|
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
|
|
|
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 |
$3,506.25
|
| Rate for Payer: Central Health Plan Commercial |
$5,100.00
|
| 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 Permanente of CA Commercial/Self Funded |
$4,252.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,428.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,946.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,275.00
|
| 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 |
$3,744.04
|
| Rate for Payer: Blue Shield of California Commercial |
$3,895.12
|
| Rate for Payer: Blue Shield of California EPN |
$2,543.62
|
| Rate for Payer: Cash Price |
$3,506.25
|
| 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: 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: InnovAge PACE Commercial |
$3,187.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,252.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,428.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,946.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,275.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,462.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,462.50
|
| Rate for Payer: Multiplan Commercial |
$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
|
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 |
$2,337.50
|
| Rate for Payer: Central Health Plan Commercial |
$3,400.00
|
| 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 Permanente of CA Commercial/Self Funded |
$2,834.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,619.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,630.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$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 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 |
$2,496.03
|
| Rate for Payer: Blue Shield of California Commercial |
$2,596.75
|
| Rate for Payer: Blue Shield of California EPN |
$1,695.75
|
| Rate for Payer: Cash Price |
$2,337.50
|
| 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: 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: InnovAge PACE Commercial |
$2,125.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,834.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,619.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,630.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$850.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,975.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,975.00
|
| Rate for Payer: Multiplan Commercial |
$3,187.50
|
| 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 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 |
$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 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 |
$2,290.47
|
| 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, 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 |
$2,290.47
|
| 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, TARGET HELICAL
|
Facility
|
IP
|
$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: 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, TARGET STANDARD
|
Facility
|
OP
|
$4,000.00
|
|
| Hospital Charge Code |
909020137
|
|
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, TARGET STANDARD
|
Facility
|
IP
|
$4,000.00
|
|
| Hospital Charge Code |
909020137
|
|
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 TERUMO AZUR 18D 2X4
|
Facility
|
OP
|
$2,917.00
|
|
| Hospital Charge Code |
906812572
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$583.40 |
| Max. Negotiated Rate |
$2,625.30 |
| Rate for Payer: Adventist Health Commercial |
$583.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,479.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,604.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,187.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,331.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,615.14
|
| Rate for Payer: Blue Shield of California Commercial |
$2,254.84
|
| Rate for Payer: Blue Shield of California EPN |
$1,470.17
|
| Rate for Payer: Cash Price |
$1,604.35
|
| Rate for Payer: Central Health Plan Commercial |
$2,333.60
|
| Rate for Payer: Cigna of CA HMO |
$2,041.90
|
| Rate for Payer: Cigna of CA PPO |
$2,041.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,479.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,479.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,479.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,166.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,166.80
|
| Rate for Payer: Galaxy Health WC |
$2,479.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,750.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,625.30
|
| Rate for Payer: InnovAge PACE Commercial |
$1,458.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,945.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,111.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,805.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$583.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,041.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,041.90
|
| Rate for Payer: Multiplan Commercial |
$2,187.75
|
| Rate for Payer: Networks By Design Commercial |
$1,458.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,479.45
|
| Rate for Payer: Riverside University Health System MISP |
$1,166.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,750.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,750.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,094.75
|
| Rate for Payer: United Healthcare All Other HMO |
$1,065.58
|
| Rate for Payer: United Healthcare HMO Rider |
$1,042.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$955.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,479.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,479.45
|
| Rate for Payer: Vantage Medical Group Senior |
$2,479.45
|
|
|
HC COIL TERUMO AZUR 18D 2X4
|
Facility
|
IP
|
$2,917.00
|
|
| Hospital Charge Code |
906812572
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$583.40 |
| Max. Negotiated Rate |
$2,625.30 |
| Rate for Payer: Adventist Health Commercial |
$583.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,254.84
|
| Rate for Payer: Blue Shield of California EPN |
$1,470.17
|
