|
HC COIL GDC-10
|
Facility
|
OP
|
$4,850.00
|
|
| Hospital Charge Code |
909020104
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$877.85 |
| Max. Negotiated Rate |
$4,122.50 |
| Rate for Payer: Adventist Health Commercial |
$970.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,592.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,331.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,122.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,667.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,637.50
|
| Rate for Payer: Blue Shield of California Commercial |
$2,958.50
|
| Rate for Payer: Blue Shield of California EPN |
$2,366.80
|
| Rate for Payer: Cash Price |
$2,667.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,152.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,122.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,122.50
|
| Rate for Payer: Dignity Health Senior |
$4,122.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,152.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,002.15
|
| Rate for Payer: Heritage Provider Network Senior |
$3,002.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,313.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$877.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,212.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,395.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,395.00
|
| Rate for Payer: Multiplan Commercial |
$3,637.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,425.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,425.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,122.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,122.50
|
| Rate for Payer: Vantage Medical Group Senior |
$4,122.50
|
|
|
HC COIL GDC-18 FIBERED
|
Facility
|
IP
|
$3,900.00
|
|
| Hospital Charge Code |
909020105
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$705.90 |
| Max. Negotiated Rate |
$2,925.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Cash Price |
$2,145.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,640.30
|
| Rate for Payer: Heritage Provider Network Senior |
$2,640.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$705.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$975.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
|
|
HC COIL GDC-18 FIBERED
|
Facility
|
OP
|
$3,900.00
|
|
| Hospital Charge Code |
909020105
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$705.90 |
| Max. Negotiated Rate |
$3,315.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,084.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,679.30
|
| 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: Blue Shield of California Commercial |
$2,379.00
|
| Rate for Payer: Blue Shield of California EPN |
$1,903.20
|
| Rate for Payer: Cash Price |
$2,145.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,535.00
|
| 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 Senior |
$3,315.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,535.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,414.10
|
| Rate for Payer: Heritage Provider Network Senior |
$2,414.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,860.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$705.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$975.00
|
| 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: United Healthcare All Other HMO/non HMO |
$1,950.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,950.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,315.00
|
|
|
HC COIL GDC 360 STANDARD
|
Facility
|
OP
|
$3,900.00
|
|
| Hospital Charge Code |
909020106
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$705.90 |
| Max. Negotiated Rate |
$3,315.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,084.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,679.30
|
| 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: Blue Shield of California Commercial |
$2,379.00
|
| Rate for Payer: Blue Shield of California EPN |
$1,903.20
|
| Rate for Payer: Cash Price |
$2,145.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,535.00
|
| 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 Senior |
$3,315.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,535.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,414.10
|
| Rate for Payer: Heritage Provider Network Senior |
$2,414.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,860.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$705.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$975.00
|
| 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: United Healthcare All Other HMO/non HMO |
$1,950.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,950.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,315.00
|
|
|
HC COIL GDC 360 STANDARD
|
Facility
|
IP
|
$3,900.00
|
|
| Hospital Charge Code |
909020106
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$705.90 |
| Max. Negotiated Rate |
$2,925.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Cash Price |
$2,145.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,640.30
|
| Rate for Payer: Heritage Provider Network Senior |
$2,640.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$705.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$975.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
|
|
HC COIL MICROVENTION HYPERSOFT
|
Facility
|
IP
|
$3,783.00
|
|
| Hospital Charge Code |
909020123
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$684.72 |
| Max. Negotiated Rate |
$2,837.25 |
| Rate for Payer: Adventist Health Commercial |
$756.60
|
| Rate for Payer: Cash Price |
$2,080.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,561.09
|
| Rate for Payer: Heritage Provider Network Senior |
$2,561.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$684.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$945.75
|
| Rate for Payer: Multiplan Commercial |
$2,837.25
|
|
|
HC COIL MICROVENTION HYPERSOFT
|
Facility
|
OP
|
$3,783.00
|
|
| Hospital Charge Code |
909020123
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$684.72 |
| Max. Negotiated Rate |
$3,215.55 |
| Rate for Payer: Adventist Health Commercial |
$756.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,022.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,598.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,215.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,080.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,837.25
|
| Rate for Payer: Blue Shield of California Commercial |
$2,307.63
|
| Rate for Payer: Blue Shield of California EPN |
