|
HC STENT COARCT NOT INCL LSCA
|
Facility
|
OP
|
$33,705.00
|
|
|
Service Code
|
CPT 33881
|
| Hospital Charge Code |
906811493
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$431.58 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$6,741.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28,649.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18,537.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25,278.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,561.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$18,537.75
|
| Rate for Payer: Cash Price |
$18,537.75
|
| Rate for Payer: Cash Price |
$18,537.75
|
| Rate for Payer: Cigna of CA HMO |
$21,571.20
|
| Rate for Payer: Cigna of CA PPO |
$24,941.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28,649.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$28,649.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$28,649.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,482.00
|
| Rate for Payer: EPIC Health Plan Senior |
$13,482.00
|
| Rate for Payer: Galaxy Health WC |
$28,649.25
|
| Rate for Payer: Global Benefits Group Commercial |
$20,223.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$431.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22,481.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$488.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20,863.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,089.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23,593.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23,593.50
|
| Rate for Payer: Multiplan Commercial |
$26,964.00
|
| Rate for Payer: Networks By Design Commercial |
$21,908.25
|
| Rate for Payer: Prime Health Services Commercial |
$28,649.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20,223.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28,649.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28,649.25
|
| Rate for Payer: Vantage Medical Group Senior |
$28,649.25
|
|
|
HC STENT COARCT NOT INCL LSCA
|
Facility
|
IP
|
$33,705.00
|
|
|
Service Code
|
CPT 33881
|
| Hospital Charge Code |
906811493
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,741.00 |
| Max. Negotiated Rate |
$28,649.25 |
| Rate for Payer: Adventist Health Commercial |
$6,741.00
|
| Rate for Payer: Cash Price |
$18,537.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,482.00
|
| Rate for Payer: EPIC Health Plan Senior |
$13,482.00
|
| Rate for Payer: Galaxy Health WC |
$28,649.25
|
| Rate for Payer: Global Benefits Group Commercial |
$20,223.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22,481.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,841.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20,863.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,089.20
|
| Rate for Payer: Multiplan Commercial |
$26,964.00
|
| Rate for Payer: Networks By Design Commercial |
$21,908.25
|
| Rate for Payer: Prime Health Services Commercial |
$28,649.25
|
|
|
HC STENT COARCT NOT INCL LSCA
|
Facility
|
OP
|
$32,757.00
|
|
|
Service Code
|
CPT 33881
|
| Hospital Charge Code |
906820202
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$431.58 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$6,551.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27,843.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18,016.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24,567.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,561.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$18,016.35
|
| Rate for Payer: Cash Price |
$18,016.35
|
| Rate for Payer: Cash Price |
$18,016.35
|
| Rate for Payer: Cigna of CA HMO |
$20,964.48
|
| Rate for Payer: Cigna of CA PPO |
$24,240.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27,843.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$27,843.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$27,843.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,102.80
|
| Rate for Payer: EPIC Health Plan Senior |
$13,102.80
|
| Rate for Payer: Galaxy Health WC |
$27,843.45
|
| Rate for Payer: Global Benefits Group Commercial |
$19,654.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$431.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21,848.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$488.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20,276.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,861.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22,929.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22,929.90
|
| Rate for Payer: Multiplan Commercial |
$26,205.60
|
| Rate for Payer: Networks By Design Commercial |
$21,292.05
|
| Rate for Payer: Prime Health Services Commercial |
$27,843.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19,654.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27,843.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27,843.45
|
| Rate for Payer: Vantage Medical Group Senior |
$27,843.45
|
|
|
HC STENT COVERED I CAST
|
Facility
|
OP
|
$6,437.50
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
909020087
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,287.50 |
| Max. Negotiated Rate |
$5,471.88 |
| Rate for Payer: Adventist Health Commercial |
$1,287.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,471.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,540.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,828.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,728.60
|
| Rate for Payer: Blue Shield of California Commercial |
$4,750.88
|
| Rate for Payer: Blue Shield of California EPN |
$3,128.62
|
| Rate for Payer: Cash Price |
$3,540.63
|
| Rate for Payer: Cigna of CA HMO |
$4,506.25
|
| Rate for Payer: Cigna of CA PPO |
$4,506.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,471.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,471.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,471.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,575.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,575.00
|
| Rate for Payer: Galaxy Health WC |
$5,471.88
|
| Rate for Payer: Global Benefits Group Commercial |