| Rate for Payer: Cash Price |
$1,604.35
|
| Rate for Payer: Central Health Plan Commercial |
$2,333.60
|
| Rate for Payer: Cigna of CA HMO |
$2,041.90
|
| Rate for Payer: Cigna of CA PPO |
$2,041.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,166.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,166.80
|
| Rate for Payer: Galaxy Health WC |
$2,479.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,750.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,625.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,945.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,111.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,805.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$583.40
|
| Rate for Payer: Multiplan Commercial |
$2,187.75
|
| Rate for Payer: Networks By Design Commercial |
$1,458.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,479.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,094.75
|
| Rate for Payer: United Healthcare All Other HMO |
$1,065.58
|
| Rate for Payer: United Healthcare HMO Rider |
$1,042.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$955.32
|
|
|
HC COIL TERUMO AZUR 18D 3X10
|
Facility
|
OP
|
$3,100.00
|
|
| Hospital Charge Code |
906812597
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$620.00 |
| Max. Negotiated Rate |
$2,790.00 |
| Rate for Payer: Adventist Health Commercial |
$620.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,635.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,705.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,325.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,415.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,716.47
|
| Rate for Payer: Blue Shield of California Commercial |
$2,396.30
|
| Rate for Payer: Blue Shield of California EPN |
$1,562.40
|
| Rate for Payer: Cash Price |
$1,705.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,480.00
|
| Rate for Payer: Cigna of CA HMO |
$2,170.00
|
| Rate for Payer: Cigna of CA PPO |
$2,170.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,635.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,635.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,635.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,240.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,240.00
|
| Rate for Payer: Galaxy Health WC |
$2,635.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,860.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,790.00
|
| Rate for Payer: InnovAge PACE Commercial |
$1,550.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,067.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,181.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,918.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$620.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,170.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,170.00
|
| Rate for Payer: Multiplan Commercial |
$2,325.00
|
| Rate for Payer: Networks By Design Commercial |
$1,550.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,635.00
|
| Rate for Payer: Riverside University Health System MISP |
$1,240.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,860.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,860.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,163.43
|
| Rate for Payer: United Healthcare All Other HMO |
$1,132.43
|
| Rate for Payer: United Healthcare HMO Rider |
$1,107.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,015.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,635.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,635.00
|
| Rate for Payer: Vantage Medical Group Senior |
$2,635.00
|
|
|
HC COIL TERUMO AZUR 18D 3X10
|
Facility
|
IP
|
$3,100.00
|
|
| Hospital Charge Code |
906812597
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$620.00 |
| Max. Negotiated Rate |
$2,790.00 |
| Rate for Payer: Adventist Health Commercial |
$620.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,396.30
|
| Rate for Payer: Blue Shield of California EPN |
$1,562.40
|
| Rate for Payer: Cash Price |
$1,705.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,480.00
|
| Rate for Payer: Cigna of CA HMO |
$2,170.00
|
| Rate for Payer: Cigna of CA PPO |
$2,170.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,240.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,240.00
|
| Rate for Payer: Galaxy Health WC |
$2,635.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,860.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,790.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,067.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,181.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,918.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$620.00
|
| Rate for Payer: Multiplan Commercial |
$2,325.00
|
| Rate for Payer: Networks By Design Commercial |
$1,550.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,635.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,163.43
|
| Rate for Payer: United Healthcare All Other HMO |
$1,132.43
|
| Rate for Payer: United Healthcare HMO Rider |
$1,107.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,015.25
|
|
|
HC COIL TERUMO AZUR 18D 4X15
|
Facility
|
OP
|
$3,318.00
|
|
| Hospital Charge Code |
906812599
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$663.60 |
| Max. Negotiated Rate |
$2,986.20 |
| Rate for Payer: Adventist Health Commercial |
$663.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,820.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,824.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,488.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,515.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,837.18
|
| Rate for Payer: Blue Shield of California Commercial |
$2,564.81
|
| Rate for Payer: Blue Shield of California EPN |
$1,672.27
|
| Rate for Payer: Cash Price |
$1,824.90
|
| Rate for Payer: Central Health Plan Commercial |
$2,654.40
|
| Rate for Payer: Cigna of CA HMO |
$2,322.60
|
| Rate for Payer: Cigna of CA PPO |
$2,322.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,820.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,820.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,820.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,327.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,327.20
|
