|
HC STENT SUPERA
|
Facility
|
IP
|
$3,987.50
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020142
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$797.50 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$797.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,794.38
|
| Rate for Payer: Cash Price |
$1,794.38
|
| Rate for Payer: Cigna of CA HMO |
$2,791.25
|
| Rate for Payer: Cigna of CA PPO |
$2,791.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,595.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,595.00
|
| Rate for Payer: Galaxy Health WC |
$3,389.38
|
| Rate for Payer: Global Benefits Group Commercial |
$2,392.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,659.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,519.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,468.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$957.00
|
| Rate for Payer: Multiplan Commercial |
$3,190.00
|
| Rate for Payer: Networks By Design Commercial |
$1,993.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,389.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,496.51
|
| Rate for Payer: United Healthcare All Other HMO |
$1,456.63
|
| Rate for Payer: United Healthcare HMO Rider |
$1,425.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,305.91
|
|
|
HC STENT SUPERA
|
Facility
|
OP
|
$3,987.50
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020142
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$797.50 |
| Max. Negotiated Rate |
$3,389.38 |
| Rate for Payer: Adventist Health Commercial |
$797.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,389.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,193.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,990.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,309.56
|
| Rate for Payer: Blue Shield of California Commercial |
$2,942.78
|
| Rate for Payer: Blue Shield of California EPN |
$1,937.92
|
| Rate for Payer: Cash Price |
$1,794.38
|
| Rate for Payer: Cigna of CA HMO |
$2,791.25
|
| Rate for Payer: Cigna of CA PPO |
$2,791.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,389.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,389.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,389.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,595.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,595.00
|
| Rate for Payer: Galaxy Health WC |
$3,389.38
|
| Rate for Payer: Global Benefits Group Commercial |
$2,392.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,659.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,519.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,468.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$957.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,791.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,791.25
|
| Rate for Payer: Multiplan Commercial |
$3,190.00
|
| Rate for Payer: Networks By Design Commercial |
$1,993.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,389.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,392.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,392.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,496.51
|
| Rate for Payer: United Healthcare All Other HMO |
$1,456.63
|
| Rate for Payer: United Healthcare HMO Rider |
$1,425.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,305.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,389.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,389.38
|
| Rate for Payer: Vantage Medical Group Senior |
$3,389.38
|
|
|
HC STENT TIBIOPERONEAL
|
Facility
|
OP
|
$26,601.00
|
|
|
Service Code
|
CPT 37230
|
| Hospital Charge Code |
906820154
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$998.86 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$5,320.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22,815.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,922.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$3,490.94
|
| Rate for Payer: Cash Price |
$11,970.45
|
| Rate for Payer: Cash Price |
$11,970.45
|
| Rate for Payer: Cash Price |
$11,970.45
|
| Rate for Payer: Cigna of CA HMO |
$17,024.64
|
| Rate for Payer: Cigna of CA PPO |
$19,684.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,097.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22,815.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$30,801.34
|
| Rate for Payer: EPIC Health Plan Senior |
$22,815.81
|
| Rate for Payer: Galaxy Health WC |
$22,610.85
|
| Rate for Payer: Global Benefits Group Commercial |
$15,960.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$37,417.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$998.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,815.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17,742.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,129.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,815.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,384.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28,747.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30,573.19
|
| Rate for Payer: Multiplan Commercial |
$21,280.80
|
| Rate for Payer: Multiplan WC |
$36,352.92
|
| Rate for Payer: Networks By Design Commercial |
$17,290.65
|
| Rate for Payer: Prime Health Services Commercial |
$22,610.85
|
| Rate for Payer: Prime Health Services WC |
$35,981.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15,960.60
|
| 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 |
$22,815.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Vantage Medical Group Senior |
$22,815.81
|
|
|
HC STENT TIBIOPERONEAL
|
Facility
|
IP
|
$27,371.00
|
|
|
Service Code
|
CPT 37230
|
| Hospital Charge Code |
909020071
