|
HC GROWTH EXTENSION PER BAR
|
Facility
|
IP
|
$119.00
|
|
|
Service Code
|
CPT L2760
|
| Hospital Charge Code |
905352760
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$23.80 |
| Max. Negotiated Rate |
$107.10 |
| Rate for Payer: Adventist Health Commercial |
$23.80
|
| Rate for Payer: Blue Shield of California Commercial |
$91.99
|
| Rate for Payer: Blue Shield of California EPN |
$59.98
|
| Rate for Payer: Cash Price |
$65.45
|
| Rate for Payer: Central Health Plan Commercial |
$95.20
|
| Rate for Payer: Cigna of CA HMO |
$83.30
|
| Rate for Payer: Cigna of CA PPO |
$83.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.60
|
| Rate for Payer: EPIC Health Plan Senior |
$47.60
|
| Rate for Payer: Galaxy Health WC |
$101.15
|
| Rate for Payer: Global Benefits Group Commercial |
$71.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$107.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$79.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$73.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.80
|
| Rate for Payer: Multiplan Commercial |
$89.25
|
| Rate for Payer: Networks By Design Commercial |
$77.35
|
| Rate for Payer: Prime Health Services Commercial |
$101.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$44.66
|
| Rate for Payer: United Healthcare All Other HMO |
$43.47
|
| Rate for Payer: United Healthcare HMO Rider |
$42.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$38.97
|
|
|
HC GROWTH EXTENSION PER BAR
|
Facility
|
IP
|
$119.00
|
|
|
Service Code
|
CPT L2760
|
| Hospital Charge Code |
915352760
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$23.80 |
| Max. Negotiated Rate |
$107.10 |
| Rate for Payer: Adventist Health Commercial |
$23.80
|
| Rate for Payer: Blue Shield of California Commercial |
$91.99
|
| Rate for Payer: Blue Shield of California EPN |
$59.98
|
| Rate for Payer: Cash Price |
$65.45
|
| Rate for Payer: Central Health Plan Commercial |
$95.20
|
| Rate for Payer: Cigna of CA HMO |
$83.30
|
| Rate for Payer: Cigna of CA PPO |
$83.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.60
|
| Rate for Payer: EPIC Health Plan Senior |
$47.60
|
| Rate for Payer: Galaxy Health WC |
$101.15
|
| Rate for Payer: Global Benefits Group Commercial |
$71.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$107.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$79.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$73.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.80
|
| Rate for Payer: Multiplan Commercial |
$89.25
|
| Rate for Payer: Networks By Design Commercial |
$77.35
|
| Rate for Payer: Prime Health Services Commercial |
$101.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$44.66
|
| Rate for Payer: United Healthcare All Other HMO |
$43.47
|
| Rate for Payer: United Healthcare HMO Rider |
$42.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$38.97
|
|
|
HC GUID CATH/NEURO ENDOVASCULAR
|
Facility
|
IP
|
$3,900.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909081802
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,510.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Cash Price |
$2,145.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,510.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$780.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: Networks By Design Commercial |
$2,535.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
|
|
HC GUID CATH/NEURO ENDOVASCULAR
|
Facility
|
OP
|
$3,900.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909081802
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,510.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,368.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,145.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,925.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,888.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,290.47
|
| Rate for Payer: Blue Shield of California Commercial |
$2,382.90
|
| Rate for Payer: Blue Shield of California EPN |
$1,556.10
|
| Rate for Payer: Cash Price |
$2,145.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.00
|
| Rate for Payer: Cigna of CA HMO |
$2,496.00
|
| Rate for Payer: Cigna of CA PPO |
$2,886.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,315.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,315.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,510.00
|
| Rate for Payer: InnovAge PACE Commercial |
$1,950.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$780.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,730.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,730.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: Networks By Design Commercial |
$2,535.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| Rate for Payer: Riverside University Health System MISP |
$1,560.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,340.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,340.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,950.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,950.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,950.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,950.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,315.00
|
|
|
HC GUIDE 0.018INX450CM EXCHANGE STIFF
|
Facility
|
OP
|
$584.80
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
900100304
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$116.96 |
| Max. Negotiated Rate |
$526.32 |
| Rate for Payer: Adventist Health Commercial |
$116.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$355.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$497.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$321.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$438.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$283.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$343.45
|
| Rate for Payer: Blue Shield of California Commercial |
$357.31
|
| Rate for Payer: Blue Shield of California EPN |
$233.34
|
| Rate for Payer: Cash Price |
$321.64
|
| Rate for Payer: Central Health Plan Commercial |
$467.84
|
| Rate for Payer: Cigna of CA HMO |
$374.27
|
| Rate for Payer: Cigna of CA PPO |
$432.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$497.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$497.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$497.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$233.92
