|
HC GUIDE ANGLED .035"X150CM
|
Facility
|
OP
|
$210.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901602721
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$396.30 |
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$396.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$178.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$115.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$157.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$101.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$122.16
|
| Rate for Payer: Blue Shield of California Commercial |
$133.14
|
| Rate for Payer: Blue Shield of California EPN |
$83.79
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Central Health Plan Commercial |
$168.00
|
| Rate for Payer: Cigna of CA HMO |
$134.40
|
| Rate for Payer: Cigna of CA PPO |
$155.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$178.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$178.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$178.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$147.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.00
|
| Rate for Payer: EPIC Health Plan Senior |
$84.00
|
| Rate for Payer: Galaxy Health WC |
$178.50
|
| Rate for Payer: Global Benefits Group Commercial |
$126.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$189.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$133.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$76.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$123.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$147.00
|
| Rate for Payer: Multiplan Commercial |
$157.50
|
| Rate for Payer: Networks By Design Commercial |
$136.50
|
| Rate for Payer: Prime Health Services Commercial |
$178.50
|
| Rate for Payer: Riverside University Health System MISP |
$84.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$126.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$126.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$105.00
|
| Rate for Payer: United Healthcare All Other HMO |
$105.00
|
| Rate for Payer: United Healthcare HMO Rider |
$105.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$105.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$178.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$178.50
|
| Rate for Payer: Vantage Medical Group Senior |
$178.50
|
|
|
HC GUIDE ARROW .32X60CM SOFT TIP
|
Facility
|
IP
|
$91.20
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901606106
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.24 |
| Max. Negotiated Rate |
$82.08 |
| Rate for Payer: Adventist Health Commercial |
$18.24
|
| Rate for Payer: Cash Price |
$41.04
|
| Rate for Payer: Central Health Plan Commercial |
$72.96
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$63.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.48
|
| Rate for Payer: EPIC Health Plan Senior |
$36.48
|
| Rate for Payer: Galaxy Health WC |
$77.52
|
| Rate for Payer: Global Benefits Group Commercial |
$54.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$82.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$57.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$53.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.24
|
| Rate for Payer: Multiplan Commercial |
$68.40
|
| Rate for Payer: Networks By Design Commercial |
$59.28
|
| Rate for Payer: Prime Health Services Commercial |
$77.52
|
|
|
HC GUIDE ARROW .32X60CM SOFT TIP
|
Facility
|
OP
|
$91.20
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901606106
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.24 |
| Max. Negotiated Rate |
$396.30 |
| Rate for Payer: Adventist Health Commercial |
$18.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$396.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$77.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$50.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$68.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$44.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$53.05
|
| Rate for Payer: Blue Shield of California Commercial |
$57.82
|
| Rate for Payer: Blue Shield of California EPN |
$36.39
|
| Rate for Payer: Cash Price |
$41.04
|
| Rate for Payer: Cash Price |
$41.04
|
| Rate for Payer: Central Health Plan Commercial |
$72.96
|
| Rate for Payer: Cigna of CA HMO |
$58.37
|
| Rate for Payer: Cigna of CA PPO |
$67.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$77.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$77.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$77.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$63.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.48
|
| Rate for Payer: EPIC Health Plan Senior |
$36.48
|
| Rate for Payer: Galaxy Health WC |
$77.52
|
| Rate for Payer: Global Benefits Group Commercial |
$54.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$82.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$57.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$33.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$53.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$63.84
|
| Rate for Payer: Multiplan Commercial |
$68.40
|
| Rate for Payer: Networks By Design Commercial |
$59.28
|
| Rate for Payer: Prime Health Services Commercial |
$77.52
|
| Rate for Payer: Riverside University Health System MISP |
$36.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$54.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$54.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$45.60
