|
HC GUIDE STRT 0.035INX480CM PURPLE
|
Facility
|
IP
|
$529.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
900100310
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$105.80 |
| Max. Negotiated Rate |
$476.10 |
| Rate for Payer: Adventist Health Commercial |
$105.80
|
| Rate for Payer: Cash Price |
$290.95
|
| Rate for Payer: Central Health Plan Commercial |
$423.20
|
| 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 |
$343.85
|
| Rate for Payer: Prime Health Services Commercial |
$449.65
|
|
|
HC GUIDE STRT 0.035INX480CM PURPLE
|
Facility
|
OP
|
$529.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
900100310
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$105.80 |
| Max. Negotiated Rate |
$476.10 |
| Rate for Payer: Adventist Health Commercial |
$105.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$321.26
|
| 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 |
$256.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$310.68
|
| Rate for Payer: Blue Shield of California Commercial |
$323.22
|
| Rate for Payer: Blue Shield of California EPN |
$211.07
|
| Rate for Payer: Cash Price |
$290.95
|
| Rate for Payer: Central Health Plan Commercial |
$423.20
|
| Rate for Payer: Cigna of CA HMO |
$338.56
|
| Rate for Payer: Cigna of CA PPO |
$391.46
|
| 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 |
$343.85
|
| 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 |
$264.50
|
| Rate for Payer: United Healthcare All Other HMO |
$264.50
|
| Rate for Payer: United Healthcare HMO Rider |
$264.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$264.50
|
| 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 STRT 0.038INX260CM DISTAL COATED
|
Facility
|
IP
|
$538.20
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
900100305
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$107.64 |
| Max. Negotiated Rate |
$484.38 |
| Rate for Payer: Adventist Health Commercial |
$107.64
|
| Rate for Payer: Cash Price |
$296.01
|
| Rate for Payer: Central Health Plan Commercial |
$430.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$215.28
|
| Rate for Payer: EPIC Health Plan Senior |
$215.28
|
| Rate for Payer: Galaxy Health WC |
$457.47
|
| Rate for Payer: Global Benefits Group Commercial |
$322.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$484.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$358.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$205.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$333.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.64
|
| Rate for Payer: Multiplan Commercial |
$403.65
|
| Rate for Payer: Networks By Design Commercial |
$349.83
|
| Rate for Payer: Prime Health Services Commercial |
$457.47
|
|
|
HC GUIDE STRT 0.038INX260CM DISTAL COATED
|
Facility
|
OP
|
$538.20
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
900100305
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$107.64 |
| Max. Negotiated Rate |
$484.38 |
| Rate for Payer: Adventist Health Commercial |
$107.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$326.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$457.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$296.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$403.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$260.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$316.08
|
| Rate for Payer: Blue Shield of California Commercial |
$328.84
|
| Rate for Payer: Blue Shield of California EPN |
$214.74
|
| Rate for Payer: Cash Price |
$296.01
|
| Rate for Payer: Central Health Plan Commercial |
$430.56
|
| Rate for Payer: Cigna of CA HMO |
$344.45
|
| Rate for Payer: Cigna of CA PPO |
$398.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$457.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$457.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$457.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$215.28
|
| Rate for Payer: EPIC Health Plan Senior |
$215.28
|
| Rate for Payer: Galaxy Health WC |
$457.47
|
| Rate for Payer: Global Benefits Group Commercial |
$322.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$484.38
|
| Rate for Payer: InnovAge PACE Commercial |
$269.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$358.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$205.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$333.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$376.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$376.74
|
| Rate for Payer: Multiplan Commercial |
$403.65
|
| Rate for Payer: Networks By Design Commercial |
$349.83
|
| Rate for Payer: Prime Health Services Commercial |
$457.47
|
| Rate for Payer: Riverside University Health System MISP |
$215.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$322.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$322.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$269.10
|
| Rate for Payer: United Healthcare All Other HMO |
$269.10
|
| Rate for Payer: United Healthcare HMO Rider |
$269.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$269.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$457.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$457.47
|
| Rate for Payer: Vantage Medical Group Senior |
$457.47
|
|
|
HC GUIDE STRT .025INX450CM
|
Facility
|
IP
|
$724.50
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
900100311
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$144.90 |
| Max. Negotiated Rate |
$652.05 |
| Rate for Payer: Adventist Health Commercial |
$144.90
|
| Rate for Payer: Cash Price |
$398.48
|
| Rate for Payer: Central Health Plan Commercial |
$579.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$289.80
|
| Rate for Payer: EPIC Health Plan Senior |
$289.80
|
| Rate for Payer: Galaxy Health WC |
$615.83
|
| Rate for Payer: Global Benefits Group Commercial |