$3,862.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,293.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,984.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,545.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,506.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,506.25
|
| Rate for Payer: Multiplan Commercial |
$5,150.00
|
| Rate for Payer: Networks By Design Commercial |
$3,218.75
|
| Rate for Payer: Prime Health Services Commercial |
$5,471.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,862.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,862.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,415.99
|
| Rate for Payer: United Healthcare All Other HMO |
$2,351.62
|
| Rate for Payer: United Healthcare HMO Rider |
$2,300.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,108.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,471.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,471.88
|
| Rate for Payer: Vantage Medical Group Senior |
$5,471.88
|
|
|
HC STENT COVERED I CAST
|
Facility
|
IP
|
$6,437.50
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
909020087
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,287.50 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,287.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$3,540.63
|
| Rate for Payer: Cash Price |
$3,540.63
|
| Rate for Payer: Cigna of CA HMO |
$4,506.25
|
| Rate for Payer: Cigna of CA PPO |
$4,506.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,575.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,575.00
|
| Rate for Payer: Galaxy Health WC |
$5,471.88
|
| Rate for Payer: Global Benefits Group Commercial |
$3,862.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,293.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,452.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,984.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,545.00
|
| Rate for Payer: Multiplan Commercial |
$5,150.00
|
| Rate for Payer: Networks By Design Commercial |
$3,218.75
|
| Rate for Payer: Prime Health Services Commercial |
$5,471.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,415.99
|
| Rate for Payer: United Healthcare All Other HMO |
$2,351.62
|
| Rate for Payer: United Healthcare HMO Rider |
$2,300.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,108.28
|
|
|
HC STENT DUMONT TRACHEOBRONCHIAL
|
Facility
|
IP
|
$1,717.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
900803701
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$343.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$343.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$944.35
|
| Rate for Payer: Cash Price |
$944.35
|
| Rate for Payer: Cigna of CA HMO |
$1,201.90
|
| Rate for Payer: Cigna of CA PPO |
$1,201.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$686.80
|
| Rate for Payer: EPIC Health Plan Senior |
$686.80
|
| Rate for Payer: Galaxy Health WC |
$1,459.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,030.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,145.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$654.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,062.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$412.08
|
| Rate for Payer: Multiplan Commercial |
$1,373.60
|
| Rate for Payer: Networks By Design Commercial |
$858.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,459.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$644.39
|
| Rate for Payer: United Healthcare All Other HMO |
$627.22
|
| Rate for Payer: United Healthcare HMO Rider |
$613.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$562.32
|
|
|
HC STENT DUMONT TRACHEOBRONCHIAL
|
Facility
|
OP
|
$1,717.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
900803701
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$343.40 |
| Max. Negotiated Rate |
$1,459.45 |
| Rate for Payer: Adventist Health Commercial |
$343.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,459.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$944.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,287.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$994.49
|
| Rate for Payer: Blue Shield of California Commercial |
$1,267.15
|
| Rate for Payer: Blue Shield of California EPN |
$834.46
|
| Rate for Payer: Cash Price |
$944.35
|
| Rate for Payer: Cigna of CA HMO |
$1,201.90
|
| Rate for Payer: Cigna of CA PPO |
$1,201.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,459.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,459.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,459.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$686.80
|
| Rate for Payer: EPIC Health Plan Senior |
$686.80
|
| Rate for Payer: Galaxy Health WC |
$1,459.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,030.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,145.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$654.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,062.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$412.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,201.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,201.90
|
| Rate for Payer: Multiplan Commercial |
$1,373.60
|
| Rate for Payer: Networks By Design Commercial |
$858.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,459.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,030.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,030.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$644.39
|
| Rate for Payer: United Healthcare All Other HMO |
$627.22
|
| Rate for Payer: United Healthcare HMO Rider |
$613.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$562.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,459.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,459.45
|
| Rate for Payer: Vantage Medical Group Senior |
$1,459.45
|
|
|
HC STENT ENTERPRISE
|
Facility
|
IP
|
$13,000.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020034
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,600.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$2,600.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$7,150.00
|
| Rate for Payer: Cash Price |
$7,150.00
|
| Rate for Payer: Cigna of CA HMO |
$9,100.00
|
| Rate for Payer: Cigna of CA PPO |
$9,100.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,200.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,200.00
|
| Rate for Payer: Galaxy Health WC |
