|
HC COCAINE METABOLITE CONF
|
Facility
|
OP
|
$298.00
|
|
|
Service Code
|
CPT 80353
|
| Hospital Charge Code |
900910518
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$59.60 |
| Max. Negotiated Rate |
$253.30 |
| Rate for Payer: Adventist Health Commercial |
$59.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$195.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$253.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$163.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$223.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$143.63
|
| Rate for Payer: Blue Shield of California Commercial |
$199.36
|
| Rate for Payer: Blue Shield of California EPN |
$131.72
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cigna of CA HMO |
$190.72
|
| Rate for Payer: Cigna of CA PPO |
$220.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$253.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$253.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$253.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$119.20
|
| Rate for Payer: EPIC Health Plan Senior |
$119.20
|
| Rate for Payer: Galaxy Health WC |
$253.30
|
| Rate for Payer: Global Benefits Group Commercial |
$178.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$198.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$113.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$184.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$208.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$208.60
|
| Rate for Payer: Multiplan Commercial |
$238.40
|
| Rate for Payer: Networks By Design Commercial |
$193.70
|
| Rate for Payer: Prime Health Services Commercial |
$253.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$178.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$178.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$149.00
|
| Rate for Payer: United Healthcare All Other HMO |
$149.00
|
| Rate for Payer: United Healthcare HMO Rider |
$149.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$149.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$253.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$253.30
|
| Rate for Payer: Vantage Medical Group Senior |
$253.30
|
|
|
HC COCAINE METABOLITE CONF
|
Facility
|
IP
|
$359.00
|
|
|
Service Code
|
CPT 80353
|
| Hospital Charge Code |
900910518
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$71.80 |
| Max. Negotiated Rate |
$305.15 |
| Rate for Payer: Adventist Health Commercial |
$71.80
|
| Rate for Payer: Cash Price |
$161.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$143.60
|
| Rate for Payer: EPIC Health Plan Senior |
$143.60
|
| Rate for Payer: Galaxy Health WC |
$305.15
|
| Rate for Payer: Global Benefits Group Commercial |
$215.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$239.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$136.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$222.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.16
|
| Rate for Payer: Multiplan Commercial |
$287.20
|
| Rate for Payer: Networks By Design Commercial |
$233.35
|
| Rate for Payer: Prime Health Services Commercial |
$305.15
|
|
|
HC CO DIFFUSION CAPACITY
|
Facility
|
IP
|
$534.00
|
|
|
Service Code
|
CPT 94729
|
| Hospital Charge Code |
900801004
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$106.80 |
| Max. Negotiated Rate |
$453.90 |
| Rate for Payer: Adventist Health Commercial |
$106.80
|
| Rate for Payer: Cash Price |
$240.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$213.60
|
| Rate for Payer: EPIC Health Plan Senior |
$213.60
|
| Rate for Payer: Galaxy Health WC |
$453.90
|
| Rate for Payer: Global Benefits Group Commercial |
$320.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$356.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$203.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$330.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$128.16
|
| Rate for Payer: Multiplan Commercial |
$427.20
|
| Rate for Payer: Networks By Design Commercial |
$347.10
|
| Rate for Payer: Prime Health Services Commercial |
$453.90
|
|
|
HC CO DIFFUSION CAPACITY
|
Facility
|
OP
|
$534.00
|
|
|
Service Code
|
CPT 94729
|
| Hospital Charge Code |
900801004
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$80.98 |
| Max. Negotiated Rate |
$764.00 |
| Rate for Payer: Adventist Health Commercial |
$106.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$350.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$453.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$293.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$400.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$327.93
|
| Rate for Payer: Blue Shield of California Commercial |
$326.81
|
| Rate for Payer: Blue Shield of California EPN |
$215.74
|
| Rate for Payer: Cash Price |
$240.30
|
| Rate for Payer: Cash Price |
$240.30
|
| Rate for Payer: Cash Price |
$240.30
|
| Rate for Payer: Cigna of CA HMO |
$341.76
|
| Rate for Payer: Cigna of CA PPO |
$395.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$453.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$453.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$453.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$213.60
|
| Rate for Payer: EPIC Health Plan Senior |
$213.60
|
| Rate for Payer: Galaxy Health WC |
$453.90
|
| Rate for Payer: Global Benefits Group Commercial |
$320.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$80.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$356.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$91.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$330.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$128.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$373.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$373.80
|
| Rate for Payer: Multiplan Commercial |
$427.20
|
| Rate for Payer: Networks By Design Commercial |
$347.10
|
| Rate for Payer: Prime Health Services Commercial |
$453.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$320.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$320.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$764.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$731.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$669.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$453.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$453.90
|
| Rate for Payer: Vantage Medical Group Senior |
$453.90
|
|
|
HC COIL AXIUM
|
Facility
|
OP
|
$3,375.00
|
|
| Hospital Charge Code |
909020035
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$675.00 |
| Max. Negotiated Rate |
$2,868.75 |
| Rate for Payer: Adventist Health Commercial |
$675.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,868.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,856.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,531.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,954.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2,490.75
|
| Rate for Payer: Blue Shield of California EPN |
$1,640.25