| Rate for Payer: Galaxy Health WC |
$2,820.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,990.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,986.20
|
| Rate for Payer: InnovAge PACE Commercial |
$1,659.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,213.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,264.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,053.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$663.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,322.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,322.60
|
| Rate for Payer: Multiplan Commercial |
$2,488.50
|
| Rate for Payer: Networks By Design Commercial |
$1,659.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,820.30
|
| Rate for Payer: Riverside University Health System MISP |
$1,327.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,990.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,990.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,245.25
|
| Rate for Payer: United Healthcare All Other HMO |
$1,212.07
|
| Rate for Payer: United Healthcare HMO Rider |
$1,185.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,086.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,820.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,820.30
|
| Rate for Payer: Vantage Medical Group Senior |
$2,820.30
|
|
|
HC COIL TERUMO AZUR 18D 4X15
|
Facility
|
IP
|
$3,318.00
|
|
| Hospital Charge Code |
906812599
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$663.60 |
| Max. Negotiated Rate |
$2,986.20 |
| Rate for Payer: Adventist Health Commercial |
$663.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,564.81
|
| Rate for Payer: Blue Shield of California EPN |
$1,672.27
|
| Rate for Payer: Cash Price |
$1,824.90
|
| Rate for Payer: Central Health Plan Commercial |
$2,654.40
|
| Rate for Payer: Cigna of CA HMO |
$2,322.60
|
| Rate for Payer: Cigna of CA PPO |
$2,322.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,327.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,327.20
|
| Rate for Payer: Galaxy Health WC |
$2,820.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,990.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,986.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,213.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,264.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,053.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$663.60
|
| Rate for Payer: Multiplan Commercial |
$2,488.50
|
| Rate for Payer: Networks By Design Commercial |
$1,659.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,820.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,245.25
|
| Rate for Payer: United Healthcare All Other HMO |
$1,212.07
|
| Rate for Payer: United Healthcare HMO Rider |
$1,185.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,086.64
|
|
|
HC COIL TERUMO AZUR 18D 4X20
|
Facility
|
OP
|
$3,501.00
|
|
| Hospital Charge Code |
906812600
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$700.20 |
| Max. Negotiated Rate |
$3,150.90 |
| Rate for Payer: Adventist Health Commercial |
$700.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,975.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,925.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,625.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,598.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,938.50
|
| Rate for Payer: Blue Shield of California Commercial |
$2,706.27
|
| Rate for Payer: Blue Shield of California EPN |
$1,764.50
|
| Rate for Payer: Cash Price |
$1,925.55
|
| Rate for Payer: Central Health Plan Commercial |
$2,800.80
|
| Rate for Payer: Cigna of CA HMO |
$2,450.70
|
| Rate for Payer: Cigna of CA PPO |
$2,450.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,975.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,975.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,975.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,400.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,400.40
|
| Rate for Payer: Galaxy Health WC |
$2,975.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,100.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,150.90
|
| Rate for Payer: InnovAge PACE Commercial |
$1,750.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,335.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,333.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,167.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$700.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,450.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,450.70
|
| Rate for Payer: Multiplan Commercial |
$2,625.75
|
| Rate for Payer: Networks By Design Commercial |
$1,750.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,975.85
|
| Rate for Payer: Riverside University Health System MISP |
$1,400.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,100.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,100.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,313.93
|
| Rate for Payer: United Healthcare All Other HMO |
$1,278.92
|
| Rate for Payer: United Healthcare HMO Rider |
$1,251.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,146.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,975.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,975.85
|
| Rate for Payer: Vantage Medical Group Senior |
$2,975.85
|
|
|
HC COIL TERUMO AZUR 18D 4X20
|
Facility
|
IP
|
$3,501.00
|
|
| Hospital Charge Code |
906812600
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$700.20 |
| Max. Negotiated Rate |
$3,150.90 |
| Rate for Payer: Adventist Health Commercial |
$700.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,706.27
|
| Rate for Payer: Blue Shield of California EPN |
$1,764.50
|
| Rate for Payer: Cash Price |
$1,925.55
|
| Rate for Payer: Central Health Plan Commercial |
$2,800.80
|
| Rate for Payer: Cigna of CA HMO |
$2,450.70
|
| Rate for Payer: Cigna of CA PPO |
$2,450.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,400.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,400.40
|
| Rate for Payer: Galaxy Health WC |
$2,975.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,100.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,150.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,335.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,333.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,167.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$700.20
