|
HC GUID CATH/NEURO ENDOVASCULAR
|
Facility
|
IP
|
$3,900.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909081802
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$705.90 |
| Max. Negotiated Rate |
$2,925.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,511.60
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,640.30
|
| Rate for Payer: Heritage Provider Network Senior |
$2,640.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$705.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$975.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
|
|
HC GUIDEWIRE ASAHI CHAKAI
|
Facility
|
OP
|
$2,070.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909000019
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$374.67 |
| Max. Negotiated Rate |
$1,759.50 |
| Rate for Payer: Adventist Health Commercial |
$414.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,279.26
|
| 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 HMO/PPO |
$1,035.41
|
| Rate for Payer: Blue Shield of California Commercial |
$1,262.70
|
| Rate for Payer: Blue Shield of California EPN |
$1,010.16
|
| Rate for Payer: Cash Price |
$931.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,345.50
|
| 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 |
$1,221.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,281.33
|
| Rate for Payer: Heritage Provider Network Senior |
$1,281.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$987.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$374.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$517.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,449.00
|
| Rate for Payer: Multiplan Commercial |
$1,552.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,035.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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 |
$374.67 |
| Max. Negotiated Rate |
$1,552.50 |
| Rate for Payer: Adventist Health Commercial |
$414.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,333.08
|
| Rate for Payer: Cash Price |
$931.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,401.39
|
| Rate for Payer: Heritage Provider Network Senior |
$1,401.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$374.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$517.50
|
| Rate for Payer: Multiplan Commercial |
$1,552.50
|
|
|
HC GUIDEWIRE/DIAG STARTER
|
Facility
|
IP
|
$106.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909081225
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.19 |
| Max. Negotiated Rate |
$79.50 |
| Rate for Payer: Adventist Health Commercial |
$21.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$68.26
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$71.76
|
| Rate for Payer: Heritage Provider Network Senior |
$71.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.50
|
| Rate for Payer: Multiplan Commercial |
$79.50
|
|
|
HC GUIDEWIRE/DIAG STARTER
|
Facility
|
OP
|
$106.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909081225
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.19 |
| Max. Negotiated Rate |
$90.10 |
| Rate for Payer: Adventist Health Commercial |
$21.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$65.51
|
| 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 HMO/PPO |
$53.02
|
| Rate for Payer: Blue Shield of California Commercial |
$64.66
|
| Rate for Payer: Blue Shield of California EPN |
$51.73
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$68.90
|
| 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 |
$62.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$65.61
|
| Rate for Payer: Heritage Provider Network Senior |
$65.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$50.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$74.20
|
| Rate for Payer: Multiplan Commercial |
$79.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$53.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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
|
IP
|
$3,842.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909000021
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$695.40 |
| Max. Negotiated Rate |
$2,881.50 |
| Rate for Payer: Adventist Health Commercial |
$768.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,474.25
|
| Rate for Payer: Cash Price |
$1,728.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,601.03
|
| Rate for Payer: Heritage Provider Network Senior |
$2,601.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$695.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$960.50
|
| Rate for Payer: Multiplan Commercial |
$2,881.50
|
|
|
HC GUIDEWIRE EXCELSIOR 18
|
Facility
|
OP
|
$3,842.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909000021
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$695.40 |
| Max. Negotiated Rate |
$3,265.70 |
| Rate for Payer: Adventist Health Commercial |
$768.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,374.36
|
| 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 HMO/PPO |
$1,921.77
|
| Rate for Payer: Blue Shield of California Commercial |
$2,343.62
|
| Rate for Payer: Blue Shield of California EPN |
$1,874.90
|
| Rate for Payer: Cash Price |
$1,728.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,497.30
|
| 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 |
$2,266.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,378.20
|
| Rate for Payer: Heritage Provider Network Senior |
$2,378.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,832.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$695.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$960.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,689.40
|
| Rate for Payer: Multiplan Commercial |
$2,881.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,921.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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/GLIDE/AMPLATZ
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909081288
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.03 |
| Max. Negotiated Rate |
$61.20 |
| Rate for Payer: Adventist Health Commercial |
$14.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$44.50
|
| 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 HMO/PPO |
$36.01
|
| Rate for Payer: Blue Shield of California Commercial |
$43.92
|
| Rate for Payer: Blue Shield of California EPN |
$35.14
