|
HC STENT MEDTRONIC SE 40-100
|
Facility
|
OP
|
$3,900.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020113
|
|
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 |
$1,755.00
|
| 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 METAL URETERAL
|
Facility
|
IP
|
$3,900.00
|
|
|
Service Code
|
CPT C2617
|
| Hospital Charge Code |
909020039
|
|
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 |
$1,755.00
|
| Rate for Payer: Cash Price |
$1,755.00
|
| 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 METAL URETERAL
|
Facility
|
OP
|
$3,900.00
|
|
|
Service Code
|
CPT C2617
|
| Hospital Charge Code |
909020039
|
|
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 |
$1,755.00
|
| 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 NEURO FORM 3
|
Facility
|
OP
|
$14,300.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909080045
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,860.00 |
| Max. Negotiated Rate |
$12,155.00 |
| Rate for Payer: Adventist Health Commercial |
$2,860.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,155.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,865.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,725.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,282.56
|
| Rate for Payer: Blue Shield of California Commercial |
$10,553.40
|
| Rate for Payer: Blue Shield of California EPN |
$6,949.80
|
| Rate for Payer: Cash Price |
$6,435.00
|
| Rate for Payer: Cigna of CA HMO |
$10,010.00
|
| Rate for Payer: Cigna of CA PPO |
$10,010.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,155.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$12,155.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12,155.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,720.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,720.00
|
| Rate for Payer: Galaxy Health WC |
$12,155.00
|
| Rate for Payer: Global Benefits Group Commercial |
$8,580.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,538.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,448.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,851.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,432.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,010.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,010.00
|
| Rate for Payer: Multiplan Commercial |
$11,440.00
|
| Rate for Payer: Networks By Design Commercial |
$7,150.00
|
| Rate for Payer: Prime Health Services Commercial |
$12,155.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,580.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8,580.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,366.79
|
| Rate for Payer: United Healthcare All Other HMO |
$5,223.79
|
| Rate for Payer: United Healthcare HMO Rider |
$5,110.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,683.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,155.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12,155.00
|
| Rate for Payer: Vantage Medical Group Senior |
$12,155.00
|
|
|
HC STENT NEURO FORM 3
|
Facility
|
IP
|
$14,300.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909080045
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,860.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$2,860.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$6,435.00
|
| Rate for Payer: Cash Price |
$6,435.00
|
| Rate for Payer: Cigna of CA HMO |
$10,010.00
|
| Rate for Payer: Cigna of CA PPO |
$10,010.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,720.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,720.00
|
| Rate for Payer: Galaxy Health WC |
$12,155.00
|
| Rate for Payer: Global Benefits Group Commercial |
$8,580.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,538.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,448.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,851.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,432.00
|
| Rate for Payer: Multiplan Commercial |
$11,440.00
|
| Rate for Payer: Networks By Design Commercial |
$7,150.00
|
| Rate for Payer: Prime Health Services Commercial |
$12,155.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,366.79
|
| Rate for Payer: United Healthcare All Other HMO |
$5,223.79
|
| Rate for Payer: United Healthcare HMO Rider |
$5,110.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,683.25
|
|
|
HC STENT PALMAZ
|
Facility
|
OP
|
$1,963.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909081209
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$392.60 |
| Max. Negotiated Rate |
$1,668.55 |
| Rate for Payer: Adventist Health Commercial |
$392.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,668.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,079.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,472.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,136.97
|
| Rate for Payer: Blue Shield of California Commercial |
$1,448.69
|
| Rate for Payer: Blue Shield of California EPN |
$954.02
|
| Rate for Payer: Cash Price |
$883.35
|
| Rate for Payer: Cigna of CA HMO |
$1,374.10
|
| Rate for Payer: Cigna of CA PPO |
$1,374.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,668.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,668.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,668.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$785.20
|
| Rate for Payer: EPIC Health Plan Senior |
$785.20
|
| Rate for Payer: Galaxy Health WC |
$1,668.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,177.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,309.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$747.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,215.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$471.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,374.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,374.10
|
| Rate for Payer: Multiplan Commercial |
$1,570.40
|
| Rate for Payer: Networks By Design Commercial |
$981.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,668.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,177.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,177.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$736.71
|
| Rate for Payer: United Healthcare All Other HMO |
$717.08
|
| Rate for Payer: United Healthcare HMO Rider |
$701.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$642.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,668.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,668.55
