|
HC STENT ENTERPRISE
|
Facility
|
OP
|
$13,000.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020034
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,600.00 |
| Max. Negotiated Rate |
$11,050.00 |
| Rate for Payer: Adventist Health Commercial |
$2,600.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,050.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,150.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,750.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,868.90
|
| Rate for Payer: Blue Shield of California Commercial |
$6,591.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,997.00
|
| Rate for Payer: Cash Price |
$5,850.00
|
| Rate for Payer: Cigna of CA HMO |
$9,100.00
|
| Rate for Payer: Cigna of CA PPO |
$9,100.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,050.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,050.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11,050.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,100.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,200.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,200.00
|
| Rate for Payer: Galaxy Health WC |
$11,050.00
|
| Rate for Payer: Global Benefits Group Commercial |
$7,800.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,255.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,719.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,670.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,120.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,100.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,100.00
|
| Rate for Payer: Multiplan Commercial |
$10,400.00
|
| Rate for Payer: Networks By Design Commercial |
$6,500.00
|
| Rate for Payer: Prime Health Services Commercial |
$11,050.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,800.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,800.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,878.90
|
| Rate for Payer: United Healthcare All Other HMO |
$4,748.90
|
| Rate for Payer: United Healthcare HMO Rider |
$4,646.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,257.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,050.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,050.00
|
| Rate for Payer: Vantage Medical Group Senior |
$11,050.00
|
|
|
HC STENT ENTERPRISE
|
Facility
|
IP
|
$13,000.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020034
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,600.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$2,600.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$5,850.00
|
| Rate for Payer: Cash Price |
$5,850.00
|
| Rate for Payer: Cigna of CA HMO |
$9,100.00
|
| Rate for Payer: Cigna of CA PPO |
$9,100.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,100.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,200.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,200.00
|
| Rate for Payer: Galaxy Health WC |
$11,050.00
|
| Rate for Payer: Global Benefits Group Commercial |
$7,800.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,255.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,670.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,120.00
|
| Rate for Payer: Multiplan Commercial |
$10,400.00
|
| Rate for Payer: Networks By Design Commercial |
$6,500.00
|
| Rate for Payer: Prime Health Services Commercial |
$11,050.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,878.90
|
| Rate for Payer: United Healthcare All Other HMO |
$4,748.90
|
| Rate for Payer: United Healthcare HMO Rider |
$4,646.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,257.50
|
|
|
HC STENT EV3 VISI PRO
|
Facility
|
OP
|
$3,705.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020092
|
|
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 |
$2,242.64
|
| Rate for Payer: Blue Shield of California Commercial |
$1,878.43
|
| Rate for Payer: Blue Shield of California Commercial |
$2,849.14
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$2,352.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,344.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,185.95
|
| 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 STENT EV3 VISI PRO
|
Facility
|
IP
|
$3,705.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020092
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$741.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Networks By Design Commercial |
$1,852.50
|
| Rate for Payer: Adventist Health Commercial |
$741.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$2,352.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,185.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$889.20
|
| Rate for Payer: Multiplan Commercial |
$2,964.00
|
| 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 STENT FEM/POP
|
Facility
|
OP
|
$20,529.00
|
|
|
Service Code
|
CPT 37226
|
| Hospital Charge Code |
909020067
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,638.65 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$4,105.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17,449.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11,290.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15,396.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,104.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,508.41
|
| Rate for Payer: Blue Shield of California Commercial |
$3,638.65
|
| Rate for Payer: Cash Price |
$9,238.05
|
| Rate for Payer: Cash Price |
$9,238.05
|
| Rate for Payer: Cash Price |
$9,238.05
|
| Rate for Payer: Cigna of CA HMO |
$13,138.56
|
| Rate for Payer: Cigna of CA PPO |
$15,191.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17,449.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$17,449.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17,449.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14,370.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,211.60