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$46.80
|
| 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 |
$42.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$44.57
|
| Rate for Payer: Heritage Provider Network Senior |
$44.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$34.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$50.40
|
| Rate for Payer: Multiplan Commercial |
$54.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$36.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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/GLIDE/AMPLATZ
|
Facility
|
IP
|
$72.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909081288
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.03 |
| Max. Negotiated Rate |
$54.00 |
| Rate for Payer: Adventist Health Commercial |
$14.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$46.37
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$48.74
|
| Rate for Payer: Heritage Provider Network Senior |
$48.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.00
|
| Rate for Payer: Multiplan Commercial |
$54.00
|
|
|
HC GUIDEWIRE GOLD TIP
|
Facility
|
OP
|
$1,334.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909000011
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$241.45 |
| Max. Negotiated Rate |
$1,133.90 |
| Rate for Payer: Adventist Health Commercial |
$266.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$824.41
|
| 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 |
$1,000.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$667.27
|
| Rate for Payer: Blue Shield of California Commercial |
$813.74
|
| Rate for Payer: Blue Shield of California EPN |
$650.99
|
| Rate for Payer: Cash Price |
$600.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$867.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,133.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,133.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,133.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$787.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$825.75
|
| Rate for Payer: Heritage Provider Network Senior |
$825.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$636.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$241.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$333.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$933.80
|
| Rate for Payer: Multiplan Commercial |
$1,000.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$667.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$667.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,133.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,133.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1,133.90
|
|
|
HC GUIDEWIRE GOLD TIP
|
Facility
|
IP
|
$1,334.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909000011
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$241.45 |
| Max. Negotiated Rate |
$1,000.50 |
| Rate for Payer: Adventist Health Commercial |
$266.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$859.10
|
| Rate for Payer: Cash Price |
$600.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$903.12
|
| Rate for Payer: Heritage Provider Network Senior |
$903.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$241.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$333.50
|
| Rate for Payer: Multiplan Commercial |
$1,000.50
|
|
|
HC GUIDEWIRE, JINDO TAPERED
|
Facility
|
IP
|
$432.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909081418
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$78.19 |
| Max. Negotiated Rate |
$324.00 |
| Rate for Payer: Adventist Health Commercial |
$86.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$278.21
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$292.46
|
| Rate for Payer: Heritage Provider Network Senior |
$292.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$78.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.00
|
| Rate for Payer: Multiplan Commercial |
$324.00
|
|
|
HC GUIDEWIRE, JINDO TAPERED
|
Facility
|
OP
|
$432.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909081418
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$78.19 |
| Max. Negotiated Rate |
$367.20 |
| Rate for Payer: Adventist Health Commercial |
$86.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$266.98
|
| 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 |
$324.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$216.09
|
| Rate for Payer: Blue Shield of California Commercial |
$263.52
|
| Rate for Payer: Blue Shield of California EPN |
$210.82
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$280.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$367.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$367.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$367.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$254.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$267.41
|
| Rate for Payer: Heritage Provider Network Senior |
$267.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$206.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$78.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$302.40
|
| Rate for Payer: Multiplan Commercial |
$324.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$216.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$216.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$367.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$367.20
|
| Rate for Payer: Vantage Medical Group Senior |
$367.20
|
|
|
HC GUIDEWIRE, LUNDERQUIST
|
Facility
|
OP
|
$378.74
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909020084
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$68.55 |
| Max. Negotiated Rate |
$321.93 |
| Rate for Payer: Adventist Health Commercial |
$75.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$234.06
|
| 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 |
$284.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$189.45
|
| Rate for Payer: Blue Shield of California Commercial |
$231.03
|
| Rate for Payer: Blue Shield of California EPN |
$184.83
|
| Rate for Payer: Cash Price |
$170.43
|
| Rate for Payer: Cigna of CA HMO/PPO |
$246.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$321.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$321.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$321.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$223.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$234.44