|
| Rate for Payer: United Healthcare All Other HMO |
$45.60
|
| Rate for Payer: United Healthcare HMO Rider |
$45.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$45.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$77.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$77.52
|
| Rate for Payer: Vantage Medical Group Senior |
$77.52
|
|
|
HC GUIDE BENTSON 035"X145CM
|
Facility
|
IP
|
$105.72
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901603846
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.14 |
| Max. Negotiated Rate |
$95.15 |
| Rate for Payer: Adventist Health Commercial |
$21.14
|
| Rate for Payer: Cash Price |
$47.57
|
| Rate for Payer: Central Health Plan Commercial |
$84.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$74.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.29
|
| Rate for Payer: EPIC Health Plan Senior |
$42.29
|
| Rate for Payer: Galaxy Health WC |
$89.86
|
| Rate for Payer: Global Benefits Group Commercial |
$63.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$95.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$67.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$62.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.14
|
| Rate for Payer: Multiplan Commercial |
$79.29
|
| Rate for Payer: Networks By Design Commercial |
$68.72
|
| Rate for Payer: Prime Health Services Commercial |
$89.86
|
|
|
HC GUIDE BENTSON 035"X145CM
|
Facility
|
OP
|
$105.72
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901603846
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.14 |
| Max. Negotiated Rate |
$396.30 |
| Rate for Payer: Adventist Health Commercial |
$21.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$396.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$89.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$58.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$79.29
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$51.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$61.50
|
| Rate for Payer: Blue Shield of California Commercial |
$67.03
|
| Rate for Payer: Blue Shield of California EPN |
$42.18
|
| Rate for Payer: Cash Price |
$47.57
|
| Rate for Payer: Cash Price |
$47.57
|
| Rate for Payer: Central Health Plan Commercial |
$84.58
|
| Rate for Payer: Cigna of CA HMO |
$67.66
|
| Rate for Payer: Cigna of CA PPO |
$78.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$89.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$89.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$89.86
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$74.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.29
|
| Rate for Payer: EPIC Health Plan Senior |
$42.29
|
| Rate for Payer: Galaxy Health WC |
$89.86
|
| Rate for Payer: Global Benefits Group Commercial |
$63.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$95.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$67.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$38.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$62.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$74.00
|
| Rate for Payer: Multiplan Commercial |
$79.29
|
| Rate for Payer: Networks By Design Commercial |
$68.72
|
| Rate for Payer: Prime Health Services Commercial |
$89.86
|
| Rate for Payer: Riverside University Health System MISP |
$42.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$63.43
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$63.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$52.86
|
| Rate for Payer: United Healthcare All Other HMO |
$52.86
|
| Rate for Payer: United Healthcare HMO Rider |
$52.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$52.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$89.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$89.86
|
| Rate for Payer: Vantage Medical Group Senior |
$89.86
|
|
|
HC GUIDE CRVD TFE COAT .35"X145
|
Facility
|
IP
|
$192.50
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901604251
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.50 |
| Max. Negotiated Rate |
$173.25 |
| Rate for Payer: Adventist Health Commercial |
$38.50
|
| Rate for Payer: Cash Price |
$86.62
|
| Rate for Payer: Central Health Plan Commercial |
$154.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$134.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$77.00
|
| Rate for Payer: EPIC Health Plan Senior |
$77.00
|
| Rate for Payer: Galaxy Health WC |
$163.62
|
| Rate for Payer: Global Benefits Group Commercial |
$115.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$173.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$122.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$113.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.50
|
| Rate for Payer: Multiplan Commercial |
$144.38
|
| Rate for Payer: Networks By Design Commercial |
$125.12
|
| Rate for Payer: Prime Health Services Commercial |
$163.62
|
|
|
HC GUIDE CRVD TFE COAT .35"X145
|
Facility
|
OP
|
$192.50
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901604251
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.50 |
| Max. Negotiated Rate |
$396.30 |
| Rate for Payer: Adventist Health Commercial |
$38.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$396.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$163.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$105.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$144.38
