|
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
|
|
|
HC STERNUM
|
Facility
|
OP
|
$814.00
|
|
|
Service Code
|
CPT 71120
|
| Hospital Charge Code |
909001427
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$43.65 |
| Max. Negotiated Rate |
$691.90 |
| Rate for Payer: Adventist Health Commercial |
$162.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$533.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$183.73
|
| Rate for Payer: Blue Shield of California Commercial |
$498.17
|
| Rate for Payer: Blue Shield of California EPN |
$328.86
|
| Rate for Payer: Cash Price |
$366.30
|
| Rate for Payer: Cash Price |
$366.30
|
| Rate for Payer: Cigna of CA HMO |
$520.96
|
| Rate for Payer: Cigna of CA PPO |
$602.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.04
|
| Rate for Payer: EPIC Health Plan Senior |
$111.88
|
| Rate for Payer: Galaxy Health WC |
$691.90
|
| Rate for Payer: Global Benefits Group Commercial |
$488.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$183.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$43.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$542.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$195.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.92
|
| Rate for Payer: Multiplan Commercial |
$651.20
|
| Rate for Payer: Networks By Design Commercial |
$529.10
|
| Rate for Payer: Prime Health Services Commercial |
$691.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$488.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$488.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC STERNUM
|
Facility
|
IP
|
$814.00
|
|
|
Service Code
|
CPT 71120
|
| Hospital Charge Code |
909001427
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$162.80 |
| Max. Negotiated Rate |
$691.90 |
| Rate for Payer: Adventist Health Commercial |
$162.80
|
| Rate for Payer: Cash Price |
$366.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$325.60
|
| Rate for Payer: EPIC Health Plan Senior |
$325.60
|
| Rate for Payer: Galaxy Health WC |
$691.90
|
| Rate for Payer: Global Benefits Group Commercial |
$488.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$542.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$310.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$503.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$195.36
|
| Rate for Payer: Multiplan Commercial |
$651.20
|
| Rate for Payer: Networks By Design Commercial |
$529.10
|
| Rate for Payer: Prime Health Services Commercial |
$691.90
|
|
|
HC ST J CATH INQUIRY DECA XL
|
Facility
|
IP
|
$1,564.00
|
|
|
Service Code
|
CPT C1730
|
| Hospital Charge Code |
906812731
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$312.80 |
| Max. Negotiated Rate |
$1,329.40 |
| Rate for Payer: Adventist Health Commercial |
$312.80
|
| Rate for Payer: Cash Price |
$703.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$625.60
|
| Rate for Payer: EPIC Health Plan Senior |
$625.60
|
| Rate for Payer: Galaxy Health WC |
$1,329.40
|
| Rate for Payer: Global Benefits Group Commercial |
$938.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,043.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$595.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$968.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$375.36
|
| Rate for Payer: Multiplan Commercial |
$1,251.20
|
| Rate for Payer: Networks By Design Commercial |
$1,016.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,329.40
|
|
|
HC ST J CATH INQUIRY DECA XL
|
Facility
|
OP
|
$1,564.00
|
|
|
Service Code
|
CPT C1730
|
| Hospital Charge Code |
906812731
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$312.80 |
| Max. Negotiated Rate |
$1,329.40 |
| Rate for Payer: Adventist Health Commercial |
$312.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,025.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,329.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$860.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,173.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$960.45
|
| Rate for Payer: Cash Price |
$703.80
|
| Rate for Payer: Cigna of CA HMO |
$1,000.96
|
| Rate for Payer: Cigna of CA PPO |
$1,157.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,329.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,329.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,329.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$625.60
|
| Rate for Payer: EPIC Health Plan Senior |
$625.60
|
| Rate for Payer: Galaxy Health WC |
$1,329.40
|
| Rate for Payer: Global Benefits Group Commercial |
$938.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,043.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$595.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$968.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$375.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,094.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,094.80
|
| Rate for Payer: Multiplan Commercial |
$1,251.20
|
| Rate for Payer: Networks By Design Commercial |
$1,016.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,329.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$938.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$938.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$782.00
|
| Rate for Payer: United Healthcare All Other HMO |
$782.00
|
| Rate for Payer: United Healthcare HMO Rider |
$782.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$782.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,329.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,329.40
|
| Rate for Payer: Vantage Medical Group Senior |
$1,329.40
|
|
|
HC STJ LIVEWIRE CANNULATOR
|
Facility
|
OP
|
$1,620.00
|
|
|
Service Code
|
CPT C1730
|
| Hospital Charge Code |
906813540
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$324.00 |
| Max. Negotiated Rate |
$1,377.00 |
