|
HC STNT BRUAN CP COVERED UNMOUNT
|
Facility
|
IP
|
$10,000.00
|
|
|
Service Code
|
CPT C1877
|
| Hospital Charge Code |
906812587
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,000.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$2,000.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$4,500.00
|
| Rate for Payer: Cash Price |
$4,500.00
|
| Rate for Payer: Cigna of CA HMO |
$7,000.00
|
| Rate for Payer: Cigna of CA PPO |
$7,000.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,000.00
|
| Rate for Payer: Galaxy Health WC |
$8,500.00
|
| Rate for Payer: Global Benefits Group Commercial |
$6,000.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,670.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,810.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,190.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,400.00
|
| Rate for Payer: Multiplan Commercial |
$8,000.00
|
| Rate for Payer: Networks By Design Commercial |
$5,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$8,500.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,753.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,653.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,574.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,275.00
|
|
|
HC STNT B/S MONORAIL ION DES
|
Facility
|
IP
|
$4,187.50
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
906812431
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$837.50 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$837.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,884.38
|
| Rate for Payer: Cash Price |
$1,884.38
|
| Rate for Payer: Cigna of CA HMO |
$2,931.25
|
| Rate for Payer: Cigna of CA PPO |
$2,931.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,675.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,675.00
|
| Rate for Payer: Galaxy Health WC |
$3,559.38
|
| Rate for Payer: Global Benefits Group Commercial |
$2,512.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,793.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,595.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,592.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,005.00
|
| Rate for Payer: Multiplan Commercial |
$3,350.00
|
| Rate for Payer: Networks By Design Commercial |
$2,093.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,559.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,571.57
|
| Rate for Payer: United Healthcare All Other HMO |
$1,529.69
|
| Rate for Payer: United Healthcare HMO Rider |
$1,496.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,371.41
|
|
|
HC STNT B/S MONORAIL ION DES
|
Facility
|
OP
|
$4,187.50
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
906812431
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$837.50 |
| Max. Negotiated Rate |
$3,559.38 |
| Rate for Payer: Adventist Health Commercial |
$837.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,559.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,303.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,140.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,425.40
|
| Rate for Payer: Blue Shield of California Commercial |
$3,090.38
|
| Rate for Payer: Blue Shield of California EPN |
$2,035.12
|
| Rate for Payer: Cash Price |
$1,884.38
|
| Rate for Payer: Cigna of CA HMO |
$2,931.25
|
| Rate for Payer: Cigna of CA PPO |
$2,931.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,559.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,559.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,559.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,675.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,675.00
|
| Rate for Payer: Galaxy Health WC |
$3,559.38
|
| Rate for Payer: Global Benefits Group Commercial |
$2,512.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,793.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,592.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,005.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,931.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,931.25
|
| Rate for Payer: Multiplan Commercial |
$3,350.00
|
| Rate for Payer: Networks By Design Commercial |
$2,093.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,559.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,512.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,512.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,571.57
|
| Rate for Payer: United Healthcare All Other HMO |
$1,529.69
|
| Rate for Payer: United Healthcare HMO Rider |
$1,496.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,371.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,559.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,559.38
|
| Rate for Payer: Vantage Medical Group Senior |
$3,559.38
|
|
|
HC STNT B/S PROMUS DES
|
Facility
|
IP
|
$4,187.50
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
906812414
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$837.50 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$837.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,884.38
|
| Rate for Payer: Cash Price |
$1,884.38
|
| Rate for Payer: Cigna of CA HMO |
$2,931.25
|
| Rate for Payer: Cigna of CA PPO |
$2,931.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,675.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,675.00
|
| Rate for Payer: Galaxy Health WC |
$3,559.38
|
| Rate for Payer: Global Benefits Group Commercial |
$2,512.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,793.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,595.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,592.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,005.00
|
| Rate for Payer: Multiplan Commercial |
$3,350.00
|
| Rate for Payer: Networks By Design Commercial |
$2,093.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,559.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,571.57
|
| Rate for Payer: United Healthcare All Other HMO |
$1,529.69
|
| Rate for Payer: United Healthcare HMO Rider |
$1,496.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,371.41
|
|
|
HC STNT B/S PROMUS DES
|
Facility
|
OP
|
$4,187.50
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
906812414
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$837.50 |
| Max. Negotiated Rate |
$3,559.38 |
| Rate for Payer: Adventist Health Commercial |
$837.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,559.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,303.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,140.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,425.40
|
| Rate for Payer: Blue Shield of California Commercial |
$3,090.38
|
| Rate for Payer: Blue Shield of California EPN |
$2,035.12
|
