|
HC GUIDE BENTSON 035"X145CM
|
Facility
|
OP
|
$105.72
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901603846
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.14 |
| Max. Negotiated Rate |
$396.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$396.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$89.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$58.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$58.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$51.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$62.46
|
| Rate for Payer: Blue Distinction Transplant |
$63.43
|
| Rate for Payer: Blue Shield of California Commercial |
$66.50
|
| Rate for Payer: Blue Shield of California EPN |
$51.70
|
| Rate for Payer: Cash Price |
$47.57
|
| Rate for Payer: Cash Price |
$47.57
|
| Rate for Payer: Central Health Plan Commercial |
$84.58
|
| Rate for Payer: Cigna of CA HMO |
$67.66
|
| Rate for Payer: Cigna of CA PPO |
$78.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$89.86
|
| Rate for Payer: Dignity Health Media |
$89.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$89.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.29
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$79.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$37.00
|
| 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: 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
|
| 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 Medi-Cal |
$89.86
|
| Rate for Payer: Vantage Medical Group Senior |
$89.86
|
|
|
HC GUIDE CRVD TFE COAT .35"X145
|
Facility
|
IP
|
$192.50
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901604251
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.50 |
| Max. Negotiated Rate |
$173.25 |
| Rate for Payer: Cash Price |
$86.63
|
| Rate for Payer: Central Health Plan Commercial |
$154.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: LLUH Dept of Risk Management WC |
$38.50
|
| Rate for Payer: Multiplan Commercial |
$144.38
|
| Rate for Payer: Networks By Design Commercial |
$125.12
|
| Rate for Payer: Prime Health Services Commercial |
$163.62
|
|
|
HC GUIDE CRVD TFE COAT .35"X145
|
Facility
|
OP
|
$192.50
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901604251
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.50 |
| Max. Negotiated Rate |
$396.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$396.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$163.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$105.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$105.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$93.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$113.73
|
| Rate for Payer: Blue Distinction Transplant |
$115.50
|
| Rate for Payer: Blue Shield of California Commercial |
$121.08
|
| Rate for Payer: Blue Shield of California EPN |
$94.13
|
| Rate for Payer: Cash Price |
$86.63
|
| Rate for Payer: Cash Price |
$86.63
|
| 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 Media |
$163.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$163.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$77.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$144.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$67.38
|
| 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: 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
|
| 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 Medi-Cal |
$163.62
|
| Rate for Payer: Vantage Medical Group Senior |
$163.62
|
|
|
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: Cash Price |
$86.72
|
| Rate for Payer: Central Health Plan Commercial |
$154.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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, CURVED .025"X80CM
|
Facility
|
OP
|
$192.71
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901600464
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.54 |
| Max. Negotiated Rate |
$396.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$396.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$163.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$105.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$105.99
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$93.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$113.85
|
| Rate for Payer: Blue Distinction Transplant |
$115.63
|
| Rate for Payer: Blue Shield of California Commercial |
$121.21
|
| Rate for Payer: Blue Shield of California EPN |
$94.24
|
| Rate for Payer: Cash Price |
$86.72
|
| Rate for Payer: Cash Price |
$86.72
|
| Rate for Payer: Central Health Plan Commercial |
$154.17
|
| Rate for Payer: Cigna of CA HMO |
$123.33
|
| Rate for Payer: Cigna of CA PPO |
$142.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$163.80
|
| Rate for Payer: Dignity Health Media |
$163.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$163.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$77.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$144.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$67.45
|
| 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: 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
|
| 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 Medi-Cal |
$163.80
|
| Rate for Payer: Vantage Medical Group Senior |
$163.80
|
|
|
HC GUIDE DUOFLEX .018 45MM
|
Facility
|
OP
|
$69.37
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901603717
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.87 |
| Max. Negotiated Rate |
$396.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$396.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$58.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$38.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$33.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.98
|
| Rate for Payer: Blue Distinction Transplant |
$41.62
|
| Rate for Payer: Blue Shield of California Commercial |