$11,050.00
|
| Rate for Payer: Global Benefits Group Commercial |
$7,800.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,671.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,953.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,047.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,120.00
|
| Rate for Payer: Multiplan Commercial |
$10,400.00
|
| Rate for Payer: Networks By Design Commercial |
$6,500.00
|
| Rate for Payer: Prime Health Services Commercial |
$11,050.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,878.90
|
| Rate for Payer: United Healthcare All Other HMO |
$4,748.90
|
| Rate for Payer: United Healthcare HMO Rider |
$4,646.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,257.50
|
|
|
HC STENT ENTERPRISE
|
Facility
|
OP
|
$13,000.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020034
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,600.00 |
| Max. Negotiated Rate |
$11,050.00 |
| Rate for Payer: Adventist Health Commercial |
$2,600.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,050.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,150.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,750.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,529.60
|
| Rate for Payer: Blue Shield of California Commercial |
$9,594.00
|
| Rate for Payer: Blue Shield of California EPN |
$6,318.00
|
| Rate for Payer: Cash Price |
$7,150.00
|
| Rate for Payer: Cigna of CA HMO |
$9,100.00
|
| Rate for Payer: Cigna of CA PPO |
$9,100.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,050.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,050.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11,050.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,200.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,200.00
|
| Rate for Payer: Galaxy Health WC |
$11,050.00
|
| Rate for Payer: Global Benefits Group Commercial |
$7,800.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,671.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,953.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,047.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,120.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,100.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,100.00
|
| Rate for Payer: Multiplan Commercial |
$10,400.00
|
| Rate for Payer: Networks By Design Commercial |
$6,500.00
|
| Rate for Payer: Prime Health Services Commercial |
$11,050.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,800.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,800.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,878.90
|
| Rate for Payer: United Healthcare All Other HMO |
$4,748.90
|
| Rate for Payer: United Healthcare HMO Rider |
$4,646.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,257.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,050.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,050.00
|
| Rate for Payer: Vantage Medical Group Senior |
$11,050.00
|
|
|
HC STENT EV3 VISI PRO
|
Facility
|
OP
|
$3,705.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020092
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$741.00 |
| Max. Negotiated Rate |
$3,149.25 |
| Rate for Payer: Adventist Health Commercial |
$741.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,149.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,037.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,778.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,145.94
|
| Rate for Payer: Blue Shield of California Commercial |
$2,734.29
|
| Rate for Payer: Blue Shield of California EPN |
$1,800.63
|
| Rate for Payer: Cash Price |
$2,037.75
|
| Rate for Payer: Cigna of CA HMO |
$2,593.50
|
| Rate for Payer: Cigna of CA PPO |
$2,593.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,149.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,149.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,149.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,482.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,482.00
|
| Rate for Payer: Galaxy Health WC |
$3,149.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,223.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,471.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,411.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,293.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$889.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,593.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,593.50
|
| Rate for Payer: Multiplan Commercial |
$2,964.00
|
| Rate for Payer: Networks By Design Commercial |
$1,852.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,149.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,223.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,223.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,390.49
|
| Rate for Payer: United Healthcare All Other HMO |
$1,353.44
|
| Rate for Payer: United Healthcare HMO Rider |
$1,324.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,213.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,149.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,149.25
|
| Rate for Payer: Vantage Medical Group Senior |
$3,149.25
|
|
|
HC STENT EV3 VISI PRO
|
Facility
|
IP
|
$3,705.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020092
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$741.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$741.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$2,037.75
|
| Rate for Payer: Cash Price |
$2,037.75
|
| Rate for Payer: Cigna of CA HMO |
$2,593.50
|
| Rate for Payer: Cigna of CA PPO |
$2,593.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,482.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,482.00
|
| Rate for Payer: Galaxy Health WC |
$3,149.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,223.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,471.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,411.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,293.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$889.20
|
| Rate for Payer: Multiplan Commercial |
$2,964.00
|
| Rate for Payer: Networks By Design Commercial |
$1,852.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,149.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,390.49
