|
HC COIL TERUMO AZUR 18D 6X10
|
Facility
|
IP
|
$3,100.00
|
|
| Hospital Charge Code |
906812598
|
|
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 6X10
|
Facility
|
OP
|
$3,100.00
|
|
| Hospital Charge Code |
906812598
|
|
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 6X20
|
Facility
|
IP
|
$3,501.00
|
|
| Hospital Charge Code |
906812601
|
|
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 6X20
|
Facility
|
OP
|
$3,501.00
|
|
| Hospital Charge Code |
906812601
|
|
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 35D 4X10
|
Facility
|
OP
|
$3,900.00
|
|
| Hospital Charge Code |
906812591
|
|
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 TERUMO AZUR 35D 4X10
|
Facility
|
IP
|
$3,900.00
|
|
| Hospital Charge Code |
906812591
|
|
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 TERUMO AZUR 35D 6X10
|
Facility
|
OP
|
$3,900.00
|
|
| Hospital Charge Code |
906812592
|
|
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 TERUMO AZUR 35D 6X10
|
Facility
|
IP
|
$3,900.00
|
|
| Hospital Charge Code |
906812592
|
|
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 TERUMO AZUR 35D 6X20
|
Facility
|
IP
|
$3,900.00
|
|
| Hospital Charge Code |
906812593
|
|
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 TERUMO AZUR 35D 6X20
|
Facility
|
OP
|
$3,900.00
|
|
| Hospital Charge Code |
906812593
|
|
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 TERUMO AZUR 3D 4X5
|
Facility
|
IP
|
$3,900.00
|
|
| Hospital Charge Code |
906812571
|
|
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 TERUMO AZUR 3D 4X5
|
Facility
|
OP
|
$3,900.00
|
|
| Hospital Charge Code |
906812571
|
|
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 TERUMO AZUR CX 018 10X32
|
Facility
|
OP
|
$2,925.00
|
|
| Hospital Charge Code |
906812605
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$585.00 |
| Max. Negotiated Rate |
$2,632.50 |
| Rate for Payer: Adventist Health Commercial |
$585.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,486.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,608.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,193.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,335.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,619.57
|
| Rate for Payer: Blue Shield of California Commercial |
$2,261.03
|
| Rate for Payer: Blue Shield of California EPN |
$1,474.20
|
| Rate for Payer: Cash Price |
$1,608.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,340.00
|
| Rate for Payer: Cigna of CA HMO |
$2,047.50
|
| Rate for Payer: Cigna of CA PPO |
$2,047.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,486.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,486.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,486.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,170.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,170.00
|
| Rate for Payer: Galaxy Health WC |
$2,486.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,755.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,632.50
|
| Rate for Payer: InnovAge PACE Commercial |
$1,462.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,950.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,114.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,810.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$585.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,047.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,047.50
|
| Rate for Payer: Multiplan Commercial |
$2,193.75
|
| Rate for Payer: Networks By Design Commercial |
$1,462.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,486.25
|
| Rate for Payer: Riverside University Health System MISP |
$1,170.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,755.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,755.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,097.75
|
| Rate for Payer: United Healthcare All Other HMO |
$1,068.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,045.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$957.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,486.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,486.25
|
| Rate for Payer: Vantage Medical Group Senior |
$2,486.25
|
|
|
HC COIL TERUMO AZUR CX 018 10X32
|
Facility
|
IP
|
$2,925.00
|
|
| Hospital Charge Code |
906812605
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$585.00 |
| Max. Negotiated Rate |
$2,632.50 |
| Rate for Payer: Adventist Health Commercial |
$585.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,261.03
|
| Rate for Payer: Blue Shield of California EPN |
$1,474.20
|
| Rate for Payer: Cash Price |
$1,608.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,340.00
|
| Rate for Payer: Cigna of CA HMO |
$2,047.50
|
| Rate for Payer: Cigna of CA PPO |
$2,047.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,170.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,170.00
|
| Rate for Payer: Galaxy Health WC |
$2,486.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,755.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,632.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,950.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,114.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,810.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$585.00
|
| Rate for Payer: Multiplan Commercial |
$2,193.75
|
| Rate for Payer: Networks By Design Commercial |
$1,462.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,486.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,097.75
|
| Rate for Payer: United Healthcare All Other HMO |
$1,068.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,045.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$957.94
|
|
|
HC COIL TERUMO AZUR CX 018 12X38
|
Facility
|
IP
|
$2,925.00
|
|
| Hospital Charge Code |
906812607
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$585.00 |
| Max. Negotiated Rate |
$2,632.50 |
| Rate for Payer: Adventist Health Commercial |
$585.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,261.03
|
| Rate for Payer: Blue Shield of California EPN |
$1,474.20
|
| Rate for Payer: Cash Price |
$1,608.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,340.00
|
| Rate for Payer: Cigna of CA HMO |
$2,047.50
|
| Rate for Payer: Cigna of CA PPO |
$2,047.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,170.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,170.00
|
| Rate for Payer: Galaxy Health WC |
$2,486.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,755.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,632.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,950.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,114.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,810.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$585.00
|
| Rate for Payer: Multiplan Commercial |
$2,193.75
|
| Rate for Payer: Networks By Design Commercial |
$1,462.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,486.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,097.75
|
| Rate for Payer: United Healthcare All Other HMO |