$43.63
|
| Rate for Payer: Blue Shield of California EPN |
$33.92
|
| Rate for Payer: Cash Price |
$31.22
|
| Rate for Payer: Cash Price |
$31.22
|
| Rate for Payer: Central Health Plan Commercial |
$55.50
|
| Rate for Payer: Cigna of CA HMO |
$44.40
|
| Rate for Payer: Cigna of CA PPO |
$51.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$58.96
|
| Rate for Payer: Dignity Health Media |
$58.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$58.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.75
|
| Rate for Payer: EPIC Health Plan Transplant |
$27.75
|
| Rate for Payer: Galaxy Health WC |
$58.96
|
| Rate for Payer: Global Benefits Group Commercial |
$41.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$62.43
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$52.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$24.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$46.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.87
|
| Rate for Payer: Multiplan Commercial |
$52.03
|
| Rate for Payer: Networks By Design Commercial |
$45.09
|
| Rate for Payer: Prime Health Services Commercial |
$58.96
|
| Rate for Payer: Riverside University Health System MISP |
$27.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$41.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$41.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$34.68
|
| Rate for Payer: United Healthcare All Other HMO |
$34.68
|
| Rate for Payer: United Healthcare HMO Rider |
$34.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$58.96
|
| Rate for Payer: Vantage Medical Group Senior |
$58.96
|
|
|
HC GUIDE DUOFLEX .018 45MM
|
Facility
|
IP
|
$69.37
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901603717
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.87 |
| Max. Negotiated Rate |
$62.43 |
| Rate for Payer: Cash Price |
$31.22
|
| Rate for Payer: Central Health Plan Commercial |
$55.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.75
|
| Rate for Payer: Galaxy Health WC |
$58.96
|
| Rate for Payer: Global Benefits Group Commercial |
$41.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$62.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$46.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.87
|
| Rate for Payer: Multiplan Commercial |
$52.03
|
| Rate for Payer: Networks By Design Commercial |
$45.09
|
| Rate for Payer: Prime Health Services Commercial |
$58.96
|
|
|
HC GUIDE, DUOFLEX 25 X 30
|
Facility
|
IP
|
$69.37
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901602056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.87 |
| Max. Negotiated Rate |
$62.43 |
| Rate for Payer: Cash Price |
$31.22
|
| Rate for Payer: Central Health Plan Commercial |
$55.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.75
|
| Rate for Payer: Galaxy Health WC |
$58.96
|
| Rate for Payer: Global Benefits Group Commercial |
$41.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$62.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$46.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.87
|
| Rate for Payer: Multiplan Commercial |
$52.03
|
| Rate for Payer: Networks By Design Commercial |
$45.09
|
| Rate for Payer: Prime Health Services Commercial |
$58.96
|
|
|
HC GUIDE, DUOFLEX 25 X 30
|
Facility
|
OP
|
$69.37
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901602056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.87 |
| Max. Negotiated Rate |
$396.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$396.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$58.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$38.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$33.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.98
|
| Rate for Payer: Blue Distinction Transplant |
$41.62
|
| Rate for Payer: Blue Shield of California Commercial |
$43.63
|
| Rate for Payer: Blue Shield of California EPN |
$33.92
|
| Rate for Payer: Cash Price |
$31.22
|
| Rate for Payer: Cash Price |
$31.22
|
| Rate for Payer: Central Health Plan Commercial |
$55.50
|
| Rate for Payer: Cigna of CA HMO |
$44.40
|
| Rate for Payer: Cigna of CA PPO |
$51.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$58.96
|
| Rate for Payer: Dignity Health Media |
$58.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$58.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.75
|
| Rate for Payer: EPIC Health Plan Transplant |
$27.75
|
| Rate for Payer: Galaxy Health WC |
$58.96
|
| Rate for Payer: Global Benefits Group Commercial |
$41.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$62.43
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$52.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$24.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$46.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.87
|
| Rate for Payer: Multiplan Commercial |
$52.03
|
| Rate for Payer: Networks By Design Commercial |
$45.09
|
| Rate for Payer: Prime Health Services Commercial |
$58.96
|
| Rate for Payer: Riverside University Health System MISP |
$27.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$41.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$41.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$34.68
|
| Rate for Payer: United Healthcare All Other HMO |
$34.68
|
| Rate for Payer: United Healthcare HMO Rider |
$34.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$58.96
|
| Rate for Payer: Vantage Medical Group Senior |
$58.96
|
|
|
HC GUIDE HYDROPHILIC 80CM X.018
|
Facility
|
OP
|
$192.50
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901607536
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.50 |
| Max. Negotiated Rate |
$396.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$396.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$163.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$105.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$105.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$93.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$113.73
