|
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 |
$527.90 |
| Rate for Payer: Cash Price |
$263.95
|
| Rate for Payer: Central Health Plan Commercial |
$469.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$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 |
$527.90
|
| 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: 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 |
$527.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$396.30
|
| 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 |
$322.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$284.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$346.53
|
| Rate for Payer: Blue Distinction Transplant |
$351.93
|
| Rate for Payer: Blue Shield of California Commercial |
$368.94
|
| Rate for Payer: Blue Shield of California EPN |
$286.82
|
| Rate for Payer: Cash Price |
$263.95
|
| Rate for Payer: Cash Price |
$263.95
|
| 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 Media |
$498.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$498.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$234.62
|
| Rate for Payer: EPIC Health Plan Transplant |
$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 |
$527.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$439.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$205.29
|
| 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: 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
|
| 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 |
$293.28
|
| Rate for Payer: United Healthcare All Other HMO |
$293.28
|
| Rate for Payer: United Healthcare HMO Rider |
$293.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$293.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$498.57
|
| Rate for Payer: Vantage Medical Group Senior |
$498.57
|
|
|
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: Cash Price |
$931.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,656.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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 ASAHI CHAKAI
|
Facility
|
OP
|
$2,070.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909000019
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$396.30 |
| Max. Negotiated Rate |
$1,863.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$396.30
|
| 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 |
$1,138.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,002.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,222.96
|
| Rate for Payer: Blue Distinction Transplant |
$1,242.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,302.03
|
| Rate for Payer: Blue Shield of California EPN |
$1,012.23
|
| Rate for Payer: Cash Price |
$931.50
|
| Rate for Payer: Cash Price |
$931.50
|
| 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 Media |
$1,759.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,759.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$828.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$1,552.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$724.50
|
| 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: 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
|
| 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 Medi-Cal |
$1,759.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,759.50
|
|
|
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 |
$396.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$396.30
|
| 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 |
$58.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$51.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$62.62
|
| Rate for Payer: Blue Distinction Transplant |
$63.60
|
| Rate for Payer: Blue Shield of California Commercial |
$66.67
|
| Rate for Payer: Blue Shield of California EPN |
$51.83
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Cash Price |
$47.70
|
| 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 Media |
$90.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$90.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$79.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$37.10
|
| 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: 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
|
| 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 Medi-Cal |
$90.10
|
| Rate for Payer: Vantage Medical Group Senior |
$90.10
|
|
|
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: Cash Price |
$47.70
|
| Rate for Payer: Central Health Plan Commercial |
$84.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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 EXCELSIOR 18
|
Facility
|
OP
|
$3,842.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909000021
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$396.30 |
| Max. Negotiated Rate |
$3,457.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$396.30
|
| 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 |
$2,113.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,860.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,269.85
|
| Rate for Payer: Blue Distinction Transplant |
$2,305.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,416.62
|
| Rate for Payer: Blue Shield of California EPN |
$1,878.74
|
| Rate for Payer: Cash Price |
$1,728.90
|
| Rate for Payer: Cash Price |
$1,728.90
|
| 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 Media |
$3,265.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,265.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,536.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$2,881.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,344.70
|
| 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: 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
|
| 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 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: Cash Price |
$1,728.90
|
| Rate for Payer: Central Health Plan Commercial |