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$93.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$111.98
|
| Rate for Payer: Blue Shield of California Commercial |
$122.05
|
| Rate for Payer: Blue Shield of California EPN |
$76.81
|
| Rate for Payer: Cash Price |
$86.62
|
| Rate for Payer: Cash Price |
$86.62
|
| Rate for Payer: Central Health Plan Commercial |
$154.00
|
| Rate for Payer: Cigna of CA HMO |
$123.20
|
| Rate for Payer: Cigna of CA PPO |
$142.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$163.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$163.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.62
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$134.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$77.00
|
| Rate for Payer: EPIC Health Plan Senior |
$77.00
|
| Rate for Payer: Galaxy Health WC |
$163.62
|
| Rate for Payer: Global Benefits Group Commercial |
$115.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$173.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$122.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$69.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$113.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$134.75
|
| Rate for Payer: Multiplan Commercial |
$144.38
|
| Rate for Payer: Networks By Design Commercial |
$125.12
|
| Rate for Payer: Prime Health Services Commercial |
$163.62
|
| Rate for Payer: Riverside University Health System MISP |
$77.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$115.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$115.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$96.25
|
| Rate for Payer: United Healthcare All Other HMO |
$96.25
|
| Rate for Payer: United Healthcare HMO Rider |
$96.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$96.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$163.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$163.62
|
| Rate for Payer: Vantage Medical Group Senior |
$163.62
|
|
|
HC GUIDE, CURVED .025"X80CM
|
Facility
|
OP
|
$192.71
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901600464
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.54 |
| Max. Negotiated Rate |
$396.30 |
| Rate for Payer: Adventist Health Commercial |
$38.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$396.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$163.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$105.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$144.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$93.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$112.10
|
| Rate for Payer: Blue Shield of California Commercial |
$122.18
|
| Rate for Payer: Blue Shield of California EPN |
$76.89
|
| Rate for Payer: Cash Price |
$86.72
|
| Rate for Payer: Cash Price |
$86.72
|
| Rate for Payer: Central Health Plan Commercial |
$154.17
|
| Rate for Payer: Cigna of CA HMO |
$123.33
|
| Rate for Payer: Cigna of CA PPO |
$142.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$163.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$163.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$134.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$77.08
|
| Rate for Payer: EPIC Health Plan Senior |
$77.08
|
| Rate for Payer: Galaxy Health WC |
$163.80
|
| Rate for Payer: Global Benefits Group Commercial |
$115.63
|
| Rate for Payer: Health Management Network EPO/PPO |
$173.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$122.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$69.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$113.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$134.90
|
| Rate for Payer: Multiplan Commercial |
$144.53
|
| Rate for Payer: Networks By Design Commercial |
$125.26
|
| Rate for Payer: Prime Health Services Commercial |
$163.80
|
| Rate for Payer: Riverside University Health System MISP |
$77.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$115.63
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$115.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$96.36
|
| Rate for Payer: United Healthcare All Other HMO |
$96.36
|
| Rate for Payer: United Healthcare HMO Rider |
$96.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$96.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$163.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$163.80
|
| Rate for Payer: Vantage Medical Group Senior |
$163.80
|
|
|
HC GUIDE, CURVED .025"X80CM
|
Facility
|
IP
|
$192.71
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901600464
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.54 |
| Max. Negotiated Rate |
$173.44 |
| Rate for Payer: Adventist Health Commercial |
$38.54
|
| Rate for Payer: Cash Price |
$86.72
|
| Rate for Payer: Central Health Plan Commercial |
$154.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$134.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$77.08
|
| Rate for Payer: EPIC Health Plan Senior |
$77.08
|
| Rate for Payer: Galaxy Health WC |
$163.80
|
| Rate for Payer: Global Benefits Group Commercial |
$115.63
|
| Rate for Payer: Health Management Network EPO/PPO |
$173.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$122.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$113.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.54
|
| Rate for Payer: Multiplan Commercial |
$144.53
|
| Rate for Payer: Networks By Design Commercial |
$125.26
|
| Rate for Payer: Prime Health Services Commercial |
$163.80
|