| Rate for Payer: Adventist Health Commercial |
$324.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,062.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,377.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$891.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,215.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$994.84
|
| Rate for Payer: Cash Price |
$729.00
|
| Rate for Payer: Cigna of CA HMO |
$1,036.80
|
| Rate for Payer: Cigna of CA PPO |
$1,198.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,377.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,377.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,377.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$648.00
|
| Rate for Payer: EPIC Health Plan Senior |
$648.00
|
| Rate for Payer: Galaxy Health WC |
$1,377.00
|
| Rate for Payer: Global Benefits Group Commercial |
$972.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,080.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$617.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,002.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$388.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,134.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,134.00
|
| Rate for Payer: Multiplan Commercial |
$1,296.00
|
| Rate for Payer: Networks By Design Commercial |
$1,053.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,377.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$972.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$972.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$810.00
|
| Rate for Payer: United Healthcare All Other HMO |
$810.00
|
| Rate for Payer: United Healthcare HMO Rider |
$810.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$810.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,377.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,377.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,377.00
|
|
|
HC STJ LIVEWIRE CANNULATOR
|
Facility
|
IP
|
$1,620.00
|
|
|
Service Code
|
CPT C1730
|
| Hospital Charge Code |
906813540
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$324.00 |
| Max. Negotiated Rate |
$1,377.00 |
| Rate for Payer: Adventist Health Commercial |
$324.00
|
| Rate for Payer: Cash Price |
$729.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$648.00
|
| Rate for Payer: EPIC Health Plan Senior |
$648.00
|
| Rate for Payer: Galaxy Health WC |
$1,377.00
|
| Rate for Payer: Global Benefits Group Commercial |
$972.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,080.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$617.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,002.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$388.80
|
| Rate for Payer: Multiplan Commercial |
$1,296.00
|
| Rate for Payer: Networks By Design Commercial |
$1,053.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,377.00
|
|
|
HC STJ REFLEXION CANN W/LUMEN
|
Facility
|
OP
|
$1,260.00
|
|
|
Service Code
|
CPT C1731
|
| Hospital Charge Code |
906813539
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$252.00 |
| Max. Negotiated Rate |
$1,071.00 |
| Rate for Payer: Adventist Health Commercial |
$252.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$826.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,071.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$693.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$945.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$773.77
|
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: Cigna of CA HMO |
$806.40
|
| Rate for Payer: Cigna of CA PPO |
$932.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,071.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,071.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,071.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$504.00
|
| Rate for Payer: EPIC Health Plan Senior |
$504.00
|
| Rate for Payer: Galaxy Health WC |
$1,071.00
|
| Rate for Payer: Global Benefits Group Commercial |
$756.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$840.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$480.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$779.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$302.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$882.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$882.00
|
| Rate for Payer: Multiplan Commercial |
$1,008.00
|
| Rate for Payer: Networks By Design Commercial |
$819.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,071.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$756.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$756.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$630.00
|
| Rate for Payer: United Healthcare All Other HMO |
$630.00
|
| Rate for Payer: United Healthcare HMO Rider |
$630.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$630.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,071.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,071.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,071.00
|
|
|
HC STJ REFLEXION CANN W/LUMEN
|
Facility
|
IP
|
$1,260.00
|
|
|
Service Code
|
CPT C1731
|
| Hospital Charge Code |
906813539
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$252.00 |
| Max. Negotiated Rate |
$1,071.00 |
| Rate for Payer: Adventist Health Commercial |
$252.00
|
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$504.00
|
| Rate for Payer: EPIC Health Plan Senior |
$504.00
|
| Rate for Payer: Galaxy Health WC |
$1,071.00
|
| Rate for Payer: Global Benefits Group Commercial |
$756.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$840.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$480.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$779.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$302.40
|
| Rate for Payer: Multiplan Commercial |
$1,008.00
|
| Rate for Payer: Networks By Design Commercial |