|
| Rate for Payer: Blue Distinction Transplant |
$115.50
|
| Rate for Payer: Blue Shield of California Commercial |
$121.08
|
| Rate for Payer: Blue Shield of California EPN |
$94.13
|
| Rate for Payer: Cash Price |
$86.63
|
| Rate for Payer: Cash Price |
$86.63
|
| 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 Media |
$163.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$163.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$77.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$144.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$67.38
|
| 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: 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
|
| 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 Medi-Cal |
$163.62
|
| Rate for Payer: Vantage Medical Group Senior |
$163.62
|
|
|
HC GUIDE HYDROPHILIC 80CM X.018
|
Facility
|
IP
|
$192.50
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901607536
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.50 |
| Max. Negotiated Rate |
$173.25 |
| Rate for Payer: Cash Price |
$86.63
|
| Rate for Payer: Central Health Plan Commercial |
$154.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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 HYDROPHILLIC.008 COATED
|
Facility
|
IP
|
$261.59
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901605118
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$52.32 |
| Max. Negotiated Rate |
$235.43 |
| Rate for Payer: Cash Price |
$117.72
|
| Rate for Payer: Central Health Plan Commercial |
$209.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$104.64
|
| Rate for Payer: Galaxy Health WC |
$222.35
|
| Rate for Payer: Global Benefits Group Commercial |
$156.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$235.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$174.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$99.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.32
|
| Rate for Payer: Multiplan Commercial |
$196.19
|
| Rate for Payer: Networks By Design Commercial |
$170.03
|
| Rate for Payer: Prime Health Services Commercial |
$222.35
|
|
|
HC GUIDE HYDROPHILLIC.008 COATED
|
Facility
|
OP
|
$261.59
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901605118
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$52.32 |
| Max. Negotiated Rate |
$396.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$396.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$222.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$143.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$143.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$126.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$154.55
|
| Rate for Payer: Blue Distinction Transplant |
$156.95
|
| Rate for Payer: Blue Shield of California Commercial |
$164.54
|
| Rate for Payer: Blue Shield of California EPN |
$127.92
|
| Rate for Payer: Cash Price |
$117.72
|
| Rate for Payer: Cash Price |
$117.72
|
| Rate for Payer: Central Health Plan Commercial |
$209.27
|
| Rate for Payer: Cigna of CA HMO |
$167.42
|
| Rate for Payer: Cigna of CA PPO |
$193.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$222.35
|
| Rate for Payer: Dignity Health Media |
$222.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$222.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$104.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$104.64
|
| Rate for Payer: Galaxy Health WC |
$222.35
|
| Rate for Payer: Global Benefits Group Commercial |
$156.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$235.43
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$196.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$91.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$174.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$99.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.32
|
| Rate for Payer: Multiplan Commercial |
$196.19
|
| Rate for Payer: Networks By Design Commercial |
$170.03
|
| Rate for Payer: Prime Health Services Commercial |
$222.35
|
| Rate for Payer: Riverside University Health System MISP |
$104.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$156.95
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$156.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$130.80
|
| Rate for Payer: United Healthcare All Other HMO |
$130.80
|
| Rate for Payer: United Healthcare HMO Rider |
$130.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$130.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$222.35
|
| Rate for Payer: Vantage Medical Group Senior |
$222.35
|
|
|
HC GUIDE NERV DESTR, ELEC STIM
|
Facility
|
IP
|
$301.00
|
|
|
Service Code
|
CPT 95873
|
| Hospital Charge Code |
900600242
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$60.20 |
| Max. Negotiated Rate |
$270.90 |
| Rate for Payer: Cash Price |
$135.45
|
| Rate for Payer: Central Health Plan Commercial |
$240.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.40
|
| Rate for Payer: Galaxy Health WC |
$255.85
|
| Rate for Payer: Global Benefits Group Commercial |
$180.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$270.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$200.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$114.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.20
|
| Rate for Payer: Multiplan Commercial |
$225.75
|
| Rate for Payer: Networks By Design Commercial |
$195.65
|
| Rate for Payer: Prime Health Services Commercial |
$255.85
|
|
|
HC GUIDE NERV DESTR, ELEC STIM
|
Facility
|
OP
|
$301.00
|
|
|
Service Code
|
CPT 95873
|
| Hospital Charge Code |
900600242
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$46.53 |
| Max. Negotiated Rate |