|
| Rate for Payer: Cash Price |
$1,518.75
|
| Rate for Payer: Cigna of CA HMO |
$2,362.50
|
| Rate for Payer: Cigna of CA PPO |
$2,362.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,868.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,868.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,868.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,350.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,350.00
|
| Rate for Payer: Galaxy Health WC |
$2,868.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,025.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,251.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,285.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,089.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$810.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,362.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,362.50
|
| Rate for Payer: Multiplan Commercial |
$2,700.00
|
| Rate for Payer: Networks By Design Commercial |
$1,687.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,868.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,025.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,025.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,266.64
|
| Rate for Payer: United Healthcare All Other HMO |
$1,232.89
|
| Rate for Payer: United Healthcare HMO Rider |
$1,206.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,105.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,868.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,868.75
|
| Rate for Payer: Vantage Medical Group Senior |
$2,868.75
|
|
|
HC COIL AXIUM
|
Facility
|
IP
|
$3,375.00
|
|
| Hospital Charge Code |
909020035
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$675.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$675.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,518.75
|
| Rate for Payer: Cash Price |
$1,518.75
|
| Rate for Payer: Cigna of CA HMO |
$2,362.50
|
| Rate for Payer: Cigna of CA PPO |
$2,362.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,350.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,350.00
|
| Rate for Payer: Galaxy Health WC |
$2,868.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,025.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,251.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,285.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,089.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$810.00
|
| Rate for Payer: Multiplan Commercial |
$2,700.00
|
| Rate for Payer: Networks By Design Commercial |
$1,687.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,868.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,266.64
|
| Rate for Payer: United Healthcare All Other HMO |
$1,232.89
|
| Rate for Payer: United Healthcare HMO Rider |
$1,206.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,105.31
|
|
|
HC COIL AXIUM 3D
|
Facility
|
IP
|
$3,900.00
|
|
| Hospital Charge Code |
909020107
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,315.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$936.00
|
| Rate for Payer: Multiplan Commercial |
$3,120.00
|
| Rate for Payer: Networks By Design Commercial |
$2,535.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
|
|
HC COIL AXIUM 3D
|
Facility
|
OP
|
$3,900.00
|
|
| Hospital Charge Code |
909020107
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,315.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,558.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,145.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,925.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,394.99
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Cigna of CA HMO |
$2,496.00
|
| Rate for Payer: Cigna of CA PPO |
$2,886.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,315.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,315.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$936.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,730.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,730.00
|
| Rate for Payer: Multiplan Commercial |
$3,120.00
|
| Rate for Payer: Networks By Design Commercial |
$2,535.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,340.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,340.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,950.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,950.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,950.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,950.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,315.00
|
|
|
HC COIL BRAUN NIT-OCCL
|
Facility
|
IP
|
$4,949.00
|
|
| Hospital Charge Code |
906812532
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$989.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$989.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$2,227.05
|
| Rate for Payer: Cash Price |
$2,227.05
|
| Rate for Payer: Cigna of CA HMO |
$3,464.30
|
| Rate for Payer: Cigna of CA PPO |
$3,464.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,979.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,979.60
|
| Rate for Payer: Galaxy Health WC |
$4,206.65
|
| Rate for Payer: Global Benefits Group Commercial |
$2,969.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,300.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,885.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,063.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,187.76
|
| Rate for Payer: Multiplan Commercial |
$3,959.20
|
| Rate for Payer: Networks By Design Commercial |
$2,474.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,206.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,857.36
|
| Rate for Payer: United Healthcare All Other HMO |
$1,807.87
|
| Rate for Payer: United Healthcare HMO Rider |
$1,768.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,620.80
|
|
|
HC COIL BRAUN NIT-OCCL
|
Facility
|
OP
|
$4,949.00
|
|
| Hospital Charge Code |
906812532
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$989.80 |
| Max. Negotiated Rate |
$4,206.65 |
| Rate for Payer: Adventist Health Commercial |
$989.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,206.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,721.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,711.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,866.46
|
| Rate for Payer: Blue Shield of California Commercial |
$3,652.36
|
| Rate for Payer: Blue Shield of California EPN |
$2,405.21
|
| Rate for Payer: Cash Price |
$2,227.05
|
| Rate for Payer: Cigna of CA HMO |
$3,464.30
|
| Rate for Payer: Cigna of CA PPO |
$3,464.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,206.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,206.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,206.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,979.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,979.60
|
| Rate for Payer: Galaxy Health WC |
$4,206.65
|
| Rate for Payer: Global Benefits Group Commercial |