$1,846.10
|
| Rate for Payer: Cash Price |
$2,080.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,458.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,215.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,215.55
|
| Rate for Payer: Dignity Health Senior |
$3,215.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,458.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,341.68
|
| Rate for Payer: Heritage Provider Network Senior |
$2,341.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,804.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$684.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$945.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,648.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,648.10
|
| Rate for Payer: Multiplan Commercial |
$2,837.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,891.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,891.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,215.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,215.55
|
| Rate for Payer: Vantage Medical Group Senior |
$3,215.55
|
|
|
HC COIL MICROVENTN HYDROSFT 10-30
|
Facility
|
IP
|
$4,875.00
|
|
| Hospital Charge Code |
909020125
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$882.38 |
| Max. Negotiated Rate |
$3,656.25 |
| Rate for Payer: Adventist Health Commercial |
$975.00
|
| Rate for Payer: Cash Price |
$2,681.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,300.38
|
| Rate for Payer: Heritage Provider Network Senior |
$3,300.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$882.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,218.75
|
| Rate for Payer: Multiplan Commercial |
$3,656.25
|
|
|
HC COIL MICROVENTN HYDROSFT 10-30
|
Facility
|
OP
|
$4,875.00
|
|
| Hospital Charge Code |
909020125
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$882.38 |
| Max. Negotiated Rate |
$4,143.75 |
| Rate for Payer: Adventist Health Commercial |
$975.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,605.69
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,349.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,143.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,681.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,656.25
|
| Rate for Payer: Blue Shield of California Commercial |
$2,973.75
|
| Rate for Payer: Blue Shield of California EPN |
$2,379.00
|
| Rate for Payer: Cash Price |
$2,681.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,168.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,143.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,143.75
|
| Rate for Payer: Dignity Health Senior |
$4,143.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,168.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,017.62
|
| Rate for Payer: Heritage Provider Network Senior |
$3,017.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,325.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$882.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,218.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,412.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,412.50
|
| Rate for Payer: Multiplan Commercial |
$3,656.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,437.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,437.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,143.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,143.75
|
| Rate for Payer: Vantage Medical Group Senior |
$4,143.75
|
|
|
HC COIL MICROVENTN HYDROSFT 4-8CM
|
Facility
|
IP
|
$4,000.00
|
|
| Hospital Charge Code |
909020124
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$724.00 |
| Max. Negotiated Rate |
$3,000.00 |
| Rate for Payer: Adventist Health Commercial |
$800.00
|
| Rate for Payer: Cash Price |
$2,200.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,708.00
|
| Rate for Payer: Heritage Provider Network Senior |
$2,708.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$724.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,000.00
|
| Rate for Payer: Multiplan Commercial |
$3,000.00
|
|
|
HC COIL MICROVENTN HYDROSFT 4-8CM
|
Facility
|
OP
|
$4,000.00
|
|
| Hospital Charge Code |
909020124
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$724.00 |
| Max. Negotiated Rate |
$3,400.00 |
| Rate for Payer: Adventist Health Commercial |
$800.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,138.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,748.00
|
| 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: Blue Shield of California Commercial |
$2,440.00
|
| Rate for Payer: Blue Shield of California EPN |
$1,952.00
|
| Rate for Payer: Cash Price |
$2,200.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,600.00
|
| 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 Senior |
$3,400.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,600.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,476.00
|
| Rate for Payer: Heritage Provider Network Senior |
$2,476.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,908.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$724.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,000.00
|
| 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: United Healthcare All Other HMO/non HMO |
$2,000.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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, MICRUSHERE
|
Facility
|
OP
|
$4,075.00
|
|
| Hospital Charge Code |
909020102
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$737.58 |
| Max. Negotiated Rate |
$3,463.75 |
| Rate for Payer: Adventist Health Commercial |
$815.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,178.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,799.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,463.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,241.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,056.25
|
| Rate for Payer: Blue Shield of California Commercial |
$2,485.75
|
| Rate for Payer: Blue Shield of California EPN |
$1,988.60
|
| Rate for Payer: Cash Price |
$2,241.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,648.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,463.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,463.75
|
| Rate for Payer: Dignity Health Senior |
$3,463.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,648.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,522.43
|
| Rate for Payer: Heritage Provider Network Senior |
