|
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
|
|
|
HC STENT ILIAC EA ADDL
|
Facility
|
OP
|
$14,969.00
|
|
|
Service Code
|
CPT 37223
|
| Hospital Charge Code |
909020064
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$61.30 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$2,993.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,723.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,232.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11,226.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| 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 |
$8,232.95
|
| Rate for Payer: Cash Price |
$8,232.95
|
| Rate for Payer: Cash Price |
$8,232.95
|
| Rate for Payer: Cigna of CA HMO |
$9,580.16
|
| Rate for Payer: Cigna of CA PPO |
$11,077.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,723.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$12,723.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12,723.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,987.60
|
| Rate for Payer: EPIC Health Plan Senior |
$5,987.60
|
| Rate for Payer: Galaxy Health WC |
$12,723.65
|
| Rate for Payer: Global Benefits Group Commercial |
$8,981.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$61.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,984.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$69.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,265.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,592.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,478.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,478.30
|
| Rate for Payer: Multiplan Commercial |
$11,975.20
|
| Rate for Payer: Networks By Design Commercial |
$9,729.85
|
| Rate for Payer: Prime Health Services Commercial |
$12,723.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,981.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,712.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,723.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12,723.65
|
| Rate for Payer: Vantage Medical Group Senior |
$12,723.65
|
|
|
HC STENT ILIAC EA ADDL
|
Facility
|
IP
|
$14,969.00
|
|
|
Service Code
|
CPT 37223
|
| Hospital Charge Code |
909020064
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,993.80 |
| Max. Negotiated Rate |
$12,723.65 |
| Rate for Payer: Adventist Health Commercial |
$2,993.80
|
| Rate for Payer: Cash Price |
$8,232.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,987.60
|
| Rate for Payer: EPIC Health Plan Senior |
$5,987.60
|
| Rate for Payer: Galaxy Health WC |
$12,723.65
|
| Rate for Payer: Global Benefits Group Commercial |
$8,981.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,984.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,703.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,265.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,592.56
|
| Rate for Payer: Multiplan Commercial |
$11,975.20
|
| Rate for Payer: Networks By Design Commercial |
$9,729.85
|
| Rate for Payer: Prime Health Services Commercial |
$12,723.65
|
|
|
HC STENT ILIAC EA ADDL
|
Facility
|
IP
|
$14,548.00
|
|
|
Service Code
|
CPT 37223
|
| Hospital Charge Code |
906820147
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,909.60 |
| Max. Negotiated Rate |
$12,365.80 |
| Rate for Payer: Adventist Health Commercial |
$2,909.60
|
| Rate for Payer: Cash Price |
$8,001.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,819.20
|
| Rate for Payer: EPIC Health Plan Senior |
$5,819.20
|
| Rate for Payer: Galaxy Health WC |
$12,365.80
|
| Rate for Payer: Global Benefits Group Commercial |
$8,728.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,703.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,542.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,005.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,491.52
|
| Rate for Payer: Multiplan Commercial |
$11,638.40
|
| Rate for Payer: Networks By Design Commercial |
$9,456.20
|
| Rate for Payer: Prime Health Services Commercial |
$12,365.80
|
|
|
HC STENT ILIAC EA ADDL
|
Facility
|
OP
|
$14,548.00
|
|
|
Service Code
|
CPT 37223
|
| Hospital Charge Code |
906820147
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$61.30 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$2,909.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,365.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,001.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,911.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| 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 |
$8,001.40
|
| Rate for Payer: Cash Price |
$8,001.40
|
| Rate for Payer: Cash Price |
$8,001.40
|
| Rate for Payer: Cigna of CA HMO |
$9,310.72
|
| Rate for Payer: Cigna of CA PPO |
$10,765.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,365.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$12,365.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12,365.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,819.20
|
| Rate for Payer: EPIC Health Plan Senior |
$5,819.20
|
| Rate for Payer: Galaxy Health WC |
$12,365.80
|
| Rate for Payer: Global Benefits Group Commercial |
$8,728.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$61.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,703.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$69.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,005.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,491.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,183.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,183.60
|
| Rate for Payer: Multiplan Commercial |
$11,638.40
|
| Rate for Payer: Networks By Design Commercial |
$9,456.20
|
| Rate for Payer: Prime Health Services Commercial |
$12,365.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,728.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,712.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,365.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12,365.80
|
| Rate for Payer: Vantage Medical Group Senior |
$12,365.80
|
|
|
HC STENT INSERTION INDWELLING DBL
|
Facility
|
OP
|
$8,052.00
|
|
|
Service Code
|
CPT 52332
|
| Hospital Charge Code |
909020042
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$925.06 |
| Max. Negotiated Rate |
$16,122.00 |
| Rate for Payer: Adventist Health Commercial |
$1,610.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,573.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,820.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,382.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,470.08
|
| Rate for Payer: Cash Price |
$4,428.60
|
| Rate for Payer: Cash Price |
$4,428.60
|
| Rate for Payer: Cash Price |
$4,428.60
|
| Rate for Payer: Cigna of CA HMO |
$5,153.28
|
| Rate for Payer: Cigna of CA PPO |
$5,958.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,573.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,820.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,382.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,916.05