$434.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$652.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$483.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$276.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$448.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$144.90
|
| Rate for Payer: Multiplan Commercial |
$543.38
|
| Rate for Payer: Networks By Design Commercial |
$470.93
|
| Rate for Payer: Prime Health Services Commercial |
$615.83
|
|
|
HC GUIDE STRT .025INX450CM
|
Facility
|
OP
|
$724.50
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
900100311
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$144.90 |
| Max. Negotiated Rate |
$652.05 |
| Rate for Payer: Adventist Health Commercial |
$144.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$439.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$615.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$398.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$543.38
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$350.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$425.50
|
| Rate for Payer: Blue Shield of California Commercial |
$442.67
|
| Rate for Payer: Blue Shield of California EPN |
$289.08
|
| Rate for Payer: Cash Price |
$398.48
|
| Rate for Payer: Central Health Plan Commercial |
$579.60
|
| Rate for Payer: Cigna of CA HMO |
$463.68
|
| Rate for Payer: Cigna of CA PPO |
$536.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$615.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$615.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$615.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$289.80
|
| Rate for Payer: EPIC Health Plan Senior |
$289.80
|
| Rate for Payer: Galaxy Health WC |
$615.83
|
| Rate for Payer: Global Benefits Group Commercial |
$434.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$652.05
|
| Rate for Payer: InnovAge PACE Commercial |
$362.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$483.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$276.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$448.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$144.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$507.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$507.15
|
| Rate for Payer: Multiplan Commercial |
$543.38
|
| Rate for Payer: Networks By Design Commercial |
$470.93
|
| Rate for Payer: Prime Health Services Commercial |
$615.83
|
| Rate for Payer: Riverside University Health System MISP |
$289.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$434.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$434.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$362.25
|
| Rate for Payer: United Healthcare All Other HMO |
$362.25
|
| Rate for Payer: United Healthcare HMO Rider |
$362.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$362.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$615.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$615.83
|
| Rate for Payer: Vantage Medical Group Senior |
$615.83
|
|
|
HC GUIDE STRT JAGWIRE 0.025INX260CM
|
Facility
|
IP
|
$708.40
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
900100307
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$141.68 |
| Max. Negotiated Rate |
$637.56 |
| Rate for Payer: Adventist Health Commercial |
$141.68
|
| Rate for Payer: Cash Price |
$389.62
|
| Rate for Payer: Central Health Plan Commercial |
$566.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$283.36
|
| Rate for Payer: EPIC Health Plan Senior |
$283.36
|
| Rate for Payer: Galaxy Health WC |
$602.14
|
| Rate for Payer: Global Benefits Group Commercial |
$425.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$637.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$472.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$269.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$438.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$141.68
|
| Rate for Payer: Multiplan Commercial |
$531.30
|
| Rate for Payer: Networks By Design Commercial |
$460.46
|
| Rate for Payer: Prime Health Services Commercial |
$602.14
|
|
|
HC GUIDE STRT JAGWIRE 0.025INX260CM
|
Facility
|
OP
|
$708.40
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
900100307
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$141.68 |
| Max. Negotiated Rate |
$637.56 |
| Rate for Payer: Adventist Health Commercial |
$141.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$430.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$602.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$389.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$531.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$343.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$416.04
|
| Rate for Payer: Blue Shield of California Commercial |
$432.83
|
| Rate for Payer: Blue Shield of California EPN |
$282.65
|
| Rate for Payer: Cash Price |
$389.62
|
| Rate for Payer: Central Health Plan Commercial |
$566.72
|
| Rate for Payer: Cigna of CA HMO |
$453.38
|
| Rate for Payer: Cigna of CA PPO |
$524.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$602.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$602.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$602.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$283.36
|
| Rate for Payer: EPIC Health Plan Senior |
$283.36
|
| Rate for Payer: Galaxy Health WC |
$602.14
|
| Rate for Payer: Global Benefits Group Commercial |
$425.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$637.56
|
| Rate for Payer: InnovAge PACE Commercial |
$354.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$472.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$269.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$438.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$141.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$495.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$495.88
|
| Rate for Payer: Multiplan Commercial |
