|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,852.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$2,587.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,404.25
|
| 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 |
$2,614.93
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,852.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$2,587.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,479.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,404.25
|
| 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
|
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 |
$2,360.67
|
| Rate for Payer: Blue Shield of California Commercial |
$1,977.30
|
| Rate for Payer: Blue Shield of California Commercial |
$2,999.10
|
| 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: 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 |
$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 ORBIT J & J
|
Facility
|
IP
|
$3,900.00
|
|
| Hospital Charge Code |
909020018
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: 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 |
$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 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 |
$4,331.48
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,725.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$4,286.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,450.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,982.50
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,725.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$4,286.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,982.50
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,462.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$4,048.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,761.25
|
| 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 |
$4,090.84
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,462.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$4,048.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,314.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,761.25
|
| 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
|
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 |
$2,727.22
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,975.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$2,698.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,542.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,507.50
|
| 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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,975.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$2,698.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,507.50
|
| 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 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: 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 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 |
$2,502.63
|
| 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, 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 |
$2,502.63
|
| 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, 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: Multiplan Commercial |
$3,120.00
|
| 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: Networks By Design Commercial |
$2,535.00
|
| Rate for Payer: Prime Health Services Commercial |
$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: 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
|
|
|
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 |
$2,566.80
|
| 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 ULTIPAQ
|
Facility
|
IP
|
$3,900.00
|
|
| Hospital Charge Code |
909020103
|
|
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 ULTIPAQ
|
Facility
|
OP
|
$3,900.00
|
|
| Hospital Charge Code |
909020103
|
|
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 COLD AGGLUTININS SCREEN
|
Facility
|
IP
|
$93.00
|
|
|
Service Code
|
CPT 86156
|
| Hospital Charge Code |
900904504
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.60 |
| Max. Negotiated Rate |
$79.05 |
| Rate for Payer: Adventist Health Commercial |
$18.60
|
| Rate for Payer: Cash Price |
$41.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$65.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$37.20
|
| Rate for Payer: EPIC Health Plan Senior |
$37.20
|
| Rate for Payer: Galaxy Health WC |
$79.05
|
| Rate for Payer: Global Benefits Group Commercial |
$55.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$59.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$54.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.32
|
| Rate for Payer: Multiplan Commercial |
$74.40
|
| Rate for Payer: Networks By Design Commercial |
$60.45
|
| Rate for Payer: Prime Health Services Commercial |
$79.05
|
|
|
HC COLD AGGLUTININS SCREEN
|
Facility
|
OP
|
$93.00
|
|
|
Service Code
|
CPT 86156
|
| Hospital Charge Code |
900904504
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.53 |
| Max. Negotiated Rate |
$79.05 |
| Rate for Payer: Adventist Health Commercial |
$18.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$55.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$68.59
|
| Rate for Payer: Blue Shield of California Commercial |
$42.87
|
| Rate for Payer: Blue Shield of California Commercial |
$64.82
|
| Rate for Payer: Cash Price |
$41.85
|
| Rate for Payer: Cash Price |
$41.85
|
| Rate for Payer: Cigna of CA HMO |
$59.52
|
| Rate for Payer: Cigna of CA PPO |
$68.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.07
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$65.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.32
|
| Rate for Payer: EPIC Health Plan Senior |
$8.88
|
| Rate for Payer: Galaxy Health WC |
$79.05
|
| Rate for Payer: Global Benefits Group Commercial |
$55.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$13.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$59.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.81
|
| Rate for Payer: Multiplan Commercial |
$74.40
|
| Rate for Payer: Networks By Design Commercial |
$60.45
|
| Rate for Payer: Prime Health Services Commercial |
$79.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$55.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$55.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.53
|
| Rate for Payer: United Healthcare All Other HMO |
$6.53
|
| Rate for Payer: United Healthcare HMO Rider |
$6.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.53
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.88
|
| Rate for Payer: Vantage Medical Group Senior |
$8.07
|
|
|
HC COLD AGGLUTININ TITER
|
Facility
|
IP
|
$229.00
|
|
|
Service Code
|
CPT 86157
|
| Hospital Charge Code |
900904451
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$45.80 |
| Max. Negotiated Rate |
$194.65 |
| Rate for Payer: Adventist Health Commercial |
$45.80
|
