|
HC COIL MICROVENTION HYPERSOFT
|
Facility
|
IP
|
$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: Cash Price |
$1,702.35
|
| 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: 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
|
|
|
HC COIL MICROVENTN HYDROSFT 10-30
|
Facility
|
IP
|
$4,875.00
|
|
| Hospital Charge Code |
909020125
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$975.00 |
| Max. Negotiated Rate |
$4,143.75 |
| Rate for Payer: Adventist Health Commercial |
$975.00
|
| Rate for Payer: Cash Price |
$2,193.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,950.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,950.00
|
| Rate for Payer: Galaxy Health WC |
$4,143.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,925.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,251.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,857.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,017.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,170.00
|
| Rate for Payer: Multiplan Commercial |
$3,900.00
|
| Rate for Payer: Networks By Design Commercial |
$3,168.75
|
| Rate for Payer: Prime Health Services Commercial |
$4,143.75
|
|
|
HC COIL MICROVENTN HYDROSFT 10-30
|
Facility
|
OP
|
$4,875.00
|
|
| Hospital Charge Code |
909020125
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$975.00 |
| Max. Negotiated Rate |
$4,143.75 |
| Rate for Payer: Adventist Health Commercial |
$975.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,197.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,143.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,681.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,656.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,993.74
|
| Rate for Payer: Cash Price |
$2,193.75
|
| Rate for Payer: Cigna of CA HMO |
$3,120.00
|
| Rate for Payer: Cigna of CA PPO |
$3,607.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,143.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,143.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,143.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,950.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,950.00
|
| Rate for Payer: Galaxy Health WC |
$4,143.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,925.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,251.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,857.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,017.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,170.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,412.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,412.50
|
| Rate for Payer: Multiplan Commercial |
$3,900.00
|
| Rate for Payer: Networks By Design Commercial |
$3,168.75
|
| Rate for Payer: Prime Health Services Commercial |
$4,143.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,925.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,925.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,437.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,437.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,437.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,437.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,143.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,143.75
|
| Rate for Payer: Vantage Medical Group Senior |
$4,143.75
|
|
|
HC COIL MICROVENTN HYDROSFT 4-8CM
|
Facility
|
OP
|
$4,000.00
|
|
| Hospital Charge Code |
909020124
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$800.00 |
| Max. Negotiated Rate |
$3,400.00 |
| Rate for Payer: Adventist Health Commercial |
$800.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,623.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,400.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,200.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,000.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,456.40
|
| Rate for Payer: Cash Price |
$1,800.00
|
| Rate for Payer: Cigna of CA HMO |
$2,560.00
|
| Rate for Payer: Cigna of CA PPO |
$2,960.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,400.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,400.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,400.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,600.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,600.00
|
| Rate for Payer: Galaxy Health WC |
$3,400.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,400.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,668.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,524.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,476.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$960.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,800.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,800.00
|
| Rate for Payer: Multiplan Commercial |
$3,200.00
|
| Rate for Payer: Networks By Design Commercial |
$2,600.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,400.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,400.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,400.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,000.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,000.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,000.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,400.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,400.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,400.00
|
|
|
HC COIL MICROVENTN HYDROSFT 4-8CM
|
Facility
|
IP
|
$4,000.00
|
|
| Hospital Charge Code |
909020124
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$800.00 |
| Max. Negotiated Rate |
$3,400.00 |
| Rate for Payer: Adventist Health Commercial |
$800.00
|
| Rate for Payer: Cash Price |
$1,800.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,600.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,600.00
|
| Rate for Payer: Galaxy Health WC |
$3,400.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,400.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,668.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,524.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,476.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$960.00
|
| Rate for Payer: Multiplan Commercial |
$3,200.00
|
| Rate for Payer: Networks By Design Commercial |
$2,600.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,400.00
|
|
|
HC COIL, MICRUSHERE
|
Facility
|
IP
|
$4,075.00
|
|
| Hospital Charge Code |
909020102
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$815.00 |
| Max. Negotiated Rate |
$3,463.75 |
| Rate for Payer: Adventist Health Commercial |
$815.00
|
| Rate for Payer: Cash Price |
$1,833.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,630.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,630.00
|
| Rate for Payer: Galaxy Health WC |
$3,463.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,445.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,718.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,552.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,522.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$978.00
|
| Rate for Payer: Multiplan Commercial |
$3,260.00
|
| Rate for Payer: Networks By Design Commercial |
$2,648.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,463.75
|
|
|
HC COIL, MICRUSHERE
|
Facility
|
OP
|
$4,075.00
|
|
| Hospital Charge Code |
909020102
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$815.00 |
| Max. Negotiated Rate |
$3,463.75 |
| Rate for Payer: Adventist Health Commercial |