$531.30
|
| Rate for Payer: Networks By Design Commercial |
$460.46
|
| Rate for Payer: Prime Health Services Commercial |
$602.14
|
| Rate for Payer: Riverside University Health System MISP |
$283.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$425.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$425.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$354.20
|
| Rate for Payer: United Healthcare All Other HMO |
$354.20
|
| Rate for Payer: United Healthcare HMO Rider |
$354.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$354.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$602.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$602.14
|
| Rate for Payer: Vantage Medical Group Senior |
$602.14
|
|
|
HC GUIDE STRT JAGWIRE 0.035INX260CM
|
Facility
|
IP
|
$840.42
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
900100306
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$168.08 |
| Max. Negotiated Rate |
$756.38 |
| Rate for Payer: Adventist Health Commercial |
$168.08
|
| Rate for Payer: Cash Price |
$462.23
|
| Rate for Payer: Central Health Plan Commercial |
$672.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$336.17
|
| Rate for Payer: EPIC Health Plan Senior |
$336.17
|
| Rate for Payer: Galaxy Health WC |
$714.36
|
| Rate for Payer: Global Benefits Group Commercial |
$504.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$756.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$560.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$320.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$520.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.08
|
| Rate for Payer: Multiplan Commercial |
$630.32
|
| Rate for Payer: Networks By Design Commercial |
$546.27
|
| Rate for Payer: Prime Health Services Commercial |
$714.36
|
|
|
HC GUIDE STRT JAGWIRE 0.035INX260CM
|
Facility
|
OP
|
$840.42
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
900100306
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$168.08 |
| Max. Negotiated Rate |
$756.38 |
| Rate for Payer: Adventist Health Commercial |
$168.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$510.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$714.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$462.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$630.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$406.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$493.58
|
| Rate for Payer: Blue Shield of California Commercial |
$513.50
|
| Rate for Payer: Blue Shield of California EPN |
$335.33
|
| Rate for Payer: Cash Price |
$462.23
|
| Rate for Payer: Central Health Plan Commercial |
$672.34
|
| Rate for Payer: Cigna of CA HMO |
$537.87
|
| Rate for Payer: Cigna of CA PPO |
$621.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$714.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$714.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$714.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$336.17
|
| Rate for Payer: EPIC Health Plan Senior |
$336.17
|
| Rate for Payer: Galaxy Health WC |
$714.36
|
| Rate for Payer: Global Benefits Group Commercial |
$504.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$756.38
|
| Rate for Payer: InnovAge PACE Commercial |
$420.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$560.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$320.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$520.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$588.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$588.29
|
| Rate for Payer: Multiplan Commercial |
$630.32
|
| Rate for Payer: Networks By Design Commercial |
$546.27
|
| Rate for Payer: Prime Health Services Commercial |
$714.36
|
| Rate for Payer: Riverside University Health System MISP |
$336.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$504.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$504.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$420.21
|
| Rate for Payer: United Healthcare All Other HMO |
$420.21
|
| Rate for Payer: United Healthcare HMO Rider |
$420.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$420.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$714.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$714.36
|
| Rate for Payer: Vantage Medical Group Senior |
$714.36
|
|
|
HC GUIDE VASCULAR
|
Facility
|
IP
|
$782.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
900100312
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$156.40 |
| Max. Negotiated Rate |
$703.80 |
| Rate for Payer: Adventist Health Commercial |
$156.40
|
| Rate for Payer: Cash Price |
$430.10
|
| Rate for Payer: Central Health Plan Commercial |
$625.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$312.80
|
| Rate for Payer: EPIC Health Plan Senior |
$312.80
|
| Rate for Payer: Galaxy Health WC |
$664.70
|
| Rate for Payer: Global Benefits Group Commercial |
$469.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$703.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$521.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$297.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$484.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$156.40
|
| Rate for Payer: Multiplan Commercial |
$586.50
|
| Rate for Payer: Networks By Design Commercial |
$508.30
|
| Rate for Payer: Prime Health Services Commercial |
$664.70
|
|
|
HC GUIDE VASCULAR
|
Facility
|
OP
|
$782.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
900100312
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$156.40 |
| Max. Negotiated Rate |
$703.80 |
| Rate for Payer: Adventist Health Commercial |
$156.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$474.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$664.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$430.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$586.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$378.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$459.27