|
| Rate for Payer: EPIC Health Plan Senior |
$233.92
|
| Rate for Payer: Galaxy Health WC |
$497.08
|
| Rate for Payer: Global Benefits Group Commercial |
$350.88
|
| Rate for Payer: Health Management Network EPO/PPO |
$526.32
|
| Rate for Payer: InnovAge PACE Commercial |
$292.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$390.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$222.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$361.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$409.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$409.36
|
| Rate for Payer: Multiplan Commercial |
$438.60
|
| Rate for Payer: Networks By Design Commercial |
$380.12
|
| Rate for Payer: Prime Health Services Commercial |
$497.08
|
| Rate for Payer: Riverside University Health System MISP |
$233.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$350.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$350.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$292.40
|
| Rate for Payer: United Healthcare All Other HMO |
$292.40
|
| Rate for Payer: United Healthcare HMO Rider |
$292.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$292.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$497.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$497.08
|
| Rate for Payer: Vantage Medical Group Senior |
$497.08
|
|
|
HC GUIDE 0.018INX450CM EXCHANGE STIFF
|
Facility
|
IP
|
$584.80
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
900100304
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$116.96 |
| Max. Negotiated Rate |
$526.32 |
| Rate for Payer: Adventist Health Commercial |
$116.96
|
| Rate for Payer: Cash Price |
$321.64
|
| Rate for Payer: Central Health Plan Commercial |
$467.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$233.92
|
| Rate for Payer: EPIC Health Plan Senior |
$233.92
|
| Rate for Payer: Galaxy Health WC |
$497.08
|
| Rate for Payer: Global Benefits Group Commercial |
$350.88
|
| Rate for Payer: Health Management Network EPO/PPO |
$526.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$390.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$222.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$361.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.96
|
| Rate for Payer: Multiplan Commercial |
$438.60
|
| Rate for Payer: Networks By Design Commercial |
$380.12
|
| Rate for Payer: Prime Health Services Commercial |
$497.08
|
|
|
HC GUIDE 18GA X 145CM
|
Facility
|
IP
|
$114.08
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901602140
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.82 |
| Max. Negotiated Rate |
$102.67 |
| Rate for Payer: Adventist Health Commercial |
$22.82
|
| Rate for Payer: Cash Price |
$62.74
|
| Rate for Payer: Central Health Plan Commercial |
$91.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.63
|
| Rate for Payer: EPIC Health Plan Senior |
$45.63
|
| Rate for Payer: Galaxy Health WC |
$96.97
|
| Rate for Payer: Global Benefits Group Commercial |
$68.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$102.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$76.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$70.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.82
|
| Rate for Payer: Multiplan Commercial |
$85.56
|
| Rate for Payer: Networks By Design Commercial |
$74.15
|
| Rate for Payer: Prime Health Services Commercial |
$96.97
|
|
|
HC GUIDE 18GA X 145CM
|
Facility
|
OP
|
$114.08
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901602140
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.82 |
| Max. Negotiated Rate |
$102.67 |
| Rate for Payer: Adventist Health Commercial |
$22.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$69.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$96.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$62.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$85.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$55.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$67.00
|
| Rate for Payer: Blue Shield of California Commercial |
$69.70
|
| Rate for Payer: Blue Shield of California EPN |
$45.52
|
| Rate for Payer: Cash Price |
$62.74
|
| Rate for Payer: Central Health Plan Commercial |
$91.26
|
| Rate for Payer: Cigna of CA HMO |
$73.01
|
| Rate for Payer: Cigna of CA PPO |
$84.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$96.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$96.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$96.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.63
|
| Rate for Payer: EPIC Health Plan Senior |
$45.63
|
| Rate for Payer: Galaxy Health WC |
$96.97
|
| Rate for Payer: Global Benefits Group Commercial |
$68.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$102.67
|
| Rate for Payer: InnovAge PACE Commercial |
$57.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$76.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$70.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$79.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$79.86
|
| Rate for Payer: Multiplan Commercial |
$85.56
|
| Rate for Payer: Networks By Design Commercial |
$74.15
|
| Rate for Payer: Prime Health Services Commercial |
$96.97
|
| Rate for Payer: Riverside University Health System MISP |
$45.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$68.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$68.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$57.04
|
| Rate for Payer: United Healthcare All Other HMO |
$57.04
|
| Rate for Payer: United Healthcare HMO Rider |
$57.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$57.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$96.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$96.97
|
| Rate for Payer: Vantage Medical Group Senior |
$96.97
|
|
|
HC GUIDE .18IN ROADRUNNER EXTRA
|
Facility
|
IP
|
$529.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
900100344
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$105.80 |
| Max. Negotiated Rate |
$476.10 |
| Rate for Payer: Adventist Health Commercial |
$105.80
|
| Rate for Payer: Blue Shield of California Commercial |
$408.92
|