|
| Rate for Payer: EPIC Health Plan Senior |
$4,382.26
|
| Rate for Payer: Galaxy Health WC |
$6,844.20
|
| Rate for Payer: Global Benefits Group Commercial |
$4,831.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,186.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$925.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,382.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,370.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,046.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,382.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,932.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,521.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,872.23
|
| Rate for Payer: Multiplan Commercial |
$6,441.60
|
| Rate for Payer: Multiplan WC |
$6,982.34
|
| Rate for Payer: Networks By Design Commercial |
$5,233.80
|
| Rate for Payer: Prime Health Services Commercial |
$6,844.20
|
| Rate for Payer: Prime Health Services WC |
$6,911.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,831.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,984.00
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,382.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,573.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,820.49
|
| Rate for Payer: Vantage Medical Group Senior |
$4,382.26
|
|
|
HC STENT INSERTION INDWELLING DBL
|
Facility
|
IP
|
$8,052.00
|
|
|
Service Code
|
CPT 52332
|
| Hospital Charge Code |
909020042
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,610.40 |
| Max. Negotiated Rate |
$6,844.20 |
| Rate for Payer: Adventist Health Commercial |
$1,610.40
|
| Rate for Payer: Cash Price |
$4,428.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,220.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,220.80
|
| Rate for Payer: Galaxy Health WC |
$6,844.20
|
| Rate for Payer: Global Benefits Group Commercial |
$4,831.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,370.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,067.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,984.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,932.48
|
| Rate for Payer: Multiplan Commercial |
$6,441.60
|
| Rate for Payer: Networks By Design Commercial |
$5,233.80
|
| Rate for Payer: Prime Health Services Commercial |
$6,844.20
|
|
|
HC STENT INTRACRAN ATHERO STENOSI
|
Facility
|
IP
|
$5,905.00
|
|
|
Service Code
|
CPT 61635
|
| Hospital Charge Code |
909081014
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,181.00 |
| Max. Negotiated Rate |
$5,019.25 |
| Rate for Payer: Adventist Health Commercial |
$1,181.00
|
| Rate for Payer: Cash Price |
$3,247.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,362.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,362.00
|
| Rate for Payer: Galaxy Health WC |
$5,019.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,543.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,938.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,249.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,655.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,417.20
|
| Rate for Payer: Multiplan Commercial |
$4,724.00
|
| Rate for Payer: Networks By Design Commercial |
$3,838.25
|
| Rate for Payer: Prime Health Services Commercial |
$5,019.25
|
|
|
HC STENT INTRACRAN ATHERO STENOSI
|
Facility
|
OP
|
$5,905.00
|
|
|
Service Code
|
CPT 61635
|
| Hospital Charge Code |
909081014
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,181.00 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,181.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,019.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,247.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,428.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,712.00
|
| 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 |
$3,247.75
|
| Rate for Payer: Cash Price |
$3,247.75
|
| Rate for Payer: Cigna of CA HMO |
$3,779.20
|
| Rate for Payer: Cigna of CA PPO |
$4,369.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,019.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,019.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,019.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,362.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,362.00
|
| Rate for Payer: Galaxy Health WC |
$5,019.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,543.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,938.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,655.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,417.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,133.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,133.50
|
| Rate for Payer: Multiplan Commercial |
$4,724.00
|
| Rate for Payer: Networks By Design Commercial |
$3,838.25
|
| Rate for Payer: Prime Health Services Commercial |
$5,019.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,543.00
|
| 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 |
$5,019.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,019.25
|
| Rate for Payer: Vantage Medical Group Senior |
$5,019.25
|
|
|
HC STENT LIFE
|
Facility
|
OP
|
$2,828.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909000008
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$565.60 |
| Max. Negotiated Rate |
$2,403.80 |
| Rate for Payer: Adventist Health Commercial |
$565.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,403.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,555.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,121.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,637.98
|
| Rate for Payer: Blue Shield of California Commercial |
$2,087.06
|
| Rate for Payer: Blue Shield of California EPN |
$1,374.41
|
| Rate for Payer: Cash Price |
$1,555.40
|
| Rate for Payer: Cigna of CA HMO |
$1,979.60
|
| Rate for Payer: Cigna of CA PPO |
$1,979.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,403.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,403.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,403.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,131.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,131.20
|
| Rate for Payer: Galaxy Health WC |
$2,403.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,696.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,886.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,077.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,750.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$678.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,979.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,979.60
|
| Rate for Payer: Multiplan Commercial |
$2,262.40
|
| Rate for Payer: Networks By Design Commercial |
$1,414.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,403.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,696.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,696.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,061.35