|
| Rate for Payer: Blue Shield of California Commercial |
$477.80
|
| Rate for Payer: Blue Shield of California EPN |
$312.02
|
| Rate for Payer: Cash Price |
$430.10
|
| Rate for Payer: Central Health Plan Commercial |
$625.60
|
| Rate for Payer: Cigna of CA HMO |
$500.48
|
| Rate for Payer: Cigna of CA PPO |
$578.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$664.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$664.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$664.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$312.80
|
| Rate for Payer: EPIC Health Plan Senior |
$312.80
|
| Rate for Payer: Galaxy Health WC |
$664.70
|
| Rate for Payer: Global Benefits Group Commercial |
$469.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$703.80
|
| Rate for Payer: InnovAge PACE Commercial |
$391.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$521.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$297.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$484.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$156.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$547.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$547.40
|
| Rate for Payer: Multiplan Commercial |
$586.50
|
| Rate for Payer: Networks By Design Commercial |
$508.30
|
| Rate for Payer: Prime Health Services Commercial |
$664.70
|
| Rate for Payer: Riverside University Health System MISP |
$312.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$469.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$469.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$391.00
|
| Rate for Payer: United Healthcare All Other HMO |
$391.00
|
| Rate for Payer: United Healthcare HMO Rider |
$391.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$391.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$664.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$664.70
|
| Rate for Payer: Vantage Medical Group Senior |
$664.70
|
|
|
HC GUIDE VASONOVA VPS
|
Facility
|
IP
|
$586.55
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901606278
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$117.31 |
| Max. Negotiated Rate |
$527.89 |
| Rate for Payer: Adventist Health Commercial |
$117.31
|
| Rate for Payer: Cash Price |
$322.60
|
| Rate for Payer: Central Health Plan Commercial |
$469.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$234.62
|
| Rate for Payer: EPIC Health Plan Senior |
$234.62
|
| Rate for Payer: Galaxy Health WC |
$498.57
|
| Rate for Payer: Global Benefits Group Commercial |
$351.93
|
| Rate for Payer: Health Management Network EPO/PPO |
$527.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$391.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$223.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$363.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$117.31
|
| Rate for Payer: Multiplan Commercial |
$439.91
|
| Rate for Payer: Networks By Design Commercial |
$381.26
|
| Rate for Payer: Prime Health Services Commercial |
$498.57
|
|
|
HC GUIDE VASONOVA VPS
|
Facility
|
OP
|
$586.55
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901606278
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$117.31 |
| Max. Negotiated Rate |
$527.89 |
| Rate for Payer: Adventist Health Commercial |
$117.31
|
| Rate for Payer: Aetna of CA HMO/PPO |
$356.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$498.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$322.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$439.91
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$284.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$344.48
|
| Rate for Payer: Blue Shield of California Commercial |
$358.38
|
| Rate for Payer: Blue Shield of California EPN |
$234.03
|
| Rate for Payer: Cash Price |
$322.60
|
| Rate for Payer: Central Health Plan Commercial |
$469.24
|
| Rate for Payer: Cigna of CA HMO |
$375.39
|
| Rate for Payer: Cigna of CA PPO |
$434.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$498.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$498.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$498.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$234.62
|
| Rate for Payer: EPIC Health Plan Senior |
$234.62
|
| Rate for Payer: Galaxy Health WC |
$498.57
|
| Rate for Payer: Global Benefits Group Commercial |
$351.93
|
| Rate for Payer: Health Management Network EPO/PPO |
$527.89
|
| Rate for Payer: InnovAge PACE Commercial |
$293.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$391.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$223.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$363.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$117.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$410.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$410.58
|
| Rate for Payer: Multiplan Commercial |
$439.91
|
| Rate for Payer: Networks By Design Commercial |
$381.26
|
| Rate for Payer: Prime Health Services Commercial |
$498.57
|
| Rate for Payer: Riverside University Health System MISP |
$234.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$351.93
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$351.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$293.27
|
| Rate for Payer: United Healthcare All Other HMO |
$293.27
|
| Rate for Payer: United Healthcare HMO Rider |
$293.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$293.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$498.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$498.57
|
| Rate for Payer: Vantage Medical Group Senior |
$498.57
|
|
|
HC GUIDEWIRE ASAHI CHAKAI
|
Facility
|
OP
|
$2,070.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909000019
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$414.00 |
| Max. Negotiated Rate |
$1,863.00 |