|
|
HC GUIDE DUOFLEX .018 45MM
|
Facility
|
IP
|
$79.95
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901603717
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.99 |
| Max. Negotiated Rate |
$71.95 |
| Rate for Payer: Adventist Health Commercial |
$15.99
|
| Rate for Payer: Cash Price |
$35.98
|
| Rate for Payer: Central Health Plan Commercial |
$63.96
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$55.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.98
|
| Rate for Payer: EPIC Health Plan Senior |
$31.98
|
| Rate for Payer: Galaxy Health WC |
$67.96
|
| Rate for Payer: Global Benefits Group Commercial |
$47.97
|
| Rate for Payer: Health Management Network EPO/PPO |
$71.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$50.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$47.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.99
|
| Rate for Payer: Multiplan Commercial |
$59.96
|
| Rate for Payer: Networks By Design Commercial |
$51.97
|
| Rate for Payer: Prime Health Services Commercial |
$67.96
|
|
|
HC GUIDE DUOFLEX .018 45MM
|
Facility
|
OP
|
$79.95
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901603717
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.99 |
| Max. Negotiated Rate |
$396.30 |
| Rate for Payer: Adventist Health Commercial |
$15.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$396.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$67.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$43.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$59.96
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$38.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$46.51
|
| Rate for Payer: Blue Shield of California Commercial |
$50.69
|
| Rate for Payer: Blue Shield of California EPN |
$31.90
|
| Rate for Payer: Cash Price |
$35.98
|
| Rate for Payer: Cash Price |
$35.98
|
| Rate for Payer: Central Health Plan Commercial |
$63.96
|
| Rate for Payer: Cigna of CA HMO |
$51.17
|
| Rate for Payer: Cigna of CA PPO |
$59.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$67.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$67.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$67.96
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$55.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.98
|
| Rate for Payer: EPIC Health Plan Senior |
$31.98
|
| Rate for Payer: Galaxy Health WC |
$67.96
|
| Rate for Payer: Global Benefits Group Commercial |
$47.97
|
| Rate for Payer: Health Management Network EPO/PPO |
$71.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$50.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$29.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$47.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$55.97
|
| Rate for Payer: Multiplan Commercial |
$59.96
|
| Rate for Payer: Networks By Design Commercial |
$51.97
|
| Rate for Payer: Prime Health Services Commercial |
$67.96
|
| Rate for Payer: Riverside University Health System MISP |
$31.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$47.97
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$47.97
|
| Rate for Payer: United Healthcare All Other Commercial |
$39.98
|
| Rate for Payer: United Healthcare All Other HMO |
$39.98
|
| Rate for Payer: United Healthcare HMO Rider |
$39.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$39.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$67.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$67.96
|
| Rate for Payer: Vantage Medical Group Senior |
$67.96
|
|
|
HC GUIDE, DUOFLEX 25 X 30
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901602056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$73.80 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Central Health Plan Commercial |
$65.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$57.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Senior |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$73.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$52.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$48.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.40
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
|
|
HC GUIDE, DUOFLEX 25 X 30
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901602056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$396.30 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$396.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$61.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$39.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47.70
|
| Rate for Payer: Blue Shield of California Commercial |
$51.99
|
| Rate for Payer: Blue Shield of California EPN |
$32.72
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Central Health Plan Commercial |
$65.60
|
| Rate for Payer: Cigna of CA HMO |
$52.48
|
| Rate for Payer: Cigna of CA PPO |
$60.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$69.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$69.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$69.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$57.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Senior |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$73.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$52.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$29.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$48.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$57.40
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
