|
HC STNT BILIARY PALM CORIN IQ&DEL
|
Facility
|
IP
|
$3,900.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909081421
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$2,145.00
|
| Rate for Payer: Cash Price |
$2,145.00
|
| Rate for Payer: Cigna of CA HMO |
$2,730.00
|
| Rate for Payer: Cigna of CA PPO |
$2,730.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$936.00
|
| Rate for Payer: Multiplan Commercial |
$3,120.00
|
| Rate for Payer: Networks By Design Commercial |
$1,950.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,463.67
|
| Rate for Payer: United Healthcare All Other HMO |
$1,424.67
|
| Rate for Payer: United Healthcare HMO Rider |
$1,393.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,277.25
|
|
|
HC STNT BILIARY PALM CORIN IQ&DEL
|
Facility
|
OP
|
$3,900.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909081421
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,315.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,145.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,925.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,258.88
|
| Rate for Payer: Blue Shield of California Commercial |
$2,878.20
|
| Rate for Payer: Blue Shield of California EPN |
$1,895.40
|
| Rate for Payer: Cash Price |
$2,145.00
|
| Rate for Payer: Cigna of CA HMO |
$2,730.00
|
| Rate for Payer: Cigna of CA PPO |
$2,730.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,315.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,315.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$936.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,730.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,730.00
|
| Rate for Payer: Multiplan Commercial |
$3,120.00
|
| Rate for Payer: Networks By Design Commercial |
$1,950.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,340.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,340.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,463.67
|
| Rate for Payer: United Healthcare All Other HMO |
$1,424.67
|
| Rate for Payer: United Healthcare HMO Rider |
$1,393.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,277.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,315.00
|
|
|
HC STNT BILIARY PALM XL TRANS 40
|
Facility
|
OP
|
$1,500.00
|
|
|
Service Code
|
CPT C1877
|
| Hospital Charge Code |
909081423
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$300.00 |
| Max. Negotiated Rate |
$1,275.00 |
| Rate for Payer: Adventist Health Commercial |
$300.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,275.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$825.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,125.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$868.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,107.00
|
| Rate for Payer: Blue Shield of California EPN |
$729.00
|
| Rate for Payer: Cash Price |
$825.00
|
| Rate for Payer: Cigna of CA HMO |
$1,050.00
|
| Rate for Payer: Cigna of CA PPO |
$1,050.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,275.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,275.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,275.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$600.00
|
| Rate for Payer: EPIC Health Plan Senior |
$600.00
|
| Rate for Payer: Galaxy Health WC |
$1,275.00
|
| Rate for Payer: Global Benefits Group Commercial |
$900.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,000.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$571.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$928.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$360.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,050.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,050.00
|
| Rate for Payer: Multiplan Commercial |
$1,200.00
|
| Rate for Payer: Networks By Design Commercial |
$750.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,275.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$900.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$900.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$562.95
|
| Rate for Payer: United Healthcare All Other HMO |
$547.95
|
| Rate for Payer: United Healthcare HMO Rider |
$536.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$491.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,275.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,275.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,275.00
|
|
|
HC STNT BILIARY PALM XL TRANS 40
|
Facility
|
IP
|
$1,500.00
|
|
|
Service Code
|
CPT C1877
|
| Hospital Charge Code |
909081423
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$300.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$300.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$825.00
|
| Rate for Payer: Cash Price |
$825.00
|
| Rate for Payer: Cigna of CA HMO |
$1,050.00
|
| Rate for Payer: Cigna of CA PPO |
$1,050.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$600.00
|
| Rate for Payer: EPIC Health Plan Senior |
$600.00
|
| Rate for Payer: Galaxy Health WC |
$1,275.00
|
| Rate for Payer: Global Benefits Group Commercial |
$900.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,000.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$571.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$928.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$360.00
|
| Rate for Payer: Multiplan Commercial |
$1,200.00
|
| Rate for Payer: Networks By Design Commercial |
$750.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,275.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$562.95
|
| Rate for Payer: United Healthcare All Other HMO |
$547.95
|
| Rate for Payer: United Healthcare HMO Rider |
$536.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$491.25
|
|
|
HC STNT BILIARY PALM XL TRANS 50
|
Facility
|
IP
|
$1,800.00
|
|
|
Service Code
|
CPT C1877
|
| Hospital Charge Code |
909081424
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$360.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$360.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$990.00
|
| Rate for Payer: Cash Price |
$990.00
|
| Rate for Payer: Cigna of CA HMO |
$1,260.00
|
| Rate for Payer: Cigna of CA PPO |
$1,260.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$720.00
|
| Rate for Payer: EPIC Health Plan Senior |
$720.00
|
| Rate for Payer: Galaxy Health WC |
