of CA PPO |
$2,871.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,298.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,298.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,298.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,552.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,552.40
|
| Rate for Payer: Galaxy Health WC |
$3,298.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,328.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,492.90
|
| Rate for Payer: InnovAge PACE Commercial |
$1,940.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,588.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,478.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,402.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$776.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,716.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,716.70
|
| Rate for Payer: Multiplan Commercial |
$2,910.75
|
| Rate for Payer: Networks By Design Commercial |
$2,522.65
|
| Rate for Payer: Prime Health Services Commercial |
$3,298.85
|
| Rate for Payer: Riverside University Health System MISP |
$1,552.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,328.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,328.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,940.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,940.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,940.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,940.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,298.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,298.85
|
| Rate for Payer: Vantage Medical Group Senior |
$3,298.85
|
|
|
HC WIRE VLCNO PRIMEWIRE
|
Facility
|
IP
|
$2,711.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812377
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$542.20 |
| Max. Negotiated Rate |
$2,439.90 |
| Rate for Payer: Adventist Health Commercial |
$542.20
|
| Rate for Payer: Cash Price |
$1,491.05
|
| Rate for Payer: Central Health Plan Commercial |
$2,168.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,084.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,084.40
|
| Rate for Payer: Galaxy Health WC |
$2,304.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,626.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,439.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,808.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,032.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,678.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$542.20
|
| Rate for Payer: Multiplan Commercial |
$2,033.25
|
| Rate for Payer: Networks By Design Commercial |
$1,762.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,304.35
|
|
|
HC WIRE VLCNO PRIMEWIRE
|
Facility
|
OP
|
$2,711.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812377
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$542.20 |
| Max. Negotiated Rate |
$2,439.90 |
| Rate for Payer: Adventist Health Commercial |
$542.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,646.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,304.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,491.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,033.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,312.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,592.17
|
| Rate for Payer: Blue Shield of California Commercial |
$1,656.42
|
| Rate for Payer: Blue Shield of California EPN |
$1,081.69
|
| Rate for Payer: Cash Price |
$1,491.05
|
| Rate for Payer: Central Health Plan Commercial |
$2,168.80
|
| Rate for Payer: Cigna of CA HMO |
$1,735.04
|
| Rate for Payer: Cigna of CA PPO |
$2,006.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,304.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,304.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,304.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,084.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,084.40
|
| Rate for Payer: Galaxy Health WC |
$2,304.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,626.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,439.90
|
| Rate for Payer: InnovAge PACE Commercial |
$1,355.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,808.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,032.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,678.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$542.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,897.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,897.70
|
| Rate for Payer: Multiplan Commercial |
$2,033.25
|
| Rate for Payer: Networks By Design Commercial |
$1,762.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,304.35
|
| Rate for Payer: Riverside University Health System MISP |
$1,084.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,626.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,626.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,355.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,355.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,355.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,355.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,304.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,304.35
|
| Rate for Payer: Vantage Medical Group Senior |
$2,304.35
|
|
|
HC WIRE VLCNO PRIMEWIRE PRESTIGE
|
Facility
|
IP
|
$3,003.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812419
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$600.60 |
| Max. Negotiated Rate |
$2,702.70 |
| Rate for Payer: Adventist Health Commercial |
$600.60
|
| Rate for Payer: Cash Price |
$1,651.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,402.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,201.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,201.20
|
| Rate for Payer: Galaxy Health WC |
$2,552.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,801.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,702.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,003.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,144.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,858.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$600.60
|
| Rate for Payer: Multiplan Commercial |
$2,252.25
|
| Rate for Payer: Networks By Design Commercial |
$1,951.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,552.55
|
|