$1,068.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,045.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$957.94
|
|
|
HC COIL TERUMO AZUR CX 018 12X38
|
Facility
|
OP
|
$2,925.00
|
|
| Hospital Charge Code |
906812607
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$585.00 |
| Max. Negotiated Rate |
$2,632.50 |
| Rate for Payer: Adventist Health Commercial |
$585.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,486.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,608.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,193.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,335.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,619.57
|
| Rate for Payer: Blue Shield of California Commercial |
$2,261.03
|
| Rate for Payer: Blue Shield of California EPN |
$1,474.20
|
| Rate for Payer: Cash Price |
$1,608.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,340.00
|
| Rate for Payer: Cigna of CA HMO |
$2,047.50
|
| Rate for Payer: Cigna of CA PPO |
$2,047.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,486.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,486.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,486.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,170.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,170.00
|
| Rate for Payer: Galaxy Health WC |
$2,486.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,755.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,632.50
|
| Rate for Payer: InnovAge PACE Commercial |
$1,462.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,950.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,114.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,810.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$585.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,047.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,047.50
|
| Rate for Payer: Multiplan Commercial |
$2,193.75
|
| Rate for Payer: Networks By Design Commercial |
$1,462.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,486.25
|
| Rate for Payer: Riverside University Health System MISP |
$1,170.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,755.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,755.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,097.75
|
| Rate for Payer: United Healthcare All Other HMO |
$1,068.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,045.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$957.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,486.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,486.25
|
| Rate for Payer: Vantage Medical Group Senior |
$2,486.25
|
|
|
HC COIL TERUMO AZUR CX 018 2X2
|
Facility
|
IP
|
$2,925.00
|
|
| Hospital Charge Code |
906812737
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$585.00 |
| Max. Negotiated Rate |
$2,632.50 |
| Rate for Payer: Adventist Health Commercial |
$585.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,261.03
|
| Rate for Payer: Blue Shield of California EPN |
$1,474.20
|
| Rate for Payer: Cash Price |
$1,608.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,340.00
|
| Rate for Payer: Cigna of CA HMO |
$2,047.50
|
| Rate for Payer: Cigna of CA PPO |
$2,047.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,170.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,170.00
|
| Rate for Payer: Galaxy Health WC |
$2,486.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,755.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,632.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,950.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,114.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,810.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$585.00
|
| Rate for Payer: Multiplan Commercial |
$2,193.75
|
| Rate for Payer: Networks By Design Commercial |
$1,462.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,486.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,097.75
|
| Rate for Payer: United Healthcare All Other HMO |
$1,068.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,045.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$957.94
|
|
|
HC COIL TERUMO AZUR CX 018 2X2
|
Facility
|
OP
|
$2,925.00
|
|
| Hospital Charge Code |
906812737
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$585.00 |
| Max. Negotiated Rate |
$2,632.50 |
| Rate for Payer: Adventist Health Commercial |
$585.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,486.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,608.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,193.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,335.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,619.57
|
| Rate for Payer: Blue Shield of California Commercial |
$2,261.03
|
| Rate for Payer: Blue Shield of California EPN |
$1,474.20
|
| Rate for Payer: Cash Price |
$1,608.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,340.00
|
| Rate for Payer: Cigna of CA HMO |
$2,047.50
|
| Rate for Payer: Cigna of CA PPO |
$2,047.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,486.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,486.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,486.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,170.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,170.00
|
| Rate for Payer: Galaxy Health WC |
$2,486.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,755.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,632.50
|
| Rate for Payer: InnovAge PACE Commercial |
$1,462.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,950.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,114.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,810.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$585.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,047.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,047.50
|
| Rate for Payer: Multiplan Commercial |
$2,193.75
|
| Rate for Payer: Networks By Design Commercial |
$1,462.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,486.25
|
| Rate for Payer: Riverside University Health System MISP |
$1,170.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,755.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,755.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,097.75
|
| Rate for Payer: United Healthcare All Other HMO |
$1,068.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,045.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$957.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,486.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,486.25
|
| Rate for Payer: Vantage Medical Group Senior |
$2,486.25
|
|
|
HC COIL TERUMO AZUR CX 018 4X13
|
Facility
|
OP
|
$2,925.00
|
|
| Hospital Charge Code |
906812573
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$585.00 |
| Max. Negotiated Rate |
$2,632.50 |
| Rate for Payer: Adventist Health Commercial |
$585.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,486.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,608.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,193.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,335.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,619.57
