|
HC STNT CORDIS PALMAZ BLUE MTND
|
Facility
|
OP
|
$797.04
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
906812463
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$159.41 |
| Max. Negotiated Rate |
$677.48 |
| Rate for Payer: Adventist Health Commercial |
$159.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$677.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$438.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$597.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$461.65
|
| Rate for Payer: Blue Shield of California Commercial |
$588.22
|
| Rate for Payer: Blue Shield of California EPN |
$387.36
|
| Rate for Payer: Cash Price |
$358.67
|
| Rate for Payer: Cigna of CA HMO |
$557.93
|
| Rate for Payer: Cigna of CA PPO |
$557.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$677.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$677.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$677.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$318.82
|
| Rate for Payer: EPIC Health Plan Senior |
$318.82
|
| Rate for Payer: Galaxy Health WC |
$677.48
|
| Rate for Payer: Global Benefits Group Commercial |
$478.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$531.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$303.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$493.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$191.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$557.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$557.93
|
| Rate for Payer: Multiplan Commercial |
$637.63
|
| Rate for Payer: Networks By Design Commercial |
$398.52
|
| Rate for Payer: Prime Health Services Commercial |
$677.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$478.22
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$478.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$299.13
|
| Rate for Payer: United Healthcare All Other HMO |
$291.16
|
| Rate for Payer: United Healthcare HMO Rider |
$284.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$261.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$677.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$677.48
|
| Rate for Payer: Vantage Medical Group Senior |
$677.48
|
|
|
HC STNT CORDIS PALMAZ BLUE MTND
|
Facility
|
IP
|
$797.04
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
906812463
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$159.41 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$159.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$358.67
|
| Rate for Payer: Cash Price |
$358.67
|
| Rate for Payer: Cigna of CA HMO |
$557.93
|
| Rate for Payer: Cigna of CA PPO |
$557.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$318.82
|
| Rate for Payer: EPIC Health Plan Senior |
$318.82
|
| Rate for Payer: Galaxy Health WC |
$677.48
|
| Rate for Payer: Global Benefits Group Commercial |
$478.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$531.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$303.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$493.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$191.29
|
| Rate for Payer: Multiplan Commercial |
$637.63
|
| Rate for Payer: Networks By Design Commercial |
$398.52
|
| Rate for Payer: Prime Health Services Commercial |
$677.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$299.13
|
| Rate for Payer: United Healthcare All Other HMO |
$291.16
|
| Rate for Payer: United Healthcare HMO Rider |
$284.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$261.03
|
|
|
HC STNT EV3 INTRASTENT
|
Facility
|
OP
|
$3,900.00
|
|
|
Service Code
|
CPT C1877
|
| Hospital Charge Code |
906812434
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,315.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,145.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,925.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,258.88
|
| Rate for Payer: Blue Shield of California Commercial |
$2,878.20
|
| Rate for Payer: Blue Shield of California EPN |
$1,895.40
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Cigna of CA HMO |
$2,730.00
|
| Rate for Payer: Cigna of CA PPO |
$2,730.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,315.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,315.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$936.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,730.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,730.00
|
| Rate for Payer: Multiplan Commercial |
$3,120.00
|
| Rate for Payer: Networks By Design Commercial |
$1,950.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,340.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,340.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,463.67
|
| Rate for Payer: United Healthcare All Other HMO |
$1,424.67
|
| Rate for Payer: United Healthcare HMO Rider |
$1,393.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,277.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,315.00
|
|
|
HC STNT EV3 INTRASTENT
|
Facility
|
IP
|
$3,900.00
|
|
|
Service Code
|
CPT C1877
|
| Hospital Charge Code |
906812434
|
|
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 EV3 VISI-PRO
|
Facility
|
OP
|
$3,705.00
|
|
|
Service Code
|
CPT C1877
|
| Hospital Charge Code |
906812417
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$741.00 |
| Max. Negotiated Rate |
$3,149.25 |
| Rate for Payer: Adventist Health Commercial |
$741.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,149.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,037.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,778.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,145.94
|
| Rate for Payer: Blue Shield of California Commercial |
$2,734.29
|
| Rate for Payer: Blue Shield of California EPN |
$1,800.63
|
| Rate for Payer: Cash Price |
$1,667.25
|
| Rate for Payer: Cigna of CA HMO |
$2,593.50
|
| Rate for Payer: Cigna of CA PPO |
$2,593.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,149.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,149.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,149.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,482.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,482.00
