|
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 |
$4,365.00 |
| Rate for Payer: Adventist Health Commercial |
$970.00
|
| Rate for Payer: Cash Price |
$2,182.50
|
| Rate for Payer: Central Health Plan Commercial |
$3,880.00
|
| 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: Health Management Network EPO/PPO |
$4,365.00
|
| 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 |
$970.00
|
| Rate for Payer: Multiplan Commercial |
$3,637.50
|
| Rate for Payer: Networks By Design Commercial |
$3,152.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,122.50
|
|
|
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 |
$4,365.00 |
| Rate for Payer: Adventist Health Commercial |
$970.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,945.41
|
| 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 Exchange |
$2,348.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,821.24
|
| Rate for Payer: Blue Shield of California Commercial |
$3,074.90
|
| Rate for Payer: Blue Shield of California EPN |
$1,935.15
|
| Rate for Payer: Cash Price |
$2,182.50
|
| Rate for Payer: Central Health Plan Commercial |
$3,880.00
|
| 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: Health Management Network EPO/PPO |
$4,365.00
|
| 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 |
$970.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,395.00
|
| Rate for Payer: Multiplan Commercial |
$3,637.50
|
| Rate for Payer: Networks By Design Commercial |
$3,152.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,122.50
|
| Rate for Payer: Riverside University Health System MISP |
$1,940.00
|
| 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-18 FIBERED
|
Facility
|
OP
|
$3,900.00
|
|
| Hospital Charge Code |
909020105
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,510.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,368.47
|
| 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 Exchange |
$1,888.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,268.63
|
| Rate for Payer: Blue Shield of California Commercial |
$2,472.60
|
| Rate for Payer: Blue Shield of California EPN |
$1,556.10
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.00
|
| 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: Health Management Network EPO/PPO |
$3,510.00
|
| 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 |
$780.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,730.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: Networks By Design Commercial |
$2,535.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| Rate for Payer: Riverside University Health System MISP |
$1,560.00
|
| 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 |
$3,510.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.00
|
| 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: Health Management Network EPO/PPO |
$3,510.00
|
| 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 |
$780.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| 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 |
$3,510.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,368.47
|
| 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 Exchange |
$1,888.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,268.63
|
| Rate for Payer: Blue Shield of California Commercial |
$2,472.60
|
| Rate for Payer: Blue Shield of California EPN |
$1,556.10
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.00
|
| 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: Health Management Network EPO/PPO |
$3,510.00
|
| 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 |
$780.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,730.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: Networks By Design Commercial |
$2,535.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| Rate for Payer: Riverside University Health System MISP |
$1,560.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,340.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,340.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,950.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,950.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,950.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,950.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,315.00
|
|
|
HC COIL GDC 360 STANDARD
|
Facility
|
IP
|
$3,900.00
|
|
| Hospital Charge Code |
909020106
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,510.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.00
|
| 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: Health Management Network EPO/PPO |
$3,510.00
|
| 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 |
$780.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: Networks By Design Commercial |
$2,535.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
|
|
HC COIL MICROVENTION HYPERSOFT
|
Facility
|
IP
|
$3,783.00
|
|
| Hospital Charge Code |
909020123
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$756.60 |
| Max. Negotiated Rate |
$3,404.70 |
| Rate for Payer: Adventist Health Commercial |
$756.60
|
| Rate for Payer: Cash Price |
$1,702.35
|
| Rate for Payer: Central Health Plan Commercial |
$3,026.40
|
| 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: Health Management Network EPO/PPO |
$3,404.70
|
| 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 |
$756.60
|
| Rate for Payer: Multiplan Commercial |
$2,837.25
|