| Rate for Payer: Cash Price |
$1,884.38
|
| Rate for Payer: Cigna of CA HMO |
$2,931.25
|
| Rate for Payer: Cigna of CA PPO |
$2,931.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,559.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,559.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,559.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,675.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,675.00
|
| Rate for Payer: Galaxy Health WC |
$3,559.38
|
| Rate for Payer: Global Benefits Group Commercial |
$2,512.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,793.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,592.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,005.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,931.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,931.25
|
| Rate for Payer: Multiplan Commercial |
$3,350.00
|
| Rate for Payer: Networks By Design Commercial |
$2,093.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,559.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,512.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,512.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,571.57
|
| Rate for Payer: United Healthcare All Other HMO |
$1,529.69
|
| Rate for Payer: United Healthcare HMO Rider |
$1,496.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,371.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,559.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,559.38
|
| Rate for Payer: Vantage Medical Group Senior |
$3,559.38
|
|
|
HC STNT B/S PROMUS ELEMENT DES
|
Facility
|
IP
|
$3,937.50
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
906812447
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$787.50 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$787.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,771.88
|
| Rate for Payer: Cash Price |
$1,771.88
|
| Rate for Payer: Cigna of CA HMO |
$2,756.25
|
| Rate for Payer: Cigna of CA PPO |
$2,756.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,575.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,575.00
|
| Rate for Payer: Galaxy Health WC |
$3,346.88
|
| Rate for Payer: Global Benefits Group Commercial |
$2,362.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,626.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,500.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,437.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$945.00
|
| Rate for Payer: Multiplan Commercial |
$3,150.00
|
| Rate for Payer: Networks By Design Commercial |
$1,968.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,346.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,477.74
|
| Rate for Payer: United Healthcare All Other HMO |
$1,438.37
|
| Rate for Payer: United Healthcare HMO Rider |
$1,407.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,289.53
|
|
|
HC STNT B/S PROMUS ELEMENT DES
|
Facility
|
OP
|
$3,937.50
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
906812447
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$787.50 |
| Max. Negotiated Rate |
$3,346.88 |
| Rate for Payer: Adventist Health Commercial |
$787.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,346.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,165.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,953.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,280.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,905.88
|
| Rate for Payer: Blue Shield of California EPN |
$1,913.62
|
| Rate for Payer: Cash Price |
$1,771.88
|
| Rate for Payer: Cigna of CA HMO |
$2,756.25
|
| Rate for Payer: Cigna of CA PPO |
$2,756.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,346.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,346.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,346.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,575.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,575.00
|
| Rate for Payer: Galaxy Health WC |
$3,346.88
|
| Rate for Payer: Global Benefits Group Commercial |
$2,362.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,626.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,437.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$945.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,756.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,756.25
|
| Rate for Payer: Multiplan Commercial |
$3,150.00
|
| Rate for Payer: Networks By Design Commercial |
$1,968.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,346.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,362.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,362.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,477.74
|
| Rate for Payer: United Healthcare All Other HMO |
$1,438.37
|
| Rate for Payer: United Healthcare HMO Rider |
$1,407.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,289.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,346.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,346.88
|
| Rate for Payer: Vantage Medical Group Senior |
$3,346.88
|
|
|
HC STNT B/S SYNERGY DES
|
Facility
|
IP
|
$3,900.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
906812569
|
|
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 B/S SYNERGY DES
|
Facility
|
OP
|
$3,900.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
906812569
|
|
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 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 B/S TAXUS LIB. ATOM DES
|
Facility
|
IP
|
$5,250.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
906812395
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,050.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,050.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$2,362.50
|
| Rate for Payer: Cash Price |
$2,362.50
|
| Rate for Payer: Cigna of CA HMO |
$3,675.00
|
| Rate for Payer: Cigna of CA PPO |
$3,675.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,100.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,100.00
|
| Rate for Payer: Galaxy Health WC |
$4,462.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,150.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,501.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,000.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,249.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,260.00
|
| Rate for Payer: Multiplan Commercial |
$4,200.00
|
| Rate for Payer: Networks By Design Commercial |
$2,625.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,462.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,970.33
|
| Rate for Payer: United Healthcare All Other HMO |
$1,917.83
|
| Rate for Payer: United Healthcare HMO Rider |
$1,876.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,719.38