|
| Rate for Payer: Galaxy Health WC |
$3,149.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,223.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,471.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,411.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,293.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$889.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,593.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,593.50
|
| Rate for Payer: Multiplan Commercial |
$2,964.00
|
| Rate for Payer: Networks By Design Commercial |
$1,852.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,149.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,223.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,223.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,390.49
|
| Rate for Payer: United Healthcare All Other HMO |
$1,353.44
|
| Rate for Payer: United Healthcare HMO Rider |
$1,324.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,213.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,149.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,149.25
|
| Rate for Payer: Vantage Medical Group Senior |
$3,149.25
|
|
|
HC STNT EV3 VISI-PRO
|
Facility
|
IP
|
$3,705.00
|
|
|
Service Code
|
CPT C1877
|
| Hospital Charge Code |
906812417
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$741.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$741.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,667.25
|
| Rate for Payer: Cash Price |
$1,667.25
|
| Rate for Payer: Cigna of CA HMO |
$2,593.50
|
| Rate for Payer: Cigna of CA PPO |
$2,593.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,482.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,482.00
|
| Rate for Payer: Galaxy Health WC |
$3,149.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,223.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,471.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,411.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,293.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$889.20
|
| Rate for Payer: Multiplan Commercial |
$2,964.00
|
| Rate for Payer: Networks By Design Commercial |
$1,852.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,149.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,390.49
|
| Rate for Payer: United Healthcare All Other HMO |
$1,353.44
|
| Rate for Payer: United Healthcare HMO Rider |
$1,324.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,213.39
|
|
|
HC STNT GORE VIABA 5MMX10CMX120CM
|
Facility
|
IP
|
$8,393.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
906812687
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,678.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,678.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$3,776.85
|
| Rate for Payer: Cash Price |
$3,776.85
|
| Rate for Payer: Cigna of CA HMO |
$5,875.10
|
| Rate for Payer: Cigna of CA PPO |
$5,875.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,357.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,357.20
|
| Rate for Payer: Galaxy Health WC |
$7,134.05
|
| Rate for Payer: Global Benefits Group Commercial |
$5,035.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,598.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,197.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,195.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,014.32
|
| Rate for Payer: Multiplan Commercial |
$6,714.40
|
| Rate for Payer: Networks By Design Commercial |
$4,196.50
|
| Rate for Payer: Prime Health Services Commercial |
$7,134.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,149.89
|
| Rate for Payer: United Healthcare All Other HMO |
$3,065.96
|
| Rate for Payer: United Healthcare HMO Rider |
$2,999.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,748.71
|
|
|
HC STNT GORE VIABA 5MMX10CMX120CM
|
Facility
|
OP
|
$8,393.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
906812687
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,678.60 |
| Max. Negotiated Rate |
$7,134.05 |
| Rate for Payer: Adventist Health Commercial |
$1,678.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,134.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,616.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,294.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,861.23
|
| Rate for Payer: Blue Shield of California Commercial |
$6,194.03
|
| Rate for Payer: Blue Shield of California EPN |
$4,079.00
|
| Rate for Payer: Cash Price |
$3,776.85
|
| Rate for Payer: Cigna of CA HMO |
$5,875.10
|
| Rate for Payer: Cigna of CA PPO |
$5,875.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,134.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,134.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,134.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,357.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,357.20
|
| Rate for Payer: Galaxy Health WC |
$7,134.05
|
| Rate for Payer: Global Benefits Group Commercial |
$5,035.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,598.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,195.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,014.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,875.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,875.10
|
| Rate for Payer: Multiplan Commercial |
$6,714.40
|
| Rate for Payer: Networks By Design Commercial |
$4,196.50
|
| Rate for Payer: Prime Health Services Commercial |
$7,134.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,035.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,035.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,149.89
|
| Rate for Payer: United Healthcare All Other HMO |
$3,065.96
|
| Rate for Payer: United Healthcare HMO Rider |
$2,999.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,748.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,134.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,134.05