| Rate for Payer: Networks By Design Commercial |
$2,458.95
|
| Rate for Payer: Prime Health Services Commercial |
$3,215.55
|
|
|
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 |
$3,404.70 |
| Rate for Payer: Adventist Health Commercial |
$756.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,297.42
|
| 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 Exchange |
$1,831.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,200.57
|
| Rate for Payer: Blue Shield of California Commercial |
$2,398.42
|
| Rate for Payer: Blue Shield of California EPN |
$1,509.42
|
| Rate for Payer: Cash Price |
$1,702.35
|
| Rate for Payer: Central Health Plan Commercial |
$3,026.40
|
| 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: Health Management Network EPO/PPO |
$3,404.70
|
| 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 |
$756.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,648.10
|
| Rate for Payer: Multiplan Commercial |
$2,837.25
|
| Rate for Payer: Networks By Design Commercial |
$2,458.95
|
| Rate for Payer: Prime Health Services Commercial |
$3,215.55
|
| Rate for Payer: Riverside University Health System MISP |
$1,513.20
|
| 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 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 |
$4,387.50 |
| Rate for Payer: Adventist Health Commercial |
$975.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,960.59
|
| 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 Exchange |
$2,360.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,835.79
|
| Rate for Payer: Blue Shield of California Commercial |
$3,090.75
|
| Rate for Payer: Blue Shield of California EPN |
$1,945.12
|
| Rate for Payer: Cash Price |
$2,193.75
|
| Rate for Payer: Central Health Plan Commercial |
$3,900.00
|
| 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: Health Management Network EPO/PPO |
$4,387.50
|
| 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 |
$975.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,412.50
|
| Rate for Payer: Multiplan Commercial |
$3,656.25
|
| Rate for Payer: Networks By Design Commercial |
$3,168.75
|
| Rate for Payer: Prime Health Services Commercial |
$4,143.75
|
| Rate for Payer: Riverside University Health System MISP |
$1,950.00
|
| 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 10-30
|
Facility
|
IP
|
$4,875.00
|
|
| Hospital Charge Code |
909020125
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$975.00 |
| Max. Negotiated Rate |
$4,387.50 |
| Rate for Payer: Adventist Health Commercial |
$975.00
|
| Rate for Payer: Cash Price |
$2,193.75
|
| Rate for Payer: Central Health Plan Commercial |
$3,900.00
|
| 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: Health Management Network EPO/PPO |
$4,387.50
|
| 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 |
$975.00
|
| Rate for Payer: Multiplan Commercial |
$3,656.25
|
| Rate for Payer: Networks By Design Commercial |
$3,168.75
|
| Rate for Payer: Prime Health Services Commercial |
$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 |
$3,600.00 |
| Rate for Payer: Adventist Health Commercial |
$800.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,429.20
|
| 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 Exchange |
$1,936.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,326.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2,536.00
|
| Rate for Payer: Blue Shield of California EPN |
$1,596.00
|
| Rate for Payer: Cash Price |
$1,800.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,200.00
|
| 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: Health Management Network EPO/PPO |
$3,600.00
|
| 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 |
$800.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,800.00
|
| Rate for Payer: Multiplan Commercial |
$3,000.00
|
| Rate for Payer: Networks By Design Commercial |
$2,600.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,400.00
|
| Rate for Payer: Riverside University Health System MISP |
$1,600.00
|
| 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 |
$3,600.00 |
| Rate for Payer: Adventist Health Commercial |
$800.00
|
| Rate for Payer: Cash Price |
$1,800.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,200.00
|
| 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: Health Management Network EPO/PPO |
$3,600.00
|
| 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 |
$800.00
|
| Rate for Payer: Multiplan Commercial |
$3,000.00
|
| Rate for Payer: Networks By Design Commercial |
$2,600.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,400.00
|
|
|
HC COIL, MICRUSHERE
|
Facility
|
OP
|
$4,075.00
|
|
| Hospital Charge Code |
909020102
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$815.00 |
| Max. Negotiated Rate |
$3,667.50 |
| Rate for Payer: Adventist Health Commercial |
$815.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,474.75
|
| 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 Exchange |
$1,973.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,370.43
|
| Rate for Payer: Blue Shield of California Commercial |
$2,583.55
|
| Rate for Payer: Blue Shield of California EPN |
$1,625.92
|
| Rate for Payer: Cash Price |
$1,833.75
|
| Rate for Payer: Central Health Plan Commercial |
$3,260.00
|
| 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: Health Management Network EPO/PPO |
$3,667.50
|
| 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 |
