|
HC COIL CASHMERE
|
Facility
|
IP
|
$4,575.00
|
|
| Hospital Charge Code |
909020101
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$915.00 |
| Max. Negotiated Rate |
$4,117.50 |
| Rate for Payer: Adventist Health Commercial |
$915.00
|
| Rate for Payer: Cash Price |
$2,516.25
|
| Rate for Payer: Central Health Plan Commercial |
$3,660.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,830.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,830.00
|
| Rate for Payer: Galaxy Health WC |
$3,888.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,745.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,117.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,051.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,743.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,831.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$915.00
|
| Rate for Payer: Multiplan Commercial |
$3,431.25
|
| Rate for Payer: Networks By Design Commercial |
$2,973.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,888.75
|
|
|
HC COIL CASHMERE
|
Facility
|
OP
|
$4,575.00
|
|
| Hospital Charge Code |
909020101
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$915.00 |
| Max. Negotiated Rate |
$4,117.50 |
| Rate for Payer: Adventist Health Commercial |
$915.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,778.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,888.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,516.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,431.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,215.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,686.90
|
| Rate for Payer: Blue Shield of California Commercial |
$2,795.32
|
| Rate for Payer: Blue Shield of California EPN |
$1,825.42
|
| Rate for Payer: Cash Price |
$2,516.25
|
| Rate for Payer: Central Health Plan Commercial |
$3,660.00
|
| Rate for Payer: Cigna of CA HMO |
$2,928.00
|
| Rate for Payer: Cigna of CA PPO |
$3,385.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,888.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,888.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,888.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,830.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,830.00
|
| Rate for Payer: Galaxy Health WC |
$3,888.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,745.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,117.50
|
| Rate for Payer: InnovAge PACE Commercial |
$2,287.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,051.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,743.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,831.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$915.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,202.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,202.50
|
| Rate for Payer: Multiplan Commercial |
$3,431.25
|
| Rate for Payer: Networks By Design Commercial |
$2,973.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,888.75
|
| Rate for Payer: Riverside University Health System MISP |
$1,830.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,745.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,745.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,287.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,287.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,287.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,287.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,888.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,888.75
|
| Rate for Payer: Vantage Medical Group Senior |
$3,888.75
|
|
|
HC COIL COOK MREYE EMBOL CUSTOM
|
Facility
|
IP
|
$584.00
|
|
| Hospital Charge Code |
906812477
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$116.80 |
| Max. Negotiated Rate |
$525.60 |
| Rate for Payer: Adventist Health Commercial |
$116.80
|
| Rate for Payer: Blue Shield of California Commercial |
$451.43
|
| Rate for Payer: Blue Shield of California EPN |
$294.34
|
| Rate for Payer: Cash Price |
$321.20
|
| Rate for Payer: Central Health Plan Commercial |
$467.20
|
| Rate for Payer: Cigna of CA HMO |
$408.80
|
| Rate for Payer: Cigna of CA PPO |
$408.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$233.60
|
| Rate for Payer: EPIC Health Plan Senior |
$233.60
|
| Rate for Payer: Galaxy Health WC |
$496.40
|
| Rate for Payer: Global Benefits Group Commercial |
$350.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$525.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$389.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$222.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$361.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.80
|
| Rate for Payer: Multiplan Commercial |
$438.00
|
| Rate for Payer: Networks By Design Commercial |
$292.00
|
| Rate for Payer: Prime Health Services Commercial |
$496.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$219.18
|
| Rate for Payer: United Healthcare All Other HMO |
$213.34
|
| Rate for Payer: United Healthcare HMO Rider |
$208.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$191.26
|
|
|
HC COIL COOK MREYE EMBOL CUSTOM
|
Facility
|
OP
|
$584.00
|
|
| Hospital Charge Code |
906812477
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$116.80 |
| Max. Negotiated Rate |
$525.60 |
| Rate for Payer: Adventist Health Commercial |
$116.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$496.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$321.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$438.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$266.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$323.36
|
| Rate for Payer: Blue Shield of California Commercial |
$451.43
|
| Rate for Payer: Blue Shield of California EPN |
$294.34
|
| Rate for Payer: Cash Price |
$321.20
|
| Rate for Payer: Central Health Plan Commercial |
$467.20
|
| Rate for Payer: Cigna of CA HMO |
$408.80
|
| Rate for Payer: Cigna of CA PPO |
$408.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$496.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$496.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$496.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$233.60
|
| Rate for Payer: EPIC Health Plan Senior |
$233.60
|
| Rate for Payer: Galaxy Health WC |
$496.40
|
| Rate for Payer: Global Benefits Group Commercial |
$350.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$525.60
|
| Rate for Payer: InnovAge PACE Commercial |
$292.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$389.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$222.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$361.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$408.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$408.80
|
| Rate for Payer: Multiplan Commercial |
$438.00
|
| Rate for Payer: Networks By Design Commercial |
$292.00
|
| Rate for Payer: Prime Health Services Commercial |
$496.40
|
| Rate for Payer: Riverside University Health System MISP |
$233.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$350.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$350.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$219.18