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,474.20 |
| Max. Negotiated Rate |
$23,265.35 |
| Rate for Payer: Adventist Health Commercial |
$5,474.20
|
| Rate for Payer: Cash Price |
$12,316.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,948.40
|
| Rate for Payer: EPIC Health Plan Senior |
$10,948.40
|
| Rate for Payer: Galaxy Health WC |
$23,265.35
|
| Rate for Payer: Global Benefits Group Commercial |
$16,422.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18,256.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,428.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,942.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,569.04
|
| Rate for Payer: Multiplan Commercial |
$21,896.80
|
| Rate for Payer: Networks By Design Commercial |
$17,791.15
|
| Rate for Payer: Prime Health Services Commercial |
$23,265.35
|
|
|
HC STENT TIBIOPERONEAL
|
Facility
|
IP
|
$26,601.00
|
|
|
Service Code
|
CPT 37230
|
| Hospital Charge Code |
906820154
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,320.20 |
| Max. Negotiated Rate |
$22,610.85 |
| Rate for Payer: Adventist Health Commercial |
$5,320.20
|
| Rate for Payer: Cash Price |
$11,970.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,640.40
|
| Rate for Payer: EPIC Health Plan Senior |
$10,640.40
|
| Rate for Payer: Galaxy Health WC |
$22,610.85
|
| Rate for Payer: Global Benefits Group Commercial |
$15,960.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17,742.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,134.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,466.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,384.24
|
| Rate for Payer: Multiplan Commercial |
$21,280.80
|
| Rate for Payer: Networks By Design Commercial |
$17,290.65
|
| Rate for Payer: Prime Health Services Commercial |
$22,610.85
|
|
|
HC STENT TIBIOPERONEAL
|
Facility
|
OP
|
$27,371.00
|
|
|
Service Code
|
CPT 37230
|
| Hospital Charge Code |
909020071
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$998.86 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$5,474.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22,815.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,922.00
|
| 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 |
$12,316.95
|
| Rate for Payer: Cash Price |
$12,316.95
|
| Rate for Payer: Cash Price |
$12,316.95
|
| Rate for Payer: Cigna of CA HMO |
$17,517.44
|
| Rate for Payer: Cigna of CA PPO |
$20,254.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,097.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22,815.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$30,801.34
|
| Rate for Payer: EPIC Health Plan Senior |
$22,815.81
|
| Rate for Payer: Galaxy Health WC |
$23,265.35
|
| Rate for Payer: Global Benefits Group Commercial |
$16,422.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$37,417.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$998.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,815.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18,256.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,129.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,815.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,569.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28,747.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30,573.19
|
| Rate for Payer: Multiplan Commercial |
$21,896.80
|
| Rate for Payer: Multiplan WC |
$36,352.92
|
| Rate for Payer: Networks By Design Commercial |
$17,791.15
|
| Rate for Payer: Prime Health Services Commercial |
$23,265.35
|
| Rate for Payer: Prime Health Services WC |
$35,981.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16,422.60
|
| 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 |
$22,815.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Vantage Medical Group Senior |
$22,815.81
|
|
|
HC STENT TIBIOPERONEAL EA ADDL
|
Facility
|
OP
|
$15,757.00
|
|
|
Service Code
|
CPT 37234
|
| Hospital Charge Code |
909020075
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$395.93 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$3,151.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,393.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,666.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11,817.75
|
| 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 |
$7,090.65
|
| Rate for Payer: Cash Price |
$7,090.65
|
| Rate for Payer: Cash Price |
$7,090.65
|
| Rate for Payer: Cigna of CA HMO |
$10,084.48
|
| Rate for Payer: Cigna of CA PPO |
$11,660.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,393.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$13,393.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13,393.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,302.80
|
| Rate for Payer: EPIC Health Plan Senior |
$6,302.80
|
| Rate for Payer: Galaxy Health WC |
$13,393.45
|
| Rate for Payer: Global Benefits Group Commercial |
$9,454.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$395.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,509.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$447.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,753.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,781.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,029.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,029.90
|
| Rate for Payer: Multiplan Commercial |
$12,605.60
|
| Rate for Payer: Networks By Design Commercial |
$10,242.05
|
| Rate for Payer: Prime Health Services Commercial |
$13,393.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,454.20
|
| 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 |
$13,393.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13,393.45