$815.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,852.50
|
| Rate for Payer: Multiplan Commercial |
$3,056.25
|
| Rate for Payer: Networks By Design Commercial |
$2,648.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,463.75
|
| Rate for Payer: Riverside University Health System MISP |
$1,630.00
|
| 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, MICRUSHERE
|
Facility
|
IP
|
$4,075.00
|
|
| Hospital Charge Code |
909020102
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$815.00 |
| Max. Negotiated Rate |
$3,667.50 |
| Rate for Payer: Adventist Health Commercial |
$815.00
|
| Rate for Payer: Cash Price |
$1,833.75
|
| Rate for Payer: Central Health Plan Commercial |
$3,260.00
|
| 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: Health Management Network EPO/PPO |
$3,667.50
|
| 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 |
$815.00
|
| Rate for Payer: Multiplan Commercial |
$3,056.25
|
| Rate for Payer: Networks By Design Commercial |
$2,648.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,463.75
|
|
|
HC COIL ORBIT J & J
|
Facility
|
IP
|
$3,900.00
|
|
| Hospital Charge Code |
909020018
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,510.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,127.80
|
| Rate for Payer: Blue Shield of California EPN |
$1,965.60
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.00
|
| 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: Health Management Network EPO/PPO |
$3,510.00
|
| 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 |
$780.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: Networks By Design Commercial |
$1,950.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,463.67
|
| Rate for Payer: United Healthcare All Other HMO |
$1,424.67
|
| Rate for Payer: United Healthcare HMO Rider |
$1,393.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,277.25
|
|
|
HC COIL ORBIT J & J
|
Facility
|
OP
|
$3,900.00
|
|
| Hospital Charge Code |
909020018
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,510.00 |
| 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 Exchange |
$1,780.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,138.76
|
| Rate for Payer: Blue Shield of California Commercial |
$3,127.80
|
| Rate for Payer: Blue Shield of California EPN |
$1,965.60
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.00
|
| 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: Health Management Network EPO/PPO |
$3,510.00
|
| 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 |
$780.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,730.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: Networks By Design Commercial |
$1,950.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| Rate for Payer: Riverside University Health System MISP |
$1,560.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,340.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,340.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,463.67
|
| Rate for Payer: United Healthcare All Other HMO |
$1,424.67
|
| Rate for Payer: United Healthcare HMO Rider |
$1,393.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,277.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,315.00
|
|
|
HC COIL PENUMBRA
|
Facility
|
OP
|
$6,750.00
|
|
| Hospital Charge Code |
909020118
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,350.00 |
| Max. Negotiated Rate |
$6,075.00 |
| Rate for Payer: Adventist Health Commercial |
$1,350.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4,099.27
|
| 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 Exchange |
$3,268.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,926.47
|
| Rate for Payer: Blue Shield of California Commercial |
$4,279.50
|
| Rate for Payer: Blue Shield of California EPN |
$2,693.25
|
| Rate for Payer: Cash Price |
$3,037.50
|
| Rate for Payer: Central Health Plan Commercial |
$5,400.00
|
| 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: Health Management Network EPO/PPO |
$6,075.00
|
| 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 |
$1,350.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,725.00
|
| Rate for Payer: Multiplan Commercial |
$5,062.50
|
| Rate for Payer: Networks By Design Commercial |
$4,387.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,737.50
|
| Rate for Payer: Riverside University Health System MISP |
$2,700.00
|
| 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 |
$6,075.00 |
| Rate for Payer: Adventist Health Commercial |
$1,350.00
|
| Rate for Payer: Cash Price |
$3,037.50
|
| Rate for Payer: Central Health Plan Commercial |
$5,400.00
|
| 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: Health Management Network EPO/PPO |
$6,075.00
|
| 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 |
$1,350.00
|
| Rate for Payer: Multiplan Commercial |
$5,062.50
|
| 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 |
$5,737.50 |
| Rate for Payer: Adventist Health Commercial |
$1,275.00
|
| Rate for Payer: Cash Price |
$2,868.75
|
| Rate for Payer: Central Health Plan Commercial |
$5,100.00
|
| 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: Health Management Network EPO/PPO |
$5,737.50
|
| 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 |
$1,275.00
|
| Rate for Payer: Multiplan Commercial |
$4,781.25
|
| 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 |
$5,737.50 |
| Rate for Payer: Adventist Health Commercial |