| Rate for Payer: Blue Shield of California EPN |
$266.62
|
| Rate for Payer: Cash Price |
$290.95
|
| Rate for Payer: Central Health Plan Commercial |
$423.20
|
| Rate for Payer: Cigna of CA HMO |
$370.30
|
| Rate for Payer: Cigna of CA PPO |
$370.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$211.60
|
| Rate for Payer: EPIC Health Plan Senior |
$211.60
|
| Rate for Payer: Galaxy Health WC |
$449.65
|
| Rate for Payer: Global Benefits Group Commercial |
$317.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$476.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$352.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$201.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$327.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.80
|
| Rate for Payer: Multiplan Commercial |
$396.75
|
| Rate for Payer: Networks By Design Commercial |
$264.50
|
| Rate for Payer: Prime Health Services Commercial |
$449.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$198.53
|
| Rate for Payer: United Healthcare All Other HMO |
$193.24
|
| Rate for Payer: United Healthcare HMO Rider |
$189.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$173.25
|
|
|
HC GUIDE .18IN ROADRUNNER EXTRA
|
Facility
|
OP
|
$529.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
900100344
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$105.80 |
| Max. Negotiated Rate |
$476.10 |
| Rate for Payer: Adventist Health Commercial |
$105.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$449.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$290.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$396.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$241.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$292.91
|
| Rate for Payer: Blue Shield of California Commercial |
$408.92
|
| Rate for Payer: Blue Shield of California EPN |
$266.62
|
| Rate for Payer: Cash Price |
$290.95
|
| Rate for Payer: Central Health Plan Commercial |
$423.20
|
| Rate for Payer: Cigna of CA HMO |
$370.30
|
| Rate for Payer: Cigna of CA PPO |
$370.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$449.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$449.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$449.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$211.60
|
| Rate for Payer: EPIC Health Plan Senior |
$211.60
|
| Rate for Payer: Galaxy Health WC |
$449.65
|
| Rate for Payer: Global Benefits Group Commercial |
$317.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$476.10
|
| Rate for Payer: InnovAge PACE Commercial |
$264.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$352.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$201.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$327.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$370.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$370.30
|
| Rate for Payer: Multiplan Commercial |
$396.75
|
| Rate for Payer: Networks By Design Commercial |
$264.50
|
| Rate for Payer: Prime Health Services Commercial |
$449.65
|
| Rate for Payer: Riverside University Health System MISP |
$211.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$317.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$317.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$198.53
|
| Rate for Payer: United Healthcare All Other HMO |
$193.24
|
| Rate for Payer: United Healthcare HMO Rider |
$189.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$173.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$449.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$449.65
|
| Rate for Payer: Vantage Medical Group Senior |
$449.65
|
|
|
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 |
$189.00 |
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$127.53
|
| 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 |
$123.33
|
| Rate for Payer: Blue Shield of California Commercial |
$128.31
|
| Rate for Payer: Blue Shield of California EPN |
$83.79
|
| Rate for Payer: Cash Price |
$115.50
|
| 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: 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: InnovAge PACE Commercial |
$105.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$140.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$129.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$147.00
|
| Rate for Payer: Molina Healthcare of CA 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 ANGLED .035"X150CM
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901602721
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$189.00 |
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Central Health Plan Commercial |
$168.00
|
| 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 Permanente of CA Commercial/Self Funded |
$140.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$129.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.00
|
| 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
|
|
|
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 |
$50.16
|
| Rate for Payer: Central Health Plan Commercial |
$72.96
|
| 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 Permanente of CA Commercial/Self Funded |
$60.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$56.45
|
| 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 |
$82.08 |
| Rate for Payer: Adventist Health Commercial |
$18.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$55.39
|
| 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 |
$53.56
|
| Rate for Payer: Blue Shield of California Commercial |
$55.72
|
| Rate for Payer: Blue Shield of California EPN |
$36.39
|
| Rate for Payer: Cash Price |
$50.16
|
| 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: 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: InnovAge PACE Commercial |
$45.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$60.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$56.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$63.84
|
| Rate for Payer: Molina Healthcare of CA 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
|
OP
|
$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: Aetna of CA HMO/PPO |
$64.20
|
| 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 |
$62.09
|
| Rate for Payer: Blue Shield of California Commercial |
$64.59
|
| Rate for Payer: Blue Shield of California EPN |