|
| Rate for Payer: Vantage Medical Group Senior |
$7,134.05
|
|
|
HC STNT GORE VIABA 5MMX5CMX120CM
|
Facility
|
IP
|
$7,650.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
906812694
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,530.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,530.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$3,442.50
|
| Rate for Payer: Cash Price |
$3,442.50
|
| Rate for Payer: Cigna of CA HMO |
$5,355.00
|
| Rate for Payer: Cigna of CA PPO |
$5,355.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,060.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,060.00
|
| Rate for Payer: Galaxy Health WC |
$6,502.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,590.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,102.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,914.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,735.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,836.00
|
| Rate for Payer: Multiplan Commercial |
$6,120.00
|
| Rate for Payer: Networks By Design Commercial |
$3,825.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,502.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,871.05
|
| Rate for Payer: United Healthcare All Other HMO |
$2,794.55
|
| Rate for Payer: United Healthcare HMO Rider |
$2,734.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,505.38
|
|
|
HC STNT GORE VIABA 5MMX5CMX120CM
|
Facility
|
OP
|
$7,650.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
906812666
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,530.00 |
| Max. Negotiated Rate |
$6,502.50 |
| Rate for Payer: Adventist Health Commercial |
$1,530.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,502.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,207.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,737.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,430.88
|
| Rate for Payer: Blue Shield of California Commercial |
$5,645.70
|
| Rate for Payer: Blue Shield of California EPN |
$3,717.90
|
| Rate for Payer: Cash Price |
$3,442.50
|
| Rate for Payer: Cigna of CA HMO |
$5,355.00
|
| Rate for Payer: Cigna of CA PPO |
$5,355.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,502.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,502.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,502.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,060.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,060.00
|
| Rate for Payer: Galaxy Health WC |
$6,502.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,590.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,102.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,735.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,836.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,355.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,355.00
|
| Rate for Payer: Multiplan Commercial |
$6,120.00
|
| Rate for Payer: Networks By Design Commercial |
$3,825.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,502.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,590.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,590.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,871.05
|
| Rate for Payer: United Healthcare All Other HMO |
$2,794.55
|
| Rate for Payer: United Healthcare HMO Rider |
$2,734.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,505.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,502.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,502.50
|
| Rate for Payer: Vantage Medical Group Senior |
$6,502.50
|
|
|
HC STNT GORE VIABA 5MMX5CMX120CM
|
Facility
|
IP
|
$7,650.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
906812666
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,530.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,530.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$3,442.50
|
| Rate for Payer: Cash Price |
$3,442.50
|
| Rate for Payer: Cigna of CA HMO |
$5,355.00
|
| Rate for Payer: Cigna of CA PPO |
$5,355.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,060.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,060.00
|
| Rate for Payer: Galaxy Health WC |
$6,502.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,590.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,102.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,914.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,735.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,836.00
|
| Rate for Payer: Multiplan Commercial |
$6,120.00
|
| Rate for Payer: Networks By Design Commercial |
$3,825.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,502.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,871.05
|
| Rate for Payer: United Healthcare All Other HMO |
$2,794.55
|
| Rate for Payer: United Healthcare HMO Rider |
$2,734.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,505.38
|
|
|
HC STNT GORE VIABA 5MMX5CMX120CM
|
Facility
|
OP
|
$7,650.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
906812694
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,530.00 |
| Max. Negotiated Rate |
$6,502.50 |
| Rate for Payer: Adventist Health Commercial |
$1,530.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,502.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,207.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,737.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,430.88
|
| Rate for Payer: Blue Shield of California Commercial |
$5,645.70
|
| Rate for Payer: Blue Shield of California EPN |
$3,717.90
|
| Rate for Payer: Cash Price |
$3,442.50
|
| Rate for Payer: Cigna of CA HMO |
$5,355.00
|
| Rate for Payer: Cigna of CA PPO |
$5,355.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,502.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,502.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,502.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,060.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,060.00
|
| Rate for Payer: Galaxy Health WC |