|
| Rate for Payer: EPIC Health Plan Senior |
$8,211.60
|
| Rate for Payer: Galaxy Health WC |
$17,449.65
|
| Rate for Payer: Global Benefits Group Commercial |
$12,317.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13,035.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7,452.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12,112.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,926.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14,370.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14,370.30
|
| Rate for Payer: Multiplan Commercial |
$16,423.20
|
| Rate for Payer: Multiplan WC |
$22,958.69
|
| Rate for Payer: Networks By Design Commercial |
$13,343.85
|
| Rate for Payer: Prime Health Services Commercial |
$17,449.65
|
| Rate for Payer: Prime Health Services WC |
$22,724.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12,317.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,264.50
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17,449.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17,449.65
|
| Rate for Payer: Vantage Medical Group Senior |
$17,449.65
|
|
|
HC STENT FEM/POP
|
Facility
|
IP
|
$20,529.00
|
|
|
Service Code
|
CPT 37226
|
| Hospital Charge Code |
909020067
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,105.80 |
| Max. Negotiated Rate |
$17,449.65 |
| Rate for Payer: Adventist Health Commercial |
$4,105.80
|
| Rate for Payer: Cash Price |
$9,238.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14,370.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,211.60
|
| Rate for Payer: EPIC Health Plan Senior |
$8,211.60
|
| Rate for Payer: Galaxy Health WC |
$17,449.65
|
| Rate for Payer: Global Benefits Group Commercial |
$12,317.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13,035.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12,112.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,926.96
|
| Rate for Payer: Multiplan Commercial |
$16,423.20
|
| Rate for Payer: Networks By Design Commercial |
$13,343.85
|
| Rate for Payer: Prime Health Services Commercial |
$17,449.65
|
|
|
HC STENT FLAIR
|
Facility
|
IP
|
$6,250.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020120
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,250.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$1,250.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$2,812.50
|
| Rate for Payer: Cash Price |
$2,812.50
|
| Rate for Payer: Cigna of CA HMO |
$4,375.00
|
| Rate for Payer: Cigna of CA PPO |
$4,375.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,375.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,500.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,500.00
|
| Rate for Payer: Galaxy Health WC |
$5,312.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,750.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,968.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,687.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,500.00
|
| Rate for Payer: Multiplan Commercial |
$5,000.00
|
| Rate for Payer: Networks By Design Commercial |
$3,125.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,312.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,345.62
|
| Rate for Payer: United Healthcare All Other HMO |
$2,283.12
|
| Rate for Payer: United Healthcare HMO Rider |
$2,233.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,046.88
|
|
|
HC STENT FLAIR
|
Facility
|
OP
|
$6,250.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020120
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,250.00 |
| Max. Negotiated Rate |
$5,312.50 |
| Rate for Payer: Adventist Health Commercial |
$1,250.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,312.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,437.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,687.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,783.12
|
| Rate for Payer: Blue Shield of California Commercial |
$3,168.75
|
| Rate for Payer: Blue Shield of California Commercial |
$4,806.25
|
| Rate for Payer: Cash Price |
$2,812.50
|
| Rate for Payer: Cigna of CA HMO |
$4,375.00
|
| Rate for Payer: Cigna of CA PPO |
$4,375.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,312.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,312.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,312.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,375.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,500.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,500.00
|
| Rate for Payer: Galaxy Health WC |
$5,312.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,750.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,968.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,268.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,687.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,500.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,375.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,375.00
|
| Rate for Payer: Multiplan Commercial |
$5,000.00
|
| Rate for Payer: Networks By Design Commercial |
$3,125.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,312.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,750.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,750.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,345.62
|
| Rate for Payer: United Healthcare All Other HMO |
$2,283.12
|
| Rate for Payer: United Healthcare HMO Rider |
$2,233.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,046.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,312.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,312.50
|
| Rate for Payer: Vantage Medical Group Senior |
$5,312.50
|
|
|
HC STENT GENESIS MOUNTED
|
Facility
|
OP
|
$3,900.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020089
|
|
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 |
$2,360.67
|