$3,073.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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/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 |
$396.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$396.30
|
| 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 |
$39.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$34.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$42.54
|
| Rate for Payer: Blue Distinction Transplant |
$43.20
|
| Rate for Payer: Blue Shield of California Commercial |
$45.29
|
| Rate for Payer: Blue Shield of California EPN |
$35.21
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cash Price |
$32.40
|
| 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 Media |
$61.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$61.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$54.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$25.20
|
| 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: 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
|
| 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 Medi-Cal |
$61.20
|
| Rate for Payer: Vantage Medical Group Senior |
$61.20
|
|
|
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: Cash Price |
$32.40
|
| Rate for Payer: Central Health Plan Commercial |
$57.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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 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: Cash Price |
$600.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,067.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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
|
|
|
HC GUIDEWIRE GOLD TIP
|
Facility
|
OP
|
$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: Aetna of CA HMO/PPO |
$396.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,133.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$733.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$733.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$645.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$788.13
|
| Rate for Payer: Blue Distinction Transplant |
$800.40
|
| Rate for Payer: Blue Shield of California Commercial |
$839.09
|
| Rate for Payer: Blue Shield of California EPN |
$652.33
|
| Rate for Payer: Cash Price |
$600.30
|
| Rate for Payer: Cash Price |
$600.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,067.20
|
| Rate for Payer: Cigna of CA HMO |
$853.76
|
| Rate for Payer: Cigna of CA PPO |
$987.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,133.90
|
| Rate for Payer: Dignity Health Media |
$1,133.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,133.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$533.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$1,000.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$466.90
|
| 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: 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
|
| Rate for Payer: Riverside University Health System MISP |
$533.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$800.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$800.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$667.00
|
| Rate for Payer: United Healthcare All Other HMO |
$667.00
|
| Rate for Payer: United Healthcare HMO Rider |
$667.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$667.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,133.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1,133.90
|
|
|
HC GUIDEWIRE HYDROPHILIC SS 80CM
|
Facility
|
IP
|
$266.49
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901698648
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$53.30 |
| Max. Negotiated Rate |
$239.84 |
| Rate for Payer: Cash Price |
$119.92
|
| Rate for Payer: Central Health Plan Commercial |
$213.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.60
|
| Rate for Payer: Galaxy Health WC |
$226.52
|
| Rate for Payer: Global Benefits Group Commercial |
$159.89
|
| Rate for Payer: Health Management Network EPO/PPO |
$239.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$177.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$101.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.30
|
| Rate for Payer: Multiplan Commercial |
$199.87
|
| Rate for Payer: Networks By Design Commercial |
$173.22
|
| Rate for Payer: Prime Health Services Commercial |
$226.52
|
|
|
HC GUIDEWIRE HYDROPHILIC SS 80CM
|
Facility
|
OP
|
$266.49
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901698648
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$53.30 |
| Max. Negotiated Rate |
$396.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$396.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$226.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$146.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$146.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$129.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$157.44
|
| Rate for Payer: Blue Distinction Transplant |
$159.89
|
| Rate for Payer: Blue Shield of California Commercial |
$167.62
|
| Rate for Payer: Blue Shield of California EPN |
$130.31
|
| Rate for Payer: Cash Price |
$119.92
|
| Rate for Payer: Cash Price |
$119.92
|
| Rate for Payer: Central Health Plan Commercial |
$213.19
|
| Rate for Payer: Cigna of CA HMO |
$170.55
|
| Rate for Payer: Cigna of CA PPO |
$197.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$226.52
|
| Rate for Payer: Dignity Health Media |
$226.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$226.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$106.60
|
| Rate for Payer: Galaxy Health WC |
$226.52
|
| Rate for Payer: Global Benefits Group Commercial |
$159.89
|
| Rate for Payer: Health Management Network EPO/PPO |
$239.84
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$199.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$93.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$177.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$101.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.30
|