| Rate for Payer: Cash Price |
$103.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$160.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.60
|
| Rate for Payer: EPIC Health Plan Senior |
$91.60
|
| Rate for Payer: Galaxy Health WC |
$194.65
|
| Rate for Payer: Global Benefits Group Commercial |
$137.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$145.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$135.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.96
|
| Rate for Payer: Multiplan Commercial |
$183.20
|
| Rate for Payer: Networks By Design Commercial |
$148.85
|
| Rate for Payer: Prime Health Services Commercial |
$194.65
|
|
|
HC COLD AGGLUTININ TITER
|
Facility
|
OP
|
$229.00
|
|
|
Service Code
|
CPT 86157
|
| Hospital Charge Code |
900904451
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.53 |
| Max. Negotiated Rate |
$194.65 |
| Rate for Payer: Adventist Health Commercial |
$45.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$67.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$83.25
|
| Rate for Payer: Blue Shield of California Commercial |
$105.57
|
| Rate for Payer: Blue Shield of California Commercial |
$159.61
|
| Rate for Payer: Cash Price |
$103.05
|
| Rate for Payer: Cash Price |
$103.05
|
| Rate for Payer: Cigna of CA HMO |
$146.56
|
| Rate for Payer: Cigna of CA PPO |
$169.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$160.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.30
|
| Rate for Payer: EPIC Health Plan Senior |
$8.87
|
| Rate for Payer: Galaxy Health WC |
$194.65
|
| Rate for Payer: Global Benefits Group Commercial |
$137.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$13.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$145.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.80
|
| Rate for Payer: Multiplan Commercial |
$183.20
|
| Rate for Payer: Networks By Design Commercial |
$148.85
|
| Rate for Payer: Prime Health Services Commercial |
$194.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$137.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$137.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.53
|
| Rate for Payer: United Healthcare All Other HMO |
$6.53
|
| Rate for Payer: United Healthcare HMO Rider |
$6.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.53
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.87
|
| Rate for Payer: Vantage Medical Group Senior |
$8.06
|
|
|
HC COLLAR CERVICAL 4IN
|
Facility
|
IP
|
$18.78
|
|
|
Service Code
|
CPT L0120
|
| Hospital Charge Code |
901698894
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3.76 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$3.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$8.45
|
| Rate for Payer: Cash Price |
$8.45
|
| Rate for Payer: Cigna of CA HMO |
$13.15
|
| Rate for Payer: Cigna of CA PPO |
$13.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.51
|
| Rate for Payer: EPIC Health Plan Senior |
$7.51
|
| Rate for Payer: Galaxy Health WC |
$15.96
|
| Rate for Payer: Global Benefits Group Commercial |
$11.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.51
|
| Rate for Payer: Multiplan Commercial |
$15.02
|
| Rate for Payer: Networks By Design Commercial |
$12.21
|
| Rate for Payer: Prime Health Services Commercial |
$15.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.05
|
| Rate for Payer: United Healthcare All Other HMO |
$6.86
|
| Rate for Payer: United Healthcare HMO Rider |
$6.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.15
|
|
|
HC COLLAR CERVICAL 4IN
|
Facility
|
OP
|
$18.78
|
|
|
Service Code
|
CPT L0120
|
| Hospital Charge Code |
901698894
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$4.51 |
| Max. Negotiated Rate |
$40.47 |
| Rate for Payer: Adventist Health Commercial |
$7.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.37
|
| Rate for Payer: Blue Shield of California Commercial |
$9.52
|
| Rate for Payer: Blue Shield of California Commercial |
$14.44
|
| Rate for Payer: Cash Price |
$8.45
|
| Rate for Payer: Cash Price |
$8.45
|
| Rate for Payer: Cigna of CA HMO |
$13.15
|
| Rate for Payer: Cigna of CA PPO |
$13.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.96
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.51
|
| Rate for Payer: EPIC Health Plan Senior |
$7.51
|
| Rate for Payer: Galaxy Health WC |
$15.96
|
| Rate for Payer: Global Benefits Group Commercial |
$11.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$35.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$40.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.15
|
| Rate for Payer: Multiplan Commercial |
$15.02
|
| Rate for Payer: Networks By Design Commercial |
$9.39
|
| Rate for Payer: Prime Health Services Commercial |
$15.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.27
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.05
|
| Rate for Payer: United Healthcare All Other HMO |
$6.86
|
| Rate for Payer: United Healthcare HMO Rider |
$6.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.96
|
| Rate for Payer: Vantage Medical Group Senior |
$15.96
|
|
|
HC COLLAR CERVICAL LG 4.0 X 20
|
Facility
|
OP
|
$43.30
|
|
|
Service Code
|
CPT L0120
|
| Hospital Charge Code |
901606823
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$10.39 |
| Max. Negotiated Rate |
$40.47 |
| Rate for Payer: Adventist Health Commercial |
$17.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$32.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.21
|
| Rate for Payer: Blue Shield of California Commercial |
$33.30
|
| Rate for Payer: Blue Shield of California Commercial |
$21.95
|
| Rate for Payer: Cash Price |
$19.48
|
| Rate for Payer: Cash Price |
$19.48
|
| Rate for Payer: Cigna of CA HMO |
$30.31
|
| Rate for Payer: Cigna of CA PPO |
$30.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$36.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$36.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$30.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.32
|
| Rate for Payer: EPIC Health Plan Senior |
$17.32
|
| Rate for Payer: Galaxy Health WC |
$36.80
|
| Rate for Payer: Global Benefits Group Commercial |
$25.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$35.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$27.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$40.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30.31
|
| Rate for Payer: Multiplan Commercial |
$34.64
|
| Rate for Payer: Networks By Design Commercial |
$21.65
|
| Rate for Payer: Prime Health Services Commercial |
$36.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.98
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.25
|
| Rate for Payer: United Healthcare All Other HMO |
$15.82
|
| Rate for Payer: United Healthcare HMO Rider |
$15.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$36.80
|
| Rate for Payer: Vantage Medical Group Senior |
$36.80
|
|