|
| Rate for Payer: Vantage Medical Group Senior |
$1,668.55
|
|
|
HC STENT PALMAZ
|
Facility
|
IP
|
$1,963.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909081209
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$392.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$392.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$883.35
|
| Rate for Payer: Cash Price |
$883.35
|
| Rate for Payer: Cigna of CA HMO |
$1,374.10
|
| Rate for Payer: Cigna of CA PPO |
$1,374.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$785.20
|
| Rate for Payer: EPIC Health Plan Senior |
$785.20
|
| Rate for Payer: Galaxy Health WC |
$1,668.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,177.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,309.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$747.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,215.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$471.12
|
| Rate for Payer: Multiplan Commercial |
$1,570.40
|
| Rate for Payer: Networks By Design Commercial |
$981.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,668.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$736.71
|
| Rate for Payer: United Healthcare All Other HMO |
$717.08
|
| Rate for Payer: United Healthcare HMO Rider |
$701.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$642.88
|
|
|
HC STENT PALMAZ BALLOON EXPAND
|
Facility
|
IP
|
$1,717.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
900803700
|
|
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 |
$772.65
|
| Rate for Payer: Cash Price |
$772.65
|
| 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 PALMAZ BALLOON EXPAND
|
Facility
|
OP
|
$1,717.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
900803700
|
|
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 |
$772.65
|
| 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 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 PLACEMT RETRO CAROTID
|
Facility
|
IP
|
$16,625.00
|
|
|
Service Code
|
CPT 37217
|
| Hospital Charge Code |
906820026
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,325.00 |
| Max. Negotiated Rate |
$14,131.25 |
| Rate for Payer: Adventist Health Commercial |
$3,325.00
|
| Rate for Payer: Cash Price |
$7,481.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,650.00
|
| Rate for Payer: EPIC Health Plan Senior |
$6,650.00
|
| Rate for Payer: Galaxy Health WC |
$14,131.25
|
| Rate for Payer: Global Benefits Group Commercial |
$9,975.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,088.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,334.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,290.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,990.00
|
| Rate for Payer: Multiplan Commercial |
$13,300.00
|
| Rate for Payer: Networks By Design Commercial |
$10,806.25
|
| Rate for Payer: Prime Health Services Commercial |
$14,131.25
|
|
|
HC STENT PLACEMT RETRO CAROTID
|
Facility
|
OP
|
$16,625.00
|
|
|
Service Code
|
CPT 37217
|
| Hospital Charge Code |
906820026
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$570.02 |
| Max. Negotiated Rate |
$14,131.25 |
| Rate for Payer: Adventist Health Commercial |
$3,325.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14,131.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,143.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12,468.75
|
| 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 |
$570.02
|
| Rate for Payer: Cash Price |
$7,481.25
|
| Rate for Payer: Cash Price |
$7,481.25
|
| Rate for Payer: Cash Price |
$7,481.25
|
| Rate for Payer: Cigna of CA HMO |
$10,640.00
|
| Rate for Payer: Cigna of CA PPO |
$12,302.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14,131.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$14,131.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,131.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,650.00
|
| Rate for Payer: EPIC Health Plan Senior |
$6,650.00
|
| Rate for Payer: Galaxy Health WC |
$14,131.25
|
| Rate for Payer: Global Benefits Group Commercial |
$9,975.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,593.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,088.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,802.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,290.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,990.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,637.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,637.50
|
| Rate for Payer: Multiplan Commercial |
$13,300.00
|
| Rate for Payer: Networks By Design Commercial |
$10,806.25
|
| Rate for Payer: Prime Health Services Commercial |
$14,131.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,975.00
|
| 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 |
$14,131.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14,131.25
|
| Rate for Payer: Vantage Medical Group Senior |
$14,131.25
|
|
|
HC STENT PLACEMT RETRO CAROTID
|
Facility
|
IP
|
$17,106.00
|
|
|
Service Code
|
CPT 37217
|
| Hospital Charge Code |
909037217
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,421.20 |
| Max. Negotiated Rate |
$14,540.10 |
| Rate for Payer: Adventist Health Commercial |
$3,421.20
|
| Rate for Payer: Cash Price |
$7,697.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,842.40
|
| Rate for Payer: EPIC Health Plan Senior |
$6,842.40
|
| Rate for Payer: Galaxy Health WC |
$14,540.10
|
| Rate for Payer: Global Benefits Group Commercial |
$10,263.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,409.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,517.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,588.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,105.44
|
| Rate for Payer: Multiplan Commercial |
$13,684.80
|
| Rate for Payer: Networks By Design Commercial |
$11,118.90
|
| Rate for Payer: Prime Health Services Commercial |
$14,540.10
|
|
|
HC STENT PLACEMT RETRO CAROTID
|
Facility
|
OP
|
$17,106.00
|
|
|
Service Code
|
CPT 37217
|
| Hospital Charge Code |
909037217
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$570.02 |
| Max. Negotiated Rate |
$14,540.10 |
| Rate for Payer: Adventist Health Commercial |
$3,421.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14,540.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,408.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12,829.50