|
| Rate for Payer: United Healthcare All Other HMO |
$1,353.44
|
| Rate for Payer: United Healthcare HMO Rider |
$1,324.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,213.39
|
|
|
HC STENT FEM/POP
|
Facility
|
OP
|
$19,952.00
|
|
|
Service Code
|
CPT 37226
|
| Hospital Charge Code |
906820150
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$741.18 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$3,990.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,409.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,712.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$3,490.94
|
| Rate for Payer: Cash Price |
$10,973.60
|
| Rate for Payer: Cash Price |
$10,973.60
|
| Rate for Payer: Cash Price |
$10,973.60
|
| Rate for Payer: Cigna of CA HMO |
$12,769.28
|
| Rate for Payer: Cigna of CA PPO |
$14,764.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,850.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,409.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,452.60
|
| Rate for Payer: EPIC Health Plan Senior |
$14,409.33
|
| Rate for Payer: Galaxy Health WC |
$16,959.20
|
| Rate for Payer: Global Benefits Group Commercial |
$11,971.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$23,631.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$741.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,409.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,307.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$838.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,409.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,788.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,155.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,308.50
|
| Rate for Payer: Multiplan Commercial |
$15,961.60
|
| Rate for Payer: Multiplan WC |
$22,958.69
|
| Rate for Payer: Networks By Design Commercial |
$12,968.80
|
| Rate for Payer: Prime Health Services Commercial |
$16,959.20
|
| Rate for Payer: Prime Health Services WC |
$22,724.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11,971.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$31,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$14,409.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Vantage Medical Group Senior |
$14,409.33
|
|
|
HC STENT FEM/POP
|
Facility
|
IP
|
$19,952.00
|
|
|
Service Code
|
CPT 37226
|
| Hospital Charge Code |
906820150
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,990.40 |
| Max. Negotiated Rate |
$16,959.20 |
| Rate for Payer: Adventist Health Commercial |
$3,990.40
|
| Rate for Payer: Cash Price |
$10,973.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,980.80
|
| Rate for Payer: EPIC Health Plan Senior |
$7,980.80
|
| Rate for Payer: Galaxy Health WC |
$16,959.20
|
| Rate for Payer: Global Benefits Group Commercial |
$11,971.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,307.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,601.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,350.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,788.48
|
| Rate for Payer: Multiplan Commercial |
$15,961.60
|
| Rate for Payer: Networks By Design Commercial |
$12,968.80
|
| Rate for Payer: Prime Health Services Commercial |
$16,959.20
|
|
|
HC STENT FEM/POP
|
Facility
|
OP
|
$20,529.00
|
|
|
Service Code
|
CPT 37226
|
| Hospital Charge Code |
909020067
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$741.18 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$4,105.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,409.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,712.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$3,490.94
|
| Rate for Payer: Cash Price |
$11,290.95
|
| Rate for Payer: Cash Price |
$11,290.95
|
| Rate for Payer: Cash Price |
$11,290.95
|
| Rate for Payer: Cigna of CA HMO |
$13,138.56
|
| Rate for Payer: Cigna of CA PPO |
$15,191.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,850.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,409.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,452.60
|
| Rate for Payer: EPIC Health Plan Senior |
$14,409.33
|
| Rate for Payer: Galaxy Health WC |
$17,449.65
|
| Rate for Payer: Global Benefits Group Commercial |
$12,317.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$23,631.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$741.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,409.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,692.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$838.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,409.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,926.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,155.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,308.50
|
| Rate for Payer: Multiplan Commercial |
$16,423.20
|
| Rate for Payer: Multiplan WC |
$22,958.69
|
| Rate for Payer: Networks By Design Commercial |
$13,343.85
|
| Rate for Payer: Prime Health Services Commercial |
$17,449.65
|
| Rate for Payer: Prime Health Services WC |
$22,724.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12,317.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$31,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$14,409.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Vantage Medical Group Senior |
$14,409.33
|
|
|
HC STENT FEM/POP
|
Facility
|
IP
|
$20,529.00
|
|
|
Service Code
|
CPT 37226
|
| Hospital Charge Code |
909020067
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,105.80 |
| Max. Negotiated Rate |
$17,449.65 |
| Rate for Payer: Adventist Health Commercial |
$4,105.80
|
| Rate for Payer: Cash Price |
$11,290.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,211.60
|
| Rate for Payer: EPIC Health Plan Senior |
$8,211.60
|
| Rate for Payer: Galaxy Health WC |
$17,449.65
|
| Rate for Payer: Global Benefits Group Commercial |
$12,317.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,692.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,821.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,707.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,926.96
|
| Rate for Payer: Multiplan Commercial |
$16,423.20
|
| Rate for Payer: Networks By Design Commercial |
$13,343.85
|
| Rate for Payer: Prime Health Services Commercial |
