|
HC COAG TIME ACTIVATED
|
Facility
|
IP
|
$284.00
|
|
|
Service Code
|
CPT 85347
|
| Hospital Charge Code |
900910011
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$56.80 |
| Max. Negotiated Rate |
$241.40 |
| Rate for Payer: Adventist Health Commercial |
$56.80
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$198.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$113.60
|
| Rate for Payer: EPIC Health Plan Senior |
$113.60
|
| Rate for Payer: Galaxy Health WC |
$241.40
|
| Rate for Payer: Global Benefits Group Commercial |
$170.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$180.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$167.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.16
|
| Rate for Payer: Multiplan Commercial |
$227.20
|
| Rate for Payer: Networks By Design Commercial |
$184.60
|
| Rate for Payer: Prime Health Services Commercial |
$241.40
|
|
|
HC COCAINE METABOLITE CONF
|
Facility
|
OP
|
$359.00
|
|
|
Service Code
|
CPT 80353
|
| Hospital Charge Code |
900910518
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$305.15 |
| Rate for Payer: EPIC Health Plan Commercial |
$143.60
|
| Rate for Payer: EPIC Health Plan Senior |
$119.20
|
| Rate for Payer: EPIC Health Plan Senior |
$143.60
|
| Rate for Payer: Galaxy Health WC |
$253.30
|
| Rate for Payer: Galaxy Health WC |
$305.15
|
| Rate for Payer: Adventist Health Commercial |
$71.80
|
| Rate for Payer: Adventist Health Commercial |
$59.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$253.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$305.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$197.45
|
| 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: Alpha Care Medical Group Medicare Advantage/Dual Product |
$269.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$150.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$150.10
|
| Rate for Payer: Blue Shield of California Commercial |
$250.22
|
| Rate for Payer: Blue Shield of California Commercial |
$137.38
|
| Rate for Payer: Blue Shield of California Commercial |
$207.71
|
| Rate for Payer: Blue Shield of California Commercial |
$165.50
|
| Rate for Payer: Cash Price |
$161.55
|
| Rate for Payer: Cash Price |
$161.55
|
| 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 HMO |
$229.76
|
| Rate for Payer: Cigna of CA PPO |
$220.52
|
| Rate for Payer: Cigna of CA PPO |
$265.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$305.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$253.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$305.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$253.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$305.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$253.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$251.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$208.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$119.20
|
| Rate for Payer: Global Benefits Group Commercial |
$178.80
|
| Rate for Payer: Global Benefits Group Commercial |
$215.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$189.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$227.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$108.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$130.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$175.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$211.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.16
|
| 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 Medi-Cal |
$251.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$208.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$251.30
|
| Rate for Payer: Multiplan Commercial |
$287.20
|
| Rate for Payer: Multiplan Commercial |
$238.40
|
| Rate for Payer: Networks By Design Commercial |
$193.70
|
| Rate for Payer: Networks By Design Commercial |
$233.35
|
| Rate for Payer: Prime Health Services Commercial |
$305.15
|
| Rate for Payer: Prime Health Services Commercial |
$253.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$215.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$178.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$215.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$178.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$179.50
|
| 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 All Other HMO |
$179.50
|
| Rate for Payer: United Healthcare HMO Rider |
$179.50
|
| Rate for Payer: United Healthcare HMO Rider |
$149.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$149.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$179.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$253.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$305.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$253.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$305.15
|
| Rate for Payer: Vantage Medical Group Senior |
$253.30
|
| Rate for Payer: Vantage Medical Group Senior |
$305.15
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$251.30
|
| 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 Foundation Hospitals Commercial/Self Funded |
$227.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$211.81
|
| 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
|
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 |
$314.93
|
| 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 |
$342.67
|
| Rate for Payer: Blue Shield of California Commercial |
$340.69
|
| Rate for Payer: Blue Shield of California Commercial |
$224.81
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$373.80
|
| 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 Foundation Hospitals Commercial/Self Funded |
$339.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$91.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$315.06
|
| 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 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: EPIC Health Plan Senior |
$213.60
|
| Rate for Payer: Galaxy Health WC |
$453.90
|
| Rate for Payer: Adventist Health Commercial |
$106.80
|
| Rate for Payer: Cash Price |
$240.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$373.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$213.60
|
| Rate for Payer: Global Benefits Group Commercial |
$320.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$339.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$315.06
|
| 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 COIL AXIUM
|
Facility
|
IP
|
$3,375.00
|
|
| Hospital Charge Code |
909020035
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$675.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$675.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$2,143.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,991.25
|
| 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
|
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 |
$2,042.89
|
| Rate for Payer: Blue Shield of California Commercial |
$1,711.12
|
| Rate for Payer: Blue Shield of California Commercial |
$2,595.38
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$2,143.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,225.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,991.25
|
| 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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$2,476.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,301.00
|
| 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 |
$2,502.63
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$2,476.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,415.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,301.00
|
| 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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,202.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$2,905.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,699.25
|
| 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 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 |
$2,935.78
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,202.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$2,905.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,660.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,699.25
|
| 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 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 |
$2,502.63
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$2,476.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,415.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,301.00
|
| 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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$2,476.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,301.00
|
| 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-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 |
$3,112.24
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,395.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$3,079.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,760.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,861.50
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,395.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$3,079.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,861.50
|
| 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
|
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 |
$2,502.63
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$2,476.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,415.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,301.00
|
| 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-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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$2,476.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,301.00
|
| 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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$2,476.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,301.00
|
| 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 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 |
$2,502.63
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$2,476.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,415.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,301.00
|
| 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 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 |
$2,427.55
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,648.10
|
| 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 Foundation Hospitals Commercial/Self Funded |
$2,402.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,373.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,231.97
|
| 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
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,648.10
|
| 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 Foundation Hospitals Commercial/Self Funded |
$2,402.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,231.97
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,412.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$3,095.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,876.25
|
| 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 |
$3,128.29
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,412.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$3,095.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,769.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,876.25
|
| 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 |
$2,566.80
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,800.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$2,540.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,452.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,360.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,800.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$2,540.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,360.00
|
| 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
|
|