$819.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,071.00
|
|
|
HC ST J TORQVUE LP DELIVERY SYSTEM
|
Facility
|
IP
|
$3,385.00
|
|
| Hospital Charge Code |
906812705
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$677.00 |
| Max. Negotiated Rate |
$2,877.25 |
| Rate for Payer: Adventist Health Commercial |
$677.00
|
| Rate for Payer: Cash Price |
$1,523.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,354.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,354.00
|
| Rate for Payer: Galaxy Health WC |
$2,877.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,031.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,257.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,289.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,095.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$812.40
|
| Rate for Payer: Multiplan Commercial |
$2,708.00
|
| Rate for Payer: Networks By Design Commercial |
$2,200.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,877.25
|
|
|
HC ST J TORQVUE LP DELIVERY SYSTEM
|
Facility
|
OP
|
$3,385.00
|
|
| Hospital Charge Code |
906812705
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$677.00 |
| Max. Negotiated Rate |
$2,877.25 |
| Rate for Payer: Adventist Health Commercial |
$677.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,220.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,877.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,861.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,538.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,078.73
|
| Rate for Payer: Cash Price |
$1,523.25
|
| Rate for Payer: Cigna of CA HMO |
$2,166.40
|
| Rate for Payer: Cigna of CA PPO |
$2,504.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,877.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,877.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,877.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,354.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,354.00
|
| Rate for Payer: Galaxy Health WC |
$2,877.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,031.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,257.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,289.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,095.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$812.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,369.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,369.50
|
| Rate for Payer: Multiplan Commercial |
$2,708.00
|
| Rate for Payer: Networks By Design Commercial |
$2,200.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,877.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,031.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,031.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,692.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,692.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,692.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,692.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,877.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,877.25
|
| Rate for Payer: Vantage Medical Group Senior |
$2,877.25
|
|
|
HC STNT ABBOTT ABSOLUTE PRO
|
Facility
|
OP
|
$3,900.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
906812669
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,315.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,145.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,925.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,258.88
|
| Rate for Payer: Blue Shield of California Commercial |
$2,878.20
|
| Rate for Payer: Blue Shield of California EPN |
$1,895.40
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Cigna of CA HMO |
$2,730.00
|
| Rate for Payer: Cigna of CA PPO |
$2,730.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,315.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,315.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$936.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,730.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,730.00
|
| Rate for Payer: Multiplan Commercial |
$3,120.00
|
| Rate for Payer: Networks By Design Commercial |
$1,950.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,340.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,340.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,463.67
|
| Rate for Payer: United Healthcare All Other HMO |
$1,424.67
|
| Rate for Payer: United Healthcare HMO Rider |
$1,393.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,277.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,315.00
|
|
|
HC STNT ABBOTT ABSOLUTE PRO
|
Facility
|
IP
|
$3,900.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
906812669
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Cigna of CA HMO |
$2,730.00
|
| Rate for Payer: Cigna of CA PPO |
$2,730.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$936.00
|
| Rate for Payer: Multiplan Commercial |
$3,120.00
|
| Rate for Payer: Networks By Design Commercial |
$1,950.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,463.67
|
| Rate for Payer: United Healthcare All Other HMO |
$1,424.67
|
| Rate for Payer: United Healthcare HMO Rider |
$1,393.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,277.25
|
|
|
HC STNT ABBOTT OMNILINK ELITE
|
Facility
|
IP
|
$3,900.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
906812668
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Cigna of CA HMO |
$2,730.00
|
| Rate for Payer: Cigna of CA PPO |
$2,730.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$936.00
|
| Rate for Payer: Multiplan Commercial |
$3,120.00
|
| Rate for Payer: Networks By Design Commercial |
$1,950.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,463.67
|
| Rate for Payer: United Healthcare All Other HMO |
$1,424.67
|
| Rate for Payer: United Healthcare HMO Rider |