$6,502.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,590.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,102.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,735.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,836.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,355.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,355.00
|
| Rate for Payer: Multiplan Commercial |
$6,120.00
|
| Rate for Payer: Networks By Design Commercial |
$3,825.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,502.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,590.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,590.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,871.05
|
| Rate for Payer: United Healthcare All Other HMO |
$2,794.55
|
| Rate for Payer: United Healthcare HMO Rider |
$2,734.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,505.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,502.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,502.50
|
| Rate for Payer: Vantage Medical Group Senior |
$6,502.50
|
|
|
HC STNT GORE VIABA 6MMX10CMX120CM
|
Facility
|
OP
|
$8,393.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
906812689
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,678.60 |
| Max. Negotiated Rate |
$7,134.05 |
| Rate for Payer: Adventist Health Commercial |
$1,678.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,134.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,616.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,294.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,861.23
|
| Rate for Payer: Blue Shield of California Commercial |
$6,194.03
|
| Rate for Payer: Blue Shield of California EPN |
$4,079.00
|
| Rate for Payer: Cash Price |
$3,776.85
|
| Rate for Payer: Cigna of CA HMO |
$5,875.10
|
| Rate for Payer: Cigna of CA PPO |
$5,875.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,134.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,134.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,134.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,357.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,357.20
|
| Rate for Payer: Galaxy Health WC |
$7,134.05
|
| Rate for Payer: Global Benefits Group Commercial |
$5,035.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,598.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,195.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,014.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,875.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,875.10
|
| Rate for Payer: Multiplan Commercial |
$6,714.40
|
| Rate for Payer: Networks By Design Commercial |
$4,196.50
|
| Rate for Payer: Prime Health Services Commercial |
$7,134.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,035.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,035.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,149.89
|
| Rate for Payer: United Healthcare All Other HMO |
$3,065.96
|
| Rate for Payer: United Healthcare HMO Rider |
$2,999.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,748.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,134.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,134.05
|
| Rate for Payer: Vantage Medical Group Senior |
$7,134.05
|
|
|
HC STNT GORE VIABA 6MMX10CMX120CM
|
Facility
|
IP
|
$8,393.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
906812689
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,678.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,678.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$3,776.85
|
| Rate for Payer: Cash Price |
$3,776.85
|
| Rate for Payer: Cigna of CA HMO |
$5,875.10
|
| Rate for Payer: Cigna of CA PPO |
$5,875.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,357.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,357.20
|
| Rate for Payer: Galaxy Health WC |
$7,134.05
|
| Rate for Payer: Global Benefits Group Commercial |
$5,035.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,598.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,197.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,195.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,014.32
|
| Rate for Payer: Multiplan Commercial |
$6,714.40
|
| Rate for Payer: Networks By Design Commercial |
$4,196.50
|
| Rate for Payer: Prime Health Services Commercial |
$7,134.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,149.89
|
| Rate for Payer: United Healthcare All Other HMO |
$3,065.96
|
| Rate for Payer: United Healthcare HMO Rider |
$2,999.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,748.71
|
|
|
HC STNT GORE VIABA 6MMX5CMX120CM
|
Facility
|
IP
|
$7,650.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
906812688
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,530.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,530.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$3,442.50
|
| Rate for Payer: Cash Price |
$3,442.50
|
| Rate for Payer: Cigna of CA HMO |
$5,355.00
|
| Rate for Payer: Cigna of CA PPO |
$5,355.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,060.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,060.00
|
| Rate for Payer: Galaxy Health WC |
$6,502.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,590.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,102.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,914.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,735.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,836.00
|
| Rate for Payer: Multiplan Commercial |
$6,120.00
|
| Rate for Payer: Networks By Design Commercial |
$3,825.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,502.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,871.05
|
| Rate for Payer: United Healthcare All Other HMO |
$2,794.55
|
| Rate for Payer: United Healthcare HMO Rider |
$2,734.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,505.38
|
|
|
HC STNT GORE VIABA 6MMX5CMX120CM
|
Facility
|
OP
|
$7,650.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
906812688
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,530.00 |