$17,449.65
|
|
|
HC STENT FLAIR
|
Facility
|
OP
|
$6,250.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020120
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,250.00 |
| Max. Negotiated Rate |
$5,312.50 |
| Rate for Payer: Adventist Health Commercial |
$1,250.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,312.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,437.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,687.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,620.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,612.50
|
| Rate for Payer: Blue Shield of California EPN |
$3,037.50
|
| Rate for Payer: Cash Price |
$3,437.50
|
| Rate for Payer: Cigna of CA HMO |
$4,375.00
|
| Rate for Payer: Cigna of CA PPO |
$4,375.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,312.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,312.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,312.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,500.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,500.00
|
| Rate for Payer: Galaxy Health WC |
$5,312.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,750.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,168.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,381.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,868.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,500.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,375.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,375.00
|
| Rate for Payer: Multiplan Commercial |
$5,000.00
|
| Rate for Payer: Networks By Design Commercial |
$3,125.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,312.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,750.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,750.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,345.62
|
| Rate for Payer: United Healthcare All Other HMO |
$2,283.12
|
| Rate for Payer: United Healthcare HMO Rider |
$2,233.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,046.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,312.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,312.50
|
| Rate for Payer: Vantage Medical Group Senior |
$5,312.50
|
|
|
HC STENT FLAIR
|
Facility
|
IP
|
$6,250.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020120
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,250.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,250.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$3,437.50
|
| Rate for Payer: Cash Price |
$3,437.50
|
| Rate for Payer: Cigna of CA HMO |
$4,375.00
|
| Rate for Payer: Cigna of CA PPO |
$4,375.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,500.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,500.00
|
| Rate for Payer: Galaxy Health WC |
$5,312.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,750.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,168.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,381.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,868.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,500.00
|
| Rate for Payer: Multiplan Commercial |
$5,000.00
|
| Rate for Payer: Networks By Design Commercial |
$3,125.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,312.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,345.62
|
| Rate for Payer: United Healthcare All Other HMO |
$2,283.12
|
| Rate for Payer: United Healthcare HMO Rider |
$2,233.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,046.88
|
|
|
HC STENT GENESIS MOUNTED
|
Facility
|
OP
|
$3,900.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020089
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,315.00 |
| 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 HMO/PPO |
$2,258.88
|
| Rate for Payer: Blue Shield of California Commercial |
$2,878.20
|
| Rate for Payer: Blue Shield of California EPN |
$1,895.40
|
| Rate for Payer: Cash Price |
$2,145.00
|
| 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: 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 |
$936.00
|
| 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 |
$3,120.00
|
| Rate for Payer: Networks By Design Commercial |
$1,950.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| 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 STENT GENESIS MOUNTED
|
Facility
|
IP
|
$3,900.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020089
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$2,145.00
|
| Rate for Payer: Cash Price |
$2,145.00
|
| 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: 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 |
$936.00
|
| Rate for Payer: Multiplan Commercial |
$3,120.00
|
| 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 STENT GENESIS UNMOUNTED
|
Facility
|
OP
|
$3,900.00
|
|
|
Service Code
|
CPT C1877
|
| Hospital Charge Code |
909020090
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,315.00 |
| 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 HMO/PPO |
$2,258.88
|
| Rate for Payer: Blue Shield of California Commercial |
$2,878.20
|
| Rate for Payer: Blue Shield of California EPN |
$1,895.40
|
| Rate for Payer: Cash Price |
$2,145.00
|
| 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: 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 |
$936.00
|
| 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 |
$3,120.00
|
| Rate for Payer: Networks By Design Commercial |
$1,950.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| 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 STENT GENESIS UNMOUNTED
|
Facility
|
IP
|
$3,900.00
|
|
|
Service Code
|
CPT C1877
|
| Hospital Charge Code |
909020090
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$2,145.00
|
| Rate for Payer: Cash Price |
$2,145.00
|
| 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: 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 |
$936.00
|
| Rate for Payer: Multiplan Commercial |
$3,120.00
|
| 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 STENT GENESIS XLG
|
Facility
|
IP
|
$4,500.00
|
|
|
Service Code
|
CPT C1877
|
| Hospital Charge Code |
909020091
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$900.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$900.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$2,475.00