|
| Rate for Payer: Vantage Medical Group Senior |
$13,393.45
|
|
|
HC STENT TIBIOPERONEAL EA ADDL
|
Facility
|
IP
|
$15,314.00
|
|
|
Service Code
|
CPT 37234
|
| Hospital Charge Code |
906820158
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,062.80 |
| Max. Negotiated Rate |
$13,016.90 |
| Rate for Payer: Adventist Health Commercial |
$3,062.80
|
| Rate for Payer: Cash Price |
$6,891.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,125.60
|
| Rate for Payer: EPIC Health Plan Senior |
$6,125.60
|
| Rate for Payer: Galaxy Health WC |
$13,016.90
|
| Rate for Payer: Global Benefits Group Commercial |
$9,188.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,214.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,834.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,479.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,675.36
|
| Rate for Payer: Multiplan Commercial |
$12,251.20
|
| Rate for Payer: Networks By Design Commercial |
$9,954.10
|
| Rate for Payer: Prime Health Services Commercial |
$13,016.90
|
|
|
HC STENT TIBIOPERONEAL EA ADDL
|
Facility
|
IP
|
$15,757.00
|
|
|
Service Code
|
CPT 37234
|
| Hospital Charge Code |
909020075
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,151.40 |
| Max. Negotiated Rate |
$13,393.45 |
| Rate for Payer: Adventist Health Commercial |
$3,151.40
|
| Rate for Payer: Cash Price |
$7,090.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,302.80
|
| Rate for Payer: EPIC Health Plan Senior |
$6,302.80
|
| Rate for Payer: Galaxy Health WC |
$13,393.45
|
| Rate for Payer: Global Benefits Group Commercial |
$9,454.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,509.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,003.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,753.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,781.68
|
| Rate for Payer: Multiplan Commercial |
$12,605.60
|
| Rate for Payer: Networks By Design Commercial |
$10,242.05
|
| Rate for Payer: Prime Health Services Commercial |
$13,393.45
|
|
|
HC STENT TIBIOPERONEAL EA ADDL
|
Facility
|
OP
|
$15,314.00
|
|
|
Service Code
|
CPT 37234
|
| Hospital Charge Code |
906820158
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$395.93 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$3,062.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,016.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,422.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11,485.50
|
| 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 |
$6,891.30
|
| Rate for Payer: Cash Price |
$6,891.30
|
| Rate for Payer: Cash Price |
$6,891.30
|
| Rate for Payer: Cigna of CA HMO |
$9,800.96
|
| Rate for Payer: Cigna of CA PPO |
$11,332.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,016.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$13,016.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13,016.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,125.60
|
| Rate for Payer: EPIC Health Plan Senior |
$6,125.60
|
| Rate for Payer: Galaxy Health WC |
$13,016.90
|
| Rate for Payer: Global Benefits Group Commercial |
$9,188.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$395.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,214.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$447.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,479.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,675.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,719.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,719.80
|
| Rate for Payer: Multiplan Commercial |
$12,251.20
|
| Rate for Payer: Networks By Design Commercial |
$9,954.10
|
| Rate for Payer: Prime Health Services Commercial |
$13,016.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,188.40
|
| 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 |
$13,016.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13,016.90
|
| Rate for Payer: Vantage Medical Group Senior |
$13,016.90
|
|
|
HC STENT ULTRAFLEX T-B COV W/DEL
|
Facility
|
OP
|
$3,053.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
900803704
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$610.60 |
| Max. Negotiated Rate |
$2,595.05 |
| Rate for Payer: Adventist Health Commercial |
$610.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,595.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,679.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,289.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,768.30
|
| Rate for Payer: Blue Shield of California Commercial |
$2,253.11
|
| Rate for Payer: Blue Shield of California EPN |
$1,483.76
|
| Rate for Payer: Cash Price |
$1,373.85
|
| Rate for Payer: Cigna of CA HMO |
$2,137.10
|
| Rate for Payer: Cigna of CA PPO |
$2,137.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,595.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,595.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,595.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,221.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,221.20
|
| Rate for Payer: Galaxy Health WC |
$2,595.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,831.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,036.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,889.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$732.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,137.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,137.10
|
| Rate for Payer: Multiplan Commercial |
$2,442.40
|
| Rate for Payer: Networks By Design Commercial |
$1,526.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,595.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,831.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,831.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,145.79