|
| Rate for Payer: United Healthcare All Other HMO |
$1,033.07
|
| Rate for Payer: United Healthcare HMO Rider |
$1,010.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$926.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,403.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,403.80
|
| Rate for Payer: Vantage Medical Group Senior |
$2,403.80
|
|
|
HC STENT LIFE
|
Facility
|
IP
|
$2,828.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909000008
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$565.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$565.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,555.40
|
| Rate for Payer: Cash Price |
$1,555.40
|
| Rate for Payer: Cigna of CA HMO |
$1,979.60
|
| Rate for Payer: Cigna of CA PPO |
$1,979.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,131.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,131.20
|
| Rate for Payer: Galaxy Health WC |
$2,403.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,696.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,886.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,077.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,750.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$678.72
|
| Rate for Payer: Multiplan Commercial |
$2,262.40
|
| Rate for Payer: Networks By Design Commercial |
$1,414.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,403.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,061.35
|
| Rate for Payer: United Healthcare All Other HMO |
$1,033.07
|
| Rate for Payer: United Healthcare HMO Rider |
$1,010.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$926.17
|
|
|
HC STENT LVIS
|
Facility
|
IP
|
$20,313.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909001876
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,062.60 |
| Max. Negotiated Rate |
$17,266.05 |
| Rate for Payer: Adventist Health Commercial |
$4,062.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$11,172.15
|
| Rate for Payer: Cash Price |
$11,172.15
|
| Rate for Payer: Cigna of CA HMO |
$14,219.10
|
| Rate for Payer: Cigna of CA PPO |
$14,219.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,125.20
|
| Rate for Payer: EPIC Health Plan Senior |
$8,125.20
|
| Rate for Payer: Galaxy Health WC |
$17,266.05
|
| Rate for Payer: Global Benefits Group Commercial |
$12,187.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,548.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,739.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,573.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,875.12
|
| Rate for Payer: Multiplan Commercial |
$16,250.40
|
| Rate for Payer: Networks By Design Commercial |
$10,156.50
|
| Rate for Payer: Prime Health Services Commercial |
$17,266.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,623.47
|
| Rate for Payer: United Healthcare All Other HMO |
$7,420.34
|
| Rate for Payer: United Healthcare HMO Rider |
$7,259.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,652.51
|
|
|
HC STENT LVIS
|
Facility
|
OP
|
$20,313.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909001876
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,062.60 |
| Max. Negotiated Rate |
$17,266.05 |
| Rate for Payer: Adventist Health Commercial |
$4,062.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17,266.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11,172.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15,234.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,765.29
|
| Rate for Payer: Blue Shield of California Commercial |
$14,990.99
|
| Rate for Payer: Blue Shield of California EPN |
$9,872.12
|
| Rate for Payer: Cash Price |
$11,172.15
|
| Rate for Payer: Cigna of CA HMO |
$14,219.10
|
| Rate for Payer: Cigna of CA PPO |
$14,219.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17,266.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$17,266.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17,266.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,125.20
|
| Rate for Payer: EPIC Health Plan Senior |
$8,125.20
|
| Rate for Payer: Galaxy Health WC |
$17,266.05
|
| Rate for Payer: Global Benefits Group Commercial |
$12,187.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,548.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,739.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,573.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,875.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14,219.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14,219.10
|
| Rate for Payer: Multiplan Commercial |
$16,250.40
|
| Rate for Payer: Networks By Design Commercial |
$10,156.50
|
| Rate for Payer: Prime Health Services Commercial |
$17,266.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12,187.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12,187.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,623.47
|
| Rate for Payer: United Healthcare All Other HMO |
$7,420.34
|
| Rate for Payer: United Healthcare HMO Rider |
$7,259.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,652.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17,266.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17,266.05
|
| Rate for Payer: Vantage Medical Group Senior |
$17,266.05
|
|
|
HC STENT MEDTRONIC BALN EXPAND
|
Facility
|
IP
|
$3,900.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020115
|
|
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 MEDTRONIC BALN EXPAND
|
Facility
|
OP
|
$3,900.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020115
|
|
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 MEDTRONIC SE 12-150
|
Facility
|
OP
|
$3,900.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020114
|
|
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 MEDTRONIC SE 12-150
|
Facility
|
IP
|
$3,900.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020114
|
|
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 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 |
$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 MEDTRONIC SE 40-100
|
Facility
|
IP
|
$3,900.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020113
|
|
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 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 |
$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 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 |
$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 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 |
$7,865.00
|
| Rate for Payer: Cash Price |
$7,865.00
|
| 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 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 |
$7,865.00
|
| 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 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 |
$1,079.65
|
| Rate for Payer: Cash Price |
$1,079.65
|
| 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
|
|