| Rate for Payer: Riverside University Health System MISP |
$32.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.00
|
| Rate for Payer: United Healthcare All Other HMO |
$41.00
|
| Rate for Payer: United Healthcare HMO Rider |
$41.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$69.70
|
| Rate for Payer: Vantage Medical Group Senior |
$69.70
|
|
|
HC GUIDE HYDROPHILIC 80CM X.018
|
Facility
|
OP
|
$320.53
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901607536
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$64.11 |
| Max. Negotiated Rate |
$396.30 |
| Rate for Payer: Adventist Health Commercial |
$64.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$396.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$272.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$176.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$240.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$155.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$186.45
|
| Rate for Payer: Blue Shield of California Commercial |
$203.22
|
| Rate for Payer: Blue Shield of California EPN |
$127.89
|
| Rate for Payer: Cash Price |
$144.24
|
| Rate for Payer: Cash Price |
$144.24
|
| Rate for Payer: Central Health Plan Commercial |
$256.42
|
| Rate for Payer: Cigna of CA HMO |
$205.14
|
| Rate for Payer: Cigna of CA PPO |
$237.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$272.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$272.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$272.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$224.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$128.21
|
| Rate for Payer: EPIC Health Plan Senior |
$128.21
|
| Rate for Payer: Galaxy Health WC |
$272.45
|
| Rate for Payer: Global Benefits Group Commercial |
$192.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$288.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$203.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$116.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$189.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$224.37
|
| Rate for Payer: Multiplan Commercial |
$240.40
|
| Rate for Payer: Networks By Design Commercial |
$208.34
|
| Rate for Payer: Prime Health Services Commercial |
$272.45
|
| Rate for Payer: Riverside University Health System MISP |
$128.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$192.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$192.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$160.26
|
| Rate for Payer: United Healthcare All Other HMO |
$160.26
|
| Rate for Payer: United Healthcare HMO Rider |
$160.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$160.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$272.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$272.45
|
| Rate for Payer: Vantage Medical Group Senior |
$272.45
|
|
|
HC GUIDE HYDROPHILIC 80CM X.018
|
Facility
|
IP
|
$320.53
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901607536
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$64.11 |
| Max. Negotiated Rate |
$288.48 |
| Rate for Payer: Adventist Health Commercial |
$64.11
|
| Rate for Payer: Cash Price |
$144.24
|
| Rate for Payer: Central Health Plan Commercial |
$256.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$224.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$128.21
|
| Rate for Payer: EPIC Health Plan Senior |
$128.21
|
| Rate for Payer: Galaxy Health WC |
$272.45
|
| Rate for Payer: Global Benefits Group Commercial |
$192.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$288.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$203.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$189.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.11
|
| Rate for Payer: Multiplan Commercial |
$240.40
|
| Rate for Payer: Networks By Design Commercial |
$208.34
|
| Rate for Payer: Prime Health Services Commercial |
$272.45
|
|
|
HC GUIDE HYDROPHILLIC.008 COATED
|
Facility
|
IP
|
$261.59
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901605118
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$52.32 |
| Max. Negotiated Rate |
$235.43 |
| Rate for Payer: Adventist Health Commercial |
$52.32
|
| Rate for Payer: Cash Price |
$117.72
|
| Rate for Payer: Central Health Plan Commercial |
$209.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$183.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$104.64
|
| Rate for Payer: EPIC Health Plan Senior |
$104.64
|
| Rate for Payer: Galaxy Health WC |
$222.35
|
| Rate for Payer: Global Benefits Group Commercial |
$156.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$235.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$166.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$154.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.32
|
| Rate for Payer: Multiplan Commercial |
$196.19
|
| Rate for Payer: Networks By Design Commercial |
$170.03
|
| Rate for Payer: Prime Health Services Commercial |
$222.35
|
|
|
HC GUIDE HYDROPHILLIC.008 COATED
|
Facility
|
OP
|
$261.59
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901605118
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$52.32 |
| Max. Negotiated Rate |
$396.30 |
| Rate for Payer: Adventist Health Commercial |
$52.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$396.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$222.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$143.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$196.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$126.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$152.17
