|
HC STENT LVIS
|
Facility
|
IP
|
$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: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$9,140.85
|
| 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: 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 Medicare Advantage |
$11,984.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,875.12
|
| 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: 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
|
|
|
HC STENT MEDTRONIC BALN EXPAND
|
Facility
|
OP
|
$3,900.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020115
|
|
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 MEDTRONIC BALN EXPAND
|
Facility
|
IP
|
$3,900.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020115
|
|
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 MEDTRONIC SE 12-150
|
Facility
|
IP
|
$3,900.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020114
|
|
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 MEDTRONIC SE 12-150
|
Facility
|
OP
|
$3,900.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020114
|
|
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 MEDTRONIC SE 40-100
|
Facility
|
OP
|
$3,900.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020113
|
|
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 MEDTRONIC SE 40-100
|
Facility
|
IP
|
$3,900.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020113
|
|
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 METAL URETERAL
|
Facility
|
OP
|
$3,900.00
|
|
|
Service Code
|
CPT C2617
|
| Hospital Charge Code |
909020039
|
|
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 METAL URETERAL
|
Facility
|
IP
|
$3,900.00
|
|
|
Service Code
|
CPT C2617
|
| Hospital Charge Code |
909020039
|
|
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 NEURO FORM 3
|
Facility
|
IP
|
$14,300.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909080045
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,860.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$2,860.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$6,435.00
|
| Rate for Payer: Cash Price |
$6,435.00
|
| Rate for Payer: Cigna of CA HMO |
$10,010.00
|
| Rate for Payer: Cigna of CA PPO |
$10,010.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,010.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,720.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,720.00
|
| Rate for Payer: Galaxy Health WC |
$12,155.00
|
| Rate for Payer: Global Benefits Group Commercial |
$8,580.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9,080.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,437.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,432.00
|
| Rate for Payer: Multiplan Commercial |
$11,440.00
|
| Rate for Payer: Networks By Design Commercial |
$7,150.00
|
| Rate for Payer: Prime Health Services Commercial |
$12,155.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,366.79
|
| Rate for Payer: United Healthcare All Other HMO |
$5,223.79
|
| Rate for Payer: United Healthcare HMO Rider |
$5,110.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,683.25
|
|
|
HC STENT NEURO FORM 3
|
Facility
|
OP
|
$14,300.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909080045
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,860.00 |
| Max. Negotiated Rate |
$12,155.00 |
| Rate for Payer: Adventist Health Commercial |
$2,860.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,155.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,865.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,725.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,655.79
|
| Rate for Payer: Blue Shield of California Commercial |
$10,996.70
|
| Rate for Payer: Blue Shield of California Commercial |
$7,250.10
|
| Rate for Payer: Cash Price |
$6,435.00
|
| Rate for Payer: Cigna of CA HMO |
$10,010.00
|
| Rate for Payer: Cigna of CA PPO |
$10,010.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,155.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$12,155.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12,155.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,010.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,720.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,720.00
|
| Rate for Payer: Galaxy Health WC |
$12,155.00
|
| Rate for Payer: Global Benefits Group Commercial |
$8,580.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9,080.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5,190.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,437.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,432.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,010.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,010.00
|
| Rate for Payer: Multiplan Commercial |
$11,440.00
|
| Rate for Payer: Networks By Design Commercial |
$7,150.00
|
| Rate for Payer: Prime Health Services Commercial |
$12,155.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,580.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8,580.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,366.79
|
| Rate for Payer: United Healthcare All Other HMO |
$5,223.79
|
| Rate for Payer: United Healthcare HMO Rider |
$5,110.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,683.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,155.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12,155.00
|
| Rate for Payer: Vantage Medical Group Senior |
$12,155.00
|
|
|
HC STENT PALMAZ
|
Facility
|
OP
|
$1,963.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909081209
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$392.60 |
| Max. Negotiated Rate |
$1,668.55 |
| Rate for Payer: Adventist Health Commercial |
$392.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,668.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,079.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,472.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,188.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,509.55