|
|
|
HC STNT B/S TAXUS LIB. ATOM DES
|
Facility
|
OP
|
$5,250.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
906812395
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,050.00 |
| Max. Negotiated Rate |
$4,462.50 |
| Rate for Payer: Adventist Health Commercial |
$1,050.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,462.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,887.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,937.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,040.80
|
| Rate for Payer: Blue Shield of California Commercial |
$3,874.50
|
| Rate for Payer: Blue Shield of California EPN |
$2,551.50
|
| Rate for Payer: Cash Price |
$2,362.50
|
| Rate for Payer: Cigna of CA HMO |
$3,675.00
|
| Rate for Payer: Cigna of CA PPO |
$3,675.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,462.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,462.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,462.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,100.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,100.00
|
| Rate for Payer: Galaxy Health WC |
$4,462.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,150.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,501.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,249.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,260.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,675.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,675.00
|
| Rate for Payer: Multiplan Commercial |
$4,200.00
|
| Rate for Payer: Networks By Design Commercial |
$2,625.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,462.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,150.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,150.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,970.33
|
| Rate for Payer: United Healthcare All Other HMO |
$1,917.83
|
| Rate for Payer: United Healthcare HMO Rider |
$1,876.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,719.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,462.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,462.50
|
| Rate for Payer: Vantage Medical Group Senior |
$4,462.50
|
|
|
HC STNT B/S TAXUS LIB LONG DES
|
Facility
|
IP
|
$4,187.50
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
906812415
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$837.50 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$837.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,884.38
|
| Rate for Payer: Cash Price |
$1,884.38
|
| Rate for Payer: Cigna of CA HMO |
$2,931.25
|
| Rate for Payer: Cigna of CA PPO |
$2,931.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,675.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,675.00
|
| Rate for Payer: Galaxy Health WC |
$3,559.38
|
| Rate for Payer: Global Benefits Group Commercial |
$2,512.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,793.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,595.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,592.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,005.00
|
| Rate for Payer: Multiplan Commercial |
$3,350.00
|
| Rate for Payer: Networks By Design Commercial |
$2,093.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,559.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,571.57
|
| Rate for Payer: United Healthcare All Other HMO |
$1,529.69
|
| Rate for Payer: United Healthcare HMO Rider |
$1,496.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,371.41
|
|
|
HC STNT B/S TAXUS LIB LONG DES
|
Facility
|
OP
|
$4,187.50
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
906812415
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$837.50 |
| Max. Negotiated Rate |
$3,559.38 |
| Rate for Payer: Adventist Health Commercial |
$837.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,559.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,303.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,140.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,425.40
|
| Rate for Payer: Blue Shield of California Commercial |
$3,090.38
|
| Rate for Payer: Blue Shield of California EPN |
$2,035.12
|
| Rate for Payer: Cash Price |
$1,884.38
|
| Rate for Payer: Cigna of CA HMO |
$2,931.25
|
| Rate for Payer: Cigna of CA PPO |
$2,931.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,559.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,559.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,559.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,675.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,675.00
|
| Rate for Payer: Galaxy Health WC |
$3,559.38
|
| Rate for Payer: Global Benefits Group Commercial |
$2,512.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,793.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,592.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,005.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,931.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,931.25
|
| Rate for Payer: Multiplan Commercial |
$3,350.00
|
| Rate for Payer: Networks By Design Commercial |
$2,093.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,559.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,512.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,512.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,571.57
|
| Rate for Payer: United Healthcare All Other HMO |
$1,529.69
|
| Rate for Payer: United Healthcare HMO Rider |
$1,496.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,371.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,559.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,559.38
|
| Rate for Payer: Vantage Medical Group Senior |
$3,559.38
|
|
|
HC STNT B/S VERIFLEX
|
Facility
|
OP
|
$2,535.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
906812408
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$507.00 |
| Max. Negotiated Rate |
$2,154.75 |
| Rate for Payer: Adventist Health Commercial |
$507.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,154.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,394.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,901.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,468.27
|
| Rate for Payer: Blue Shield of California Commercial |
$1,870.83
|
| Rate for Payer: Blue Shield of California EPN |
$1,232.01
|
| Rate for Payer: Cash Price |
$1,140.75
|
| Rate for Payer: Cigna of CA HMO |
$1,774.50
|
| Rate for Payer: Cigna of CA PPO |
$1,774.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,154.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,154.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,154.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,014.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,014.00