$815.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,672.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,463.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,241.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,056.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,502.46
|
| Rate for Payer: Cash Price |
$1,833.75
|
| Rate for Payer: Cigna of CA HMO |
$2,608.00
|
| Rate for Payer: Cigna of CA PPO |
$3,015.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,463.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,463.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,463.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,630.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,630.00
|
| Rate for Payer: Galaxy Health WC |
$3,463.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,445.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,718.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,552.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,522.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$978.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,852.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,852.50
|
| Rate for Payer: Multiplan Commercial |
$3,260.00
|
| Rate for Payer: Networks By Design Commercial |
$2,648.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,463.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,445.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,445.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,037.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,037.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,037.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,037.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,463.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,463.75
|
| Rate for Payer: Vantage Medical Group Senior |
$3,463.75
|
|
|
HC COIL ORBIT J & J
|
Facility
|
IP
|
$3,900.00
|
|
| Hospital Charge Code |
909020018
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Cigna of CA HMO |
$2,730.00
|
| Rate for Payer: Cigna of CA PPO |
$2,730.00
|
| 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 |
$1,950.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,463.67
|
| Rate for Payer: United Healthcare All Other HMO |
$1,424.67
|
| Rate for Payer: United Healthcare HMO Rider |
$1,393.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,277.25
|
|
|
HC COIL ORBIT J & J
|
Facility
|
OP
|
$3,900.00
|
|
| Hospital Charge Code |
909020018
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,315.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| 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 |
$2,258.88
|
| Rate for Payer: Blue Shield of California Commercial |
$2,878.20
|
| Rate for Payer: Blue Shield of California EPN |
$1,895.40
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Cigna of CA HMO |
$2,730.00
|
| Rate for Payer: Cigna of CA PPO |
$2,730.00
|
| 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 |
$1,950.00
|
| 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 |
$1,463.67
|
| Rate for Payer: United Healthcare All Other HMO |
$1,424.67
|
| Rate for Payer: United Healthcare HMO Rider |
$1,393.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,277.25
|
| 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 PENUMBRA
|
Facility
|
OP
|
$6,750.00
|
|
| Hospital Charge Code |
909020118
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,350.00 |
| Max. Negotiated Rate |
$5,737.50 |
| Rate for Payer: Adventist Health Commercial |
$1,350.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4,427.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,737.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,712.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,062.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,145.18
|
| Rate for Payer: Cash Price |
$3,037.50
|
| Rate for Payer: Cigna of CA HMO |
$4,320.00
|
| Rate for Payer: Cigna of CA PPO |
$4,995.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,737.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,737.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,737.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,700.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,700.00
|
| Rate for Payer: Galaxy Health WC |
$5,737.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,050.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,502.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,571.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,178.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,620.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,725.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,725.00
|
| Rate for Payer: Multiplan Commercial |
$5,400.00
|
| Rate for Payer: Networks By Design Commercial |
$4,387.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,737.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,050.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,050.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,375.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,375.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,375.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,737.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,737.50
|
| Rate for Payer: Vantage Medical Group Senior |
$5,737.50
|
|
|
HC COIL PENUMBRA
|
Facility
|
IP
|
$6,750.00
|
|
| Hospital Charge Code |
909020118
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,350.00 |
| Max. Negotiated Rate |
$5,737.50 |
| Rate for Payer: Adventist Health Commercial |
$1,350.00
|
| Rate for Payer: Cash Price |
$3,037.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,700.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,700.00
|
| Rate for Payer: Galaxy Health WC |
$5,737.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,050.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,502.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,571.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,178.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,620.00
|
| Rate for Payer: Multiplan Commercial |
$5,400.00
|
| Rate for Payer: Networks By Design Commercial |
$4,387.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,737.50
|
|
|
HC COIL PRESIDIO
|
Facility
|
IP
|
$6,375.00
|
|
| Hospital Charge Code |
909020099
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,275.00 |
| Max. Negotiated Rate |
$5,418.75 |
| Rate for Payer: Adventist Health Commercial |
$1,275.00
|
| Rate for Payer: Cash Price |
$2,868.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,550.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,550.00
|
| Rate for Payer: Galaxy Health WC |
$5,418.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,825.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,252.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,428.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,946.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,530.00
|
| Rate for Payer: Multiplan Commercial |
$5,100.00
|
| Rate for Payer: Networks By Design Commercial |
$4,143.75
|
| Rate for Payer: Prime Health Services Commercial |
$5,418.75
|
|
|
HC COIL PRESIDIO
|
Facility
|
OP
|
$6,375.00
|
|
| Hospital Charge Code |
909020099
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,275.00 |
| Max. Negotiated Rate |
$5,418.75 |
| Rate for Payer: Adventist Health Commercial |
$1,275.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4,181.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,418.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,506.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,781.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,914.89