$1,530.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,080.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,200.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$685.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,114.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$432.00
|
| Rate for Payer: Multiplan Commercial |
$1,440.00
|
| Rate for Payer: Networks By Design Commercial |
$900.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,530.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$675.54
|
| Rate for Payer: United Healthcare All Other HMO |
$657.54
|
| Rate for Payer: United Healthcare HMO Rider |
$643.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$589.50
|
|
|
HC STNT BILIARY PALM XL TRANS 50
|
Facility
|
OP
|
$1,800.00
|
|
|
Service Code
|
CPT C1877
|
| Hospital Charge Code |
909081424
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$360.00 |
| Max. Negotiated Rate |
$1,530.00 |
| Rate for Payer: Adventist Health Commercial |
$360.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,530.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$990.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,350.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,042.56
|
| Rate for Payer: Blue Shield of California Commercial |
$1,328.40
|
| Rate for Payer: Blue Shield of California EPN |
$874.80
|
| Rate for Payer: Cash Price |
$990.00
|
| Rate for Payer: Cigna of CA HMO |
$1,260.00
|
| Rate for Payer: Cigna of CA PPO |
$1,260.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,530.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,530.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,530.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$720.00
|
| Rate for Payer: EPIC Health Plan Senior |
$720.00
|
| Rate for Payer: Galaxy Health WC |
$1,530.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,080.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,200.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$685.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,114.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$432.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,260.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,260.00
|
| Rate for Payer: Multiplan Commercial |
$1,440.00
|
| Rate for Payer: Networks By Design Commercial |
$900.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,530.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,080.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,080.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$675.54
|
| Rate for Payer: United Healthcare All Other HMO |
$657.54
|
| Rate for Payer: United Healthcare HMO Rider |
$643.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$589.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,530.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,530.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,530.00
|
|
|
HC STNT BILIARY SMART CORDIS 7-14
|
Facility
|
OP
|
$4,020.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909081693
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$804.00 |
| Max. Negotiated Rate |
$3,417.00 |
| Rate for Payer: Adventist Health Commercial |
$804.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,417.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,211.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,015.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,328.38
|
| Rate for Payer: Blue Shield of California Commercial |
$2,966.76
|
| Rate for Payer: Blue Shield of California EPN |
$1,953.72
|
| Rate for Payer: Cash Price |
$2,211.00
|
| Rate for Payer: Cigna of CA HMO |
$2,814.00
|
| Rate for Payer: Cigna of CA PPO |
$2,814.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,417.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,417.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,417.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,608.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,608.00
|
| Rate for Payer: Galaxy Health WC |
$3,417.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,412.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,681.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,531.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,488.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$964.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,814.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,814.00
|
| Rate for Payer: Multiplan Commercial |
$3,216.00
|
| Rate for Payer: Networks By Design Commercial |
$2,010.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,417.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,412.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,412.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,508.71
|
| Rate for Payer: United Healthcare All Other HMO |
$1,468.51
|
| Rate for Payer: United Healthcare HMO Rider |
$1,436.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,316.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,417.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,417.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,417.00
|
|
|
HC STNT BILIARY SMART CORDIS 7-14
|
Facility
|
IP
|
$4,020.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909081693
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$804.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$804.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$2,211.00
|
| Rate for Payer: Cash Price |
$2,211.00
|
| Rate for Payer: Cigna of CA HMO |
$2,814.00
|
| Rate for Payer: Cigna of CA PPO |
$2,814.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,608.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,608.00
|
| Rate for Payer: Galaxy Health WC |
$3,417.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,412.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,681.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,531.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,488.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$964.80
|
| Rate for Payer: Multiplan Commercial |
$3,216.00
|
| Rate for Payer: Networks By Design Commercial |
$2,010.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,417.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,508.71