|
| Rate for Payer: Blue Shield of California Commercial |
$165.85
|
| Rate for Payer: Blue Shield of California EPN |
$104.37
|
| Rate for Payer: Cash Price |
$117.72
|
| Rate for Payer: Cash Price |
$117.72
|
| Rate for Payer: Central Health Plan Commercial |
$209.27
|
| Rate for Payer: Cigna of CA HMO |
$167.42
|
| Rate for Payer: Cigna of CA PPO |
$193.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$222.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$222.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$222.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$183.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$104.64
|
| Rate for Payer: EPIC Health Plan Senior |
$104.64
|
| Rate for Payer: Galaxy Health WC |
$222.35
|
| Rate for Payer: Global Benefits Group Commercial |
$156.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$235.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$166.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$94.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$154.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$183.11
|
| Rate for Payer: Multiplan Commercial |
$196.19
|
| Rate for Payer: Networks By Design Commercial |
$170.03
|
| Rate for Payer: Prime Health Services Commercial |
$222.35
|
| Rate for Payer: Riverside University Health System MISP |
$104.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$156.95
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$156.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$130.79
|
| Rate for Payer: United Healthcare All Other HMO |
$130.79
|
| Rate for Payer: United Healthcare HMO Rider |
$130.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$130.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$222.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$222.35
|
| Rate for Payer: Vantage Medical Group Senior |
$222.35
|
|
|
HC GUIDE NERV DESTR, ELEC STIM
|
Facility
|
OP
|
$294.00
|
|
|
Service Code
|
CPT 95873
|
| Hospital Charge Code |
900600242
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$42.12 |
| Max. Negotiated Rate |
$1,297.00 |
| Rate for Payer: Adventist Health Commercial |
$58.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$249.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$249.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$161.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$220.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$47.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$171.02
|
| Rate for Payer: Blue Shield of California Commercial |
$185.22
|
| Rate for Payer: Blue Shield of California EPN |
$116.72
|
| Rate for Payer: Cash Price |
$132.30
|
| Rate for Payer: Cash Price |
$132.30
|
| Rate for Payer: Cash Price |
$132.30
|
| Rate for Payer: Central Health Plan Commercial |
$235.20
|
| Rate for Payer: Cigna of CA HMO |
$188.16
|
| Rate for Payer: Cigna of CA PPO |
$217.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$249.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$249.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$249.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$205.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$117.60
|
| Rate for Payer: EPIC Health Plan Senior |
$117.60
|
| Rate for Payer: Galaxy Health WC |
$249.90
|
| Rate for Payer: Global Benefits Group Commercial |
$176.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$264.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$42.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$186.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$46.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$173.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$205.80
|
| Rate for Payer: Multiplan Commercial |
$220.50
|
| Rate for Payer: Networks By Design Commercial |
$191.10
|
| Rate for Payer: Prime Health Services Commercial |
$249.90
|
| Rate for Payer: Riverside University Health System MISP |
$117.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$176.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$176.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,297.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,024.00
|
| Rate for Payer: United Healthcare HMO Rider |
$776.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$711.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$249.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$249.90
|
| Rate for Payer: Vantage Medical Group Senior |
$249.90
|
|
|
HC GUIDE NERV DESTR, ELEC STIM
|
Facility
|
IP
|
$294.00
|
|
|
Service Code
|
CPT 95873
|
| Hospital Charge Code |
900600242
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$58.80 |
| Max. Negotiated Rate |
$264.60 |
| Rate for Payer: Adventist Health Commercial |
$58.80
|
| Rate for Payer: Cash Price |
$132.30
|
| Rate for Payer: Central Health Plan Commercial |
$235.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$205.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$117.60
|
| Rate for Payer: EPIC Health Plan Senior |
$117.60
|
| Rate for Payer: Galaxy Health WC |
$249.90
|
| Rate for Payer: Global Benefits Group Commercial |
$176.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$264.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$186.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$173.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.80