$2,522.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,943.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$737.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,018.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,852.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,852.50
|
| Rate for Payer: Multiplan Commercial |
$3,056.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,037.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,037.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,463.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,463.75
|
| Rate for Payer: Vantage Medical Group Senior |
$3,463.75
|
|
|
HC COIL, MICRUSHERE
|
Facility
|
IP
|
$4,075.00
|
|
| Hospital Charge Code |
909020102
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$737.58 |
| Max. Negotiated Rate |
$3,056.25 |
| Rate for Payer: Adventist Health Commercial |
$815.00
|
| Rate for Payer: Cash Price |
$2,241.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,758.78
|
| Rate for Payer: Heritage Provider Network Senior |
$2,758.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$737.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,018.75
|
| Rate for Payer: Multiplan Commercial |
$3,056.25
|
|
|
HC COIL ORBIT J & J
|
Facility
|
IP
|
$3,900.00
|
|
| Hospital Charge Code |
909020018
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,872.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,567.80
|
| Rate for Payer: Blue Shield of California EPN |
$1,567.80
|
| Rate for Payer: Cash Price |
$2,145.00
|
| Rate for Payer: Cash Price |
$2,145.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,794.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,106.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,805.70
|
| Rate for Payer: Heritage Provider Network Senior |
$1,805.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,950.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,950.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,950.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$975.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,409.07
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,291.29
|
|
|
HC COIL ORBIT J & J
|
Facility
|
OP
|
$3,900.00
|
|
| Hospital Charge Code |
909020018
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,872.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,679.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,145.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,925.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,567.80
|
| Rate for Payer: Blue Shield of California EPN |
$1,567.80
|
| Rate for Payer: Cash Price |
$2,145.00
|
| Rate for Payer: Cash Price |
$2,145.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,794.00
|
| 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 Senior |
$3,315.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,496.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,805.70
|
| Rate for Payer: Heritage Provider Network Senior |
$1,805.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,950.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,950.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,950.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$975.00
|
| 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: United Healthcare All Other HMO/non HMO |
$1,409.07
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,291.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,315.00
|
|
|
HC COIL PENUMBRA
|
Facility
|
IP
|
$6,750.00
|
|
| Hospital Charge Code |
909020118
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,221.75 |
| Max. Negotiated Rate |
$5,062.50 |
| Rate for Payer: Adventist Health Commercial |
$1,350.00
|
| Rate for Payer: Cash Price |
$3,712.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,569.75
|
| Rate for Payer: Heritage Provider Network Senior |
$4,569.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,221.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,687.50
|
| Rate for Payer: Multiplan Commercial |
$5,062.50
|
|
|
HC COIL PENUMBRA
|
Facility
|
OP
|
$6,750.00
|
|
| Hospital Charge Code |
909020118
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,221.75 |
| Max. Negotiated Rate |
$5,737.50 |
| Rate for Payer: Adventist Health Commercial |
$1,350.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,607.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,637.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,737.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,712.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,062.50
|
| Rate for Payer: Blue Shield of California Commercial |
$4,117.50
|
| Rate for Payer: Blue Shield of California EPN |
$3,294.00
|
| Rate for Payer: Cash Price |
$3,712.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,387.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,737.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,737.50
|
| Rate for Payer: Dignity Health Senior |
$5,737.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,387.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,178.25
|
| Rate for Payer: Heritage Provider Network Senior |
$4,178.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,219.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,221.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,687.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,725.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,725.00
|
| Rate for Payer: Multiplan Commercial |
$5,062.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,375.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,375.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,737.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,737.50
|
| Rate for Payer: Vantage Medical Group Senior |
$5,737.50
|
|
|
HC COIL PRESIDIO
|
Facility
|
OP
|
$6,375.00
|
|
| Hospital Charge Code |
909020099
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,153.88 |
| Max. Negotiated Rate |
$5,418.75 |
| Rate for Payer: Adventist Health Commercial |
$1,275.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,407.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,379.62
|
| 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: Blue Shield of California Commercial |
$3,888.75
|
| Rate for Payer: Blue Shield of California EPN |
$3,111.00
|
| Rate for Payer: Cash Price |
$3,506.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,143.75
|
| 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 Senior |
$5,418.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,143.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,946.12
|
| Rate for Payer: Heritage Provider Network Senior |
