|
HC STENT RUSCH Y
|
Facility
|
IP
|
$1,725.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
900803703
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$345.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$345.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$776.25
|
| Rate for Payer: Cash Price |
$776.25
|
| Rate for Payer: Cigna of CA HMO |
$1,207.50
|
| Rate for Payer: Cigna of CA PPO |
$1,207.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,207.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$690.00
|
| Rate for Payer: EPIC Health Plan Senior |
$690.00
|
| Rate for Payer: Galaxy Health WC |
$1,466.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,035.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,095.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,017.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$414.00
|
| Rate for Payer: Multiplan Commercial |
$1,380.00
|
| Rate for Payer: Networks By Design Commercial |
$862.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,466.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$647.39
|
| Rate for Payer: United Healthcare All Other HMO |
$630.14
|
| Rate for Payer: United Healthcare HMO Rider |
$616.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$564.94
|
|
|
HC STENT RUSCH Y
|
Facility
|
OP
|
$1,725.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
900803703
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$345.00 |
| Max. Negotiated Rate |
$1,466.25 |
| Rate for Payer: Adventist Health Commercial |
$345.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,466.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$948.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,293.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,044.14
|
| Rate for Payer: Blue Shield of California Commercial |
$1,326.53
|
| Rate for Payer: Blue Shield of California Commercial |
$874.58
|
| Rate for Payer: Cash Price |
$776.25
|
| Rate for Payer: Cigna of CA HMO |
$1,207.50
|
| Rate for Payer: Cigna of CA PPO |
$1,207.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,466.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,466.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,466.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,207.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$690.00
|
| Rate for Payer: EPIC Health Plan Senior |
$690.00
|
| Rate for Payer: Galaxy Health WC |
$1,466.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,035.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,095.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,017.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$414.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,207.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,207.50
|
| Rate for Payer: Multiplan Commercial |
$1,380.00
|
| Rate for Payer: Networks By Design Commercial |
$862.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,466.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,035.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,035.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$647.39
|
| Rate for Payer: United Healthcare All Other HMO |
$630.14
|
| Rate for Payer: United Healthcare HMO Rider |
$616.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$564.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,466.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,466.25
|
| Rate for Payer: Vantage Medical Group Senior |
$1,466.25
|
|
|
HC STENT SCHNEIDER WALL
|
Facility
|
IP
|
$1,717.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
900803702
|
|
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 SCHNEIDER WALL
|
Facility
|
OP
|
$1,717.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
900803702
|
|
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 SUPERA
|
Facility
|
IP
|
$3,987.50
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020142
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$797.50 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$797.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$1,794.38
|
| Rate for Payer: Cash Price |
$1,794.38
|
| Rate for Payer: Cigna of CA HMO |
$2,791.25
|
| Rate for Payer: Cigna of CA PPO |
$2,791.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,791.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,595.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,595.00
|
| Rate for Payer: Galaxy Health WC |
$3,389.38
|
| Rate for Payer: Global Benefits Group Commercial |
$2,392.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,532.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,352.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$957.00
|
| Rate for Payer: Multiplan Commercial |
$3,190.00
|
| Rate for Payer: Networks By Design Commercial |
$1,993.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,389.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,496.51
|
| Rate for Payer: United Healthcare All Other HMO |
$1,456.63
|
| Rate for Payer: United Healthcare HMO Rider |
$1,425.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,305.91
|
|
|
HC STENT SUPERA
|
Facility
|
OP
|
$3,987.50
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020142
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$797.50 |
| Max. Negotiated Rate |
$3,389.38 |
| Rate for Payer: Adventist Health Commercial |
$797.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,389.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,193.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,990.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,413.63
|
| Rate for Payer: Blue Shield of California Commercial |
$2,021.66
|
| Rate for Payer: Blue Shield of California Commercial |
$3,066.39
|
| Rate for Payer: Cash Price |
$1,794.38
|
| Rate for Payer: Cigna of CA HMO |
$2,791.25
|
| Rate for Payer: Cigna of CA PPO |
$2,791.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,389.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,389.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,389.38
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,791.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,595.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,595.00
|
| Rate for Payer: Galaxy Health WC |
$3,389.38
|
| Rate for Payer: Global Benefits Group Commercial |
$2,392.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,532.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,447.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,352.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$957.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,791.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,791.25