|
| Rate for Payer: United Healthcare All Other HMO |
$1,115.26
|
| Rate for Payer: United Healthcare HMO Rider |
$1,091.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$999.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,595.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,595.05
|
| Rate for Payer: Vantage Medical Group Senior |
$2,595.05
|
|
|
HC STENT ULTRAFLEX T-B COV W/DEL
|
Facility
|
IP
|
$3,053.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
900803704
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$610.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$610.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,373.85
|
| Rate for Payer: Cash Price |
$1,373.85
|
| Rate for Payer: Cigna of CA HMO |
$2,137.10
|
| Rate for Payer: Cigna of CA PPO |
$2,137.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,221.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,221.20
|
| Rate for Payer: Galaxy Health WC |
$2,595.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,831.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,036.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,163.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,889.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$732.72
|
| Rate for Payer: Multiplan Commercial |
$2,442.40
|
| Rate for Payer: Networks By Design Commercial |
$1,526.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,595.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,145.79
|
| Rate for Payer: United Healthcare All Other HMO |
$1,115.26
|
| Rate for Payer: United Healthcare HMO Rider |
$1,091.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$999.86
|
|
|
HC STENT ULTRAFLEX T-B NON-COV W/
|
Facility
|
OP
|
$3,053.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
900803705
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$610.60 |
| Max. Negotiated Rate |
$2,595.05 |
| Rate for Payer: Adventist Health Commercial |
$610.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,595.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,679.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,289.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,768.30
|
| Rate for Payer: Blue Shield of California Commercial |
$2,253.11
|
| Rate for Payer: Blue Shield of California EPN |
$1,483.76
|
| Rate for Payer: Cash Price |
$1,373.85
|
| Rate for Payer: Cigna of CA HMO |
$2,137.10
|
| Rate for Payer: Cigna of CA PPO |
$2,137.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,595.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,595.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,595.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,221.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,221.20
|
| Rate for Payer: Galaxy Health WC |
$2,595.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,831.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,036.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,163.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,889.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$732.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,137.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,137.10
|
| Rate for Payer: Multiplan Commercial |
$2,442.40
|
| Rate for Payer: Networks By Design Commercial |
$1,526.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,595.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,831.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,831.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,145.79
|
| Rate for Payer: United Healthcare All Other HMO |
$1,115.26
|
| Rate for Payer: United Healthcare HMO Rider |
$1,091.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$999.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,595.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,595.05
|
| Rate for Payer: Vantage Medical Group Senior |
$2,595.05
|
|
|
HC STENT ULTRAFLEX T-B NON-COV W/
|
Facility
|
IP
|
$3,053.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
900803705
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$610.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$610.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,373.85
|
| Rate for Payer: Cash Price |
$1,373.85
|
| Rate for Payer: Cigna of CA HMO |
$2,137.10
|
| Rate for Payer: Cigna of CA PPO |
$2,137.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,221.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,221.20
|
| Rate for Payer: Galaxy Health WC |
$2,595.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,831.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,036.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,163.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,889.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$732.72
|
| Rate for Payer: Multiplan Commercial |
$2,442.40
|
| Rate for Payer: Networks By Design Commercial |
$1,526.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,595.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,145.79
|
| Rate for Payer: United Healthcare All Other HMO |
$1,115.26
|
| Rate for Payer: United Healthcare HMO Rider |
$1,091.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$999.86
|
|
|
HC STENT VIABAHN
|
Facility
|
IP
|
$7,625.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
909020094
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,525.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,525.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$3,431.25
|
| Rate for Payer: Cash Price |
$3,431.25
|
| Rate for Payer: Cigna of CA HMO |
$5,337.50
|
| Rate for Payer: Cigna of CA PPO |