$42.18
|
| Rate for Payer: Cash Price |
$58.15
|
| 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: 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: InnovAge PACE Commercial |
$52.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$70.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$65.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$74.00
|
| Rate for Payer: Molina Healthcare of CA 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 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 |
$58.15
|
| Rate for Payer: Central Health Plan Commercial |
$84.58
|
| 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 Permanente of CA Commercial/Self Funded |
$70.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$65.44
|
| 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 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 |
$105.88
|
| Rate for Payer: Central Health Plan Commercial |
$154.00
|
| 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 Permanente of CA Commercial/Self Funded |
$128.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$73.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$119.16
|
| 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 |
$173.25 |
| Rate for Payer: Adventist Health Commercial |
$38.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$116.91
|
| 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 |
$113.06
|
| Rate for Payer: Blue Shield of California Commercial |
$117.62
|
| Rate for Payer: Blue Shield of California EPN |
$76.81
|
| Rate for Payer: Cash Price |
$105.88
|
| 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: 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: InnovAge PACE Commercial |
$96.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$128.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$73.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$119.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$134.75
|
| Rate for Payer: Molina Healthcare of CA 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 |
$173.44 |
| Rate for Payer: Adventist Health Commercial |
$38.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$117.03
|
| 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 |
$113.18
|
| Rate for Payer: Blue Shield of California Commercial |
$117.75
|
| Rate for Payer: Blue Shield of California EPN |
$76.89
|
| Rate for Payer: Cash Price |
$105.99
|
| 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: 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: InnovAge PACE Commercial |
$96.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$128.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$73.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$119.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$134.90
|
| Rate for Payer: Molina Healthcare of CA 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 |
$105.99
|
| Rate for Payer: Central Health Plan Commercial |
$154.17
|
| 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 Permanente of CA Commercial/Self Funded |
$128.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$73.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$119.29
|
| 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
|
OP
|
$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: Aetna of CA HMO/PPO |
$48.55
|
| 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 |
$46.95
|
| Rate for Payer: Blue Shield of California Commercial |
$48.85
|
| Rate for Payer: Blue Shield of California EPN |
$31.90
|
| Rate for Payer: Cash Price |
$43.97
|
| 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: 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: InnovAge PACE Commercial |
$39.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$53.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$49.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$55.97
|
| Rate for Payer: Molina Healthcare of CA 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 .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 |
$43.97
|
| Rate for Payer: Central Health Plan Commercial |
$63.96
|
| 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 Permanente of CA Commercial/Self Funded |
$53.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$49.49
|
| 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 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 |
$45.10
|
| Rate for Payer: Central Health Plan Commercial |
$65.60
|
| 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 Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.76
|
| 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 |
$73.80 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$49.80
|
| 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 |
$48.16
|
| Rate for Payer: Blue Shield of California Commercial |
$50.10
|
| Rate for Payer: Blue Shield of California EPN |
$32.72
|
| Rate for Payer: Cash Price |
$45.10
|
| 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: 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: InnovAge PACE Commercial |
$41.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$57.40
|
| Rate for Payer: Molina Healthcare of CA 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 ENDOS 0.035INX260CM
|
Facility
|
IP
|
$851.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
900100301
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$170.20 |
| Max. Negotiated Rate |
$765.90 |
| Rate for Payer: Adventist Health Commercial |
$170.20
|
| Rate for Payer: Cash Price |
$468.05
|
| Rate for Payer: Central Health Plan Commercial |
$680.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.40
|
| Rate for Payer: EPIC Health Plan Senior |
$340.40
|
| Rate for Payer: Galaxy Health WC |
$723.35
|
| Rate for Payer: Global Benefits Group Commercial |
$510.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$765.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$567.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$324.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$526.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.20
|
| Rate for Payer: Multiplan Commercial |
$638.25
|
| Rate for Payer: Networks By Design Commercial |
$553.15
|
| Rate for Payer: Prime Health Services Commercial |
$723.35
|
|