|
| Rate for Payer: Blue Shield of California Commercial |
$2,261.03
|
| Rate for Payer: Blue Shield of California EPN |
$1,474.20
|
| Rate for Payer: Cash Price |
$1,608.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,340.00
|
| Rate for Payer: Cigna of CA HMO |
$2,047.50
|
| Rate for Payer: Cigna of CA PPO |
$2,047.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,486.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,486.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,486.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,170.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,170.00
|
| Rate for Payer: Galaxy Health WC |
$2,486.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,755.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,632.50
|
| Rate for Payer: InnovAge PACE Commercial |
$1,462.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,950.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,114.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,810.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$585.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,047.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,047.50
|
| Rate for Payer: Multiplan Commercial |
$2,193.75
|
| Rate for Payer: Networks By Design Commercial |
$1,462.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,486.25
|
| Rate for Payer: Riverside University Health System MISP |
$1,170.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,755.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,755.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,097.75
|
| Rate for Payer: United Healthcare All Other HMO |
$1,068.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,045.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$957.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,486.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,486.25
|
| Rate for Payer: Vantage Medical Group Senior |
$2,486.25
|
|
|
HC COIL TERUMO AZUR CX 018 4X13
|
Facility
|
IP
|
$2,925.00
|
|
| Hospital Charge Code |
906812573
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$585.00 |
| Max. Negotiated Rate |
$2,632.50 |
| Rate for Payer: Adventist Health Commercial |
$585.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,261.03
|
| Rate for Payer: Blue Shield of California EPN |
$1,474.20
|
| Rate for Payer: Cash Price |
$1,608.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,340.00
|
| Rate for Payer: Cigna of CA HMO |
$2,047.50
|
| Rate for Payer: Cigna of CA PPO |
$2,047.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,170.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,170.00
|
| Rate for Payer: Galaxy Health WC |
$2,486.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,755.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,632.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,950.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,114.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,810.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$585.00
|
| Rate for Payer: Multiplan Commercial |
$2,193.75
|
| Rate for Payer: Networks By Design Commercial |
$1,462.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,486.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,097.75
|
| Rate for Payer: United Healthcare All Other HMO |
$1,068.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,045.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$957.94
|
|
|
HC COIL TERUMO AZUR CX 018 5X16
|
Facility
|
IP
|
$2,925.00
|
|
| Hospital Charge Code |
906812602
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$585.00 |
| Max. Negotiated Rate |
$2,632.50 |
| Rate for Payer: Adventist Health Commercial |
$585.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,261.03
|
| Rate for Payer: Blue Shield of California EPN |
$1,474.20
|
| Rate for Payer: Cash Price |
$1,608.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,340.00
|
| Rate for Payer: Cigna of CA HMO |
$2,047.50
|
| Rate for Payer: Cigna of CA PPO |
$2,047.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,170.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,170.00
|
| Rate for Payer: Galaxy Health WC |
$2,486.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,755.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,632.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,950.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,114.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,810.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$585.00
|
| Rate for Payer: Multiplan Commercial |
$2,193.75
|
| Rate for Payer: Networks By Design Commercial |
$1,462.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,486.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,097.75
|
| Rate for Payer: United Healthcare All Other HMO |
$1,068.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,045.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$957.94
|
|
|
HC COIL TERUMO AZUR CX 018 5X16
|
Facility
|
OP
|
$2,925.00
|
|
| Hospital Charge Code |
906812602
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$585.00 |
| Max. Negotiated Rate |
$2,632.50 |
| Rate for Payer: Adventist Health Commercial |
$585.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,486.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,608.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,193.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,335.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,619.57
|
| Rate for Payer: Blue Shield of California Commercial |
$2,261.03
|
| Rate for Payer: Blue Shield of California EPN |
$1,474.20
|
| Rate for Payer: Cash Price |
$1,608.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,340.00
|
| Rate for Payer: Cigna of CA HMO |
$2,047.50
|
| Rate for Payer: Cigna of CA PPO |
$2,047.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,486.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,486.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,486.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,170.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,170.00
|
| Rate for Payer: Galaxy Health WC |
$2,486.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,755.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,632.50
|
| Rate for Payer: InnovAge PACE Commercial |
$1,462.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,950.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,114.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,810.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$585.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,047.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,047.50
|
| Rate for Payer: Multiplan Commercial |
$2,193.75
|
| Rate for Payer: Networks By Design Commercial |
$1,462.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,486.25
|
| Rate for Payer: Riverside University Health System MISP |