|
| Rate for Payer: Galaxy Health WC |
$2,154.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,521.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,690.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$965.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,569.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$608.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,774.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,774.50
|
| Rate for Payer: Multiplan Commercial |
$2,028.00
|
| Rate for Payer: Networks By Design Commercial |
$1,267.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,154.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,521.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,521.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$951.39
|
| Rate for Payer: United Healthcare All Other HMO |
$926.04
|
| Rate for Payer: United Healthcare HMO Rider |
$906.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$830.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,154.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,154.75
|
| Rate for Payer: Vantage Medical Group Senior |
$2,154.75
|
|
|
HC STNT B/S VERIFLEX
|
Facility
|
IP
|
$2,535.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
906812408
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$507.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$507.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,140.75
|
| Rate for Payer: Cash Price |
$1,140.75
|
| Rate for Payer: Cigna of CA HMO |
$1,774.50
|
| Rate for Payer: Cigna of CA PPO |
$1,774.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,014.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,014.00
|
| Rate for Payer: Galaxy Health WC |
$2,154.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,521.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,690.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$965.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,569.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$608.40
|
| Rate for Payer: Multiplan Commercial |
$2,028.00
|
| Rate for Payer: Networks By Design Commercial |
$1,267.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,154.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$951.39
|
| Rate for Payer: United Healthcare All Other HMO |
$926.04
|
| Rate for Payer: United Healthcare HMO Rider |
$906.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$830.21
|
|
|
HC STNT COATED/COVERED W DELIVER
|
Facility
|
OP
|
$8,900.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
909081446
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,780.00 |
| Max. Negotiated Rate |
$7,565.00 |
| Rate for Payer: Adventist Health Commercial |
$1,780.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,565.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,895.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,675.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,154.88
|
| Rate for Payer: Blue Shield of California Commercial |
$6,568.20
|
| Rate for Payer: Blue Shield of California EPN |
$4,325.40
|
| Rate for Payer: Cash Price |
$4,005.00
|
| Rate for Payer: Cigna of CA HMO |
$6,230.00
|
| Rate for Payer: Cigna of CA PPO |
$6,230.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,565.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,565.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,565.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,560.00
|
| Rate for Payer: Galaxy Health WC |
$7,565.00
|
| Rate for Payer: Global Benefits Group Commercial |
$5,340.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,936.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,509.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,136.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,230.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,230.00
|
| Rate for Payer: Multiplan Commercial |
$7,120.00
|
| Rate for Payer: Networks By Design Commercial |
$4,450.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,565.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,340.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,340.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,340.17
|
| Rate for Payer: United Healthcare All Other HMO |
$3,251.17
|
| Rate for Payer: United Healthcare HMO Rider |
$3,180.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,914.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,565.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,565.00
|
| Rate for Payer: Vantage Medical Group Senior |
$7,565.00
|
|
|
HC STNT COATED/COVERED W DELIVER
|
Facility
|
IP
|
$8,900.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
909081446
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,780.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,780.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$4,005.00
|
| Rate for Payer: Cash Price |
$4,005.00
|
| Rate for Payer: Cigna of CA HMO |
$6,230.00
|
| Rate for Payer: Cigna of CA PPO |
$6,230.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,560.00
|
| Rate for Payer: Galaxy Health WC |
$7,565.00
|
| Rate for Payer: Global Benefits Group Commercial |
$5,340.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,936.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,390.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,509.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,136.00
|
| Rate for Payer: Multiplan Commercial |
$7,120.00
|
| Rate for Payer: Networks By Design Commercial |
$4,450.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,565.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,340.17
|
| Rate for Payer: United Healthcare All Other HMO |
$3,251.17
|
| Rate for Payer: United Healthcare HMO Rider |
$3,180.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,914.75
|
|
|
HC STNT COOK ZILVER PTX 40MM
|
Facility
|
IP
|
$3,900.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
906812670
|
|
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 COOK ZILVER PTX 40MM
|
Facility
|
OP
|
$3,900.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
906812670
|
|
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 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 COOK ZILVER PTX 60MM
|
Facility
|
IP
|
$3,900.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
906812671
|
|
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 COOK ZILVER PTX 60MM
|
Facility
|
OP
|
$3,900.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
906812671
|
|
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 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 COOK ZILVER PTX 80-100MM
|
Facility
|
IP
|