$1,393.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,277.25
|
|
|
HC STNT ABBOTT OMNILINK ELITE
|
Facility
|
OP
|
$3,900.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
906812668
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,315.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,145.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,925.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,258.88
|
| Rate for Payer: Blue Shield of California Commercial |
$2,878.20
|
| Rate for Payer: Blue Shield of California EPN |
$1,895.40
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Cigna of CA HMO |
$2,730.00
|
| Rate for Payer: Cigna of CA PPO |
$2,730.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,315.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,315.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$936.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,730.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,730.00
|
| Rate for Payer: Multiplan Commercial |
$3,120.00
|
| Rate for Payer: Networks By Design Commercial |
$1,950.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,340.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,340.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,463.67
|
| Rate for Payer: United Healthcare All Other HMO |
$1,424.67
|
| Rate for Payer: United Healthcare HMO Rider |
$1,393.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,277.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,315.00
|
|
|
HC STNT ATRIUM ICAST
|
Facility
|
OP
|
$6,437.50
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
906812461
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,287.50 |
| Max. Negotiated Rate |
$5,471.88 |
| Rate for Payer: Adventist Health Commercial |
$1,287.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,471.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,540.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,828.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,728.60
|
| Rate for Payer: Blue Shield of California Commercial |
$4,750.88
|
| Rate for Payer: Blue Shield of California EPN |
$3,128.62
|
| Rate for Payer: Cash Price |
$2,896.88
|
| Rate for Payer: Cigna of CA HMO |
$4,506.25
|
| Rate for Payer: Cigna of CA PPO |
$4,506.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,471.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,471.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,471.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,575.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,575.00
|
| Rate for Payer: Galaxy Health WC |
$5,471.88
|
| Rate for Payer: Global Benefits Group Commercial |
$3,862.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,293.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,984.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,545.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,506.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,506.25
|
| Rate for Payer: Multiplan Commercial |
$5,150.00
|
| Rate for Payer: Networks By Design Commercial |
$3,218.75
|
| Rate for Payer: Prime Health Services Commercial |
$5,471.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,862.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,862.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,415.99
|
| Rate for Payer: United Healthcare All Other HMO |
$2,351.62
|
| Rate for Payer: United Healthcare HMO Rider |
$2,300.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,108.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,471.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,471.88
|
| Rate for Payer: Vantage Medical Group Senior |
$5,471.88
|
|
|
HC STNT ATRIUM ICAST
|
Facility
|
IP
|
$6,437.50
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
906812461
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,287.50 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,287.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$2,896.88
|
| Rate for Payer: Cash Price |
$2,896.88
|
| Rate for Payer: Cigna of CA HMO |
$4,506.25
|
| Rate for Payer: Cigna of CA PPO |
$4,506.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,575.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,575.00
|
| Rate for Payer: Galaxy Health WC |
$5,471.88
|
| Rate for Payer: Global Benefits Group Commercial |
$3,862.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,293.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,452.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,984.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,545.00
|
| Rate for Payer: Multiplan Commercial |
$5,150.00
|
| Rate for Payer: Networks By Design Commercial |
$3,218.75
|
| Rate for Payer: Prime Health Services Commercial |
$5,471.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,415.99
|
| Rate for Payer: United Healthcare All Other HMO |
$2,351.62
|
| Rate for Payer: United Healthcare HMO Rider |
$2,300.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,108.28
|
|
|
HC STNT ATRIUM ICAST 22MM
|
Facility
|
IP
|
$5,973.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
906812673
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,194.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,194.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$2,687.85
|
| Rate for Payer: Cash Price |
$2,687.85
|
| Rate for Payer: Cigna of CA HMO |
$4,181.10
|
| Rate for Payer: Cigna of CA PPO |
$4,181.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,389.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,389.20
|
| Rate for Payer: Galaxy Health WC |
$5,077.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,583.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,983.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,275.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,697.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,433.52