$2,969.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,300.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,885.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,063.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,187.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,464.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,464.30
|
| Rate for Payer: Multiplan Commercial |
$3,959.20
|
| Rate for Payer: Networks By Design Commercial |
$2,474.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,206.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,969.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,969.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,857.36
|
| Rate for Payer: United Healthcare All Other HMO |
$1,807.87
|
| Rate for Payer: United Healthcare HMO Rider |
$1,768.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,620.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,206.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,206.65
|
| Rate for Payer: Vantage Medical Group Senior |
$4,206.65
|
|
|
HC COIL CASHMERE
|
Facility
|
OP
|
$4,575.00
|
|
| Hospital Charge Code |
909020101
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$915.00 |
| Max. Negotiated Rate |
$3,888.75 |
| Rate for Payer: Adventist Health Commercial |
$915.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,000.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,888.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,516.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,431.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,809.51
|
| Rate for Payer: Cash Price |
$2,058.75
|
| Rate for Payer: Cigna of CA HMO |
$2,928.00
|
| Rate for Payer: Cigna of CA PPO |
$3,385.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,888.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,888.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,888.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,830.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,830.00
|
| Rate for Payer: Galaxy Health WC |
$3,888.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,745.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,051.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,743.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,831.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,098.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,202.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,202.50
|
| Rate for Payer: Multiplan Commercial |
$3,660.00
|
| Rate for Payer: Networks By Design Commercial |
$2,973.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,888.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,745.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,745.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,287.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,287.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,287.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,287.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,888.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,888.75
|
| Rate for Payer: Vantage Medical Group Senior |
$3,888.75
|
|
|
HC COIL CASHMERE
|
Facility
|
IP
|
$4,575.00
|
|
| Hospital Charge Code |
909020101
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$915.00 |
| Max. Negotiated Rate |
$3,888.75 |
| Rate for Payer: Adventist Health Commercial |
$915.00
|
| Rate for Payer: Cash Price |
$2,058.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,830.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,830.00
|
| Rate for Payer: Galaxy Health WC |
$3,888.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,745.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,051.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,743.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,831.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,098.00
|
| Rate for Payer: Multiplan Commercial |
$3,660.00
|
| Rate for Payer: Networks By Design Commercial |
$2,973.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,888.75
|
|
|
HC COIL COOK MREYE EMBOL CUSTOM
|
Facility
|
OP
|
$584.00
|
|
| Hospital Charge Code |
906812477
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$116.80 |
| Max. Negotiated Rate |
$496.40 |
| Rate for Payer: Adventist Health Commercial |
$116.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$496.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$321.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$438.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$338.25
|
| Rate for Payer: Blue Shield of California Commercial |
$430.99
|
| Rate for Payer: Blue Shield of California EPN |
$283.82
|
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Cigna of CA HMO |
$408.80
|
| Rate for Payer: Cigna of CA PPO |
$408.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$496.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$496.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$496.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$233.60
|
| Rate for Payer: EPIC Health Plan Senior |
$233.60
|
| Rate for Payer: Galaxy Health WC |
$496.40
|
| Rate for Payer: Global Benefits Group Commercial |
$350.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$389.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$222.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$361.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$408.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$408.80
|
| Rate for Payer: Multiplan Commercial |
$467.20
|
| Rate for Payer: Networks By Design Commercial |
$292.00
|
| Rate for Payer: Prime Health Services Commercial |
$496.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$350.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$350.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$219.18
|
| Rate for Payer: United Healthcare All Other HMO |
$213.34
|
| Rate for Payer: United Healthcare HMO Rider |
$208.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$191.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$496.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$496.40
|
| Rate for Payer: Vantage Medical Group Senior |
$496.40
|
|
|
HC COIL COOK MREYE EMBOL CUSTOM
|
Facility
|
IP
|
$584.00
|
|
| Hospital Charge Code |
906812477
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$116.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$116.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Cigna of CA HMO |
$408.80
|
| Rate for Payer: Cigna of CA PPO |
$408.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$233.60
|
| Rate for Payer: EPIC Health Plan Senior |
$233.60
|
| Rate for Payer: Galaxy Health WC |
$496.40
|
| Rate for Payer: Global Benefits Group Commercial |
$350.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$389.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$222.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$361.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.16
|
| Rate for Payer: Multiplan Commercial |
$467.20