$1,275.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,871.54
|
| 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 Exchange |
$3,086.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,708.34
|
| Rate for Payer: Blue Shield of California Commercial |
$4,041.75
|
| Rate for Payer: Blue Shield of California EPN |
$2,543.62
|
| Rate for Payer: Cash Price |
$2,868.75
|
| Rate for Payer: Central Health Plan Commercial |
$5,100.00
|
| 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: Health Management Network EPO/PPO |
$5,737.50
|
| 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 |
$1,275.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,462.50
|
| Rate for Payer: Multiplan Commercial |
$4,781.25
|
| Rate for Payer: Networks By Design Commercial |
$4,143.75
|
| Rate for Payer: Prime Health Services Commercial |
$5,418.75
|
| Rate for Payer: Riverside University Health System MISP |
$2,550.00
|
| 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 |
$3,825.00 |
| Rate for Payer: Adventist Health Commercial |
$850.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,581.03
|
| 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 Exchange |
$2,057.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,472.22
|
| Rate for Payer: Blue Shield of California Commercial |
$2,694.50
|
| Rate for Payer: Blue Shield of California EPN |
$1,695.75
|
| Rate for Payer: Cash Price |
$1,912.50
|
| Rate for Payer: Central Health Plan Commercial |
$3,400.00
|
| 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: Health Management Network EPO/PPO |
$3,825.00
|
| 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 |
$850.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,975.00
|
| Rate for Payer: Multiplan Commercial |
$3,187.50
|
| Rate for Payer: Networks By Design Commercial |
$2,762.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,612.50
|
| Rate for Payer: Riverside University Health System MISP |
$1,700.00
|
| 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 |
$3,825.00 |
| Rate for Payer: Adventist Health Commercial |
$850.00
|
| Rate for Payer: Cash Price |
$1,912.50
|
| Rate for Payer: Central Health Plan Commercial |
$3,400.00
|
| 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: Health Management Network EPO/PPO |
$3,825.00
|
| 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 |
$850.00
|
| Rate for Payer: Multiplan Commercial |
$3,187.50
|
| 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
|
OP
|
$3,900.00
|
|
| Hospital Charge Code |
909020135
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,510.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,368.47
|
| 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 Exchange |
$1,888.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,268.63
|
| Rate for Payer: Blue Shield of California Commercial |
$2,472.60
|
| Rate for Payer: Blue Shield of California EPN |
$1,556.10
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.00
|
| 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: Health Management Network EPO/PPO |
$3,510.00
|
| 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 |
$780.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,730.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: Networks By Design Commercial |
$2,535.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| Rate for Payer: Riverside University Health System MISP |
$1,560.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,340.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,340.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,950.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,950.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,950.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,950.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,315.00
|
|
|
HC COIL TARGET 360 ULTRA
|
Facility
|
IP
|
$3,900.00
|
|
| Hospital Charge Code |
909020135
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,510.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.00
|
| 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: Health Management Network EPO/PPO |
$3,510.00
|
| 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 |
$780.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: Networks By Design Commercial |
$2,535.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
|
|
HC COIL, TARGET HELICAL
|
Facility
|
OP
|
$3,900.00
|
|
| Hospital Charge Code |
909020136
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,510.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,368.47
|
| 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 Exchange |
$1,888.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,268.63
|
| Rate for Payer: Blue Shield of California Commercial |
$2,472.60
|
| Rate for Payer: Blue Shield of California EPN |
$1,556.10
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.00
|
| 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: Health Management Network EPO/PPO |
$3,510.00
|
| 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 |
$780.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,730.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: Networks By Design Commercial |
$2,535.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| Rate for Payer: Riverside University Health System MISP |
$1,560.00
|
| 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
|
|