$5,337.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,050.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,050.00
|
| Rate for Payer: Galaxy Health WC |
$6,481.25
|
| Rate for Payer: Global Benefits Group Commercial |
$4,575.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,085.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,905.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,719.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,830.00
|
| Rate for Payer: Multiplan Commercial |
$6,100.00
|
| Rate for Payer: Networks By Design Commercial |
$3,812.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,481.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,861.66
|
| Rate for Payer: United Healthcare All Other HMO |
$2,785.41
|
| Rate for Payer: United Healthcare HMO Rider |
$2,725.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,497.19
|
|
|
HC STENT VIABAHN
|
Facility
|
OP
|
$7,625.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
909020094
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,525.00 |
| Max. Negotiated Rate |
$6,481.25 |
| Rate for Payer: Adventist Health Commercial |
$1,525.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,481.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,193.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,718.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,416.40
|
| Rate for Payer: Blue Shield of California Commercial |
$5,627.25
|
| Rate for Payer: Blue Shield of California EPN |
$3,705.75
|
| Rate for Payer: Cash Price |
$3,431.25
|
| Rate for Payer: Cigna of CA HMO |
$5,337.50
|
| Rate for Payer: Cigna of CA PPO |
$5,337.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,481.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,481.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,481.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,050.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,050.00
|
| Rate for Payer: Galaxy Health WC |
$6,481.25
|
| Rate for Payer: Global Benefits Group Commercial |
$4,575.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,085.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,719.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,830.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,337.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,337.50
|
| Rate for Payer: Multiplan Commercial |
$6,100.00
|
| Rate for Payer: Networks By Design Commercial |
$3,812.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,481.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,575.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,575.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,861.66
|
| Rate for Payer: United Healthcare All Other HMO |
$2,785.41
|
| Rate for Payer: United Healthcare HMO Rider |
$2,725.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,497.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,481.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,481.25
|
| Rate for Payer: Vantage Medical Group Senior |
$6,481.25
|
|
|
HC STENT VIATORR/COVERED
|
Facility
|
OP
|
$9,412.50
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
909081419
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,882.50 |
| Max. Negotiated Rate |
$8,000.62 |
| Rate for Payer: Adventist Health Commercial |
$1,882.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,000.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,176.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,059.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,451.72
|
| Rate for Payer: Blue Shield of California Commercial |
$6,946.43
|
| Rate for Payer: Blue Shield of California EPN |
$4,574.48
|
| Rate for Payer: Cash Price |
$4,235.62
|
| Rate for Payer: Cigna of CA HMO |
$6,588.75
|
| Rate for Payer: Cigna of CA PPO |
$6,588.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,000.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,000.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,000.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,765.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,765.00
|
| Rate for Payer: Galaxy Health WC |
$8,000.62
|
| Rate for Payer: Global Benefits Group Commercial |
$5,647.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,278.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,826.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,259.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,588.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,588.75
|
| Rate for Payer: Multiplan Commercial |
$7,530.00
|
| Rate for Payer: Networks By Design Commercial |
$4,706.25
|
| Rate for Payer: Prime Health Services Commercial |
$8,000.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,647.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,647.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,532.51
|
| Rate for Payer: United Healthcare All Other HMO |
$3,438.39
|
| Rate for Payer: United Healthcare HMO Rider |
$3,364.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,082.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,000.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,000.62
|
| Rate for Payer: Vantage Medical Group Senior |
$8,000.62
|
|
|
HC STENT VIATORR/COVERED
|
Facility
|
IP
|
$9,412.50
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
909081419
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,882.50 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,882.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$4,235.62
|
| Rate for Payer: Cash Price |
$4,235.62
|
| Rate for Payer: Cigna of CA HMO |
$6,588.75
|
| Rate for Payer: Cigna of CA PPO |