| Rate for Payer: Adventist Health Commercial |
$414.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,257.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,759.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,138.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,552.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,002.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,215.71
|
| Rate for Payer: Blue Shield of California Commercial |
$1,264.77
|
| Rate for Payer: Blue Shield of California EPN |
$825.93
|
| Rate for Payer: Cash Price |
$1,138.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,656.00
|
| Rate for Payer: Cigna of CA HMO |
$1,324.80
|
| Rate for Payer: Cigna of CA PPO |
$1,531.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,759.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,759.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,759.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$828.00
|
| Rate for Payer: EPIC Health Plan Senior |
$828.00
|
| Rate for Payer: Galaxy Health WC |
$1,759.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,242.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,863.00
|
| Rate for Payer: InnovAge PACE Commercial |
$1,035.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,380.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$788.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,281.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$414.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,449.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,449.00
|
| Rate for Payer: Multiplan Commercial |
$1,552.50
|
| Rate for Payer: Networks By Design Commercial |
$1,345.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,759.50
|
| Rate for Payer: Riverside University Health System MISP |
$828.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,242.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,242.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,035.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,035.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,035.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,035.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,759.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,759.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,759.50
|
|
|
HC GUIDEWIRE ASAHI CHAKAI
|
Facility
|
IP
|
$2,070.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909000019
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$414.00 |
| Max. Negotiated Rate |
$1,863.00 |
| Rate for Payer: Adventist Health Commercial |
$414.00
|
| Rate for Payer: Cash Price |
$1,138.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,656.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$828.00
|
| Rate for Payer: EPIC Health Plan Senior |
$828.00
|
| Rate for Payer: Galaxy Health WC |
$1,759.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,242.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,863.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,380.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$788.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,281.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$414.00
|
| Rate for Payer: Multiplan Commercial |
$1,552.50
|
| Rate for Payer: Networks By Design Commercial |
$1,345.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,759.50
|
|
|
HC GUIDEWIRE/DIAG STARTER
|
Facility
|
IP
|
$106.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909081225
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.20 |
| Max. Negotiated Rate |
$95.40 |
| Rate for Payer: Adventist Health Commercial |
$21.20
|
| Rate for Payer: Cash Price |
$58.30
|
| Rate for Payer: Central Health Plan Commercial |
$84.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.40
|
| Rate for Payer: EPIC Health Plan Senior |
$42.40
|
| Rate for Payer: Galaxy Health WC |
$90.10
|
| Rate for Payer: Global Benefits Group Commercial |
$63.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$95.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$70.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$65.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.20
|
| Rate for Payer: Multiplan Commercial |
$79.50
|
| Rate for Payer: Networks By Design Commercial |
$68.90
|
| Rate for Payer: Prime Health Services Commercial |
$90.10
|
|
|
HC GUIDEWIRE/DIAG STARTER
|
Facility
|
OP
|
$106.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909081225
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.20 |
| Max. Negotiated Rate |
$95.40 |
| Rate for Payer: Adventist Health Commercial |
$21.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$64.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$90.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$58.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$79.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$51.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$62.25
|
| Rate for Payer: Blue Shield of California Commercial |
$64.77
|
| Rate for Payer: Blue Shield of California EPN |
$42.29
|
| Rate for Payer: Cash Price |
$58.30
|
| Rate for Payer: Central Health Plan Commercial |
$84.80
|
| Rate for Payer: Cigna of CA HMO |
$67.84
|
| Rate for Payer: Cigna of CA PPO |
$78.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$90.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$90.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$90.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.40
|
| Rate for Payer: EPIC Health Plan Senior |
$42.40
|
| Rate for Payer: Galaxy Health WC |
$90.10
|
| Rate for Payer: Global Benefits Group Commercial |
$63.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$95.40
|
| Rate for Payer: InnovAge PACE Commercial |
$53.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$70.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$65.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$74.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$74.20