|
| 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 |
$570.02
|
| Rate for Payer: Cash Price |
$7,697.70
|
| Rate for Payer: Cash Price |
$7,697.70
|
| Rate for Payer: Cash Price |
$7,697.70
|
| Rate for Payer: Cigna of CA HMO |
$10,947.84
|
| Rate for Payer: Cigna of CA PPO |
$12,658.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14,540.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$14,540.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,540.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,842.40
|
| Rate for Payer: EPIC Health Plan Senior |
$6,842.40
|
| Rate for Payer: Galaxy Health WC |
$14,540.10
|
| Rate for Payer: Global Benefits Group Commercial |
$10,263.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,593.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,409.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,802.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,588.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,105.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,974.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,974.20
|
| Rate for Payer: Multiplan Commercial |
$13,684.80
|
| Rate for Payer: Networks By Design Commercial |
$11,118.90
|
| Rate for Payer: Prime Health Services Commercial |
$14,540.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,263.60
|
| 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 |
$14,540.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14,540.10
|
| Rate for Payer: Vantage Medical Group Senior |
$14,540.10
|
|
|
HC STENT PLACMNT ANTE CAROTID
|
Facility
|
OP
|
$17,106.00
|
|
|
Service Code
|
CPT 37218
|
| Hospital Charge Code |
909037218
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$237.67 |
| Max. Negotiated Rate |
$14,540.10 |
| Rate for Payer: Adventist Health Commercial |
$3,421.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14,540.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,408.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12,829.50
|
| 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 |
$570.02
|
| Rate for Payer: Cash Price |
$7,697.70
|
| Rate for Payer: Cash Price |
$7,697.70
|
| Rate for Payer: Cash Price |
$7,697.70
|
| Rate for Payer: Cigna of CA HMO |
$10,947.84
|
| Rate for Payer: Cigna of CA PPO |
$12,658.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14,540.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$14,540.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,540.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,842.40
|
| Rate for Payer: EPIC Health Plan Senior |
$6,842.40
|
| Rate for Payer: Galaxy Health WC |
$14,540.10
|
| Rate for Payer: Global Benefits Group Commercial |
$10,263.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$237.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,409.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$268.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,588.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,105.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,974.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,974.20
|
| Rate for Payer: Multiplan Commercial |
$13,684.80
|
| Rate for Payer: Networks By Design Commercial |
$11,118.90
|
| Rate for Payer: Prime Health Services Commercial |
$14,540.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,263.60
|
| 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 |
$14,540.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14,540.10
|
| Rate for Payer: Vantage Medical Group Senior |
$14,540.10
|
|
|
HC STENT PLACMNT ANTE CAROTID
|
Facility
|
IP
|
$17,106.00
|
|
|
Service Code
|
CPT 37218
|
| Hospital Charge Code |
909037218
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,421.20 |
| Max. Negotiated Rate |
$14,540.10 |
| Rate for Payer: Adventist Health Commercial |
$3,421.20
|
| Rate for Payer: Cash Price |
$7,697.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,842.40
|
| Rate for Payer: EPIC Health Plan Senior |
$6,842.40
|
| Rate for Payer: Galaxy Health WC |
$14,540.10
|
| Rate for Payer: Global Benefits Group Commercial |
$10,263.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,409.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,517.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,588.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,105.44
|
| Rate for Payer: Multiplan Commercial |
$13,684.80
|
| Rate for Payer: Networks By Design Commercial |
$11,118.90
|
| Rate for Payer: Prime Health Services Commercial |
$14,540.10
|
|
|
HC STENT PROTEGE
|
Facility
|
OP
|
$6,050.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020030
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,210.00 |
| Max. Negotiated Rate |
$5,142.50 |
| Rate for Payer: Adventist Health Commercial |
$1,210.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,142.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,327.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,537.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,504.16
|
| Rate for Payer: Blue Shield of California Commercial |
$4,464.90
|
| Rate for Payer: Blue Shield of California EPN |
$2,940.30
|
| Rate for Payer: Cash Price |
$2,722.50
|
| Rate for Payer: Cigna of CA HMO |
$4,235.00
|
| Rate for Payer: Cigna of CA PPO |
$4,235.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,142.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,142.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,142.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,420.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,420.00
|
| Rate for Payer: Galaxy Health WC |
$5,142.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,630.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,035.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,305.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,744.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,452.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,235.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,235.00
|
| Rate for Payer: Multiplan Commercial |
$4,840.00
|
| Rate for Payer: Networks By Design Commercial |
$3,025.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,142.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,630.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,630.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,270.57
|