| Rate for Payer: Multiplan Commercial |
$199.87
|
| Rate for Payer: Networks By Design Commercial |
$173.22
|
| Rate for Payer: Prime Health Services Commercial |
$226.52
|
| Rate for Payer: Riverside University Health System MISP |
$106.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$159.89
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$159.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$133.24
|
| Rate for Payer: United Healthcare All Other HMO |
$133.24
|
| Rate for Payer: United Healthcare HMO Rider |
$133.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$133.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$226.52
|
| Rate for Payer: Vantage Medical Group Senior |
$226.52
|
|
|
HC GUIDEWIRE, JINDO TAPERED
|
Facility
|
IP
|
$432.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909081418
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$86.40 |
| Max. Negotiated Rate |
$388.80 |
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Central Health Plan Commercial |
$345.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$172.80
|
| Rate for Payer: Galaxy Health WC |
$367.20
|
| Rate for Payer: Global Benefits Group Commercial |
$259.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$388.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$288.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$164.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.40
|
| Rate for Payer: Multiplan Commercial |
$324.00
|
| Rate for Payer: Networks By Design Commercial |
$280.80
|
| Rate for Payer: Prime Health Services Commercial |
$367.20
|
|
|
HC GUIDEWIRE, JINDO TAPERED
|
Facility
|
OP
|
$432.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909081418
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$86.40 |
| Max. Negotiated Rate |
$396.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$396.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$367.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$237.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$237.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$209.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$255.23
|
| Rate for Payer: Blue Distinction Transplant |
$259.20
|
| Rate for Payer: Blue Shield of California Commercial |
$271.73
|
| Rate for Payer: Blue Shield of California EPN |
$211.25
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Central Health Plan Commercial |
$345.60
|
| Rate for Payer: Cigna of CA HMO |
$276.48
|
| Rate for Payer: Cigna of CA PPO |
$319.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$367.20
|
| Rate for Payer: Dignity Health Media |
$367.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$367.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$172.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$172.80
|
| Rate for Payer: Galaxy Health WC |
$367.20
|
| Rate for Payer: Global Benefits Group Commercial |
$259.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$388.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$324.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$151.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$288.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$164.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.40
|
| Rate for Payer: Multiplan Commercial |
$324.00
|
| Rate for Payer: Networks By Design Commercial |
$280.80
|
| Rate for Payer: Prime Health Services Commercial |
$367.20
|
| Rate for Payer: Riverside University Health System MISP |
$172.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$259.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$259.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$216.00
|
| Rate for Payer: United Healthcare All Other HMO |
$216.00
|
| Rate for Payer: United Healthcare HMO Rider |
$216.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$216.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$367.20
|
| Rate for Payer: Vantage Medical Group Senior |
$367.20
|
|
|
HC GUIDEWIRE, LUNDERQUIST
|
Facility
|
IP
|
$378.74
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909020084
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$75.75 |
| Max. Negotiated Rate |
$340.87 |
| Rate for Payer: Cash Price |
$170.43
|
| Rate for Payer: Central Health Plan Commercial |
$302.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.50
|
| Rate for Payer: Galaxy Health WC |
$321.93
|
| Rate for Payer: Global Benefits Group Commercial |
$227.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$340.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$252.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$144.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.75
|
| Rate for Payer: Multiplan Commercial |
$284.06
|
| Rate for Payer: Networks By Design Commercial |
$246.18
|
| Rate for Payer: Prime Health Services Commercial |
$321.93
|
|
|
HC GUIDEWIRE, LUNDERQUIST
|
Facility
|
OP
|
$378.74
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909020084
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$75.75 |
| Max. Negotiated Rate |
$396.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$396.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$321.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$208.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$208.31
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$183.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$223.76
|
| Rate for Payer: Blue Distinction Transplant |
$227.24
|
| Rate for Payer: Blue Shield of California Commercial |
$238.23
|
| Rate for Payer: Blue Shield of California EPN |
$185.20
|
| Rate for Payer: Cash Price |
$170.43
|
| Rate for Payer: Cash Price |
$170.43
|
| Rate for Payer: Central Health Plan Commercial |
$302.99
|
| Rate for Payer: Cigna of CA HMO |
$242.39
|
| Rate for Payer: Cigna of CA PPO |
$280.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$321.93
|
| Rate for Payer: Dignity Health Media |
$321.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$321.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$151.50