|
| Rate for Payer: Networks By Design Commercial |
$292.00
|
| Rate for Payer: Prime Health Services Commercial |
$496.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$219.18
|
| Rate for Payer: United Healthcare All Other HMO |
$213.34
|
| Rate for Payer: United Healthcare HMO Rider |
$208.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$191.26
|
|
|
HC COIL COOK MREYE EMBOLIZATION
|
Facility
|
OP
|
$464.00
|
|
| Hospital Charge Code |
906812478
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$92.80 |
| Max. Negotiated Rate |
$394.40 |
| Rate for Payer: Adventist Health Commercial |
$92.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$394.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$255.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$348.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$268.75
|
| Rate for Payer: Blue Shield of California Commercial |
$342.43
|
| Rate for Payer: Blue Shield of California EPN |
$225.50
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cigna of CA HMO |
$324.80
|
| Rate for Payer: Cigna of CA PPO |
$324.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$394.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$394.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$394.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.60
|
| Rate for Payer: EPIC Health Plan Senior |
$185.60
|
| Rate for Payer: Galaxy Health WC |
$394.40
|
| Rate for Payer: Global Benefits Group Commercial |
$278.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$309.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$176.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$287.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$111.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$324.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$324.80
|
| Rate for Payer: Multiplan Commercial |
$371.20
|
| Rate for Payer: Networks By Design Commercial |
$232.00
|
| Rate for Payer: Prime Health Services Commercial |
$394.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$278.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$278.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$174.14
|
| Rate for Payer: United Healthcare All Other HMO |
$169.50
|
| Rate for Payer: United Healthcare HMO Rider |
$165.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$151.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$394.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$394.40
|
| Rate for Payer: Vantage Medical Group Senior |
$394.40
|
|
|
HC COIL COOK MREYE EMBOLIZATION
|
Facility
|
IP
|
$464.00
|
|
| Hospital Charge Code |
906812478
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$92.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: EPIC Health Plan Commercial |
$185.60
|
| Rate for Payer: Adventist Health Commercial |
$92.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cigna of CA HMO |
$324.80
|
| Rate for Payer: Cigna of CA PPO |
$324.80
|
| Rate for Payer: EPIC Health Plan Senior |
$185.60
|
| Rate for Payer: Galaxy Health WC |
$394.40
|
| Rate for Payer: Global Benefits Group Commercial |
$278.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$309.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$176.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$287.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$111.36
|
| Rate for Payer: Multiplan Commercial |
$371.20
|
| Rate for Payer: Networks By Design Commercial |
$232.00
|
| Rate for Payer: Prime Health Services Commercial |
$394.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$174.14
|
| Rate for Payer: United Healthcare All Other HMO |
$169.50
|
| Rate for Payer: United Healthcare HMO Rider |
$165.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$151.96
|
|
|
HC COIL DELTA PLUSH
|
Facility
|
IP
|
$3,900.00
|
|
| Hospital Charge Code |
909020100
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,315.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$936.00
|
| Rate for Payer: Multiplan Commercial |
$3,120.00
|
| Rate for Payer: Networks By Design Commercial |
$2,535.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
|
|
HC COIL DELTA PLUSH
|
Facility
|
OP
|
$3,900.00
|
|
| Hospital Charge Code |
909020100
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,315.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,558.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,145.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,925.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,394.99
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Cigna of CA HMO |
$2,496.00
|
| Rate for Payer: Cigna of CA PPO |
$2,886.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,315.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,315.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$936.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,730.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,730.00
|
| Rate for Payer: Multiplan Commercial |
$3,120.00
|
| Rate for Payer: Networks By Design Commercial |
$2,535.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,340.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,340.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,950.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,950.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,950.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,950.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,315.00
|
|
|
HC COIL GDC-10
|
Facility
|
OP
|
$4,850.00
|
|
| Hospital Charge Code |
909020104
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$970.00 |
| Max. Negotiated Rate |
$4,122.50 |
| Rate for Payer: Adventist Health Commercial |
$970.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,181.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,122.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,667.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,637.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,978.39
|
| Rate for Payer: Cash Price |
$2,182.50
|
| Rate for Payer: Cigna of CA HMO |
$3,104.00
|
| Rate for Payer: Cigna of CA PPO |
$3,589.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,122.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,122.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,122.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,940.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,940.00
|
| Rate for Payer: Galaxy Health WC |
$4,122.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,910.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,234.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,847.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,002.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,164.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,395.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,395.00
|
| Rate for Payer: Multiplan Commercial |
$3,880.00
|
| Rate for Payer: Networks By Design Commercial |