|
| Rate for Payer: United Healthcare All Other HMO |
$1,468.51
|
| Rate for Payer: United Healthcare HMO Rider |
$1,436.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,316.55
|
|
|
HC STNT BILRY LG PALM BLLN W/DELI
|
Facility
|
IP
|
$1,718.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909081445
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$343.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$343.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$944.90
|
| Rate for Payer: Cash Price |
$944.90
|
| Rate for Payer: Cigna of CA HMO |
$1,202.60
|
| Rate for Payer: Cigna of CA PPO |
$1,202.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$687.20
|
| Rate for Payer: EPIC Health Plan Senior |
$687.20
|
| Rate for Payer: Galaxy Health WC |
$1,460.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,030.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,145.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$654.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,063.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$412.32
|
| Rate for Payer: Multiplan Commercial |
$1,374.40
|
| Rate for Payer: Networks By Design Commercial |
$859.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,460.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$644.77
|
| Rate for Payer: United Healthcare All Other HMO |
$627.59
|
| Rate for Payer: United Healthcare HMO Rider |
$614.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$562.64
|
|
|
HC STNT BILRY LG PALM BLLN W/DELI
|
Facility
|
OP
|
$1,718.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909081445
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$343.60 |
| Max. Negotiated Rate |
$1,460.30 |
| Rate for Payer: Adventist Health Commercial |
$343.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,460.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$944.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,288.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$995.07
|
| Rate for Payer: Blue Shield of California Commercial |
$1,267.88
|
| Rate for Payer: Blue Shield of California EPN |
$834.95
|
| Rate for Payer: Cash Price |
$944.90
|
| Rate for Payer: Cigna of CA HMO |
$1,202.60
|
| Rate for Payer: Cigna of CA PPO |
$1,202.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,460.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,460.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,460.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$687.20
|
| Rate for Payer: EPIC Health Plan Senior |
$687.20
|
| Rate for Payer: Galaxy Health WC |
$1,460.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,030.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,145.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$654.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,063.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$412.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,202.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,202.60
|
| Rate for Payer: Multiplan Commercial |
$1,374.40
|
| Rate for Payer: Networks By Design Commercial |
$859.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,460.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,030.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,030.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$644.77
|
| Rate for Payer: United Healthcare All Other HMO |
$627.59
|
| Rate for Payer: United Healthcare HMO Rider |
$614.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$562.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,460.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,460.30
|
| Rate for Payer: Vantage Medical Group Senior |
$1,460.30
|
|
|
HC STNT BILRY SMART CORDIS NIT 20
|
Facility
|
IP
|
$1,800.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909081428
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$360.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$360.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$990.00
|
| Rate for Payer: Cash Price |
$990.00
|
| Rate for Payer: Cigna of CA HMO |
$1,260.00
|
| Rate for Payer: Cigna of CA PPO |
$1,260.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$720.00
|
| Rate for Payer: EPIC Health Plan Senior |
$720.00
|
| Rate for Payer: Galaxy Health WC |
$1,530.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,080.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,200.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$685.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,114.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$432.00
|
| Rate for Payer: Multiplan Commercial |
$1,440.00
|
| Rate for Payer: Networks By Design Commercial |
$900.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,530.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$675.54
|
| Rate for Payer: United Healthcare All Other HMO |
$657.54
|
| Rate for Payer: United Healthcare HMO Rider |
$643.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$589.50
|
|
|
HC STNT BILRY SMART CORDIS NIT 20
|
Facility
|
OP
|
$1,800.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909081428
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$360.00 |
| Max. Negotiated Rate |
$1,530.00 |
| Rate for Payer: Adventist Health Commercial |
$360.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,530.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$990.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,350.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,042.56
|
| Rate for Payer: Blue Shield of California Commercial |
$1,328.40
|
| Rate for Payer: Blue Shield of California EPN |
$874.80
|
| Rate for Payer: Cash Price |
$990.00
|
| Rate for Payer: Cigna of CA HMO |
$1,260.00
|
| Rate for Payer: Cigna of CA PPO |
$1,260.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,530.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,530.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,530.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$720.00
|
| Rate for Payer: EPIC Health Plan Senior |
$720.00
|
| Rate for Payer: Galaxy Health WC |