| Rate for Payer: Blue Shield of California Commercial |
$1,977.30
|
| Rate for Payer: Blue Shield of California Commercial |
$2,999.10
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$2,476.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,415.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,301.00
|
| 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 STENT GENESIS MOUNTED
|
Facility
|
IP
|
$3,900.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020089
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$2,476.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,301.00
|
| 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 STENT GENESIS UNMOUNTED
|
Facility
|
IP
|
$3,900.00
|
|
|
Service Code
|
CPT C1877
|
| Hospital Charge Code |
909020090
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$2,476.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,301.00
|
| 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 STENT GENESIS UNMOUNTED
|
Facility
|
OP
|
$3,900.00
|
|
|
Service Code
|
CPT C1877
|
| Hospital Charge Code |
909020090
|
|
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 |
$2,360.67
|
| Rate for Payer: Blue Shield of California Commercial |
$1,977.30
|
| Rate for Payer: Blue Shield of California Commercial |
$2,999.10
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$2,476.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,415.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,301.00
|
| 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 STENT GENESIS XLG
|
Facility
|
OP
|
$4,500.00
|
|
|
Service Code
|
CPT C1877
|
| Hospital Charge Code |
909020091
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$900.00 |
| Max. Negotiated Rate |
$3,825.00 |
| Rate for Payer: Adventist Health Commercial |
$900.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,825.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,475.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,375.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,723.85
|
| Rate for Payer: Blue Shield of California Commercial |
$2,281.50
|
| Rate for Payer: Blue Shield of California Commercial |
$3,460.50
|
| Rate for Payer: Cash Price |
$2,025.00
|
| Rate for Payer: Cigna of CA HMO |
$3,150.00
|
| Rate for Payer: Cigna of CA PPO |
$3,150.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,825.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,825.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,825.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,150.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,800.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,800.00
|
| Rate for Payer: Galaxy Health WC |
$3,825.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,700.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,857.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,633.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,655.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,080.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,150.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,150.00
|
| Rate for Payer: Multiplan Commercial |
$3,600.00
|
| Rate for Payer: Networks By Design Commercial |
$2,250.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,825.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,700.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,700.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,688.85
|
| Rate for Payer: United Healthcare All Other HMO |
$1,643.85
|
| Rate for Payer: United Healthcare HMO Rider |
$1,608.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,473.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,825.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,825.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,825.00
|
|
|
HC STENT GENESIS XLG
|
Facility
|
IP
|
$4,500.00
|
|
|
Service Code
|
CPT C1877
|
| Hospital Charge Code |
909020091
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$900.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$900.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$2,025.00
|
| Rate for Payer: Cash Price |
$2,025.00
|
| Rate for Payer: Cigna of CA HMO |
$3,150.00
|
| Rate for Payer: Cigna of CA PPO |
$3,150.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,150.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,800.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,800.00
|
| Rate for Payer: Galaxy Health WC |
$3,825.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,700.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,857.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,655.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,080.00
|
| Rate for Payer: Multiplan Commercial |
$3,600.00
|
| Rate for Payer: Networks By Design Commercial |
$2,250.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,825.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,688.85
|
| Rate for Payer: United Healthcare All Other HMO |
$1,643.85
|
| Rate for Payer: United Healthcare HMO Rider |
$1,608.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,473.75
|
|
|
HC STENT ILIAC
|
Facility
|
IP
|
$24,901.00
|
|
|
Service Code
|
CPT 37221
|
| Hospital Charge Code |
909020062
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,980.20 |
| Max. Negotiated Rate |
$21,165.85 |
| Rate for Payer: Adventist Health Commercial |
$4,980.20
|
| Rate for Payer: Cash Price |
$11,205.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17,430.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,960.40
|
| Rate for Payer: EPIC Health Plan Senior |
$9,960.40
|
| Rate for Payer: Galaxy Health WC |
$21,165.85
|
| Rate for Payer: Global Benefits Group Commercial |
$14,940.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15,812.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14,691.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,976.24