| Rate for Payer: United Healthcare All Other HMO |
$2,210.07
|
| Rate for Payer: United Healthcare HMO Rider |
$2,162.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,981.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,142.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,142.50
|
| Rate for Payer: Vantage Medical Group Senior |
$5,142.50
|
|
|
HC STENT PROTEGE
|
Facility
|
IP
|
$6,050.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020030
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,210.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,210.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$2,722.50
|
| Rate for Payer: Cash Price |
$2,722.50
|
| Rate for Payer: Cigna of CA HMO |
$4,235.00
|
| Rate for Payer: Cigna of CA PPO |
$4,235.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,420.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,420.00
|
| Rate for Payer: Galaxy Health WC |
$5,142.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,630.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,035.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,305.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,744.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,452.00
|
| Rate for Payer: Multiplan Commercial |
$4,840.00
|
| Rate for Payer: Networks By Design Commercial |
$3,025.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,142.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,270.57
|
| Rate for Payer: United Healthcare All Other HMO |
$2,210.07
|
| Rate for Payer: United Healthcare HMO Rider |
$2,162.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,981.38
|
|
|
HC STENT PROTEGE EVERFLEX
|
Facility
|
IP
|
$3,510.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020093
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$702.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$702.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,579.50
|
| Rate for Payer: Cash Price |
$1,579.50
|
| Rate for Payer: Cigna of CA HMO |
$2,457.00
|
| Rate for Payer: Cigna of CA PPO |
$2,457.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,404.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,404.00
|
| Rate for Payer: Galaxy Health WC |
$2,983.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,106.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,341.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,337.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,172.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$842.40
|
| Rate for Payer: Multiplan Commercial |
$2,808.00
|
| Rate for Payer: Networks By Design Commercial |
$1,755.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,983.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,317.30
|
| Rate for Payer: United Healthcare All Other HMO |
$1,282.20
|
| Rate for Payer: United Healthcare HMO Rider |
$1,254.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,149.53
|
|
|
HC STENT PROTEGE EVERFLEX
|
Facility
|
OP
|
$3,510.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020093
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$702.00 |
| Max. Negotiated Rate |
$2,983.50 |
| Rate for Payer: Adventist Health Commercial |
$702.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,983.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,930.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,632.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,032.99
|
| Rate for Payer: Blue Shield of California Commercial |
$2,590.38
|
| Rate for Payer: Blue Shield of California EPN |
$1,705.86
|
| Rate for Payer: Cash Price |
$1,579.50
|
| Rate for Payer: Cigna of CA HMO |
$2,457.00
|
| Rate for Payer: Cigna of CA PPO |
$2,457.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,983.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,983.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,983.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,404.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,404.00
|
| Rate for Payer: Galaxy Health WC |
$2,983.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,106.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,341.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,337.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,172.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$842.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,457.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,457.00
|
| Rate for Payer: Multiplan Commercial |
$2,808.00
|
| Rate for Payer: Networks By Design Commercial |
$1,755.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,983.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,106.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,106.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,317.30
|
| Rate for Payer: United Healthcare All Other HMO |
$1,282.20
|
| Rate for Payer: United Healthcare HMO Rider |
$1,254.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,149.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,983.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,983.50
|
| Rate for Payer: Vantage Medical Group Senior |
$2,983.50
|
|
|
HC STENT RETRIEVER TREVO
|
Facility
|
IP
|
$19,488.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909000006
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,897.60 |
| Max. Negotiated Rate |
$16,564.80 |
| Rate for Payer: Adventist Health Commercial |
$3,897.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$8,769.60
|
| Rate for Payer: Cash Price |
$8,769.60
|
| Rate for Payer: Cigna of CA HMO |
$13,641.60
|
| Rate for Payer: Cigna of CA PPO |
$13,641.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,795.20
|
| Rate for Payer: EPIC Health Plan Senior |
$7,795.20
|
| Rate for Payer: Galaxy Health WC |
$16,564.80
|
| Rate for Payer: Global Benefits Group Commercial |
$11,692.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,998.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,424.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,063.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,677.12
|
| Rate for Payer: Multiplan Commercial |
$15,590.40
|
| Rate for Payer: Networks By Design Commercial |
$9,744.00
|
| Rate for Payer: Prime Health Services Commercial |
$16,564.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,313.85
|
| Rate for Payer: United Healthcare All Other HMO |