|
| Rate for Payer: Blue Shield of California Commercial |
$995.24
|
| Rate for Payer: Cash Price |
$883.35
|
| Rate for Payer: Cigna of CA HMO |
$1,374.10
|
| Rate for Payer: Cigna of CA PPO |
$1,374.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,668.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,668.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,668.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,374.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$785.20
|
| Rate for Payer: EPIC Health Plan Senior |
$785.20
|
| Rate for Payer: Galaxy Health WC |
$1,668.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,177.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,246.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$712.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,158.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$471.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,374.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,374.10
|
| Rate for Payer: Multiplan Commercial |
$1,570.40
|
| Rate for Payer: Networks By Design Commercial |
$981.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,668.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,177.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,177.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$736.71
|
| Rate for Payer: United Healthcare All Other HMO |
$717.08
|
| Rate for Payer: United Healthcare HMO Rider |
$701.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$642.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,668.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,668.55
|
| Rate for Payer: Vantage Medical Group Senior |
$1,668.55
|
|
|
HC STENT PALMAZ
|
Facility
|
IP
|
$1,963.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909081209
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$392.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$392.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$883.35
|
| Rate for Payer: Cash Price |
$883.35
|
| Rate for Payer: Cigna of CA HMO |
$1,374.10
|
| Rate for Payer: Cigna of CA PPO |
$1,374.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,374.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$785.20
|
| Rate for Payer: EPIC Health Plan Senior |
$785.20
|
| Rate for Payer: Galaxy Health WC |
$1,668.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,177.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,246.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,158.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$471.12
|
| Rate for Payer: Multiplan Commercial |
$1,570.40
|
| Rate for Payer: Networks By Design Commercial |
$981.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,668.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$736.71
|
| Rate for Payer: United Healthcare All Other HMO |
$717.08
|
| Rate for Payer: United Healthcare HMO Rider |
$701.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$642.88
|
|
|
HC STENT PALMAZ BALLOON EXPAND
|
Facility
|
IP
|
$1,717.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
900803700
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$343.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$343.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$772.65
|
| Rate for Payer: Cash Price |
$772.65
|
| Rate for Payer: Cigna of CA HMO |
$1,201.90
|
| Rate for Payer: Cigna of CA PPO |
$1,201.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,201.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$686.80
|
| Rate for Payer: EPIC Health Plan Senior |
$686.80
|
| Rate for Payer: Galaxy Health WC |
$1,459.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,030.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,090.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,013.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$412.08
|
| Rate for Payer: Multiplan Commercial |
$1,373.60
|
| Rate for Payer: Networks By Design Commercial |
$858.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,459.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$644.39
|
| Rate for Payer: United Healthcare All Other HMO |
$627.22
|
| Rate for Payer: United Healthcare HMO Rider |
$613.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$562.32
|
|
|
HC STENT PALMAZ BALLOON EXPAND
|
Facility
|
OP
|
$1,717.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
900803700
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$343.40 |
| Max. Negotiated Rate |
$1,459.45 |
| Rate for Payer: Adventist Health Commercial |
$343.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,459.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$944.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,287.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,039.30
|
| Rate for Payer: Blue Shield of California Commercial |
$1,320.37
|
| Rate for Payer: Blue Shield of California Commercial |
$870.52
|
| Rate for Payer: Cash Price |
$772.65
|
| Rate for Payer: Cigna of CA HMO |
$1,201.90
|
| Rate for Payer: Cigna of CA PPO |
$1,201.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,459.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,459.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,459.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,201.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$686.80
|
| Rate for Payer: EPIC Health Plan Senior |
$686.80
|
| Rate for Payer: Galaxy Health WC |
$1,459.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,030.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,090.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,013.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$412.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,201.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,201.90
|
| Rate for Payer: Multiplan Commercial |
$1,373.60
|
| Rate for Payer: Networks By Design Commercial |