|
| Rate for Payer: Multiplan Commercial |
$3,190.00
|
| Rate for Payer: Networks By Design Commercial |
$1,993.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,389.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,392.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,392.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,496.51
|
| Rate for Payer: United Healthcare All Other HMO |
$1,456.63
|
| Rate for Payer: United Healthcare HMO Rider |
$1,425.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,305.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,389.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,389.38
|
| Rate for Payer: Vantage Medical Group Senior |
$3,389.38
|
|
|
HC STENT TIBIOPERONEAL
|
Facility
|
OP
|
$27,371.00
|
|
|
Service Code
|
CPT 37230
|
| Hospital Charge Code |
909020071
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,638.65 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$5,474.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23,265.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,054.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20,528.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,323.00
|
| 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 |
$12,316.95
|
| Rate for Payer: Cash Price |
$12,316.95
|
| Rate for Payer: Cash Price |
$12,316.95
|
| Rate for Payer: Cigna of CA HMO |
$17,517.44
|
| Rate for Payer: Cigna of CA PPO |
$20,254.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23,265.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$23,265.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23,265.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$19,159.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,948.40
|
| Rate for Payer: EPIC Health Plan Senior |
$10,948.40
|
| Rate for Payer: Galaxy Health WC |
$23,265.35
|
| Rate for Payer: Global Benefits Group Commercial |
$16,422.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17,380.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9,935.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16,148.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,569.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19,159.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,159.70
|
| Rate for Payer: Multiplan Commercial |
$21,896.80
|
| Rate for Payer: Multiplan WC |
$36,352.92
|
| Rate for Payer: Networks By Design Commercial |
$17,791.15
|
| Rate for Payer: Prime Health Services Commercial |
$23,265.35
|
| Rate for Payer: Prime Health Services WC |
$35,981.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16,422.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,685.50
|
| 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 |
$23,265.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23,265.35
|
| Rate for Payer: Vantage Medical Group Senior |
$23,265.35
|
|
|
HC STENT TIBIOPERONEAL
|
Facility
|
IP
|
$27,371.00
|
|
|
Service Code
|
CPT 37230
|
| Hospital Charge Code |
909020071
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,474.20 |
| Max. Negotiated Rate |
$23,265.35 |
| Rate for Payer: Adventist Health Commercial |
$5,474.20
|
| Rate for Payer: Cash Price |
$12,316.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$19,159.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,948.40
|
| Rate for Payer: EPIC Health Plan Senior |
$10,948.40
|
| Rate for Payer: Galaxy Health WC |
$23,265.35
|
| Rate for Payer: Global Benefits Group Commercial |
$16,422.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17,380.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16,148.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,569.04
|
| Rate for Payer: Multiplan Commercial |
$21,896.80
|
| Rate for Payer: Networks By Design Commercial |
$17,791.15
|
| Rate for Payer: Prime Health Services Commercial |
$23,265.35
|
|
|
HC STENT TIBIOPERONEAL EA ADDL
|
Facility
|
IP
|
$15,757.00
|
|
|
Service Code
|
CPT 37234
|
| Hospital Charge Code |
909020075
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,151.40 |
| Max. Negotiated Rate |
$13,393.45 |
| Rate for Payer: Adventist Health Commercial |
$3,151.40
|
| Rate for Payer: Cash Price |
$7,090.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11,029.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,302.80
|
| Rate for Payer: EPIC Health Plan Senior |
$6,302.80
|
| Rate for Payer: Galaxy Health WC |
$13,393.45
|
| Rate for Payer: Global Benefits Group Commercial |
$9,454.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10,005.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9,296.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,781.68
|
| Rate for Payer: Multiplan Commercial |
$12,605.60
|
| Rate for Payer: Networks By Design Commercial |
$10,242.05
|
| Rate for Payer: Prime Health Services Commercial |
$13,393.45
|
|
|
HC STENT TIBIOPERONEAL EA ADDL
|
Facility
|
OP
|
$15,757.00
|
|
|
Service Code
|
CPT 37234
|
| Hospital Charge Code |
909020075
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,151.40 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$3,151.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,393.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,666.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11,817.75
|
| 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 |
$7,090.65
|
| Rate for Payer: Cash Price |
$7,090.65
|
| Rate for Payer: Cigna of CA HMO |
$10,084.48
|
| Rate for Payer: Cigna of CA PPO |
$11,660.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,393.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$13,393.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13,393.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11,029.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,302.80
|
| Rate for Payer: EPIC Health Plan Senior |
$6,302.80
|
| Rate for Payer: Galaxy Health WC |
$13,393.45
|
| Rate for Payer: Global Benefits Group Commercial |
$9,454.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10,005.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5,719.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9,296.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,781.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,029.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,029.90
|
| Rate for Payer: Multiplan Commercial |
$12,605.60
|
| Rate for Payer: Networks By Design Commercial |
$10,242.05
|
| Rate for Payer: Prime Health Services Commercial |