|
| Rate for Payer: Multiplan Commercial |
$2,625.75
|
| Rate for Payer: Networks By Design Commercial |
$1,750.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,975.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,313.93
|
| Rate for Payer: United Healthcare All Other HMO |
$1,278.92
|
| Rate for Payer: United Healthcare HMO Rider |
$1,251.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,146.58
|
|
|
HC COIL TERUMO AZUR 18D 4X5
|
Facility
|
OP
|
$2,917.00
|
|
| Hospital Charge Code |
906812594
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$583.40 |
| Max. Negotiated Rate |
$2,625.30 |
| Rate for Payer: Adventist Health Commercial |
$583.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,479.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,604.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,187.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,331.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,615.14
|
| Rate for Payer: Blue Shield of California Commercial |
$2,254.84
|
| Rate for Payer: Blue Shield of California EPN |
$1,470.17
|
| Rate for Payer: Cash Price |
$1,604.35
|
| Rate for Payer: Central Health Plan Commercial |
$2,333.60
|
| Rate for Payer: Cigna of CA HMO |
$2,041.90
|
| Rate for Payer: Cigna of CA PPO |
$2,041.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,479.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,479.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,479.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,166.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,166.80
|
| Rate for Payer: Galaxy Health WC |
$2,479.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,750.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,625.30
|
| Rate for Payer: InnovAge PACE Commercial |
$1,458.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,945.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,111.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,805.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$583.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,041.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,041.90
|
| Rate for Payer: Multiplan Commercial |
$2,187.75
|
| Rate for Payer: Networks By Design Commercial |
$1,458.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,479.45
|
| Rate for Payer: Riverside University Health System MISP |
$1,166.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,750.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,750.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,094.75
|
| Rate for Payer: United Healthcare All Other HMO |
$1,065.58
|
| Rate for Payer: United Healthcare HMO Rider |
$1,042.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$955.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,479.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,479.45
|
| Rate for Payer: Vantage Medical Group Senior |
$2,479.45
|
|
|
HC COIL TERUMO AZUR 18D 4X5
|
Facility
|
IP
|
$2,917.00
|
|
| Hospital Charge Code |
906812594
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$583.40 |
| Max. Negotiated Rate |
$2,625.30 |
| Rate for Payer: Adventist Health Commercial |
$583.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,254.84
|
| Rate for Payer: Blue Shield of California EPN |
$1,470.17
|
| Rate for Payer: Cash Price |
$1,604.35
|
| Rate for Payer: Central Health Plan Commercial |
$2,333.60
|
| Rate for Payer: Cigna of CA HMO |
$2,041.90
|
| Rate for Payer: Cigna of CA PPO |
$2,041.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,166.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,166.80
|
| Rate for Payer: Galaxy Health WC |
$2,479.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,750.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,625.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,945.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,111.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,805.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$583.40
|
| Rate for Payer: Multiplan Commercial |
$2,187.75
|
| Rate for Payer: Networks By Design Commercial |
$1,458.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,479.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,094.75
|
| Rate for Payer: United Healthcare All Other HMO |
$1,065.58
|
| Rate for Payer: United Healthcare HMO Rider |
$1,042.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$955.32
|
|
|
HC COIL TERUMO AZUR 18D 5X10
|
Facility
|
OP
|
$2,917.00
|
|
| Hospital Charge Code |
906812595
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$583.40 |
| Max. Negotiated Rate |
$2,625.30 |
| Rate for Payer: Adventist Health Commercial |
$583.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,479.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,604.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,187.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,331.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,615.14
|
| Rate for Payer: Blue Shield of California Commercial |
$2,254.84
|
| Rate for Payer: Blue Shield of California EPN |
$1,470.17
|
| Rate for Payer: Cash Price |
$1,604.35
|
| Rate for Payer: Central Health Plan Commercial |
$2,333.60
|
| Rate for Payer: Cigna of CA HMO |
$2,041.90
|
| Rate for Payer: Cigna of CA PPO |
$2,041.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,479.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,479.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,479.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,166.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,166.80
|
| Rate for Payer: Galaxy Health WC |
$2,479.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,750.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,625.30
|
| Rate for Payer: InnovAge PACE Commercial |
$1,458.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,945.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,111.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,805.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$583.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,041.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,041.90