$858.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,459.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,030.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,030.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$644.39
|
| Rate for Payer: United Healthcare All Other HMO |
$627.22
|
| Rate for Payer: United Healthcare HMO Rider |
$613.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$562.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,459.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,459.45
|
| Rate for Payer: Vantage Medical Group Senior |
$1,459.45
|
|
|
HC STENT PLACEMT RETRO CAROTID
|
Facility
|
IP
|
$17,106.00
|
|
|
Service Code
|
CPT 37217
|
| Hospital Charge Code |
909037217
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,421.20 |
| Max. Negotiated Rate |
$14,540.10 |
| Rate for Payer: Adventist Health Commercial |
$3,421.20
|
| Rate for Payer: Cash Price |
$7,697.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11,974.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,842.40
|
| Rate for Payer: EPIC Health Plan Senior |
$6,842.40
|
| Rate for Payer: Galaxy Health WC |
$14,540.10
|
| Rate for Payer: Global Benefits Group Commercial |
$10,263.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10,862.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,092.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,105.44
|
| Rate for Payer: Multiplan Commercial |
$13,684.80
|
| Rate for Payer: Networks By Design Commercial |
$11,118.90
|
| Rate for Payer: Prime Health Services Commercial |
$14,540.10
|
|
|
HC STENT PLACEMT RETRO CAROTID
|
Facility
|
OP
|
$17,106.00
|
|
|
Service Code
|
CPT 37217
|
| Hospital Charge Code |
909037217
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$594.18 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$3,421.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14,540.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,408.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12,829.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,104.00
|
| Rate for Payer: Blue Shield of California Commercial |
$899.51
|
| Rate for Payer: Blue Shield of California Commercial |
$594.18
|
| Rate for Payer: Cash Price |
$7,697.70
|
| Rate for Payer: Cash Price |
$7,697.70
|
| Rate for Payer: Cash Price |
$7,697.70
|
| Rate for Payer: Cigna of CA HMO |
$10,947.84
|
| Rate for Payer: Cigna of CA PPO |
$12,658.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14,540.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$14,540.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,540.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11,974.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,842.40
|
| Rate for Payer: EPIC Health Plan Senior |
$6,842.40
|
| Rate for Payer: Galaxy Health WC |
$14,540.10
|
| Rate for Payer: Global Benefits Group Commercial |
$10,263.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,593.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10,862.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,802.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,092.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,105.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,974.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,974.20
|
| Rate for Payer: Multiplan Commercial |
$13,684.80
|
| Rate for Payer: Networks By Design Commercial |
$11,118.90
|
| Rate for Payer: Prime Health Services Commercial |
$14,540.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,263.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,553.00
|
| 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 |
$14,540.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14,540.10
|
| Rate for Payer: Vantage Medical Group Senior |
$14,540.10
|
|
|
HC STENT PLACMNT ANTE CAROTID
|
Facility
|
OP
|
$17,106.00
|
|
|
Service Code
|
CPT 37218
|
| Hospital Charge Code |
909037218
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$237.67 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$3,421.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14,540.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,408.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12,829.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,104.00
|
| Rate for Payer: Blue Shield of California Commercial |
$899.51
|
| Rate for Payer: Blue Shield of California Commercial |
$594.18
|
| Rate for Payer: Cash Price |
$7,697.70
|
| Rate for Payer: Cash Price |
$7,697.70
|
| Rate for Payer: Cash Price |
$7,697.70
|
| Rate for Payer: Cigna of CA HMO |
$10,947.84
|
| Rate for Payer: Cigna of CA PPO |
$12,658.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14,540.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$14,540.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,540.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11,974.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,842.40
|
| Rate for Payer: EPIC Health Plan Senior |
$6,842.40
|
| Rate for Payer: Galaxy Health WC |
$14,540.10
|
| Rate for Payer: Global Benefits Group Commercial |
$10,263.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$237.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10,862.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$268.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,092.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,105.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,974.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,974.20
|
| Rate for Payer: Multiplan Commercial |
$13,684.80
|
| Rate for Payer: Networks By Design Commercial |
$11,118.90
|
| Rate for Payer: Prime Health Services Commercial |
$14,540.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,263.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,553.00
|
| 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 |
$14,540.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14,540.10