|
| Rate for Payer: Multiplan Commercial |
$79.50
|
| Rate for Payer: Networks By Design Commercial |
$68.90
|
| Rate for Payer: Prime Health Services Commercial |
$90.10
|
| Rate for Payer: Riverside University Health System MISP |
$42.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$63.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$63.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$53.00
|
| Rate for Payer: United Healthcare All Other HMO |
$53.00
|
| Rate for Payer: United Healthcare HMO Rider |
$53.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$53.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$90.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$90.10
|
| Rate for Payer: Vantage Medical Group Senior |
$90.10
|
|
|
HC GUIDEWIRE EXCELSIOR 18
|
Facility
|
OP
|
$3,842.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909000021
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$768.40 |
| Max. Negotiated Rate |
$3,457.80 |
| Rate for Payer: Adventist Health Commercial |
$768.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,333.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,265.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,113.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,881.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,860.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,256.41
|
| Rate for Payer: Blue Shield of California Commercial |
$2,347.46
|
| Rate for Payer: Blue Shield of California EPN |
$1,532.96
|
| Rate for Payer: Cash Price |
$2,113.10
|
| Rate for Payer: Central Health Plan Commercial |
$3,073.60
|
| Rate for Payer: Cigna of CA HMO |
$2,458.88
|
| Rate for Payer: Cigna of CA PPO |
$2,843.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,265.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,265.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,265.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,536.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,536.80
|
| Rate for Payer: Galaxy Health WC |
$3,265.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,305.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,457.80
|
| Rate for Payer: InnovAge PACE Commercial |
$1,921.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,562.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,463.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,378.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$768.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,689.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,689.40
|
| Rate for Payer: Multiplan Commercial |
$2,881.50
|
| Rate for Payer: Networks By Design Commercial |
$2,497.30
|
| Rate for Payer: Prime Health Services Commercial |
$3,265.70
|
| Rate for Payer: Riverside University Health System MISP |
$1,536.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,305.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,305.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,921.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,921.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,921.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,921.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,265.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,265.70
|
| Rate for Payer: Vantage Medical Group Senior |
$3,265.70
|
|
|
HC GUIDEWIRE EXCELSIOR 18
|
Facility
|
IP
|
$3,842.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909000021
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$768.40 |
| Max. Negotiated Rate |
$3,457.80 |
| Rate for Payer: Adventist Health Commercial |
$768.40
|
| Rate for Payer: Cash Price |
$2,113.10
|
| Rate for Payer: Central Health Plan Commercial |
$3,073.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,536.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,536.80
|
| Rate for Payer: Galaxy Health WC |
$3,265.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,305.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,457.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,562.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,463.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,378.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$768.40
|
| Rate for Payer: Multiplan Commercial |
$2,881.50
|
| Rate for Payer: Networks By Design Commercial |
$2,497.30
|
| Rate for Payer: Prime Health Services Commercial |
$3,265.70
|
|
|
HC GUIDEWIRE FIX CORE STRT 180CM
|
Facility
|
OP
|
$81.92
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901698839
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.38 |
| Max. Negotiated Rate |
$73.73 |
| Rate for Payer: Adventist Health Commercial |
$16.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$49.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$69.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$61.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$39.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48.11
|
| Rate for Payer: Blue Shield of California Commercial |
$50.05
|
| Rate for Payer: Blue Shield of California EPN |
$32.69
|
| Rate for Payer: Cash Price |
$45.06
|
| Rate for Payer: Central Health Plan Commercial |
$65.54
|
| Rate for Payer: Cigna of CA HMO |
$52.43
|
| Rate for Payer: Cigna of CA PPO |
$60.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$69.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$69.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$69.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.77
|
| Rate for Payer: EPIC Health Plan Senior |
$32.77
|
| Rate for Payer: Galaxy Health WC |
$69.63
|
| Rate for Payer: Global Benefits Group Commercial |
$49.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$73.73
|
| Rate for Payer: InnovAge PACE Commercial |