|
| Rate for Payer: Multiplan Commercial |
$220.50
|
| Rate for Payer: Networks By Design Commercial |
$191.10
|
| Rate for Payer: Prime Health Services Commercial |
$249.90
|
|
|
HC GUIDE NERV DESTR NEEDLE EMG
|
Facility
|
OP
|
$404.00
|
|
|
Service Code
|
CPT 95874
|
| Hospital Charge Code |
900600243
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$42.71 |
| Max. Negotiated Rate |
$1,297.00 |
| Rate for Payer: Adventist Health Commercial |
$80.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$235.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$343.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$222.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$303.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$47.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$235.01
|
| Rate for Payer: Blue Shield of California Commercial |
$254.52
|
| Rate for Payer: Blue Shield of California EPN |
$160.39
|
| Rate for Payer: Cash Price |
$181.80
|
| Rate for Payer: Cash Price |
$181.80
|
| Rate for Payer: Cash Price |
$181.80
|
| Rate for Payer: Central Health Plan Commercial |
$323.20
|
| Rate for Payer: Cigna of CA HMO |
$258.56
|
| Rate for Payer: Cigna of CA PPO |
$298.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$343.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$343.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$343.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$282.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$161.60
|
| Rate for Payer: EPIC Health Plan Senior |
$161.60
|
| Rate for Payer: Galaxy Health WC |
$343.40
|
| Rate for Payer: Global Benefits Group Commercial |
$242.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$363.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$42.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$256.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$47.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$238.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$282.80
|
| Rate for Payer: Multiplan Commercial |
$303.00
|
| Rate for Payer: Networks By Design Commercial |
$262.60
|
| Rate for Payer: Prime Health Services Commercial |
$343.40
|
| Rate for Payer: Riverside University Health System MISP |
$161.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$242.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$242.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,297.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,024.00
|
| Rate for Payer: United Healthcare HMO Rider |
$776.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$711.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$343.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$343.40
|
| Rate for Payer: Vantage Medical Group Senior |
$343.40
|
|
|
HC GUIDE NERV DESTR NEEDLE EMG
|
Facility
|
IP
|
$404.00
|
|
|
Service Code
|
CPT 95874
|
| Hospital Charge Code |
900600243
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$80.80 |
| Max. Negotiated Rate |
$363.60 |
| Rate for Payer: Adventist Health Commercial |
$80.80
|
| Rate for Payer: Cash Price |
$181.80
|
| Rate for Payer: Central Health Plan Commercial |
$323.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$282.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$161.60
|
| Rate for Payer: EPIC Health Plan Senior |
$161.60
|
| Rate for Payer: Galaxy Health WC |
$343.40
|
| Rate for Payer: Global Benefits Group Commercial |
$242.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$363.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$256.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$238.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.80
|
| Rate for Payer: Multiplan Commercial |
$303.00
|
| Rate for Payer: Networks By Design Commercial |
$262.60
|
| Rate for Payer: Prime Health Services Commercial |
$343.40
|
|
|
HC GUIDE NITINOL MANDREL 40CM .014"
|
Facility
|
IP
|
$154.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901698137
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.80 |
| Max. Negotiated Rate |
$138.60 |
| Rate for Payer: Adventist Health Commercial |
$30.80
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Central Health Plan Commercial |
$123.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$107.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.60
|
| Rate for Payer: EPIC Health Plan Senior |
$61.60
|
| Rate for Payer: Galaxy Health WC |
$130.90
|
| Rate for Payer: Global Benefits Group Commercial |
$92.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$138.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$97.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$90.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.80
|
| Rate for Payer: Multiplan Commercial |
$115.50
|
| Rate for Payer: Networks By Design Commercial |
$100.10
|
| Rate for Payer: Prime Health Services Commercial |
$130.90
|
|
|
HC GUIDE NITINOL MANDREL 40CM .014"
|
Facility
|
OP
|
$154.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901698137
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.80 |
| Max. Negotiated Rate |
$396.30 |
| Rate for Payer: Adventist Health Commercial |
$30.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$396.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$130.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$84.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$115.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$74.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$89.58