$6,588.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,765.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,765.00
|
| Rate for Payer: Galaxy Health WC |
$8,000.62
|
| Rate for Payer: Global Benefits Group Commercial |
$5,647.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,278.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,586.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,826.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,259.00
|
| Rate for Payer: Multiplan Commercial |
$7,530.00
|
| Rate for Payer: Networks By Design Commercial |
$4,706.25
|
| Rate for Payer: Prime Health Services Commercial |
$8,000.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,532.51
|
| Rate for Payer: United Healthcare All Other HMO |
$3,438.39
|
| Rate for Payer: United Healthcare HMO Rider |
$3,364.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,082.59
|
|
|
HC STENT WINGSPAN
|
Facility
|
OP
|
$15,287.50
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020055
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,057.50 |
| Max. Negotiated Rate |
$12,994.38 |
| Rate for Payer: Adventist Health Commercial |
$3,057.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,994.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,408.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11,465.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,854.52
|
| Rate for Payer: Blue Shield of California Commercial |
$11,282.17
|
| Rate for Payer: Blue Shield of California EPN |
$7,429.73
|
| Rate for Payer: Cash Price |
$6,879.38
|
| Rate for Payer: Cigna of CA HMO |
$10,701.25
|
| Rate for Payer: Cigna of CA PPO |
$10,701.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,994.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$12,994.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12,994.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,115.00
|
| Rate for Payer: EPIC Health Plan Senior |
$6,115.00
|
| Rate for Payer: Galaxy Health WC |
$12,994.38
|
| Rate for Payer: Global Benefits Group Commercial |
$9,172.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,196.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,824.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,462.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,669.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,701.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,701.25
|
| Rate for Payer: Multiplan Commercial |
$12,230.00
|
| Rate for Payer: Networks By Design Commercial |
$7,643.75
|
| Rate for Payer: Prime Health Services Commercial |
$12,994.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,172.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,172.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,737.40
|
| Rate for Payer: United Healthcare All Other HMO |
$5,584.52
|
| Rate for Payer: United Healthcare HMO Rider |
$5,463.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,006.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,994.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12,994.38
|
| Rate for Payer: Vantage Medical Group Senior |
$12,994.38
|
|
|
HC STENT WINGSPAN
|
Facility
|
IP
|
$15,287.50
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020055
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,057.50 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$3,057.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$6,879.38
|
| Rate for Payer: Cash Price |
$6,879.38
|
| Rate for Payer: Cigna of CA HMO |
$10,701.25
|
| Rate for Payer: Cigna of CA PPO |
$10,701.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,115.00
|
| Rate for Payer: EPIC Health Plan Senior |
$6,115.00
|
| Rate for Payer: Galaxy Health WC |
$12,994.38
|
| Rate for Payer: Global Benefits Group Commercial |
$9,172.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,196.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,824.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,462.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,669.00
|
| Rate for Payer: Multiplan Commercial |
$12,230.00
|
| Rate for Payer: Networks By Design Commercial |
$7,643.75
|
| Rate for Payer: Prime Health Services Commercial |
$12,994.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,737.40
|
| Rate for Payer: United Healthcare All Other HMO |
$5,584.52
|
| Rate for Payer: United Healthcare HMO Rider |
$5,463.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,006.66
|
|
|
HC STEREOTACTIC PROBE 11 GA
|
Facility
|
OP
|
$774.00
|
|
| Hospital Charge Code |
909001127
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$154.80 |
| Max. Negotiated Rate |
$657.90 |
| Rate for Payer: Adventist Health Commercial |
$154.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$507.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$657.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$425.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$580.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$475.31
|
| Rate for Payer: Cash Price |
$348.30
|
| Rate for Payer: Cigna of CA HMO |
$495.36
|
| Rate for Payer: Cigna of CA PPO |
$572.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$657.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$657.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$657.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$309.60
|
| Rate for Payer: EPIC Health Plan Senior |
$309.60
|
| Rate for Payer: Galaxy Health WC |
$657.90
|
| Rate for Payer: Global Benefits Group Commercial |
$464.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$516.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$294.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$479.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$541.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$541.80