|
| Rate for Payer: Heritage Provider Network Senior |
$234.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$180.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$68.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$265.12
|
| Rate for Payer: Multiplan Commercial |
$284.06
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$189.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$189.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$321.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$321.93
|
| Rate for Payer: Vantage Medical Group Senior |
$321.93
|
|
|
HC GUIDEWIRE, LUNDERQUIST
|
Facility
|
IP
|
$378.74
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909020084
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$68.55 |
| Max. Negotiated Rate |
$284.06 |
| Rate for Payer: Adventist Health Commercial |
$75.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$243.91
|
| Rate for Payer: Cash Price |
$170.43
|
| Rate for Payer: Heritage Provider Network Commercial |
$256.41
|
| Rate for Payer: Heritage Provider Network Senior |
$256.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$68.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.69
|
| Rate for Payer: Multiplan Commercial |
$284.06
|
|
|
HC GUIDE WIRE M
|
Facility
|
IP
|
$900.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
900803803
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$162.90 |
| Max. Negotiated Rate |
$675.00 |
| Rate for Payer: Adventist Health Commercial |
$180.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$579.60
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$609.30
|
| Rate for Payer: Heritage Provider Network Senior |
$609.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$162.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$225.00
|
| Rate for Payer: Multiplan Commercial |
$675.00
|
|
|
HC GUIDE WIRE M
|
Facility
|
OP
|
$900.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
900803803
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$162.90 |
| Max. Negotiated Rate |
$765.00 |
| Rate for Payer: Adventist Health Commercial |
$180.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$556.20
|
| 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 |
$675.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$450.18
|
| Rate for Payer: Blue Shield of California Commercial |
$549.00
|
| Rate for Payer: Blue Shield of California EPN |
$439.20
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$585.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$765.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$765.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$765.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$531.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$557.10
|
| Rate for Payer: Heritage Provider Network Senior |
$557.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$429.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$162.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$225.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$630.00
|
| Rate for Payer: Multiplan Commercial |
$675.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$450.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$450.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$765.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$765.00
|
| Rate for Payer: Vantage Medical Group Senior |
$765.00
|
|
|
HC GUIDEWIRE, PERSUADER
|
Facility
|
OP
|
$551.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909020116
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$99.73 |
| Max. Negotiated Rate |
$468.35 |
| Rate for Payer: Adventist Health Commercial |
$110.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$340.52
|
| 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 |
$413.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$275.61
|
| Rate for Payer: Blue Shield of California Commercial |
$336.11
|
| Rate for Payer: Blue Shield of California EPN |
$268.89
|
| Rate for Payer: Cash Price |
$247.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$358.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$468.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$468.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$468.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$325.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$341.07
|
| Rate for Payer: Heritage Provider Network Senior |
$341.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$262.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$99.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$137.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$385.70
|
| Rate for Payer: Multiplan Commercial |
$413.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$275.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$275.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$468.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$468.35
|
| Rate for Payer: Vantage Medical Group Senior |
$468.35
|
|
|
HC GUIDEWIRE, PERSUADER
|
Facility
|
IP
|
$551.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909020116
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$99.73 |
| Max. Negotiated Rate |
$413.25 |
| Rate for Payer: Adventist Health Commercial |
$110.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$354.84
|
| Rate for Payer: Cash Price |
$247.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$373.03
|
| Rate for Payer: Heritage Provider Network Senior |
$373.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$99.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$137.75
|
| Rate for Payer: Multiplan Commercial |
$413.25
|
|
|
HC GUIDEWIRE SEPARATOR
|
Facility
|
OP
|
$5,500.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909020026
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$995.50 |
| Max. Negotiated Rate |
$4,675.00 |
| Rate for Payer: Adventist Health Commercial |
$1,100.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,399.00
|
| 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 |
$4,125.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,751.10
|
| Rate for Payer: Blue Shield of California Commercial |
$3,355.00
|
| Rate for Payer: Blue Shield of California EPN |
$2,684.00
|
| Rate for Payer: Cash Price |