|
| Rate for Payer: Multiplan Commercial |
$19,920.80
|
| Rate for Payer: Networks By Design Commercial |
$16,185.65
|
| Rate for Payer: Prime Health Services Commercial |
$21,165.85
|
|
|
HC STENT ILIAC
|
Facility
|
OP
|
$24,901.00
|
|
|
Service Code
|
CPT 37221
|
| Hospital Charge Code |
909020062
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,638.65 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$4,980.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,165.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13,695.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18,675.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,104.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,508.41
|
| Rate for Payer: Blue Shield of California Commercial |
$3,638.65
|
| Rate for Payer: Cash Price |
$11,205.45
|
| Rate for Payer: Cash Price |
$11,205.45
|
| Rate for Payer: Cash Price |
$11,205.45
|
| Rate for Payer: Cigna of CA HMO |
$15,936.64
|
| Rate for Payer: Cigna of CA PPO |
$18,426.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,165.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$21,165.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21,165.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17,430.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,960.40
|
| Rate for Payer: EPIC Health Plan Senior |
$9,960.40
|
| Rate for Payer: Galaxy Health WC |
$21,165.85
|
| Rate for Payer: Global Benefits Group Commercial |
$14,940.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15,812.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9,039.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14,691.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,976.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,430.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17,430.70
|
| Rate for Payer: Multiplan Commercial |
$19,920.80
|
| Rate for Payer: Multiplan WC |
$22,958.69
|
| Rate for Payer: Networks By Design Commercial |
$16,185.65
|
| Rate for Payer: Prime Health Services Commercial |
$21,165.85
|
| Rate for Payer: Prime Health Services WC |
$22,724.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14,940.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,450.50
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,165.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21,165.85
|
| Rate for Payer: Vantage Medical Group Senior |
$21,165.85
|
|
|
HC STENT ILIAC EA ADDL
|
Facility
|
IP
|
$14,969.00
|
|
|
Service Code
|
CPT 37223
|
| Hospital Charge Code |
909020064
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,993.80 |
| Max. Negotiated Rate |
$12,723.65 |
| Rate for Payer: Adventist Health Commercial |
$2,993.80
|
| Rate for Payer: Cash Price |
$6,736.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,478.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,987.60
|
| Rate for Payer: EPIC Health Plan Senior |
$5,987.60
|
| Rate for Payer: Galaxy Health WC |
$12,723.65
|
| Rate for Payer: Global Benefits Group Commercial |
$8,981.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9,505.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,831.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,592.56
|
| Rate for Payer: Multiplan Commercial |
$11,975.20
|
| Rate for Payer: Networks By Design Commercial |
$9,729.85
|
| Rate for Payer: Prime Health Services Commercial |
$12,723.65
|
|
|
HC STENT ILIAC EA ADDL
|
Facility
|
OP
|
$14,969.00
|
|
|
Service Code
|
CPT 37223
|
| Hospital Charge Code |
909020064
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,993.80 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$2,993.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,723.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,232.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11,226.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,638.65
|
| Rate for Payer: Blue Shield of California Commercial |
$5,508.41
|
| Rate for Payer: Cash Price |
$6,736.05
|
| Rate for Payer: Cash Price |
$6,736.05
|
| Rate for Payer: Cigna of CA HMO |
$9,580.16
|
| Rate for Payer: Cigna of CA PPO |
$11,077.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,723.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$12,723.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12,723.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,478.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,987.60
|
| Rate for Payer: EPIC Health Plan Senior |
$5,987.60
|
| Rate for Payer: Galaxy Health WC |
$12,723.65
|
| Rate for Payer: Global Benefits Group Commercial |
$8,981.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9,505.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5,433.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,831.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,592.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,478.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,478.30
|
| Rate for Payer: Multiplan Commercial |
$11,975.20
|
| Rate for Payer: Networks By Design Commercial |
$9,729.85
|
| Rate for Payer: Prime Health Services Commercial |
$12,723.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,981.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,484.50
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,723.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12,723.65
|
| Rate for Payer: Vantage Medical Group Senior |
$12,723.65
|
|
|
HC STENT INSERTION INDWELLING DBL
|
Facility
|
IP
|
$8,052.00
|
|
|
Service Code
|
CPT 52332
|
| Hospital Charge Code |
909020042
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,610.40 |
| Max. Negotiated Rate |
$6,844.20 |
| Rate for Payer: Adventist Health Commercial |
$1,610.40
|
| Rate for Payer: Cash Price |
$3,623.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,636.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,220.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,220.80