|
| Rate for Payer: United Healthcare All Other HMO |
$213.34
|
| Rate for Payer: United Healthcare HMO Rider |
$208.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$191.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$496.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$496.40
|
| Rate for Payer: Vantage Medical Group Senior |
$496.40
|
|
|
HC COIL COOK MREYE EMBOLIZATION
|
Facility
|
IP
|
$464.00
|
|
| Hospital Charge Code |
906812478
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$92.80 |
| Max. Negotiated Rate |
$417.60 |
| Rate for Payer: Adventist Health Commercial |
$92.80
|
| Rate for Payer: Blue Shield of California Commercial |
$358.67
|
| Rate for Payer: Blue Shield of California EPN |
$233.86
|
| Rate for Payer: Cash Price |
$255.20
|
| Rate for Payer: Central Health Plan Commercial |
$371.20
|
| Rate for Payer: Cigna of CA HMO |
$324.80
|
| Rate for Payer: Cigna of CA PPO |
$324.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.60
|
| Rate for Payer: EPIC Health Plan Senior |
$185.60
|
| Rate for Payer: Galaxy Health WC |
$394.40
|
| Rate for Payer: Global Benefits Group Commercial |
$278.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$417.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$309.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$176.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$287.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.80
|
| Rate for Payer: Multiplan Commercial |
$348.00
|
| Rate for Payer: Networks By Design Commercial |
$232.00
|
| Rate for Payer: Prime Health Services Commercial |
$394.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$174.14
|
| Rate for Payer: United Healthcare All Other HMO |
$169.50
|
| Rate for Payer: United Healthcare HMO Rider |
$165.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$151.96
|
|
|
HC COIL COOK MREYE EMBOLIZATION
|
Facility
|
OP
|
$464.00
|
|
| Hospital Charge Code |
906812478
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$92.80 |
| Max. Negotiated Rate |
$417.60 |
| Rate for Payer: Adventist Health Commercial |
$92.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$394.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$255.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$348.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$211.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$256.92
|
| Rate for Payer: Blue Shield of California Commercial |
$358.67
|
| Rate for Payer: Blue Shield of California EPN |
$233.86
|
| Rate for Payer: Cash Price |
$255.20
|
| Rate for Payer: Central Health Plan Commercial |
$371.20
|
| Rate for Payer: Cigna of CA HMO |
$324.80
|
| Rate for Payer: Cigna of CA PPO |
$324.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$394.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$394.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$394.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.60
|
| Rate for Payer: EPIC Health Plan Senior |
$185.60
|
| Rate for Payer: Galaxy Health WC |
$394.40
|
| Rate for Payer: Global Benefits Group Commercial |
$278.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$417.60
|
| Rate for Payer: InnovAge PACE Commercial |
$232.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$309.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$176.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$287.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$324.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$324.80
|
| Rate for Payer: Multiplan Commercial |
$348.00
|
| Rate for Payer: Networks By Design Commercial |
$232.00
|
| Rate for Payer: Prime Health Services Commercial |
$394.40
|
| Rate for Payer: Riverside University Health System MISP |
$185.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$278.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$278.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$174.14
|
| Rate for Payer: United Healthcare All Other HMO |
$169.50
|
| Rate for Payer: United Healthcare HMO Rider |
$165.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$151.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$394.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$394.40
|
| Rate for Payer: Vantage Medical Group Senior |
$394.40
|
|
|
HC COIL DELTA PLUSH
|
Facility
|
IP
|
$3,900.00
|
|
| Hospital Charge Code |
909020100
|
|
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 |
$2,145.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.00
|
| 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 Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$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 DELTA PLUSH
|
Facility
|
OP
|
$3,900.00
|
|
| Hospital Charge Code |
909020100
|
|
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 |
$2,290.47
|
| Rate for Payer: Blue Shield of California Commercial |
$2,382.90
|
| Rate for Payer: Blue Shield of California EPN |
$1,556.10
|
| Rate for Payer: Cash Price |
$2,145.00
|
| 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: 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: InnovAge PACE Commercial |
$1,950.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$780.00
|
| 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 |
$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-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 |
$2,667.50
|
| Rate for Payer: Central Health Plan Commercial |
$3,880.00
|
| 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 Permanente of CA Commercial/Self Funded |
$3,234.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,847.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,002.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$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 |
$2,848.41
|
| Rate for Payer: Blue Shield of California Commercial |
$2,963.35
|
| Rate for Payer: Blue Shield of California EPN |
$1,935.15
|
| Rate for Payer: Cash Price |
$2,667.50
|
| 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: 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: InnovAge PACE Commercial |
$2,425.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,234.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,847.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,002.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$970.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,395.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,395.00
|
| Rate for Payer: Multiplan Commercial |
$3,637.50
|
| 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
|
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 |
$2,145.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.00
|
| 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 Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$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-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 |
$2,290.47
|
| Rate for Payer: Blue Shield of California Commercial |
$2,382.90
|
| Rate for Payer: Blue Shield of California EPN |
$1,556.10
|