$1,530.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,080.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,200.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$685.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,114.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$432.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,260.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,260.00
|
| Rate for Payer: Multiplan Commercial |
$1,440.00
|
| Rate for Payer: Networks By Design Commercial |
$900.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,530.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,080.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,080.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$675.54
|
| Rate for Payer: United Healthcare All Other HMO |
$657.54
|
| Rate for Payer: United Healthcare HMO Rider |
$643.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$589.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,530.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,530.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,530.00
|
|
|
HC STNT BILRY SMRT CORD NIT 40/60
|
Facility
|
OP
|
$4,350.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909081429
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$870.00 |
| Max. Negotiated Rate |
$3,697.50 |
| Rate for Payer: Adventist Health Commercial |
$870.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,697.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,392.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,262.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,519.52
|
| Rate for Payer: Blue Shield of California Commercial |
$3,210.30
|
| Rate for Payer: Blue Shield of California EPN |
$2,114.10
|
| Rate for Payer: Cash Price |
$2,392.50
|
| Rate for Payer: Cigna of CA HMO |
$3,045.00
|
| Rate for Payer: Cigna of CA PPO |
$3,045.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,697.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,697.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,697.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,740.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,740.00
|
| Rate for Payer: Galaxy Health WC |
$3,697.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,610.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,901.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,657.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,692.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,044.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,045.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,045.00
|
| Rate for Payer: Multiplan Commercial |
$3,480.00
|
| Rate for Payer: Networks By Design Commercial |
$2,175.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,697.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,610.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,610.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,632.56
|
| Rate for Payer: United Healthcare All Other HMO |
$1,589.06
|
| Rate for Payer: United Healthcare HMO Rider |
$1,554.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,424.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,697.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,697.50
|
| Rate for Payer: Vantage Medical Group Senior |
$3,697.50
|
|
|
HC STNT BILRY SMRT CORD NIT 40/60
|
Facility
|
IP
|
$4,350.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909081429
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$870.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$870.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$2,392.50
|
| Rate for Payer: Cash Price |
$2,392.50
|
| Rate for Payer: Cigna of CA HMO |
$3,045.00
|
| Rate for Payer: Cigna of CA PPO |
$3,045.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,740.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,740.00
|
| Rate for Payer: Galaxy Health WC |
$3,697.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,610.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,901.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,657.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,692.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,044.00
|
| Rate for Payer: Multiplan Commercial |
$3,480.00
|
| Rate for Payer: Networks By Design Commercial |
$2,175.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,697.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,632.56
|
| Rate for Payer: United Healthcare All Other HMO |
$1,589.06
|
| Rate for Payer: United Healthcare HMO Rider |
$1,554.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,424.62
|
|
|
HC STNT BILRY SMRT CORD NITINL 80
|
Facility
|
IP
|
$3,900.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909081430
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$2,145.00
|
| Rate for Payer: Cash Price |
$2,145.00
|
| Rate for Payer: Cigna of CA HMO |
$2,730.00
|
| Rate for Payer: Cigna of CA PPO |
$2,730.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$936.00
|
| Rate for Payer: Multiplan Commercial |
$3,120.00
|
| Rate for Payer: Networks By Design Commercial |
$1,950.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,463.67
|
| Rate for Payer: United Healthcare All Other HMO |
$1,424.67
|
| Rate for Payer: United Healthcare HMO Rider |
$1,393.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,277.25
|
|
|
HC STNT BILRY SMRT CORD NITINL 80
|
Facility
|
OP
|
$3,900.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909081430
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,315.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,145.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,925.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,258.88
|
| Rate for Payer: Blue Shield of California Commercial |
$2,878.20
|
| Rate for Payer: Blue Shield of California EPN |
$1,895.40
|
| Rate for Payer: Cash Price |
$2,145.00
|
| Rate for Payer: Cigna of CA HMO |
$2,730.00
|
| Rate for Payer: Cigna of CA PPO |
$2,730.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,315.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,315.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$936.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,730.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,730.00
|
| Rate for Payer: Multiplan Commercial |
$3,120.00
|
| Rate for Payer: Networks By Design Commercial |