|
| Rate for Payer: Galaxy Health WC |
$6,844.20
|
| Rate for Payer: Global Benefits Group Commercial |
$4,831.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,113.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,750.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,932.48
|
| Rate for Payer: Multiplan Commercial |
$6,441.60
|
| Rate for Payer: Networks By Design Commercial |
$5,233.80
|
| Rate for Payer: Prime Health Services Commercial |
$6,844.20
|
|
|
HC STENT INSERTION INDWELLING DBL
|
Facility
|
OP
|
$8,052.00
|
|
|
Service Code
|
CPT 52332
|
| Hospital Charge Code |
909020042
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$925.06 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,610.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,800.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,987.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,533.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,574.78
|
| Rate for Payer: Blue Shield of California Commercial |
$3,897.87
|
| Rate for Payer: Cash Price |
$3,623.40
|
| Rate for Payer: Cash Price |
$3,623.40
|
| Rate for Payer: Cash Price |
$3,623.40
|
| Rate for Payer: Cigna of CA HMO |
$5,153.28
|
| Rate for Payer: Cigna of CA PPO |
$5,958.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,800.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,987.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,533.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,636.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,480.62
|
| Rate for Payer: EPIC Health Plan Senior |
$4,987.08
|
| Rate for Payer: Galaxy Health WC |
$6,844.20
|
| Rate for Payer: Global Benefits Group Commercial |
$4,831.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,435.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$925.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,533.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,113.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,046.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,347.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,932.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,712.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,075.17
|
| Rate for Payer: Multiplan Commercial |
$6,441.60
|
| Rate for Payer: Multiplan WC |
$6,982.34
|
| Rate for Payer: Networks By Design Commercial |
$5,233.80
|
| Rate for Payer: Prime Health Services Commercial |
$6,844.20
|
| Rate for Payer: Prime Health Services WC |
$6,911.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,831.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,026.00
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,533.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,800.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,987.08
|
| Rate for Payer: Vantage Medical Group Senior |
$4,533.71
|
|
|
HC STENT INTRACRAN ATHERO STENOSI
|
Facility
|
OP
|
$5,905.00
|
|
|
Service Code
|
CPT 61635
|
| Hospital Charge Code |
909081014
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,181.00 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,181.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,019.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,247.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,428.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,104.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Cash Price |
$2,657.25
|
| Rate for Payer: Cash Price |
$2,657.25
|
| Rate for Payer: Cigna of CA HMO |
$3,779.20
|
| Rate for Payer: Cigna of CA PPO |
$4,369.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,019.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,019.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,019.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,133.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,362.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,362.00
|
| Rate for Payer: Galaxy Health WC |
$5,019.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,543.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,749.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,483.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,417.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,133.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,133.50
|
| Rate for Payer: Multiplan Commercial |
$4,724.00
|
| Rate for Payer: Networks By Design Commercial |
$3,838.25
|
| Rate for Payer: Prime Health Services Commercial |
$5,019.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,543.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,952.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,019.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,019.25
|
| Rate for Payer: Vantage Medical Group Senior |
$5,019.25
|
|
|
HC STENT INTRACRAN ATHERO STENOSI
|
Facility
|
IP
|
$5,905.00
|
|
|
Service Code
|
CPT 61635
|
| Hospital Charge Code |
909081014
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,181.00 |
| Max. Negotiated Rate |
$5,019.25 |
| Rate for Payer: Adventist Health Commercial |
$1,181.00
|
| Rate for Payer: Cash Price |
$2,657.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,133.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,362.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,362.00
|
| Rate for Payer: Galaxy Health WC |
$5,019.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,543.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,749.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,483.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,417.20
|
| Rate for Payer: Multiplan Commercial |
$4,724.00
|
| Rate for Payer: Networks By Design Commercial |
$3,838.25
|
| Rate for Payer: Prime Health Services Commercial |
$5,019.25
|
|
|
HC STENT LIFE
|
Facility