|
| Rate for Payer: Cash Price |
$2,868.75
|
| Rate for Payer: Cigna of CA HMO |
$4,080.00
|
| Rate for Payer: Cigna of CA PPO |
$4,717.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,418.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,418.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,418.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,550.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,550.00
|
| Rate for Payer: Galaxy Health WC |
$5,418.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,825.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,252.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,428.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,946.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,530.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,462.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,462.50
|
| Rate for Payer: Multiplan Commercial |
$5,100.00
|
| Rate for Payer: Networks By Design Commercial |
$4,143.75
|
| Rate for Payer: Prime Health Services Commercial |
$5,418.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,825.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,825.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,187.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,187.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,187.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,187.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,418.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,418.75
|
| Rate for Payer: Vantage Medical Group Senior |
$5,418.75
|
|
|
HC COIL, TARGET 360 SOFT
|
Facility
|
IP
|
$4,250.00
|
|
| Hospital Charge Code |
909020138
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$850.00 |
| Max. Negotiated Rate |
$3,612.50 |
| Rate for Payer: Adventist Health Commercial |
$850.00
|
| Rate for Payer: Cash Price |
$1,912.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,700.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,700.00
|
| Rate for Payer: Galaxy Health WC |
$3,612.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,550.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,834.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,619.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,630.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,020.00
|
| Rate for Payer: Multiplan Commercial |
$3,400.00
|
| Rate for Payer: Networks By Design Commercial |
$2,762.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,612.50
|
|
|
HC COIL, TARGET 360 SOFT
|
Facility
|
OP
|
$4,250.00
|
|
| Hospital Charge Code |
909020138
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$850.00 |
| Max. Negotiated Rate |
$3,612.50 |
| Rate for Payer: Adventist Health Commercial |
$850.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,787.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,612.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,337.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,187.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,609.93
|
| Rate for Payer: Cash Price |
$1,912.50
|
| Rate for Payer: Cigna of CA HMO |
$2,720.00
|
| Rate for Payer: Cigna of CA PPO |
$3,145.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,612.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,612.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,612.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,700.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,700.00
|
| Rate for Payer: Galaxy Health WC |
$3,612.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,550.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,834.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,619.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,630.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,020.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,975.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,975.00
|
| Rate for Payer: Multiplan Commercial |
$3,400.00
|
| Rate for Payer: Networks By Design Commercial |
$2,762.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,612.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,550.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,550.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,125.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,125.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,125.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,125.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,612.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,612.50
|
| Rate for Payer: Vantage Medical Group Senior |
$3,612.50
|
|
|
HC COIL TARGET 360 ULTRA
|
Facility
|
OP
|
$3,900.00
|
|
| Hospital Charge Code |
909020135
|
|
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 TARGET 360 ULTRA
|
Facility
|
IP
|
$3,900.00
|
|
| Hospital Charge Code |
909020135
|
|
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, TARGET HELICAL
|
Facility
|
IP
|
$3,900.00
|
|
| Hospital Charge Code |
909020136
|
|
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, TARGET HELICAL
|
Facility
|
OP
|
$3,900.00
|
|
| Hospital Charge Code |
909020136
|
|
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, TARGET STANDARD
|
Facility
|
IP
|
$4,000.00
|
|
| Hospital Charge Code |
909020137
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$800.00 |
| Max. Negotiated Rate |
$3,400.00 |
| Rate for Payer: Adventist Health Commercial |
$800.00
|
| Rate for Payer: Cash Price |
$1,800.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,600.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,600.00
|
| Rate for Payer: Galaxy Health WC |
$3,400.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,400.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,668.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,524.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,476.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$960.00
|
| Rate for Payer: Multiplan Commercial |
$3,200.00
|
| Rate for Payer: Networks By Design Commercial |
$2,600.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,400.00
|
|
|
HC COIL, TARGET STANDARD
|
Facility
|
OP
|
$4,000.00
|
|
| Hospital Charge Code |
909020137
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$800.00 |
| Max. Negotiated Rate |
$3,400.00 |
| Rate for Payer: Adventist Health Commercial |
$800.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,623.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,400.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,200.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,000.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,456.40
|
| Rate for Payer: Cash Price |
$1,800.00
|
| Rate for Payer: Cigna of CA HMO |
$2,560.00
|
| Rate for Payer: Cigna of CA PPO |
$2,960.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,400.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,400.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,400.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,600.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,600.00
|
| Rate for Payer: Galaxy Health WC |
$3,400.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,400.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,668.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,524.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,476.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$960.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,800.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,800.00
|