|
| Rate for Payer: Vantage Medical Group Senior |
$14,540.10
|
|
|
HC STENT PLACMNT ANTE CAROTID
|
Facility
|
IP
|
$17,106.00
|
|
|
Service Code
|
CPT 37218
|
| Hospital Charge Code |
909037218
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,421.20 |
| Max. Negotiated Rate |
$14,540.10 |
| Rate for Payer: Adventist Health Commercial |
$3,421.20
|
| Rate for Payer: Cash Price |
$7,697.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11,974.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,842.40
|
| Rate for Payer: EPIC Health Plan Senior |
$6,842.40
|
| Rate for Payer: Galaxy Health WC |
$14,540.10
|
| Rate for Payer: Global Benefits Group Commercial |
$10,263.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10,862.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,092.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,105.44
|
| Rate for Payer: Multiplan Commercial |
$13,684.80
|
| Rate for Payer: Networks By Design Commercial |
$11,118.90
|
| Rate for Payer: Prime Health Services Commercial |
$14,540.10
|
|
|
HC STENT PROTEGE
|
Facility
|
IP
|
$6,050.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020030
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,210.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$1,210.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$2,722.50
|
| Rate for Payer: Cash Price |
$2,722.50
|
| Rate for Payer: Cigna of CA HMO |
$4,235.00
|
| Rate for Payer: Cigna of CA PPO |
$4,235.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,235.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,420.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,420.00
|
| Rate for Payer: Galaxy Health WC |
$5,142.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,630.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,841.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,569.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,452.00
|
| Rate for Payer: Multiplan Commercial |
$4,840.00
|
| Rate for Payer: Networks By Design Commercial |
$3,025.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,142.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,270.57
|
| Rate for Payer: United Healthcare All Other HMO |
$2,210.07
|
| Rate for Payer: United Healthcare HMO Rider |
$2,162.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,981.38
|
|
|
HC STENT PROTEGE
|
Facility
|
OP
|
$6,050.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020030
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,210.00 |
| Max. Negotiated Rate |
$5,142.50 |
| Rate for Payer: Adventist Health Commercial |
$1,210.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,142.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,327.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,537.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,662.07
|
| Rate for Payer: Blue Shield of California Commercial |
$3,067.35
|
| Rate for Payer: Blue Shield of California Commercial |
$4,652.45
|
| Rate for Payer: Cash Price |
$2,722.50
|
| Rate for Payer: Cigna of CA HMO |
$4,235.00
|
| Rate for Payer: Cigna of CA PPO |
$4,235.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,142.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,142.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,142.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,235.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,420.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,420.00
|
| Rate for Payer: Galaxy Health WC |
$5,142.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,630.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,841.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,196.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,569.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,452.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,235.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,235.00
|
| Rate for Payer: Multiplan Commercial |
$4,840.00
|
| Rate for Payer: Networks By Design Commercial |
$3,025.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,142.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,630.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,630.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,270.57
|
| Rate for Payer: United Healthcare All Other HMO |
$2,210.07
|
| Rate for Payer: United Healthcare HMO Rider |
$2,162.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,981.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,142.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,142.50
|
| Rate for Payer: Vantage Medical Group Senior |
$5,142.50
|
|
|
HC STENT PROTEGE EVERFLEX
|
Facility
|
IP
|
$3,510.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020093
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$702.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$702.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$1,579.50
|
| Rate for Payer: Cash Price |
$1,579.50
|
| Rate for Payer: Cigna of CA HMO |
$2,457.00
|
| Rate for Payer: Cigna of CA PPO |
$2,457.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,457.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,404.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,404.00
|
| Rate for Payer: Galaxy Health WC |
$2,983.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,106.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,228.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,070.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$842.40
|
| Rate for Payer: Multiplan Commercial |
$2,808.00
|
| Rate for Payer: Networks By Design Commercial |
$1,755.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,983.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,317.30
|
| Rate for Payer: United Healthcare All Other HMO |
$1,282.20
|
| Rate for Payer: United Healthcare HMO Rider |
$1,254.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,149.53
|
|
|
HC STENT PROTEGE EVERFLEX