| Max. Negotiated Rate |
$6,502.50 |
| Rate for Payer: Adventist Health Commercial |
$1,530.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,502.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,207.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,737.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,430.88
|
| Rate for Payer: Blue Shield of California Commercial |
$5,645.70
|
| Rate for Payer: Blue Shield of California EPN |
$3,717.90
|
| Rate for Payer: Cash Price |
$3,442.50
|
| Rate for Payer: Cigna of CA HMO |
$5,355.00
|
| Rate for Payer: Cigna of CA PPO |
$5,355.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,502.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,502.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,502.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,060.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,060.00
|
| Rate for Payer: Galaxy Health WC |
$6,502.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,590.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,102.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,735.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,836.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,355.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,355.00
|
| Rate for Payer: Multiplan Commercial |
$6,120.00
|
| Rate for Payer: Networks By Design Commercial |
$3,825.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,502.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,590.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,590.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,871.05
|
| Rate for Payer: United Healthcare All Other HMO |
$2,794.55
|
| Rate for Payer: United Healthcare HMO Rider |
$2,734.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,505.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,502.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,502.50
|
| Rate for Payer: Vantage Medical Group Senior |
$6,502.50
|
|
|
HC STNT GORE VIABA 7MMX10CMX120CM
|
Facility
|
OP
|
$8,393.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
906812691
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,678.60 |
| Max. Negotiated Rate |
$7,134.05 |
| Rate for Payer: Adventist Health Commercial |
$1,678.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,134.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,616.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,294.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,861.23
|
| Rate for Payer: Blue Shield of California Commercial |
$6,194.03
|
| Rate for Payer: Blue Shield of California EPN |
$4,079.00
|
| Rate for Payer: Cash Price |
$3,776.85
|
| Rate for Payer: Cigna of CA HMO |
$5,875.10
|
| Rate for Payer: Cigna of CA PPO |
$5,875.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,134.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,134.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,134.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,357.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,357.20
|
| Rate for Payer: Galaxy Health WC |
$7,134.05
|
| Rate for Payer: Global Benefits Group Commercial |
$5,035.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,598.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,195.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,014.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,875.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,875.10
|
| Rate for Payer: Multiplan Commercial |
$6,714.40
|
| Rate for Payer: Networks By Design Commercial |
$4,196.50
|
| Rate for Payer: Prime Health Services Commercial |
$7,134.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,035.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,035.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,149.89
|
| Rate for Payer: United Healthcare All Other HMO |
$3,065.96
|
| Rate for Payer: United Healthcare HMO Rider |
$2,999.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,748.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,134.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,134.05
|
| Rate for Payer: Vantage Medical Group Senior |
$7,134.05
|
|
|
HC STNT GORE VIABA 7MMX10CMX120CM
|
Facility
|
IP
|
$8,393.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
906812691
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,678.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,678.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$3,776.85
|
| Rate for Payer: Cash Price |
$3,776.85
|
| Rate for Payer: Cigna of CA HMO |
$5,875.10
|
| Rate for Payer: Cigna of CA PPO |
$5,875.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,357.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,357.20
|
| Rate for Payer: Galaxy Health WC |
$7,134.05
|
| Rate for Payer: Global Benefits Group Commercial |
$5,035.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,598.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,197.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,195.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,014.32
|
| Rate for Payer: Multiplan Commercial |
$6,714.40
|
| Rate for Payer: Networks By Design Commercial |
$4,196.50
|
| Rate for Payer: Prime Health Services Commercial |
$7,134.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,149.89
|
| Rate for Payer: United Healthcare All Other HMO |
$3,065.96
|
| Rate for Payer: United Healthcare HMO Rider |
$2,999.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,748.71
|
|
|
HC STNT GORE VIABA 7MMX5CMX120CM
|
Facility
|
IP
|
$7,650.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
906812690
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,530.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,530.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$3,442.50
|
| Rate for Payer: Cash Price |
$3,442.50
|
| Rate for Payer: Cigna of CA HMO |
$5,355.00
|
| Rate for Payer: Cigna of CA PPO |
$5,355.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,060.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,060.00