|
| Rate for Payer: Cash Price |
$2,475.00
|
| Rate for Payer: Cigna of CA HMO |
$3,150.00
|
| Rate for Payer: Cigna of CA PPO |
$3,150.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,800.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,800.00
|
| Rate for Payer: Galaxy Health WC |
$3,825.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,700.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,001.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,714.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,785.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,080.00
|
| Rate for Payer: Multiplan Commercial |
$3,600.00
|
| Rate for Payer: Networks By Design Commercial |
$2,250.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,825.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,688.85
|
| Rate for Payer: United Healthcare All Other HMO |
$1,643.85
|
| Rate for Payer: United Healthcare HMO Rider |
$1,608.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,473.75
|
|
|
HC STENT GENESIS XLG
|
Facility
|
OP
|
$4,500.00
|
|
|
Service Code
|
CPT C1877
|
| Hospital Charge Code |
909020091
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$900.00 |
| Max. Negotiated Rate |
$3,825.00 |
| Rate for Payer: Adventist Health Commercial |
$900.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,825.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,475.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,375.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,606.40
|
| Rate for Payer: Blue Shield of California Commercial |
$3,321.00
|
| Rate for Payer: Blue Shield of California EPN |
$2,187.00
|
| Rate for Payer: Cash Price |
$2,475.00
|
| Rate for Payer: Cigna of CA HMO |
$3,150.00
|
| Rate for Payer: Cigna of CA PPO |
$3,150.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,825.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,825.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,825.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,800.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,800.00
|
| Rate for Payer: Galaxy Health WC |
$3,825.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,700.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,001.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,714.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,785.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,080.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,150.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,150.00
|
| Rate for Payer: Multiplan Commercial |
$3,600.00
|
| Rate for Payer: Networks By Design Commercial |
$2,250.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,825.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,700.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,700.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,688.85
|
| Rate for Payer: United Healthcare All Other HMO |
$1,643.85
|
| Rate for Payer: United Healthcare HMO Rider |
$1,608.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,473.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,825.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,825.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,825.00
|
|
|
HC STENT ILIAC
|
Facility
|
OP
|
$24,200.00
|
|
|
Service Code
|
CPT 37221
|
| Hospital Charge Code |
906820145
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$145.10 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$4,840.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,409.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,712.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$3,490.94
|
| Rate for Payer: Cash Price |
$13,310.00
|
| Rate for Payer: Cash Price |
$13,310.00
|
| Rate for Payer: Cash Price |
$13,310.00
|
| Rate for Payer: Cigna of CA HMO |
$15,488.00
|
| Rate for Payer: Cigna of CA PPO |
$17,908.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,850.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,409.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,452.60
|
| Rate for Payer: EPIC Health Plan Senior |
$14,409.33
|
| Rate for Payer: Galaxy Health WC |
$20,570.00
|
| Rate for Payer: Global Benefits Group Commercial |
$14,520.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$23,631.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$145.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,409.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,141.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$164.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,409.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,808.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,155.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,308.50
|
| Rate for Payer: Multiplan Commercial |
$19,360.00
|
| Rate for Payer: Multiplan WC |
$22,958.69
|
| Rate for Payer: Networks By Design Commercial |
$15,730.00
|
| Rate for Payer: Prime Health Services Commercial |
$20,570.00
|
| Rate for Payer: Prime Health Services WC |
$22,724.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14,520.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$31,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$14,409.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Vantage Medical Group Senior |
$14,409.33
|
|
|
HC STENT ILIAC
|
Facility
|
IP
|
$24,901.00
|
|
|
Service Code
|
CPT 37221
|
| Hospital Charge Code |
909020062
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,980.20 |
| Max. Negotiated Rate |
$21,165.85 |
| Rate for Payer: Adventist Health Commercial |
$4,980.20
|
| Rate for Payer: Cash Price |
$13,695.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,960.40
|
| Rate for Payer: EPIC Health Plan Senior |
$9,960.40
|
| Rate for Payer: Galaxy Health WC |
$21,165.85
|
| Rate for Payer: Global Benefits Group Commercial |
$14,940.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,608.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,487.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,413.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,976.24
|
| Rate for Payer: Multiplan Commercial |
$19,920.80
|
| Rate for Payer: Networks By Design Commercial |
$16,185.65
|
| Rate for Payer: Prime Health Services Commercial |
$21,165.85
|
|