$7,118.97
|
| Rate for Payer: United Healthcare HMO Rider |
$6,965.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,382.32
|
|
|
HC STENT RETRIEVER TREVO
|
Facility
|
OP
|
$19,488.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909000006
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,897.60 |
| Max. Negotiated Rate |
$16,564.80 |
| Rate for Payer: Adventist Health Commercial |
$3,897.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16,564.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,718.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,616.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,287.45
|
| Rate for Payer: Blue Shield of California Commercial |
$14,382.14
|
| Rate for Payer: Blue Shield of California EPN |
$9,471.17
|
| Rate for Payer: Cash Price |
$8,769.60
|
| Rate for Payer: Cigna of CA HMO |
$13,641.60
|
| Rate for Payer: Cigna of CA PPO |
$13,641.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16,564.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$16,564.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16,564.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,795.20
|
| Rate for Payer: EPIC Health Plan Senior |
$7,795.20
|
| Rate for Payer: Galaxy Health WC |
$16,564.80
|
| Rate for Payer: Global Benefits Group Commercial |
$11,692.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,998.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,424.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,063.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,677.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13,641.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13,641.60
|
| Rate for Payer: Multiplan Commercial |
$15,590.40
|
| Rate for Payer: Networks By Design Commercial |
$9,744.00
|
| Rate for Payer: Prime Health Services Commercial |
$16,564.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11,692.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11,692.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,313.85
|
| Rate for Payer: United Healthcare All Other HMO |
$7,118.97
|
| Rate for Payer: United Healthcare HMO Rider |
$6,965.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,382.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16,564.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16,564.80
|
| Rate for Payer: Vantage Medical Group Senior |
$16,564.80
|
|
|
HC STENT RUSCH Y
|
Facility
|
IP
|
$1,725.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
900803703
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$345.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$345.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$776.25
|
| Rate for Payer: Cash Price |
$776.25
|
| Rate for Payer: Cigna of CA HMO |
$1,207.50
|
| Rate for Payer: Cigna of CA PPO |
$1,207.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$690.00
|
| Rate for Payer: EPIC Health Plan Senior |
$690.00
|
| Rate for Payer: Galaxy Health WC |
$1,466.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,035.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,150.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$657.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,067.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$414.00
|
| Rate for Payer: Multiplan Commercial |
$1,380.00
|
| Rate for Payer: Networks By Design Commercial |
$862.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,466.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$647.39
|
| Rate for Payer: United Healthcare All Other HMO |
$630.14
|
| Rate for Payer: United Healthcare HMO Rider |
$616.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$564.94
|
|
|
HC STENT RUSCH Y
|
Facility
|
OP
|
$1,725.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
900803703
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$345.00 |
| Max. Negotiated Rate |
$1,466.25 |
| Rate for Payer: Adventist Health Commercial |
$345.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,466.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$948.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,293.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$999.12
|
| Rate for Payer: Blue Shield of California Commercial |
$1,273.05
|
| Rate for Payer: Blue Shield of California EPN |
$838.35
|
| Rate for Payer: Cash Price |
$776.25
|
| Rate for Payer: Cigna of CA HMO |
$1,207.50
|
| Rate for Payer: Cigna of CA PPO |
$1,207.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,466.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,466.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,466.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$690.00
|
| Rate for Payer: EPIC Health Plan Senior |
$690.00
|
| Rate for Payer: Galaxy Health WC |
$1,466.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,035.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,150.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,067.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$414.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,207.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,207.50
|
| Rate for Payer: Multiplan Commercial |
$1,380.00
|
| Rate for Payer: Networks By Design Commercial |
$862.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,466.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,035.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,035.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$647.39
|
| Rate for Payer: United Healthcare All Other HMO |
$630.14
|
| Rate for Payer: United Healthcare HMO Rider |
$616.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$564.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,466.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,466.25
|
| Rate for Payer: Vantage Medical Group Senior |
$1,466.25
|
|
|
HC STENT SCHNEIDER WALL
|
Facility
|
IP
|
$1,717.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
900803702
|
|
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 |
$772.65
|
| Rate for Payer: Cash Price |
$772.65
|
| 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 SCHNEIDER WALL
|
Facility
|
OP
|
$1,717.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
900803702
|
|
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 |
$772.65
|
| 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 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
|
|