$1,231.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$232.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$255.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$165.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$165.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$47.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$177.83
|
| Rate for Payer: Blue Distinction Transplant |
$180.60
|
| Rate for Payer: Blue Shield of California Commercial |
$186.02
|
| Rate for Payer: Blue Shield of California EPN |
$146.29
|
| Rate for Payer: Cash Price |
$135.45
|
| Rate for Payer: Cash Price |
$135.45
|
| Rate for Payer: Cash Price |
$135.45
|
| Rate for Payer: Central Health Plan Commercial |
$240.80
|
| Rate for Payer: Cigna of CA HMO |
$192.64
|
| Rate for Payer: Cigna of CA PPO |
$222.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$255.85
|
| Rate for Payer: Dignity Health Media |
$255.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$255.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$120.40
|
| Rate for Payer: Galaxy Health WC |
$255.85
|
| Rate for Payer: Global Benefits Group Commercial |
$180.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$270.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$225.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$105.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$200.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.20
|
| Rate for Payer: Multiplan Commercial |
$225.75
|
| Rate for Payer: Networks By Design Commercial |
$195.65
|
| Rate for Payer: Prime Health Services Commercial |
$255.85
|
| Rate for Payer: Riverside University Health System MISP |
$120.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$180.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$180.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,231.00
|
| Rate for Payer: United Healthcare All Other HMO |
$975.00
|
| Rate for Payer: United Healthcare HMO Rider |
$739.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$255.85
|
| Rate for Payer: Vantage Medical Group Senior |
$255.85
|
|
|
HC GUIDE NERV DESTR NEEDLE EMG
|
Facility
|
IP
|
$305.00
|
|
|
Service Code
|
CPT 95874
|
| Hospital Charge Code |
900600243
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$61.00 |
| Max. Negotiated Rate |
$274.50 |
| Rate for Payer: Cash Price |
$137.25
|
| Rate for Payer: Central Health Plan Commercial |
$244.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$122.00
|
| Rate for Payer: Galaxy Health WC |
$259.25
|
| Rate for Payer: Global Benefits Group Commercial |
$183.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$274.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$203.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$116.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.00
|
| Rate for Payer: Multiplan Commercial |
$228.75
|
| Rate for Payer: Networks By Design Commercial |
$198.25
|
| Rate for Payer: Prime Health Services Commercial |
$259.25
|
|
|
HC GUIDE NERV DESTR NEEDLE EMG
|
Facility
|
OP
|
$305.00
|
|
|
Service Code
|
CPT 95874
|
| Hospital Charge Code |
900600243
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$47.18 |
| Max. Negotiated Rate |
$1,231.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$220.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$259.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$167.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$167.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$47.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$180.19
|
| Rate for Payer: Blue Distinction Transplant |
$183.00
|
| Rate for Payer: Blue Shield of California Commercial |
$188.49
|
| Rate for Payer: Blue Shield of California EPN |
$148.23
|
| Rate for Payer: Cash Price |
$137.25
|
| Rate for Payer: Cash Price |
$137.25
|
| Rate for Payer: Cash Price |
$137.25
|
| Rate for Payer: Central Health Plan Commercial |
$244.00
|
| Rate for Payer: Cigna of CA HMO |
$195.20
|
| Rate for Payer: Cigna of CA PPO |
$225.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$259.25
|
| Rate for Payer: Dignity Health Media |
$259.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$259.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$122.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$122.00
|
| Rate for Payer: Galaxy Health WC |
$259.25
|
| Rate for Payer: Global Benefits Group Commercial |
$183.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$274.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$228.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$106.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$203.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.00
|
| Rate for Payer: Multiplan Commercial |
$228.75
|
| Rate for Payer: Networks By Design Commercial |
$198.25
|
| Rate for Payer: Prime Health Services Commercial |
$259.25
|
| Rate for Payer: Riverside University Health System MISP |
$122.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$183.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$183.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,231.00
|
| Rate for Payer: United Healthcare All Other HMO |
$975.00
|
| Rate for Payer: United Healthcare HMO Rider |
$739.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$259.25
|
| Rate for Payer: Vantage Medical Group Senior |
$259.25
|
|
|
HC GUIDE NITINOL MANDREL 40CM .014"
|
Facility
|
OP
|
$154.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901698137
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.80 |
| Max. Negotiated Rate |
$396.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$396.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$130.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$84.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$84.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$74.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$90.98
|
| Rate for Payer: Blue Distinction Transplant |
$92.40
|
| Rate for Payer: Blue Shield of California Commercial |
$96.87
|
| Rate for Payer: Blue Shield of California EPN |