$40.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$57.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$57.34
|
| Rate for Payer: Multiplan Commercial |
$61.44
|
| Rate for Payer: Networks By Design Commercial |
$53.25
|
| Rate for Payer: Prime Health Services Commercial |
$69.63
|
| Rate for Payer: Riverside University Health System MISP |
$32.77
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$40.96
|
| Rate for Payer: United Healthcare All Other HMO |
$40.96
|
| Rate for Payer: United Healthcare HMO Rider |
$40.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$40.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$69.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$69.63
|
| Rate for Payer: Vantage Medical Group Senior |
$69.63
|
|
|
HC GUIDEWIRE FIX CORE STRT 180CM
|
Facility
|
IP
|
$81.92
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901698839
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.38 |
| Max. Negotiated Rate |
$73.73 |
| Rate for Payer: Adventist Health Commercial |
$16.38
|
| Rate for Payer: Cash Price |
$45.06
|
| Rate for Payer: Central Health Plan Commercial |
$65.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.77
|
| Rate for Payer: EPIC Health Plan Senior |
$32.77
|
| Rate for Payer: Galaxy Health WC |
$69.63
|
| Rate for Payer: Global Benefits Group Commercial |
$49.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$73.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.38
|
| Rate for Payer: Multiplan Commercial |
$61.44
|
| Rate for Payer: Networks By Design Commercial |
$53.25
|
| Rate for Payer: Prime Health Services Commercial |
$69.63
|
|
|
HC GUIDEWIRE/GLIDE/AMPLATZ
|
Facility
|
IP
|
$72.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909081288
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$64.80 |
| Rate for Payer: Adventist Health Commercial |
$14.40
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Central Health Plan Commercial |
$57.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.80
|
| Rate for Payer: EPIC Health Plan Senior |
$28.80
|
| Rate for Payer: Galaxy Health WC |
$61.20
|
| Rate for Payer: Global Benefits Group Commercial |
$43.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$64.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$48.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$44.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.40
|
| Rate for Payer: Multiplan Commercial |
$54.00
|
| Rate for Payer: Networks By Design Commercial |
$46.80
|
| Rate for Payer: Prime Health Services Commercial |
$61.20
|
|
|
HC GUIDEWIRE/GLIDE/AMPLATZ
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909081288
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$64.80 |
| Rate for Payer: Adventist Health Commercial |
$14.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$43.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$61.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$39.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$54.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$34.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$42.29
|
| Rate for Payer: Blue Shield of California Commercial |
$43.99
|
| Rate for Payer: Blue Shield of California EPN |
$28.73
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Central Health Plan Commercial |
$57.60
|
| Rate for Payer: Cigna of CA HMO |
$46.08
|
| Rate for Payer: Cigna of CA PPO |
$53.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$61.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$61.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$61.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.80
|
| Rate for Payer: EPIC Health Plan Senior |
$28.80
|
| Rate for Payer: Galaxy Health WC |
$61.20
|
| Rate for Payer: Global Benefits Group Commercial |
$43.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$64.80
|
| Rate for Payer: InnovAge PACE Commercial |
$36.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$48.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$44.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$50.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$50.40
|
| Rate for Payer: Multiplan Commercial |
$54.00
|
| Rate for Payer: Networks By Design Commercial |
$46.80
|
| Rate for Payer: Prime Health Services Commercial |
$61.20
|
| Rate for Payer: Riverside University Health System MISP |
$28.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$43.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$43.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$36.00
|
| Rate for Payer: United Healthcare All Other HMO |
$36.00
|
| Rate for Payer: United Healthcare HMO Rider |
$36.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$61.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$61.20
|
| Rate for Payer: Vantage Medical Group Senior |
$61.20
|
|
|
HC GUIDEWIRE GOLD TIP
|
Facility
|
IP
|
$1,334.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909000011
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$266.80 |
| Max. Negotiated Rate |
$1,200.60 |
| Rate for Payer: Adventist Health Commercial |
$266.80
|
| Rate for Payer: Cash Price |
$733.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,067.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$533.60
|
| Rate for Payer: EPIC Health Plan Senior |
$533.60
|
| Rate for Payer: Galaxy Health WC |
$1,133.90
|
| Rate for Payer: Global Benefits Group Commercial |
$800.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,200.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$889.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$508.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$825.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$266.80
|
| Rate for Payer: Multiplan Commercial |
$1,000.50
|
| Rate for Payer: Networks By Design Commercial |
$867.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,133.90
|
|