|
| Rate for Payer: Blue Shield of California Commercial |
$97.64
|
| Rate for Payer: Blue Shield of California EPN |
$61.45
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Central Health Plan Commercial |
$123.20
|
| Rate for Payer: Cigna of CA HMO |
$98.56
|
| Rate for Payer: Cigna of CA PPO |
$113.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$130.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$130.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$130.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$107.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.60
|
| Rate for Payer: EPIC Health Plan Senior |
$61.60
|
| Rate for Payer: Galaxy Health WC |
$130.90
|
| Rate for Payer: Global Benefits Group Commercial |
$92.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$138.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$97.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$55.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$90.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$107.80
|
| Rate for Payer: Multiplan Commercial |
$115.50
|
| Rate for Payer: Networks By Design Commercial |
$100.10
|
| Rate for Payer: Prime Health Services Commercial |
$130.90
|
| Rate for Payer: Riverside University Health System MISP |
$61.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$92.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$92.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$77.00
|
| Rate for Payer: United Healthcare All Other HMO |
$77.00
|
| Rate for Payer: United Healthcare HMO Rider |
$77.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$77.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$130.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$130.90
|
| Rate for Payer: Vantage Medical Group Senior |
$130.90
|
|
|
HC GUIDE NITINOL MANDREL 60CM .018"
|
Facility
|
IP
|
$182.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901698136
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.40 |
| Max. Negotiated Rate |
$163.80 |
| Rate for Payer: Adventist Health Commercial |
$36.40
|
| Rate for Payer: Cash Price |
$81.90
|
| Rate for Payer: Central Health Plan Commercial |
$145.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$127.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.80
|
| Rate for Payer: EPIC Health Plan Senior |
$72.80
|
| Rate for Payer: Galaxy Health WC |
$154.70
|
| Rate for Payer: Global Benefits Group Commercial |
$109.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$163.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$115.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$107.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.40
|
| Rate for Payer: Multiplan Commercial |
$136.50
|
| Rate for Payer: Networks By Design Commercial |
$118.30
|
| Rate for Payer: Prime Health Services Commercial |
$154.70
|
|
|
HC GUIDE NITINOL MANDREL 60CM .018"
|
Facility
|
OP
|
$182.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901698136
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.40 |
| Max. Negotiated Rate |
$396.30 |
| Rate for Payer: Adventist Health Commercial |
$36.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$396.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$154.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$100.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$136.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$88.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$105.87
|
| Rate for Payer: Blue Shield of California Commercial |
$115.39
|
| Rate for Payer: Blue Shield of California EPN |
$72.62
|
| Rate for Payer: Cash Price |
$81.90
|
| Rate for Payer: Cash Price |
$81.90
|
| Rate for Payer: Central Health Plan Commercial |
$145.60
|
| Rate for Payer: Cigna of CA HMO |
$116.48
|
| Rate for Payer: Cigna of CA PPO |
$134.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$154.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$154.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$154.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$127.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.80
|
| Rate for Payer: EPIC Health Plan Senior |
$72.80
|
| Rate for Payer: Galaxy Health WC |
$154.70
|
| Rate for Payer: Global Benefits Group Commercial |
$109.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$163.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$115.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$66.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$107.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$127.40
|
| Rate for Payer: Multiplan Commercial |
$136.50
|
| Rate for Payer: Networks By Design Commercial |
$118.30
|
| Rate for Payer: Prime Health Services Commercial |
$154.70
|
| Rate for Payer: Riverside University Health System MISP |
$72.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$109.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$109.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$91.00
|
| Rate for Payer: United Healthcare All Other HMO |
$91.00
|
| Rate for Payer: United Healthcare HMO Rider |
$91.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$91.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$154.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$154.70
|
| Rate for Payer: Vantage Medical Group Senior |
$154.70
|
|