$75.31
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Central Health Plan Commercial |
$123.20
|
| Rate for Payer: Cigna of CA HMO |
$98.56
|
| Rate for Payer: Cigna of CA PPO |
$113.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$130.90
|
| Rate for Payer: Dignity Health Media |
$130.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$130.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$61.60
|
| Rate for Payer: Galaxy Health WC |
$130.90
|
| Rate for Payer: Global Benefits Group Commercial |
$92.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$138.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$115.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$53.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$102.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.80
|
| Rate for Payer: Multiplan Commercial |
$115.50
|
| Rate for Payer: Networks By Design Commercial |
$100.10
|
| Rate for Payer: Prime Health Services Commercial |
$130.90
|
| Rate for Payer: Riverside University Health System MISP |
$61.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$92.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$92.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$77.00
|
| Rate for Payer: United Healthcare All Other HMO |
$77.00
|
| Rate for Payer: United Healthcare HMO Rider |
$77.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$77.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$130.90
|
| Rate for Payer: Vantage Medical Group Senior |
$130.90
|
|
|
HC GUIDE NITINOL MANDREL 40CM .014"
|
Facility
|
IP
|
$154.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901698137
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.80 |
| Max. Negotiated Rate |
$138.60 |
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Central Health Plan Commercial |
$123.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.60
|
| Rate for Payer: Galaxy Health WC |
$130.90
|
| Rate for Payer: Global Benefits Group Commercial |
$92.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$138.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$102.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.80
|
| Rate for Payer: Multiplan Commercial |
$115.50
|
| Rate for Payer: Networks By Design Commercial |
$100.10
|
| Rate for Payer: Prime Health Services Commercial |
$130.90
|
|
|
HC GUIDE NITINOL MANDREL 60CM .018"
|
Facility
|
IP
|
$182.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901698136
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.40 |
| Max. Negotiated Rate |
$163.80 |
| Rate for Payer: Cash Price |
$81.90
|
| Rate for Payer: Central Health Plan Commercial |
$145.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.80
|
| Rate for Payer: Galaxy Health WC |
$154.70
|
| Rate for Payer: Global Benefits Group Commercial |
$109.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$163.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$121.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$69.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.40
|
| Rate for Payer: Multiplan Commercial |
$136.50
|
| Rate for Payer: Networks By Design Commercial |
$118.30
|
| Rate for Payer: Prime Health Services Commercial |
$154.70
|
|
|
HC GUIDE NITINOL MANDREL 60CM .018"
|
Facility
|
OP
|
$182.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901698136
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.40 |
| Max. Negotiated Rate |
$396.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$396.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$154.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$100.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$100.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$88.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$107.53
|
| Rate for Payer: Blue Distinction Transplant |
$109.20
|
| Rate for Payer: Blue Shield of California Commercial |
$114.48
|
| Rate for Payer: Blue Shield of California EPN |
$89.00
|
| Rate for Payer: Cash Price |
$81.90
|
| Rate for Payer: Cash Price |
$81.90
|
| Rate for Payer: Central Health Plan Commercial |
$145.60
|
| Rate for Payer: Cigna of CA HMO |
$116.48
|
| Rate for Payer: Cigna of CA PPO |
$134.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$154.70
|
| Rate for Payer: Dignity Health Media |
$154.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$154.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$72.80
|
| Rate for Payer: Galaxy Health WC |
$154.70
|
| Rate for Payer: Global Benefits Group Commercial |
$109.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$163.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$136.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$63.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$121.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$69.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.40
|
| Rate for Payer: Multiplan Commercial |
$136.50
|
| Rate for Payer: Networks By Design Commercial |
$118.30
|
| Rate for Payer: Prime Health Services Commercial |
$154.70
|
| Rate for Payer: Riverside University Health System MISP |
$72.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$109.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$109.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$91.00
|
| Rate for Payer: United Healthcare All Other HMO |
$91.00
|
| Rate for Payer: United Healthcare HMO Rider |
$91.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$91.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$154.70
|
| Rate for Payer: Vantage Medical Group Senior |
$154.70
|
|
|
HC GUIDE STR 0.021IN X 50CM
|
Facility
|
OP
|
$132.92
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901605558
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$26.58 |
| Max. Negotiated Rate |