$1,170.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,755.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,755.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,097.75
|
| Rate for Payer: United Healthcare All Other HMO |
$1,068.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,045.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$957.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,486.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,486.25
|
| Rate for Payer: Vantage Medical Group Senior |
$2,486.25
|
|
|
HC COIL TERUMO AZUR CX 018 6X20
|
Facility
|
OP
|
$2,925.00
|
|
| Hospital Charge Code |
906812603
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$585.00 |
| Max. Negotiated Rate |
$2,632.50 |
| Rate for Payer: Adventist Health Commercial |
$585.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,486.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,608.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,193.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,335.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,619.57
|
| Rate for Payer: Blue Shield of California Commercial |
$2,261.03
|
| Rate for Payer: Blue Shield of California EPN |
$1,474.20
|
| Rate for Payer: Cash Price |
$1,608.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,340.00
|
| Rate for Payer: Cigna of CA HMO |
$2,047.50
|
| Rate for Payer: Cigna of CA PPO |
$2,047.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,486.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,486.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,486.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,170.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,170.00
|
| Rate for Payer: Galaxy Health WC |
$2,486.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,755.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,632.50
|
| Rate for Payer: InnovAge PACE Commercial |
$1,462.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,950.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,114.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,810.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$585.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,047.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,047.50
|
| Rate for Payer: Multiplan Commercial |
$2,193.75
|
| Rate for Payer: Networks By Design Commercial |
$1,462.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,486.25
|
| Rate for Payer: Riverside University Health System MISP |
$1,170.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,755.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,755.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,097.75
|
| Rate for Payer: United Healthcare All Other HMO |
$1,068.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,045.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$957.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,486.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,486.25
|
| Rate for Payer: Vantage Medical Group Senior |
$2,486.25
|
|
|
HC COIL TERUMO AZUR CX 018 6X20
|
Facility
|
IP
|
$2,925.00
|
|
| Hospital Charge Code |
906812603
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$585.00 |
| Max. Negotiated Rate |
$2,632.50 |
| Rate for Payer: Adventist Health Commercial |
$585.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,261.03
|
| Rate for Payer: Blue Shield of California EPN |
$1,474.20
|
| Rate for Payer: Cash Price |
$1,608.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,340.00
|
| Rate for Payer: Cigna of CA HMO |
$2,047.50
|
| Rate for Payer: Cigna of CA PPO |
$2,047.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,170.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,170.00
|
| Rate for Payer: Galaxy Health WC |
$2,486.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,755.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,632.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,950.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,114.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,810.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$585.00
|
| Rate for Payer: Multiplan Commercial |
$2,193.75
|
| Rate for Payer: Networks By Design Commercial |
$1,462.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,486.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,097.75
|
| Rate for Payer: United Healthcare All Other HMO |
$1,068.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,045.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$957.94
|
|
|
HC COIL TERUMO AZUR CX 018 8X28
|
Facility
|
OP
|
$2,925.00
|
|
| Hospital Charge Code |
906812604
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$585.00 |
| Max. Negotiated Rate |
$2,632.50 |
| Rate for Payer: Adventist Health Commercial |
$585.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,486.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,608.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,193.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,335.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,619.57
|
| Rate for Payer: Blue Shield of California Commercial |
$2,261.03
|
| Rate for Payer: Blue Shield of California EPN |
$1,474.20
|
| Rate for Payer: Cash Price |
$1,608.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,340.00
|
| Rate for Payer: Cigna of CA HMO |
$2,047.50
|
| Rate for Payer: Cigna of CA PPO |
$2,047.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,486.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,486.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,486.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,170.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,170.00
|
| Rate for Payer: Galaxy Health WC |
$2,486.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,755.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,632.50
|
| Rate for Payer: InnovAge PACE Commercial |
$1,462.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,950.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,114.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,810.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$585.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,047.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,047.50
|
| Rate for Payer: Multiplan Commercial |
$2,193.75
|
| Rate for Payer: Networks By Design Commercial |
$1,462.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,486.25
|
| Rate for Payer: Riverside University Health System MISP |
$1,170.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,755.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,755.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,097.75
|
| Rate for Payer: United Healthcare All Other HMO |
$1,068.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,045.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$957.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,486.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,486.25
|
| Rate for Payer: Vantage Medical Group Senior |
$2,486.25
|
|