$4,488.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
906812672
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$897.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$897.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$2,019.60
|
| Rate for Payer: Cash Price |
$2,019.60
|
| Rate for Payer: Cigna of CA HMO |
$3,141.60
|
| Rate for Payer: Cigna of CA PPO |
$3,141.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,795.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,795.20
|
| Rate for Payer: Galaxy Health WC |
$3,814.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,692.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,993.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,709.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,778.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,077.12
|
| Rate for Payer: Multiplan Commercial |
$3,590.40
|
| Rate for Payer: Networks By Design Commercial |
$2,244.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,814.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,684.35
|
| Rate for Payer: United Healthcare All Other HMO |
$1,639.47
|
| Rate for Payer: United Healthcare HMO Rider |
$1,604.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,469.82
|
|
|
HC STNT COOK ZILVER PTX 80-100MM
|
Facility
|
OP
|
$4,488.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
906812672
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$897.60 |
| Max. Negotiated Rate |
$3,814.80 |
| Rate for Payer: Adventist Health Commercial |
$897.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,814.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,468.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,366.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,599.45
|
| Rate for Payer: Blue Shield of California Commercial |
$3,312.14
|
| Rate for Payer: Blue Shield of California EPN |
$2,181.17
|
| Rate for Payer: Cash Price |
$2,019.60
|
| Rate for Payer: Cigna of CA HMO |
$3,141.60
|
| Rate for Payer: Cigna of CA PPO |
$3,141.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,814.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,814.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,814.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,795.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,795.20
|
| Rate for Payer: Galaxy Health WC |
$3,814.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,692.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,993.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,778.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,077.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,141.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,141.60
|
| Rate for Payer: Multiplan Commercial |
$3,590.40
|
| Rate for Payer: Networks By Design Commercial |
$2,244.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,814.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,692.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,692.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,684.35
|
| Rate for Payer: United Healthcare All Other HMO |
$1,639.47
|
| Rate for Payer: United Healthcare HMO Rider |
$1,604.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,469.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,814.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,814.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,814.80
|
|
|
HC STNT CORDIS PALMAZ
|
Facility
|
IP
|
$3,901.50
|
|
|
Service Code
|
CPT C1877
|
| Hospital Charge Code |
906812435
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.30 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$780.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,755.67
|
| Rate for Payer: Cash Price |
$1,755.67
|
| Rate for Payer: Cigna of CA HMO |
$2,731.05
|
| Rate for Payer: Cigna of CA PPO |
$2,731.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.60
|
| Rate for Payer: Galaxy Health WC |
$3,316.28
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,602.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,486.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,415.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$936.36
|
| Rate for Payer: Multiplan Commercial |
$3,121.20
|
| Rate for Payer: Networks By Design Commercial |
$1,950.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,316.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,464.23
|
| Rate for Payer: United Healthcare All Other HMO |
$1,425.22
|
| Rate for Payer: United Healthcare HMO Rider |
$1,394.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,277.74
|
|
|
HC STNT CORDIS PALMAZ
|
Facility
|
OP
|
$3,901.50
|
|
|
Service Code
|
CPT C1877
|
| Hospital Charge Code |
906812435
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.30 |
| Max. Negotiated Rate |
$3,316.28 |
| Rate for Payer: Adventist Health Commercial |
$780.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,316.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,145.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,926.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,259.75
|
| Rate for Payer: Blue Shield of California Commercial |
$2,879.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,896.13
|
| Rate for Payer: Cash Price |
$1,755.67
|
| Rate for Payer: Cigna of CA HMO |
$2,731.05
|
| Rate for Payer: Cigna of CA PPO |
$2,731.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,316.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,316.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,316.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.60
|
| Rate for Payer: Galaxy Health WC |
$3,316.28
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,602.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,486.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,415.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$936.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,731.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,731.05
|
| Rate for Payer: Multiplan Commercial |
$3,121.20
|
| Rate for Payer: Networks By Design Commercial |
$1,950.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,316.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,340.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,340.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,464.23
|
| Rate for Payer: United Healthcare All Other HMO |
$1,425.22
|
| Rate for Payer: United Healthcare HMO Rider |
$1,394.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,277.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,316.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,316.28
|
| Rate for Payer: Vantage Medical Group Senior |
$3,316.28
|
|