$1,950.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,340.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,340.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,463.67
|
| Rate for Payer: United Healthcare All Other HMO |
$1,424.67
|
| Rate for Payer: United Healthcare HMO Rider |
$1,393.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,277.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,315.00
|
|
|
HC STNT BRUAN CP COVERED PREMOUNT
|
Facility
|
OP
|
$16,500.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
906812586
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,300.00 |
| Max. Negotiated Rate |
$14,025.00 |
| Rate for Payer: Adventist Health Commercial |
$3,300.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14,025.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,075.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12,375.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,556.80
|
| Rate for Payer: Blue Shield of California Commercial |
$12,177.00
|
| Rate for Payer: Blue Shield of California EPN |
$8,019.00
|
| Rate for Payer: Cash Price |
$9,075.00
|
| Rate for Payer: Cigna of CA HMO |
$11,550.00
|
| Rate for Payer: Cigna of CA PPO |
$11,550.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14,025.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$14,025.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,025.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,600.00
|
| Rate for Payer: EPIC Health Plan Senior |
$6,600.00
|
| Rate for Payer: Galaxy Health WC |
$14,025.00
|
| Rate for Payer: Global Benefits Group Commercial |
$9,900.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,005.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,286.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,213.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,960.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,550.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,550.00
|
| Rate for Payer: Multiplan Commercial |
$13,200.00
|
| Rate for Payer: Networks By Design Commercial |
$8,250.00
|
| Rate for Payer: Prime Health Services Commercial |
$14,025.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,900.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,900.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,192.45
|
| Rate for Payer: United Healthcare All Other HMO |
$6,027.45
|
| Rate for Payer: United Healthcare HMO Rider |
$5,897.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,403.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14,025.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14,025.00
|
| Rate for Payer: Vantage Medical Group Senior |
$14,025.00
|
|
|
HC STNT BRUAN CP COVERED PREMOUNT
|
Facility
|
IP
|
$16,500.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
906812586
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,300.00 |
| Max. Negotiated Rate |
$14,025.00 |
| Rate for Payer: Adventist Health Commercial |
$3,300.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$9,075.00
|
| Rate for Payer: Cash Price |
$9,075.00
|
| Rate for Payer: Cigna of CA HMO |
$11,550.00
|
| Rate for Payer: Cigna of CA PPO |
$11,550.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,600.00
|
| Rate for Payer: EPIC Health Plan Senior |
$6,600.00
|
| Rate for Payer: Galaxy Health WC |
$14,025.00
|
| Rate for Payer: Global Benefits Group Commercial |
$9,900.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,005.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,286.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,213.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,960.00
|
| Rate for Payer: Multiplan Commercial |
$13,200.00
|
| Rate for Payer: Networks By Design Commercial |
$8,250.00
|
| Rate for Payer: Prime Health Services Commercial |
$14,025.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,192.45
|
| Rate for Payer: United Healthcare All Other HMO |
$6,027.45
|
| Rate for Payer: United Healthcare HMO Rider |
$5,897.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,403.75
|
|
|
HC STNT BRUAN CP COVERED UNMOUNT
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT C1877
|
| Hospital Charge Code |
906812587
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,000.00 |
| Max. Negotiated Rate |
$8,500.00 |
| Rate for Payer: Adventist Health Commercial |
$2,000.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,500.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,500.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,500.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,792.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,380.00
|
| Rate for Payer: Blue Shield of California EPN |
$4,860.00
|
| Rate for Payer: Cash Price |
$5,500.00
|
| Rate for Payer: Cigna of CA HMO |
$7,000.00
|
| Rate for Payer: Cigna of CA PPO |
$7,000.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,500.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,500.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,500.00
|
| 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: Molina Healthcare of CA Medi-Cal |
$7,000.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,000.00
|
| 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: Temecula Valley Physicians Medical Group Commercial |
$6,000.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,000.00
|
| 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
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,500.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,500.00
|
| Rate for Payer: Vantage Medical Group Senior |
$8,500.00
|
|
|
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 |
$5,500.00
|
| Rate for Payer: Cash Price |
$5,500.00
|
| 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
|
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 |
$2,303.12
|
| 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 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 |
$2,303.12
|
| Rate for Payer: Cash Price |
$2,303.12
|
| 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 |
$2,303.12
|
| 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 |
$2,303.12
|
| Rate for Payer: Cash Price |
$2,303.12
|
| 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 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 |
$2,165.62
|
| 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
|
|