|
| Rate for Payer: Multiplan Commercial |
$619.20
|
| Rate for Payer: Networks By Design Commercial |
$503.10
|
| Rate for Payer: Prime Health Services Commercial |
$657.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$464.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$464.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$387.00
|
| Rate for Payer: United Healthcare All Other HMO |
$387.00
|
| Rate for Payer: United Healthcare HMO Rider |
$387.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$387.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$657.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$657.90
|
| Rate for Payer: Vantage Medical Group Senior |
$657.90
|
|
|
HC STEREOTACTIC PROBE 11 GA
|
Facility
|
IP
|
$774.00
|
|
| Hospital Charge Code |
909001127
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$154.80 |
| Max. Negotiated Rate |
$657.90 |
| Rate for Payer: Adventist Health Commercial |
$154.80
|
| Rate for Payer: Cash Price |
$348.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$309.60
|
| Rate for Payer: EPIC Health Plan Senior |
$309.60
|
| Rate for Payer: Galaxy Health WC |
$657.90
|
| Rate for Payer: Global Benefits Group Commercial |
$464.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$516.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$294.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$479.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.76
|
| Rate for Payer: Multiplan Commercial |
$619.20
|
| Rate for Payer: Networks By Design Commercial |
$503.10
|
| Rate for Payer: Prime Health Services Commercial |
$657.90
|
|
|
HC STEREOTACTIC PROBE 8 GA
|
Facility
|
OP
|
$921.00
|
|
| Hospital Charge Code |
909001128
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$184.20 |
| Max. Negotiated Rate |
$782.85 |
| Rate for Payer: Adventist Health Commercial |
$184.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$604.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$782.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$506.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$690.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$565.59
|
| Rate for Payer: Cash Price |
$414.45
|
| Rate for Payer: Cigna of CA HMO |
$589.44
|
| Rate for Payer: Cigna of CA PPO |
$681.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$782.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$782.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$782.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$368.40
|
| Rate for Payer: EPIC Health Plan Senior |
$368.40
|
| Rate for Payer: Galaxy Health WC |
$782.85
|
| Rate for Payer: Global Benefits Group Commercial |
$552.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$614.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$350.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$570.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$221.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$644.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$644.70
|
| Rate for Payer: Multiplan Commercial |
$736.80
|
| Rate for Payer: Networks By Design Commercial |
$598.65
|
| Rate for Payer: Prime Health Services Commercial |
$782.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$552.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$552.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$460.50
|
| Rate for Payer: United Healthcare All Other HMO |
$460.50
|
| Rate for Payer: United Healthcare HMO Rider |
$460.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$460.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$782.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$782.85
|
| Rate for Payer: Vantage Medical Group Senior |
$782.85
|
|
|
HC STEREOTACTIC PROBE 8 GA
|
Facility
|
IP
|
$921.00
|
|
| Hospital Charge Code |
909001128
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$184.20 |
| Max. Negotiated Rate |
$782.85 |
| Rate for Payer: Adventist Health Commercial |
$184.20
|
| Rate for Payer: Cash Price |
$414.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$368.40
|
| Rate for Payer: EPIC Health Plan Senior |
$368.40
|
| Rate for Payer: Galaxy Health WC |
$782.85
|
| Rate for Payer: Global Benefits Group Commercial |
$552.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$614.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$350.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$570.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$221.04
|
| Rate for Payer: Multiplan Commercial |
$736.80
|
| Rate for Payer: Networks By Design Commercial |
$598.65
|
| Rate for Payer: Prime Health Services Commercial |
$782.85
|
|
|
HC STERNO CLAV JOINTS
|
Facility
|
IP
|
$699.00
|
|
|
Service Code
|
CPT 71130
|
| Hospital Charge Code |
909001428
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$139.80 |
| Max. Negotiated Rate |
$594.15 |
| Rate for Payer: Adventist Health Commercial |
$139.80
|
| Rate for Payer: Cash Price |
$314.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$279.60
|
| Rate for Payer: EPIC Health Plan Senior |
$279.60
|
| Rate for Payer: Galaxy Health WC |
$594.15
|
| Rate for Payer: Global Benefits Group Commercial |
$419.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$466.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$266.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$432.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$167.76
|
| Rate for Payer: Multiplan Commercial |
$559.20
|
| Rate for Payer: Networks By Design Commercial |
$454.35
|
| Rate for Payer: Prime Health Services Commercial |
$594.15
|
|