|
| Rate for Payer: Multiplan Commercial |
$2,187.75
|
| Rate for Payer: Networks By Design Commercial |
$1,458.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,479.45
|
| Rate for Payer: Riverside University Health System MISP |
$1,166.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,750.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,750.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,094.75
|
| Rate for Payer: United Healthcare All Other HMO |
$1,065.58
|
| Rate for Payer: United Healthcare HMO Rider |
$1,042.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$955.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,479.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,479.45
|
| Rate for Payer: Vantage Medical Group Senior |
$2,479.45
|
|
|
HC COIL TERUMO AZUR 18D 5X10
|
Facility
|
IP
|
$2,917.00
|
|
| Hospital Charge Code |
906812595
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$583.40 |
| Max. Negotiated Rate |
$2,625.30 |
| Rate for Payer: Adventist Health Commercial |
$583.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,254.84
|
| Rate for Payer: Blue Shield of California EPN |
$1,470.17
|
| Rate for Payer: Cash Price |
$1,604.35
|
| Rate for Payer: Central Health Plan Commercial |
$2,333.60
|
| Rate for Payer: Cigna of CA HMO |
$2,041.90
|
| Rate for Payer: Cigna of CA PPO |
$2,041.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,166.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,166.80
|
| Rate for Payer: Galaxy Health WC |
$2,479.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,750.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,625.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,945.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,111.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,805.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$583.40
|
| Rate for Payer: Multiplan Commercial |
$2,187.75
|
| Rate for Payer: Networks By Design Commercial |
$1,458.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,479.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,094.75
|
| Rate for Payer: United Healthcare All Other HMO |
$1,065.58
|
| Rate for Payer: United Healthcare HMO Rider |
$1,042.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$955.32
|
|
|
HC COIL TERUMO AZUR 18D 5X20
|
Facility
|
IP
|
$2,917.00
|
|
| Hospital Charge Code |
906812596
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$583.40 |
| Max. Negotiated Rate |
$2,625.30 |
| Rate for Payer: Adventist Health Commercial |
$583.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,254.84
|
| Rate for Payer: Blue Shield of California EPN |
$1,470.17
|
| Rate for Payer: Cash Price |
$1,604.35
|
| Rate for Payer: Central Health Plan Commercial |
$2,333.60
|
| Rate for Payer: Cigna of CA HMO |
$2,041.90
|
| Rate for Payer: Cigna of CA PPO |
$2,041.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,166.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,166.80
|
| Rate for Payer: Galaxy Health WC |
$2,479.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,750.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,625.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,945.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,111.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,805.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$583.40
|
| Rate for Payer: Multiplan Commercial |
$2,187.75
|
| Rate for Payer: Networks By Design Commercial |
$1,458.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,479.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,094.75
|
| Rate for Payer: United Healthcare All Other HMO |
$1,065.58
|
| Rate for Payer: United Healthcare HMO Rider |
$1,042.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$955.32
|
|
|
HC COIL TERUMO AZUR 18D 5X20
|
Facility
|
OP
|
$2,917.00
|
|
| Hospital Charge Code |
906812596
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$583.40 |
| Max. Negotiated Rate |
$2,625.30 |
| Rate for Payer: Adventist Health Commercial |
$583.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,479.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,604.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,187.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,331.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,615.14
|
| Rate for Payer: Blue Shield of California Commercial |
$2,254.84
|
| Rate for Payer: Blue Shield of California EPN |
$1,470.17
|
| Rate for Payer: Cash Price |
$1,604.35
|
| Rate for Payer: Central Health Plan Commercial |
$2,333.60
|
| Rate for Payer: Cigna of CA HMO |
$2,041.90
|
| Rate for Payer: Cigna of CA PPO |
$2,041.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,479.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,479.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,479.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,166.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,166.80
|
| Rate for Payer: Galaxy Health WC |
$2,479.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,750.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,625.30
|
| Rate for Payer: InnovAge PACE Commercial |
$1,458.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,945.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,111.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,805.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$583.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,041.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,041.90
|
| Rate for Payer: Multiplan Commercial |
$2,187.75
|
| Rate for Payer: Networks By Design Commercial |
$1,458.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,479.45
|
| Rate for Payer: Riverside University Health System MISP |
$1,166.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,750.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,750.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,094.75
|
| Rate for Payer: United Healthcare All Other HMO |
$1,065.58
|
| Rate for Payer: United Healthcare HMO Rider |
$1,042.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$955.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,479.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,479.45
|
| Rate for Payer: Vantage Medical Group Senior |
$2,479.45
|
|