|
| Rate for Payer: Galaxy Health WC |
$6,502.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,590.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,102.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,914.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,735.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,836.00
|
| Rate for Payer: Multiplan Commercial |
$6,120.00
|
| Rate for Payer: Networks By Design Commercial |
$3,825.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,502.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,871.05
|
| Rate for Payer: United Healthcare All Other HMO |
$2,794.55
|
| Rate for Payer: United Healthcare HMO Rider |
$2,734.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,505.38
|
|
|
HC STNT GORE VIABA 7MMX5CMX120CM
|
Facility
|
OP
|
$7,650.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
906812690
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,530.00 |
| Max. Negotiated Rate |
$6,502.50 |
| Rate for Payer: Adventist Health Commercial |
$1,530.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,502.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,207.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,737.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,430.88
|
| Rate for Payer: Blue Shield of California Commercial |
$5,645.70
|
| Rate for Payer: Blue Shield of California EPN |
$3,717.90
|
| Rate for Payer: Cash Price |
$3,442.50
|
| Rate for Payer: Cigna of CA HMO |
$5,355.00
|
| Rate for Payer: Cigna of CA PPO |
$5,355.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,502.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,502.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,502.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,060.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,060.00
|
| Rate for Payer: Galaxy Health WC |
$6,502.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,590.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,102.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,735.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,836.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,355.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,355.00
|
| Rate for Payer: Multiplan Commercial |
$6,120.00
|
| Rate for Payer: Networks By Design Commercial |
$3,825.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,502.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,590.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,590.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,871.05
|
| Rate for Payer: United Healthcare All Other HMO |
$2,794.55
|
| Rate for Payer: United Healthcare HMO Rider |
$2,734.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,505.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,502.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,502.50
|
| Rate for Payer: Vantage Medical Group Senior |
$6,502.50
|
|
|
HC STNT GORE VIABAHN
|
Facility
|
IP
|
$7,097.50
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
906812513
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,419.50 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,419.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$3,193.88
|
| Rate for Payer: Cash Price |
$3,193.88
|
| Rate for Payer: Cigna of CA HMO |
$4,968.25
|
| Rate for Payer: Cigna of CA PPO |
$4,968.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,839.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,839.00
|
| Rate for Payer: Galaxy Health WC |
$6,032.88
|
| Rate for Payer: Global Benefits Group Commercial |
$4,258.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,734.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,704.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,393.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,703.40
|
| Rate for Payer: Multiplan Commercial |
$5,678.00
|
| Rate for Payer: Networks By Design Commercial |
$3,548.75
|
| Rate for Payer: Prime Health Services Commercial |
$6,032.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,663.69
|
| Rate for Payer: United Healthcare All Other HMO |
$2,592.72
|
| Rate for Payer: United Healthcare HMO Rider |
$2,536.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,324.43
|
|
|
HC STNT GORE VIABAHN
|
Facility
|
OP
|
$7,097.50
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
906812513
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,419.50 |
| Max. Negotiated Rate |
$6,032.88 |
| Rate for Payer: Adventist Health Commercial |
$1,419.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,032.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,903.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,323.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,110.87
|
| Rate for Payer: Blue Shield of California Commercial |
$5,237.95
|
| Rate for Payer: Blue Shield of California EPN |
$3,449.39
|
| Rate for Payer: Cash Price |
$3,193.88
|
| Rate for Payer: Cigna of CA HMO |
$4,968.25
|
| Rate for Payer: Cigna of CA PPO |
$4,968.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,032.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,032.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,032.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,839.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,839.00
|
| Rate for Payer: Galaxy Health WC |
$6,032.88
|
| Rate for Payer: Global Benefits Group Commercial |
$4,258.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,734.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,393.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,703.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,968.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,968.25
|
| Rate for Payer: Multiplan Commercial |
$5,678.00
|
| Rate for Payer: Networks By Design Commercial |
$3,548.75
|
| Rate for Payer: Prime Health Services Commercial |
$6,032.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,258.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,258.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,663.69