$2,475.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,575.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,675.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,675.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,675.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,245.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,404.50
|
| Rate for Payer: Heritage Provider Network Senior |
$3,404.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,623.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$995.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,375.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,850.00
|
| Rate for Payer: Multiplan Commercial |
$4,125.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,750.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,750.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,675.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,675.00
|
| Rate for Payer: Vantage Medical Group Senior |
$4,675.00
|
|
|
HC GUIDEWIRE SEPARATOR
|
Facility
|
IP
|
$5,500.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909020026
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$995.50 |
| Max. Negotiated Rate |
$4,125.00 |
| Rate for Payer: Adventist Health Commercial |
$1,100.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,542.00
|
| Rate for Payer: Cash Price |
$2,475.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,723.50
|
| Rate for Payer: Heritage Provider Network Senior |
$3,723.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$995.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,375.00
|
| Rate for Payer: Multiplan Commercial |
$4,125.00
|
|
|
HC GUIDEWIRE SYNCHRO
|
Facility
|
OP
|
$2,901.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909000003
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$525.08 |
| Max. Negotiated Rate |
$2,465.85 |
| Rate for Payer: Adventist Health Commercial |
$580.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,792.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,465.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,595.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,175.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,451.08
|
| Rate for Payer: Blue Shield of California Commercial |
$1,769.61
|
| Rate for Payer: Blue Shield of California EPN |
$1,415.69
|
| Rate for Payer: Cash Price |
$1,305.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,885.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,465.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,465.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,465.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,711.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,795.72
|
| Rate for Payer: Heritage Provider Network Senior |
$1,795.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,383.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$525.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$725.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,030.70
|
| Rate for Payer: Multiplan Commercial |
$2,175.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,450.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,450.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,465.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,465.85
|
| Rate for Payer: Vantage Medical Group Senior |
$2,465.85
|
|
|
HC GUIDEWIRE SYNCHRO
|
Facility
|
IP
|
$2,901.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909000003
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$525.08 |
| Max. Negotiated Rate |
$2,175.75 |
| Rate for Payer: Adventist Health Commercial |
$580.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,868.24
|
| Rate for Payer: Cash Price |
$1,305.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,963.98
|
| Rate for Payer: Heritage Provider Network Senior |
$1,963.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$525.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$725.25
|
| Rate for Payer: Multiplan Commercial |
$2,175.75
|
|
|
HC GUIDEWIRE, TRANSEND
|
Facility
|
IP
|
$1,108.60
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909020096
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$200.66 |
| Max. Negotiated Rate |
$831.45 |
| Rate for Payer: Adventist Health Commercial |
$221.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$713.94
|
| Rate for Payer: Cash Price |
$498.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$750.52
|
| Rate for Payer: Heritage Provider Network Senior |
$750.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$200.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$277.15
|
| Rate for Payer: Multiplan Commercial |
$831.45
|
|
|
HC GUIDEWIRE, TRANSEND
|
Facility
|
OP
|
$1,108.60
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909020096
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$200.66 |
| Max. Negotiated Rate |
$942.31 |
| Rate for Payer: Adventist Health Commercial |
$221.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$685.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$942.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$609.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$831.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$554.52
|
| Rate for Payer: Blue Shield of California Commercial |
$676.25
|
| Rate for Payer: Blue Shield of California EPN |
$541.00
|
| Rate for Payer: Cash Price |
$498.87
|
| Rate for Payer: Cigna of CA HMO/PPO |
$720.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$942.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$942.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$942.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$654.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$686.22
|
| Rate for Payer: Heritage Provider Network Senior |
$686.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$528.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$200.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$277.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$776.02
|
| Rate for Payer: Multiplan Commercial |
$831.45
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$554.30
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$554.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$942.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$942.31
|
| Rate for Payer: Vantage Medical Group Senior |
$942.31
|
|