$3,152.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,122.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,910.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,910.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,425.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,425.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,425.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,425.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,122.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,122.50
|
| Rate for Payer: Vantage Medical Group Senior |
$4,122.50
|
|
|
HC COIL GDC-10
|
Facility
|
IP
|
$4,850.00
|
|
| Hospital Charge Code |
909020104
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$970.00 |
| Max. Negotiated Rate |
$4,122.50 |
| Rate for Payer: Adventist Health Commercial |
$970.00
|
| Rate for Payer: Cash Price |
$2,182.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,940.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,940.00
|
| Rate for Payer: Galaxy Health WC |
$4,122.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,910.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,234.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,847.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,002.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,164.00
|
| Rate for Payer: Multiplan Commercial |
$3,880.00
|
| Rate for Payer: Networks By Design Commercial |
$3,152.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,122.50
|
|
|
HC COIL GDC-18 FIBERED
|
Facility
|
IP
|
$3,900.00
|
|
| Hospital Charge Code |
909020105
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,315.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$936.00
|
| Rate for Payer: Multiplan Commercial |
$3,120.00
|
| Rate for Payer: Networks By Design Commercial |
$2,535.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
|
|
HC COIL GDC-18 FIBERED
|
Facility
|
OP
|
$3,900.00
|
|
| Hospital Charge Code |
909020105
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,315.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,558.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,145.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,925.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,394.99
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Cigna of CA HMO |
$2,496.00
|
| Rate for Payer: Cigna of CA PPO |
$2,886.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,315.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,315.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$936.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,730.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,730.00
|
| Rate for Payer: Multiplan Commercial |
$3,120.00
|
| Rate for Payer: Networks By Design Commercial |
$2,535.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,340.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,340.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,950.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,950.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,950.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,950.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,315.00
|
|
|
HC COIL GDC 360 STANDARD
|
Facility
|
OP
|
$3,900.00
|
|
| Hospital Charge Code |
909020106
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,315.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,558.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,145.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,925.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,394.99
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Cigna of CA HMO |
$2,496.00
|
| Rate for Payer: Cigna of CA PPO |
$2,886.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,315.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,315.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$936.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,730.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,730.00
|
| Rate for Payer: Multiplan Commercial |
$3,120.00
|
| Rate for Payer: Networks By Design Commercial |
$2,535.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,340.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,340.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,950.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,950.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,950.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,950.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,315.00
|
|
|
HC COIL GDC 360 STANDARD
|
Facility
|
IP
|
$3,900.00
|
|
| Hospital Charge Code |
909020106
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,315.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$936.00
|
| Rate for Payer: Multiplan Commercial |
$3,120.00
|
| Rate for Payer: Networks By Design Commercial |
$2,535.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
|
|
HC COIL MICROVENTION HYPERSOFT
|
Facility
|
OP
|
$3,783.00
|
|
| Hospital Charge Code |
909020123
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$756.60 |
| Max. Negotiated Rate |
$3,215.55 |
| Rate for Payer: Adventist Health Commercial |
$756.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,481.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,215.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,080.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,837.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,323.14
|
| Rate for Payer: Cash Price |
$1,702.35
|
| Rate for Payer: Cigna of CA HMO |
$2,421.12
|
| Rate for Payer: Cigna of CA PPO |
$2,799.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,215.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,215.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,215.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,513.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,513.20
|
| Rate for Payer: Galaxy Health WC |
$3,215.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,269.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,523.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,441.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,341.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$907.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,648.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,648.10
|
| Rate for Payer: Multiplan Commercial |
$3,026.40
|
| Rate for Payer: Networks By Design Commercial |
$2,458.95
|
| Rate for Payer: Prime Health Services Commercial |
$3,215.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,269.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,269.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,891.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,891.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,891.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,891.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,215.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,215.55
|
| Rate for Payer: Vantage Medical Group Senior |
$3,215.55
|
|