|
| Rate for Payer: Galaxy Health WC |
$321.93
|
| Rate for Payer: Global Benefits Group Commercial |
$227.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$340.87
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$284.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$132.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$252.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$144.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.75
|
| Rate for Payer: Multiplan Commercial |
$284.06
|
| Rate for Payer: Networks By Design Commercial |
$246.18
|
| Rate for Payer: Prime Health Services Commercial |
$321.93
|
| Rate for Payer: Riverside University Health System MISP |
$151.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$227.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$227.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$189.37
|
| Rate for Payer: United Healthcare All Other HMO |
$189.37
|
| Rate for Payer: United Healthcare HMO Rider |
$189.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$189.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$321.93
|
| Rate for Payer: Vantage Medical Group Senior |
$321.93
|
|
|
HC GUIDE WIRE M
|
Facility
|
OP
|
$900.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
900803803
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$180.00 |
| Max. Negotiated Rate |
$810.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$396.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$765.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$495.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$495.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$435.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$531.72
|
| Rate for Payer: Blue Distinction Transplant |
$540.00
|
| Rate for Payer: Blue Shield of California Commercial |
$566.10
|
| Rate for Payer: Blue Shield of California EPN |
$440.10
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Central Health Plan Commercial |
$720.00
|
| Rate for Payer: Cigna of CA HMO |
$576.00
|
| Rate for Payer: Cigna of CA PPO |
$666.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$765.00
|
| Rate for Payer: Dignity Health Media |
$765.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$765.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$360.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$360.00
|
| Rate for Payer: Galaxy Health WC |
$765.00
|
| Rate for Payer: Global Benefits Group Commercial |
$540.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$810.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$675.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$315.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$600.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$342.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$180.00
|
| Rate for Payer: Multiplan Commercial |
$675.00
|
| Rate for Payer: Networks By Design Commercial |
$585.00
|
| Rate for Payer: Prime Health Services Commercial |
$765.00
|
| Rate for Payer: Riverside University Health System MISP |
$360.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$540.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$540.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$450.00
|
| Rate for Payer: United Healthcare All Other HMO |
$450.00
|
| Rate for Payer: United Healthcare HMO Rider |
$450.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$450.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$765.00
|
| Rate for Payer: Vantage Medical Group Senior |
$765.00
|
|
|
HC GUIDE WIRE M
|
Facility
|
IP
|
$900.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
900803803
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$180.00 |
| Max. Negotiated Rate |
$810.00 |
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Central Health Plan Commercial |
$720.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$360.00
|
| Rate for Payer: Galaxy Health WC |
$765.00
|
| Rate for Payer: Global Benefits Group Commercial |
$540.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$810.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$600.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$342.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$180.00
|
| Rate for Payer: Multiplan Commercial |
$675.00
|
| Rate for Payer: Networks By Design Commercial |
$585.00
|
| Rate for Payer: Prime Health Services Commercial |
$765.00
|
|
|
HC GUIDEWIRE, PERSUADER
|
Facility
|
IP
|
$551.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909020116
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$110.20 |
| Max. Negotiated Rate |
$495.90 |
| Rate for Payer: Cash Price |
$247.95
|
| Rate for Payer: Central Health Plan Commercial |
$440.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$220.40
|
| Rate for Payer: Galaxy Health WC |
$468.35
|
| Rate for Payer: Global Benefits Group Commercial |
$330.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$495.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$367.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$209.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$110.20
|
| Rate for Payer: Multiplan Commercial |
$413.25
|
| Rate for Payer: Networks By Design Commercial |
$358.15
|
| Rate for Payer: Prime Health Services Commercial |
$468.35
|
|
|
HC GUIDEWIRE, PERSUADER
|
Facility
|
OP
|
$551.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909020116
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$110.20 |
| Max. Negotiated Rate |
$495.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$396.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$468.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$303.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$303.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$266.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$325.53
|
| Rate for Payer: Blue Distinction Transplant |
$330.60
|
| Rate for Payer: Blue Shield of California Commercial |