| Rate for Payer: Multiplan Commercial |
$3,200.00
|
| Rate for Payer: Networks By Design Commercial |
$2,600.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,400.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,400.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,400.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,000.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,000.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,000.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,400.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,400.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,400.00
|
|
|
HC COIL TERUMO AZUR 18D 2X4
|
Facility
|
OP
|
$2,917.00
|
|
| Hospital Charge Code |
906812572
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$583.40 |
| Max. Negotiated Rate |
$2,479.45 |
| Rate for Payer: Adventist Health Commercial |
$583.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,479.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,604.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,187.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,689.53
|
| Rate for Payer: Blue Shield of California Commercial |
$2,152.75
|
| Rate for Payer: Blue Shield of California EPN |
$1,417.66
|
| Rate for Payer: Cash Price |
$1,312.65
|
| Rate for Payer: Cigna of CA HMO |
$2,041.90
|
| Rate for Payer: Cigna of CA PPO |
$2,041.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,479.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,479.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,479.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,166.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,166.80
|
| Rate for Payer: Galaxy Health WC |
$2,479.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,750.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,945.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,111.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,805.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$700.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,041.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,041.90
|
| Rate for Payer: Multiplan Commercial |
$2,333.60
|
| Rate for Payer: Networks By Design Commercial |
$1,458.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,479.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,750.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,750.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,094.75
|
| Rate for Payer: United Healthcare All Other HMO |
$1,065.58
|
| Rate for Payer: United Healthcare HMO Rider |
$1,042.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$955.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,479.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,479.45
|
| Rate for Payer: Vantage Medical Group Senior |
$2,479.45
|
|
|
HC COIL TERUMO AZUR 18D 2X4
|
Facility
|
IP
|
$2,917.00
|
|
| Hospital Charge Code |
906812572
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$583.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$583.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,312.65
|
| Rate for Payer: Cash Price |
$1,312.65
|
| Rate for Payer: Cigna of CA HMO |
$2,041.90
|
| Rate for Payer: Cigna of CA PPO |
$2,041.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,166.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,166.80
|
| Rate for Payer: Galaxy Health WC |
$2,479.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,750.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,945.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,111.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,805.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$700.08
|
| Rate for Payer: Multiplan Commercial |
$2,333.60
|
| Rate for Payer: Networks By Design Commercial |
$1,458.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,479.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,094.75
|
| Rate for Payer: United Healthcare All Other HMO |
$1,065.58
|
| Rate for Payer: United Healthcare HMO Rider |
$1,042.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$955.32
|
|
|
HC COIL TERUMO AZUR 18D 3X10
|
Facility
|
IP
|
$3,100.00
|
|
| Hospital Charge Code |
906812597
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$620.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$620.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,395.00
|
| Rate for Payer: Cash Price |
$1,395.00
|
| Rate for Payer: Cigna of CA HMO |
$2,170.00
|
| Rate for Payer: Cigna of CA PPO |
$2,170.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,240.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,240.00
|
| Rate for Payer: Galaxy Health WC |
$2,635.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,860.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,067.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,181.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,918.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$744.00
|
| Rate for Payer: Multiplan Commercial |
$2,480.00
|
| Rate for Payer: Networks By Design Commercial |
$1,550.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,635.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,163.43
|
| Rate for Payer: United Healthcare All Other HMO |
$1,132.43
|
| Rate for Payer: United Healthcare HMO Rider |
$1,107.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,015.25
|
|
|
HC COIL TERUMO AZUR 18D 3X10
|
Facility
|
OP
|
$3,100.00
|
|
| Hospital Charge Code |
906812597
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$620.00 |
| Max. Negotiated Rate |
$2,635.00 |
| Rate for Payer: Adventist Health Commercial |
$620.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,635.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,705.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,325.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,795.52
|
| Rate for Payer: Blue Shield of California Commercial |
$2,287.80
|
| Rate for Payer: Blue Shield of California EPN |
$1,506.60
|
| Rate for Payer: Cash Price |
$1,395.00
|
| Rate for Payer: Cigna of CA HMO |
$2,170.00
|
| Rate for Payer: Cigna of CA PPO |
$2,170.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,635.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,635.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,635.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,240.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,240.00
|
| Rate for Payer: Galaxy Health WC |
$2,635.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,860.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,067.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,181.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,918.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$744.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,170.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,170.00
|
| Rate for Payer: Multiplan Commercial |
$2,480.00
|
| Rate for Payer: Networks By Design Commercial |
$1,550.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,635.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,860.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,860.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,163.43
|
| Rate for Payer: United Healthcare All Other HMO |
$1,132.43
|
| Rate for Payer: United Healthcare HMO Rider |
$1,107.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,015.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,635.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,635.00
|
| Rate for Payer: Vantage Medical Group Senior |
$2,635.00
|
|