|
OP
|
$2,828.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909000008
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$565.60 |
| Max. Negotiated Rate |
$2,403.80 |
| Rate for Payer: Adventist Health Commercial |
$565.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,403.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,555.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,121.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,711.79
|
| Rate for Payer: Blue Shield of California Commercial |
$1,433.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2,174.73
|
| Rate for Payer: Cash Price |
$1,272.60
|
| Rate for Payer: Cigna of CA HMO |
$1,979.60
|
| Rate for Payer: Cigna of CA PPO |
$1,979.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,403.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,403.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,403.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,979.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,131.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,131.20
|
| Rate for Payer: Galaxy Health WC |
$2,403.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,696.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,795.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,026.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,668.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$678.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,979.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,979.60
|
| Rate for Payer: Multiplan Commercial |
$2,262.40
|
| Rate for Payer: Networks By Design Commercial |
$1,414.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,403.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,696.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,696.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,061.35
|
| Rate for Payer: United Healthcare All Other HMO |
$1,033.07
|
| Rate for Payer: United Healthcare HMO Rider |
$1,010.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$926.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,403.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,403.80
|
| Rate for Payer: Vantage Medical Group Senior |
$2,403.80
|
|
|
HC STENT LIFE
|
Facility
|
IP
|
$2,828.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909000008
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$565.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$565.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$1,272.60
|
| Rate for Payer: Cash Price |
$1,272.60
|
| Rate for Payer: Cigna of CA HMO |
$1,979.60
|
| Rate for Payer: Cigna of CA PPO |
$1,979.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,979.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,131.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,131.20
|
| Rate for Payer: Galaxy Health WC |
$2,403.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,696.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,795.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,668.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$678.72
|
| Rate for Payer: Multiplan Commercial |
$2,262.40
|
| Rate for Payer: Networks By Design Commercial |
$1,414.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,403.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,061.35
|
| Rate for Payer: United Healthcare All Other HMO |
$1,033.07
|
| Rate for Payer: United Healthcare HMO Rider |
$1,010.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$926.17
|
|
|
HC STENT LVIS
|
Facility
|
OP
|
$20,313.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909001876
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,062.60 |
| Max. Negotiated Rate |
$17,266.05 |
| Rate for Payer: Adventist Health Commercial |
$4,062.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17,266.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11,172.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15,234.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,295.46
|
| Rate for Payer: Blue Shield of California Commercial |
$10,298.69
|
| Rate for Payer: Blue Shield of California Commercial |
$15,620.70
|
| Rate for Payer: Cash Price |
$9,140.85
|
| Rate for Payer: Cigna of CA HMO |
$14,219.10
|
| Rate for Payer: Cigna of CA PPO |
$14,219.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17,266.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$17,266.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17,266.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14,219.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,125.20
|
| Rate for Payer: EPIC Health Plan Senior |
$8,125.20
|
| Rate for Payer: Galaxy Health WC |
$17,266.05
|
| Rate for Payer: Global Benefits Group Commercial |
$12,187.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12,898.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7,373.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11,984.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,875.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14,219.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14,219.10
|
| Rate for Payer: Multiplan Commercial |
$16,250.40
|
| Rate for Payer: Networks By Design Commercial |
$10,156.50
|
| Rate for Payer: Prime Health Services Commercial |
$17,266.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12,187.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12,187.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,623.47
|
| Rate for Payer: United Healthcare All Other HMO |
$7,420.34
|
| Rate for Payer: United Healthcare HMO Rider |
$7,259.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,652.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17,266.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17,266.05
|
| Rate for Payer: Vantage Medical Group Senior |
$17,266.05
|
|