$3,946.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,040.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,153.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,593.75
|
| 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: United Healthcare All Other HMO/non HMO |
$3,187.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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 PRESIDIO
|
Facility
|
IP
|
$6,375.00
|
|
| Hospital Charge Code |
909020099
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,153.88 |
| Max. Negotiated Rate |
$4,781.25 |
| Rate for Payer: Adventist Health Commercial |
$1,275.00
|
| Rate for Payer: Cash Price |
$3,506.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,315.88
|
| Rate for Payer: Heritage Provider Network Senior |
$4,315.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,153.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,593.75
|
| Rate for Payer: Multiplan Commercial |
$4,781.25
|
|
|
HC COIL, TARGET 360 SOFT
|
Facility
|
OP
|
$4,250.00
|
|
| Hospital Charge Code |
909020138
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$769.25 |
| Max. Negotiated Rate |
$3,612.50 |
| Rate for Payer: Adventist Health Commercial |
$850.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,271.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,919.75
|
| 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: Blue Shield of California Commercial |
$2,592.50
|
| Rate for Payer: Blue Shield of California EPN |
$2,074.00
|
| Rate for Payer: Cash Price |
$2,337.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,762.50
|
| 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 Senior |
$3,612.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,762.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,630.75
|
| Rate for Payer: Heritage Provider Network Senior |
$2,630.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,027.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$769.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,062.50
|
| 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: United Healthcare All Other HMO/non HMO |
$2,125.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,125.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,612.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,612.50
|
| Rate for Payer: Vantage Medical Group Senior |
$3,612.50
|
|
|
HC COIL, TARGET 360 SOFT
|
Facility
|
IP
|
$4,250.00
|
|
| Hospital Charge Code |
909020138
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$769.25 |
| Max. Negotiated Rate |
$3,187.50 |
| Rate for Payer: Adventist Health Commercial |
$850.00
|
| Rate for Payer: Cash Price |
$2,337.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,877.25
|
| Rate for Payer: Heritage Provider Network Senior |
$2,877.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$769.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,062.50
|
| Rate for Payer: Multiplan Commercial |
$3,187.50
|
|
|
HC COIL TARGET 360 ULTRA
|
Facility
|
OP
|
$3,900.00
|
|
| Hospital Charge Code |
909020135
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$705.90 |
| Max. Negotiated Rate |
$3,315.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,084.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,679.30
|
| 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: Blue Shield of California Commercial |
$2,379.00
|
| Rate for Payer: Blue Shield of California EPN |
$1,903.20
|
| Rate for Payer: Cash Price |
$2,145.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,535.00
|
| 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 Senior |
$3,315.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,535.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,414.10
|
| Rate for Payer: Heritage Provider Network Senior |
$2,414.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,860.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$705.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$975.00
|
| 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: United Healthcare All Other HMO/non HMO |
$1,950.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,950.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,315.00
|
|
|
HC COIL TARGET 360 ULTRA
|
Facility
|
IP
|
$3,900.00
|
|
| Hospital Charge Code |
909020135
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$705.90 |
| Max. Negotiated Rate |
$2,925.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Cash Price |
$2,145.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,640.30
|
| Rate for Payer: Heritage Provider Network Senior |
$2,640.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$705.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$975.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
|
|
HC COIL, TARGET HELICAL
|
Facility
|
IP
|
$3,900.00
|
|
| Hospital Charge Code |
909020136
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$705.90 |
| Max. Negotiated Rate |
$2,925.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Cash Price |
$2,145.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,640.30
|
| Rate for Payer: Heritage Provider Network Senior |
$2,640.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$705.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$975.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
|
|
HC COIL, TARGET HELICAL
|
Facility
|
OP
|
$3,900.00
|
|
| Hospital Charge Code |
909020136
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$705.90 |
| Max. Negotiated Rate |
$3,315.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,084.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,679.30
|
| 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: Blue Shield of California Commercial |
$2,379.00
|
| Rate for Payer: Blue Shield of California EPN |
$1,903.20
|
| Rate for Payer: Cash Price |
$2,145.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,535.00
|
| 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 Senior |
$3,315.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,535.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,414.10
|
| Rate for Payer: Heritage Provider Network Senior |
$2,414.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,860.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$705.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$975.00
|
| 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: United Healthcare All Other HMO/non HMO |
$1,950.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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
|
|