$13,393.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,454.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,878.50
|
| 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 |
$13,393.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13,393.45
|
| Rate for Payer: Vantage Medical Group Senior |
$13,393.45
|
|
|
HC STENT ULTRAFLEX T-B COV W/DEL
|
Facility
|
IP
|
$3,053.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
900803704
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$610.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$610.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$1,373.85
|
| Rate for Payer: Cash Price |
$1,373.85
|
| Rate for Payer: Cigna of CA HMO |
$2,137.10
|
| Rate for Payer: Cigna of CA PPO |
$2,137.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,137.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,221.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,221.20
|
| Rate for Payer: Galaxy Health WC |
$2,595.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,831.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,938.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,801.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$732.72
|
| Rate for Payer: Multiplan Commercial |
$2,442.40
|
| Rate for Payer: Networks By Design Commercial |
$1,526.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,595.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,145.79
|
| Rate for Payer: United Healthcare All Other HMO |
$1,115.26
|
| Rate for Payer: United Healthcare HMO Rider |
$1,091.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$999.86
|
|
|
HC STENT ULTRAFLEX T-B COV W/DEL
|
Facility
|
OP
|
$3,053.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
900803704
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$610.60 |
| Max. Negotiated Rate |
$2,595.05 |
| Rate for Payer: Dignity Health Medi-Cal |
$2,595.05
|
| Rate for Payer: Adventist Health Commercial |
$610.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,595.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,679.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,289.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,847.98
|
| Rate for Payer: Blue Shield of California Commercial |
$1,547.87
|
| Rate for Payer: Blue Shield of California Commercial |
$2,347.76
|
| Rate for Payer: Cash Price |
$1,373.85
|
| Rate for Payer: Cigna of CA HMO |
$2,137.10
|
| Rate for Payer: Cigna of CA PPO |
$2,137.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,595.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,595.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,137.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,221.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,221.20
|
| Rate for Payer: Galaxy Health WC |
$2,595.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,831.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,938.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,801.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$732.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,137.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,137.10
|
| Rate for Payer: Multiplan Commercial |
$2,442.40
|
| Rate for Payer: Networks By Design Commercial |
$1,526.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,595.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,831.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,831.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,145.79
|
| Rate for Payer: United Healthcare All Other HMO |
$1,115.26
|
| Rate for Payer: United Healthcare HMO Rider |
$1,091.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$999.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,595.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,595.05
|
| Rate for Payer: Vantage Medical Group Senior |
$2,595.05
|
|
|
HC STENT ULTRAFLEX T-B NON-COV W/
|
Facility
|
IP
|
$3,053.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
900803705
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$610.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$610.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$1,373.85
|
| Rate for Payer: Cash Price |
$1,373.85
|
| Rate for Payer: Cigna of CA HMO |
$2,137.10
|
| Rate for Payer: Cigna of CA PPO |
$2,137.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,137.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,221.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,221.20
|
| Rate for Payer: Galaxy Health WC |
$2,595.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,831.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,938.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,801.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$732.72
|
| Rate for Payer: Multiplan Commercial |
$2,442.40
|
| Rate for Payer: Networks By Design Commercial |
$1,526.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,595.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,145.79
|
| Rate for Payer: United Healthcare All Other HMO |
$1,115.26
|
| Rate for Payer: United Healthcare HMO Rider |
$1,091.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$999.86
|
|
|
HC STENT ULTRAFLEX T-B NON-COV W/
|
Facility
|
OP
|
$3,053.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
900803705
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$610.60 |
| Max. Negotiated Rate |
$2,595.05 |
| Rate for Payer: Adventist Health Commercial |
$610.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,595.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,679.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,289.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,847.98
|
| Rate for Payer: Blue Shield of California Commercial |
$1,547.87
|
| Rate for Payer: Blue Shield of California Commercial |
$2,347.76
|
| Rate for Payer: Cash Price |
$1,373.85
|
| Rate for Payer: Cigna of CA HMO |
$2,137.10
|
| Rate for Payer: Cigna of CA PPO |
$2,137.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,595.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,595.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,595.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,137.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,221.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,221.20
|
| Rate for Payer: Galaxy Health WC |
$2,595.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,831.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,938.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,108.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,801.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$732.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,137.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,137.10