|
| Rate for Payer: Multiplan Commercial |
$4,778.40
|
| Rate for Payer: Networks By Design Commercial |
$2,986.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,077.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,241.67
|
| Rate for Payer: United Healthcare All Other HMO |
$2,181.94
|
| Rate for Payer: United Healthcare HMO Rider |
$2,134.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,956.16
|
|
|
HC STNT ATRIUM ICAST 22MM
|
Facility
|
OP
|
$5,973.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
906812673
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,194.60 |
| Max. Negotiated Rate |
$5,077.05 |
| Rate for Payer: Adventist Health Commercial |
$1,194.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,077.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,285.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,479.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,459.56
|
| Rate for Payer: Blue Shield of California Commercial |
$4,408.07
|
| Rate for Payer: Blue Shield of California EPN |
$2,902.88
|
| Rate for Payer: Cash Price |
$2,687.85
|
| Rate for Payer: Cigna of CA HMO |
$4,181.10
|
| Rate for Payer: Cigna of CA PPO |
$4,181.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,077.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,077.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,077.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,389.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,389.20
|
| Rate for Payer: Galaxy Health WC |
$5,077.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,583.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,983.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,697.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,433.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,181.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,181.10
|
| Rate for Payer: Multiplan Commercial |
$4,778.40
|
| Rate for Payer: Networks By Design Commercial |
$2,986.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,077.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,583.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,583.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,241.67
|
| Rate for Payer: United Healthcare All Other HMO |
$2,181.94
|
| Rate for Payer: United Healthcare HMO Rider |
$2,134.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,956.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,077.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,077.05
|
| Rate for Payer: Vantage Medical Group Senior |
$5,077.05
|
|
|
HC STNT ATRIUM ICAST 38MM
|
Facility
|
OP
|
$6,116.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
906812674
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,223.20 |
| Max. Negotiated Rate |
$5,198.60 |
| Rate for Payer: Adventist Health Commercial |
$1,223.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,198.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,363.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,587.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,542.39
|
| Rate for Payer: Blue Shield of California Commercial |
$4,513.61
|
| Rate for Payer: Blue Shield of California EPN |
$2,972.38
|
| Rate for Payer: Cash Price |
$2,752.20
|
| Rate for Payer: Cigna of CA HMO |
$4,281.20
|
| Rate for Payer: Cigna of CA PPO |
$4,281.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,198.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,198.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,198.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,446.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,446.40
|
| Rate for Payer: Galaxy Health WC |
$5,198.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,669.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,079.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,785.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,467.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,281.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,281.20
|
| Rate for Payer: Multiplan Commercial |
$4,892.80
|
| Rate for Payer: Networks By Design Commercial |
$3,058.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,198.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,669.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,669.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,295.33
|
| Rate for Payer: United Healthcare All Other HMO |
$2,234.17
|
| Rate for Payer: United Healthcare HMO Rider |
$2,185.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,002.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,198.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,198.60
|
| Rate for Payer: Vantage Medical Group Senior |
$5,198.60
|
|
|
HC STNT ATRIUM ICAST 38MM
|
Facility
|
IP
|
$6,116.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
906812674
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,223.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,223.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$2,752.20
|
| Rate for Payer: Cash Price |
$2,752.20
|
| Rate for Payer: Cigna of CA HMO |
$4,281.20
|
| Rate for Payer: Cigna of CA PPO |
$4,281.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,446.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,446.40
|
| Rate for Payer: Galaxy Health WC |
$5,198.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,669.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,079.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,330.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,785.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,467.84
|
| Rate for Payer: Multiplan Commercial |
$4,892.80
|
| Rate for Payer: Networks By Design Commercial |
$3,058.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,198.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,295.33