|
Facility
|
OP
|
$3,510.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020093
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$702.00 |
| Max. Negotiated Rate |
$2,983.50 |
| Rate for Payer: Adventist Health Commercial |
$702.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,983.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,930.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,632.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,124.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,779.57
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.19
|
| Rate for Payer: Cash Price |
$1,579.50
|
| Rate for Payer: Cigna of CA HMO |
$2,457.00
|
| Rate for Payer: Cigna of CA PPO |
$2,457.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,983.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,983.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,983.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,457.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,404.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,404.00
|
| Rate for Payer: Galaxy Health WC |
$2,983.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,106.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,228.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,274.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,070.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$842.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,457.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,457.00
|
| Rate for Payer: Multiplan Commercial |
$2,808.00
|
| Rate for Payer: Networks By Design Commercial |
$1,755.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,983.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,106.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,106.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,317.30
|
| Rate for Payer: United Healthcare All Other HMO |
$1,282.20
|
| Rate for Payer: United Healthcare HMO Rider |
$1,254.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,149.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,983.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,983.50
|
| Rate for Payer: Vantage Medical Group Senior |
$2,983.50
|
|
|
HC STENT RETRIEVER TREVO
|
Facility
|
OP
|
$19,488.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909000006
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,897.60 |
| Max. Negotiated Rate |
$16,564.80 |
| Rate for Payer: Adventist Health Commercial |
$3,897.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16,564.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,718.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,616.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,796.09
|
| Rate for Payer: Blue Shield of California Commercial |
$14,986.27
|
| Rate for Payer: Blue Shield of California Commercial |
$9,880.42
|
| Rate for Payer: Cash Price |
$8,769.60
|
| Rate for Payer: Cigna of CA HMO |
$13,641.60
|
| Rate for Payer: Cigna of CA PPO |
$13,641.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16,564.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$16,564.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16,564.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13,641.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,795.20
|
| Rate for Payer: EPIC Health Plan Senior |
$7,795.20
|
| Rate for Payer: Galaxy Health WC |
$16,564.80
|
| Rate for Payer: Global Benefits Group Commercial |
$11,692.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12,374.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7,074.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11,497.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,677.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13,641.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13,641.60
|
| Rate for Payer: Multiplan Commercial |
$15,590.40
|
| Rate for Payer: Networks By Design Commercial |
$9,744.00
|
| Rate for Payer: Prime Health Services Commercial |
$16,564.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11,692.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11,692.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,313.85
|
| Rate for Payer: United Healthcare All Other HMO |
$7,118.97
|
| Rate for Payer: United Healthcare HMO Rider |
$6,965.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,382.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16,564.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16,564.80
|
| Rate for Payer: Vantage Medical Group Senior |
$16,564.80
|
|
|
HC STENT RETRIEVER TREVO
|
Facility
|
IP
|
$19,488.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909000006
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,897.60 |
| Max. Negotiated Rate |
$16,564.80 |
| Rate for Payer: Adventist Health Commercial |
$3,897.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$8,769.60
|
| Rate for Payer: Cash Price |
$8,769.60
|
| Rate for Payer: Cigna of CA HMO |
$13,641.60
|
| Rate for Payer: Cigna of CA PPO |
$13,641.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13,641.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,795.20
|
| Rate for Payer: EPIC Health Plan Senior |
$7,795.20
|
| Rate for Payer: Galaxy Health WC |
$16,564.80
|
| Rate for Payer: Global Benefits Group Commercial |
$11,692.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12,374.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11,497.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,677.12
|
| Rate for Payer: Multiplan Commercial |
$15,590.40
|
| Rate for Payer: Networks By Design Commercial |
$9,744.00
|
| Rate for Payer: Prime Health Services Commercial |
$16,564.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,313.85
|
| Rate for Payer: United Healthcare All Other HMO |
$7,118.97
|
| Rate for Payer: United Healthcare HMO Rider |
$6,965.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,382.32
|
|