$396.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$396.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$112.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$73.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$73.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$64.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$78.53
|
| Rate for Payer: Blue Distinction Transplant |
$79.75
|
| Rate for Payer: Blue Shield of California Commercial |
$83.61
|
| Rate for Payer: Blue Shield of California EPN |
$65.00
|
| Rate for Payer: Cash Price |
$59.81
|
| Rate for Payer: Cash Price |
$59.81
|
| Rate for Payer: Central Health Plan Commercial |
$106.34
|
| Rate for Payer: Cigna of CA HMO |
$85.07
|
| Rate for Payer: Cigna of CA PPO |
$98.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$112.98
|
| Rate for Payer: Dignity Health Media |
$112.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$112.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$53.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$53.17
|
| Rate for Payer: Galaxy Health WC |
$112.98
|
| Rate for Payer: Global Benefits Group Commercial |
$79.75
|
| Rate for Payer: Health Management Network EPO/PPO |
$119.63
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$99.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$46.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$88.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.58
|
| Rate for Payer: Multiplan Commercial |
$99.69
|
| Rate for Payer: Networks By Design Commercial |
$86.40
|
| Rate for Payer: Prime Health Services Commercial |
$112.98
|
| Rate for Payer: Riverside University Health System MISP |
$53.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$79.75
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$79.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$66.46
|
| Rate for Payer: United Healthcare All Other HMO |
$66.46
|
| Rate for Payer: United Healthcare HMO Rider |
$66.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$66.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$112.98
|
| Rate for Payer: Vantage Medical Group Senior |
$112.98
|
|
|
HC GUIDE STR 0.021IN X 50CM
|
Facility
|
IP
|
$132.92
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901605558
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$26.58 |
| Max. Negotiated Rate |
$119.63 |
| Rate for Payer: Cash Price |
$59.81
|
| Rate for Payer: Central Health Plan Commercial |
$106.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$53.17
|
| Rate for Payer: Galaxy Health WC |
$112.98
|
| Rate for Payer: Global Benefits Group Commercial |
$79.75
|
| Rate for Payer: Health Management Network EPO/PPO |
$119.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$88.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.58
|
| Rate for Payer: Multiplan Commercial |
$99.69
|
| Rate for Payer: Networks By Design Commercial |
$86.40
|
| Rate for Payer: Prime Health Services Commercial |
$112.98
|
|
|
HC GUIDE STRAIGHT .038"X145C
|
Facility
|
IP
|
$64.53
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901603847
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.91 |
| Max. Negotiated Rate |
$58.08 |
| Rate for Payer: Cash Price |
$29.04
|
| Rate for Payer: Central Health Plan Commercial |
$51.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.81
|
| Rate for Payer: Galaxy Health WC |
$54.85
|
| Rate for Payer: Global Benefits Group Commercial |
$38.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$58.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$43.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.91
|
| Rate for Payer: Multiplan Commercial |
$48.40
|
| Rate for Payer: Networks By Design Commercial |
$41.94
|
| Rate for Payer: Prime Health Services Commercial |
$54.85
|
|
|
HC GUIDE STRAIGHT .038"X145C
|
Facility
|
OP
|
$64.53
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901603847
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.91 |
| Max. Negotiated Rate |
$396.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$396.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$54.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$35.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$31.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$38.12
|
| Rate for Payer: Blue Distinction Transplant |
$38.72
|
| Rate for Payer: Blue Shield of California Commercial |
$40.59
|
| Rate for Payer: Blue Shield of California EPN |
$31.56
|
| Rate for Payer: Cash Price |
$29.04
|
| Rate for Payer: Cash Price |
$29.04
|
| Rate for Payer: Central Health Plan Commercial |
$51.62
|
| Rate for Payer: Cigna of CA HMO |
$41.30
|
| Rate for Payer: Cigna of CA PPO |
$47.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$54.85
|
| Rate for Payer: Dignity Health Media |
$54.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$54.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.81
|
| Rate for Payer: EPIC Health Plan Transplant |
$25.81
|
| Rate for Payer: Galaxy Health WC |
$54.85
|
| Rate for Payer: Global Benefits Group Commercial |
$38.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$58.08
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$48.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$22.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$43.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.91
|
| Rate for Payer: Multiplan Commercial |
$48.40
|
| Rate for Payer: Networks By Design Commercial |
$41.94
|
| Rate for Payer: Prime Health Services Commercial |
$54.85
|
| Rate for Payer: Riverside University Health System MISP |
$25.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$38.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$38.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$32.26
|
| Rate for Payer: United Healthcare All Other HMO |
$32.26
|
| Rate for Payer: United Healthcare HMO Rider |
$32.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$54.85
|
| Rate for Payer: Vantage Medical Group Senior |
$54.85
|
|