|
| Rate for Payer: United Healthcare All Other HMO |
$2,592.72
|
| Rate for Payer: United Healthcare HMO Rider |
$2,536.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,324.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,032.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,032.88
|
| Rate for Payer: Vantage Medical Group Senior |
$6,032.88
|
|
|
HC STNT MED ENDEAVOR DES
|
Facility
|
OP
|
$5,438.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
906812361
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,087.60 |
| Max. Negotiated Rate |
$4,622.30 |
| Rate for Payer: Adventist Health Commercial |
$1,087.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,622.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,990.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,078.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,149.69
|
| Rate for Payer: Blue Shield of California Commercial |
$4,013.24
|
| Rate for Payer: Blue Shield of California EPN |
$2,642.87
|
| Rate for Payer: Cash Price |
$2,447.10
|
| Rate for Payer: Cigna of CA HMO |
$3,806.60
|
| Rate for Payer: Cigna of CA PPO |
$3,806.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,622.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,622.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,622.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,175.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,175.20
|
| Rate for Payer: Galaxy Health WC |
$4,622.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,262.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,627.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,366.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,305.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,806.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,806.60
|
| Rate for Payer: Multiplan Commercial |
$4,350.40
|
| Rate for Payer: Networks By Design Commercial |
$2,719.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,622.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,262.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,262.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,040.88
|
| Rate for Payer: United Healthcare All Other HMO |
$1,986.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,943.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,780.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,622.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,622.30
|
| Rate for Payer: Vantage Medical Group Senior |
$4,622.30
|
|
|
HC STNT MED ENDEAVOR DES
|
Facility
|
IP
|
$5,438.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
906812361
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,087.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,087.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$2,447.10
|
| Rate for Payer: Cash Price |
$2,447.10
|
| Rate for Payer: Cigna of CA HMO |
$3,806.60
|
| Rate for Payer: Cigna of CA PPO |
$3,806.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,175.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,175.20
|
| Rate for Payer: Galaxy Health WC |
$4,622.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,262.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,627.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,071.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,366.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,305.12
|
| Rate for Payer: Multiplan Commercial |
$4,350.40
|
| Rate for Payer: Networks By Design Commercial |
$2,719.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,622.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,040.88
|
| Rate for Payer: United Healthcare All Other HMO |
$1,986.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,943.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,780.94
|
|
|
HC STNT MED RESOLUTE ONYX DES
|
Facility
|
OP
|
$3,238.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
906812742
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$647.60 |
| Max. Negotiated Rate |
$2,752.30 |
| Rate for Payer: Adventist Health Commercial |
$647.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,752.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,780.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,428.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,875.45
|
| Rate for Payer: Blue Shield of California Commercial |
$2,389.64
|
| Rate for Payer: Blue Shield of California EPN |
$1,573.67
|
| Rate for Payer: Cash Price |
$1,457.10
|
| Rate for Payer: Cigna of CA HMO |
$2,266.60
|
| Rate for Payer: Cigna of CA PPO |
$2,266.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,752.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,752.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,752.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,295.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,295.20
|
| Rate for Payer: Galaxy Health WC |
$2,752.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,942.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,159.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,004.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$777.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,266.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,266.60
|
| Rate for Payer: Multiplan Commercial |
$2,590.40
|
| Rate for Payer: Networks By Design Commercial |
$1,619.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,752.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,942.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,942.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,215.22
|
| Rate for Payer: United Healthcare All Other HMO |
$1,182.84
|
| Rate for Payer: United Healthcare HMO Rider |
$1,157.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,060.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,752.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,752.30
|
| Rate for Payer: Vantage Medical Group Senior |
$2,752.30
|
|