|
| Rate for Payer: United Healthcare All Other HMO |
$2,234.17
|
| Rate for Payer: United Healthcare HMO Rider |
$2,185.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,002.99
|
|
|
HC STNT ATRIUM ICAST 59MM
|
Facility
|
OP
|
$6,591.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
906812675
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,318.20 |
| Max. Negotiated Rate |
$5,602.35 |
| Rate for Payer: Adventist Health Commercial |
$1,318.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,602.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,625.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,943.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,817.51
|
| Rate for Payer: Blue Shield of California Commercial |
$4,864.16
|
| Rate for Payer: Blue Shield of California EPN |
$3,203.23
|
| Rate for Payer: Cash Price |
$2,965.95
|
| Rate for Payer: Cigna of CA HMO |
$4,613.70
|
| Rate for Payer: Cigna of CA PPO |
$4,613.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,602.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,602.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,602.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,636.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,636.40
|
| Rate for Payer: Galaxy Health WC |
$5,602.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,954.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,396.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,079.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,581.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,613.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,613.70
|
| Rate for Payer: Multiplan Commercial |
$5,272.80
|
| Rate for Payer: Networks By Design Commercial |
$3,295.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,602.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,954.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,954.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,473.60
|
| Rate for Payer: United Healthcare All Other HMO |
$2,407.69
|
| Rate for Payer: United Healthcare HMO Rider |
$2,355.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,158.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,602.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,602.35
|
| Rate for Payer: Vantage Medical Group Senior |
$5,602.35
|
|
|
HC STNT ATRIUM ICAST 59MM
|
Facility
|
IP
|
$6,591.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
906812675
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,318.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Networks By Design Commercial |
$3,295.50
|
| Rate for Payer: Adventist Health Commercial |
$1,318.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$2,965.95
|
| Rate for Payer: Cash Price |
$2,965.95
|
| Rate for Payer: Cigna of CA HMO |
$4,613.70
|
| Rate for Payer: Cigna of CA PPO |
$4,613.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,636.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,636.40
|
| Rate for Payer: Galaxy Health WC |
$5,602.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,954.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,396.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,511.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,079.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,581.84
|
| Rate for Payer: Multiplan Commercial |
$5,272.80
|
| Rate for Payer: Prime Health Services Commercial |
$5,602.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,473.60
|
| Rate for Payer: United Healthcare All Other HMO |
$2,407.69
|
| Rate for Payer: United Healthcare HMO Rider |
$2,355.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,158.55
|
|
|
HC STNT BARD VALEO BILIARY
|
Facility
|
IP
|
$3,900.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
906812460
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Cigna of CA HMO |
$2,730.00
|
| Rate for Payer: Cigna of CA PPO |
$2,730.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$936.00
|
| Rate for Payer: Multiplan Commercial |
$3,120.00
|
| Rate for Payer: Networks By Design Commercial |
$1,950.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,463.67
|
| Rate for Payer: United Healthcare All Other HMO |
$1,424.67
|
| Rate for Payer: United Healthcare HMO Rider |
$1,393.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,277.25
|
|
|
HC STNT BARD VALEO BILIARY
|
Facility
|
OP
|
$3,900.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
906812460
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,315.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,145.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,925.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,258.88
|
| Rate for Payer: Blue Shield of California Commercial |
$2,878.20
|
| Rate for Payer: Blue Shield of California EPN |
$1,895.40
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Cigna of CA HMO |
$2,730.00
|
| Rate for Payer: Cigna of CA PPO |
$2,730.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,315.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,315.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$936.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,730.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,730.00
|
| Rate for Payer: Multiplan Commercial |
$3,120.00
|
| Rate for Payer: Networks By Design Commercial |
$1,950.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,340.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,340.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,463.67
|
| Rate for Payer: United Healthcare All Other HMO |
$1,424.67
|
| Rate for Payer: United Healthcare HMO Rider |
$1,393.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,277.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,315.00
|
|