$346.58
|
| Rate for Payer: Blue Shield of California EPN |
$269.44
|
| Rate for Payer: Cash Price |
$247.95
|
| Rate for Payer: Cash Price |
$247.95
|
| Rate for Payer: Central Health Plan Commercial |
$440.80
|
| Rate for Payer: Cigna of CA HMO |
$352.64
|
| Rate for Payer: Cigna of CA PPO |
$407.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$468.35
|
| Rate for Payer: Dignity Health Media |
$468.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$468.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$220.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$220.40
|
| Rate for Payer: Galaxy Health WC |
$468.35
|
| Rate for Payer: Global Benefits Group Commercial |
$330.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$495.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$413.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$192.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$367.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$209.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$110.20
|
| Rate for Payer: Multiplan Commercial |
$413.25
|
| Rate for Payer: Networks By Design Commercial |
$358.15
|
| Rate for Payer: Prime Health Services Commercial |
$468.35
|
| Rate for Payer: Riverside University Health System MISP |
$220.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$330.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$330.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$275.50
|
| Rate for Payer: United Healthcare All Other HMO |
$275.50
|
| Rate for Payer: United Healthcare HMO Rider |
$275.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$275.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$468.35
|
| Rate for Payer: Vantage Medical Group Senior |
$468.35
|
|
|
HC GUIDEWIRE SEPARATOR
|
Facility
|
IP
|
$5,500.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909020026
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,100.00 |
| Max. Negotiated Rate |
$4,950.00 |
| Rate for Payer: Cash Price |
$2,475.00
|
| Rate for Payer: Central Health Plan Commercial |
$4,400.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,200.00
|
| Rate for Payer: Galaxy Health WC |
$4,675.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,300.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,950.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,668.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,095.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,100.00
|
| Rate for Payer: Multiplan Commercial |
$4,125.00
|
| Rate for Payer: Networks By Design Commercial |
$3,575.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,675.00
|
|
|
HC GUIDEWIRE SEPARATOR
|
Facility
|
OP
|
$5,500.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909020026
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$396.30 |
| Max. Negotiated Rate |
$4,950.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$396.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,675.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,025.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,025.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,663.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,249.40
|
| Rate for Payer: Blue Distinction Transplant |
$3,300.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,459.50
|
| Rate for Payer: Blue Shield of California EPN |
$2,689.50
|
| Rate for Payer: Cash Price |
$2,475.00
|
| Rate for Payer: Cash Price |
$2,475.00
|
| Rate for Payer: Central Health Plan Commercial |
$4,400.00
|
| Rate for Payer: Cigna of CA HMO |
$3,520.00
|
| Rate for Payer: Cigna of CA PPO |
$4,070.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,675.00
|
| Rate for Payer: Dignity Health Media |
$4,675.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,675.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,200.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,200.00
|
| Rate for Payer: Galaxy Health WC |
$4,675.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,300.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,950.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,125.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,925.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,668.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,095.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,100.00
|
| Rate for Payer: Multiplan Commercial |
$4,125.00
|
| Rate for Payer: Networks By Design Commercial |
$3,575.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,675.00
|
| Rate for Payer: Riverside University Health System MISP |
$2,200.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,300.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,300.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,750.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,750.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,750.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,750.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,675.00
|
| Rate for Payer: Vantage Medical Group Senior |
$4,675.00
|
|
|
HC GUIDEWIRE SYNCHRO
|
Facility
|
IP
|
$2,901.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909000003
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$580.20 |
| Max. Negotiated Rate |
$2,610.90 |
| Rate for Payer: Cash Price |
$1,305.45
|
| Rate for Payer: Central Health Plan Commercial |
$2,320.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,160.40
|
| Rate for Payer: Galaxy Health WC |
$2,465.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,740.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,610.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,934.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,105.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$580.20
|
| Rate for Payer: Multiplan Commercial |
$2,175.75
|
| Rate for Payer: Networks By Design Commercial |
$1,885.65
|
| Rate for Payer: Prime Health Services Commercial |
$2,465.85
|
|