| Rate for Payer: Cash Price |
$2,145.00
|
| 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: 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: InnovAge PACE Commercial |
$1,950.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$780.00
|
| 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 |
$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
|
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 |
$2,290.47
|
| Rate for Payer: Blue Shield of California Commercial |
$2,382.90
|
| Rate for Payer: Blue Shield of California EPN |
$1,556.10
|
| Rate for Payer: Cash Price |
$2,145.00
|
| 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: 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: InnovAge PACE Commercial |
$1,950.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$780.00
|
| 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 |
$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 |
$2,145.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.00
|
| 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 Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$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
|
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 |
$2,221.76
|
| Rate for Payer: Blue Shield of California Commercial |
$2,311.41
|
| Rate for Payer: Blue Shield of California EPN |
$1,509.42
|
| Rate for Payer: Cash Price |
$2,080.65
|
| 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: 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: InnovAge PACE Commercial |
$1,891.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,523.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,441.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,341.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$756.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,648.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,648.10
|
| Rate for Payer: Multiplan Commercial |
$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 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 |
$2,080.65
|
| Rate for Payer: Central Health Plan Commercial |
$3,026.40
|
| 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 Permanente of CA Commercial/Self Funded |
$2,523.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,441.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,341.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$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 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 |
$2,863.09
|
| Rate for Payer: Blue Shield of California Commercial |
$2,978.62
|
| Rate for Payer: Blue Shield of California EPN |
$1,945.12
|
| Rate for Payer: Cash Price |
$2,681.25
|
| 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: 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: InnovAge PACE Commercial |
$2,437.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,251.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,857.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,017.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$975.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,412.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,412.50
|
| Rate for Payer: Multiplan Commercial |
$3,656.25
|
| 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 |
$2,681.25
|
| Rate for Payer: Central Health Plan Commercial |
$3,900.00
|
| 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 Permanente of CA Commercial/Self Funded |
$3,251.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,857.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,017.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$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 |
$2,349.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,444.00
|
| Rate for Payer: Blue Shield of California EPN |
$1,596.00
|
| Rate for Payer: Cash Price |
$2,200.00
|
| 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: 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: InnovAge PACE Commercial |
$2,000.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,668.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,524.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,476.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$800.00
|
| 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 |
$3,000.00
|
| 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 |
$2,200.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,200.00
|
| 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 Permanente of CA Commercial/Self Funded |
$2,668.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,524.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,476.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$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 |
$2,393.25
|
| Rate for Payer: Blue Shield of California Commercial |
$2,489.82
|
| Rate for Payer: Blue Shield of California EPN |
$1,625.92
|
| Rate for Payer: Cash Price |
$2,241.25
|
| 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: 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: InnovAge PACE Commercial |
$2,037.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,718.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,552.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,522.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$815.00
|
| 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 |
$3,056.25
|
| 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 |
$2,241.25
|
| Rate for Payer: Central Health Plan Commercial |
$3,260.00
|
| 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 Permanente of CA Commercial/Self Funded |
$2,718.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,552.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,522.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$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 |
$3,014.70
|
| Rate for Payer: Blue Shield of California EPN |
$1,965.60
|
| Rate for Payer: Cash Price |
$2,145.00
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$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 |
$2,159.43
|
| Rate for Payer: Blue Shield of California Commercial |
$3,014.70
|
| Rate for Payer: Blue Shield of California EPN |
$1,965.60
|
| Rate for Payer: Cash Price |
$2,145.00
|
| 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: 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: InnovAge PACE Commercial |
$1,950.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$780.00
|
| 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 |
$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
|
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 |
$3,712.50
|
| Rate for Payer: Central Health Plan Commercial |
$5,400.00
|
| 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 Permanente of CA Commercial/Self Funded |
$4,502.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,571.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,178.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,350.00
|
| 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
|
|