|
| Rate for Payer: Multiplan Commercial |
$2,442.40
|
| Rate for Payer: Networks By Design Commercial |
$1,526.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,595.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,831.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,831.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,145.79
|
| Rate for Payer: United Healthcare All Other HMO |
$1,115.26
|
| Rate for Payer: United Healthcare HMO Rider |
$1,091.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$999.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,595.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,595.05
|
| Rate for Payer: Vantage Medical Group Senior |
$2,595.05
|
|
|
HC STENT VIABAHN
|
Facility
|
OP
|
$7,625.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
909020094
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,525.00 |
| Max. Negotiated Rate |
$6,481.25 |
| Rate for Payer: Adventist Health Commercial |
$1,525.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,481.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,193.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,718.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,615.41
|
| Rate for Payer: Blue Shield of California Commercial |
$3,865.88
|
| Rate for Payer: Blue Shield of California Commercial |
$5,863.62
|
| Rate for Payer: Cash Price |
$3,431.25
|
| Rate for Payer: Cigna of CA HMO |
$5,337.50
|
| Rate for Payer: Cigna of CA PPO |
$5,337.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,481.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,481.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,481.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,337.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,050.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,050.00
|
| Rate for Payer: Galaxy Health WC |
$6,481.25
|
| Rate for Payer: Global Benefits Group Commercial |
$4,575.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,841.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,498.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,830.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,337.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,337.50
|
| Rate for Payer: Multiplan Commercial |
$6,100.00
|
| Rate for Payer: Networks By Design Commercial |
$3,812.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,481.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,575.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,575.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,861.66
|
| Rate for Payer: United Healthcare All Other HMO |
$2,785.41
|
| Rate for Payer: United Healthcare HMO Rider |
$2,725.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,497.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,481.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,481.25
|
| Rate for Payer: Vantage Medical Group Senior |
$6,481.25
|
|
|
HC STENT VIABAHN
|
Facility
|
IP
|
$7,625.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
909020094
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,525.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$1,525.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$3,431.25
|
| Rate for Payer: Cash Price |
$3,431.25
|
| Rate for Payer: Cigna of CA HMO |
$5,337.50
|
| Rate for Payer: Cigna of CA PPO |
$5,337.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,337.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,050.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,050.00
|
| Rate for Payer: Galaxy Health WC |
$6,481.25
|
| Rate for Payer: Global Benefits Group Commercial |
$4,575.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,841.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,498.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,830.00
|
| Rate for Payer: Multiplan Commercial |
$6,100.00
|
| Rate for Payer: Networks By Design Commercial |
$3,812.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,481.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,861.66
|
| Rate for Payer: United Healthcare All Other HMO |
$2,785.41
|
| Rate for Payer: United Healthcare HMO Rider |
$2,725.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,497.19
|
|
|
HC STENT VIATORR/COVERED
|
Facility
|
OP
|
$9,412.50
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
909081419
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,882.50 |
| Max. Negotiated Rate |
$8,000.62 |
| Rate for Payer: Adventist Health Commercial |
$1,882.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,000.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,176.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,059.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,697.39
|
| Rate for Payer: Blue Shield of California Commercial |
$4,772.14
|
| Rate for Payer: Blue Shield of California Commercial |
$7,238.21
|
| Rate for Payer: Cash Price |
$4,235.62
|
| Rate for Payer: Cigna of CA HMO |
$6,588.75
|
| Rate for Payer: Cigna of CA PPO |
$6,588.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,000.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,000.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,000.62
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,588.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,765.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,765.00
|
| Rate for Payer: Galaxy Health WC |
$8,000.62
|
| Rate for Payer: Global Benefits Group Commercial |
$5,647.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,976.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,553.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,259.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,588.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,588.75
|
| Rate for Payer: Multiplan Commercial |
$7,530.00
|
| Rate for Payer: Networks By Design Commercial |
$4,706.25
|
| Rate for Payer: Prime Health Services Commercial |
$8,000.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,647.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,647.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,532.51
|
| Rate for Payer: United Healthcare All Other HMO |
$3,438.39
|
| Rate for Payer: United Healthcare HMO Rider |
$3,364.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,082.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,000.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,000.62
|
| Rate for Payer: Vantage Medical Group Senior |
$8,000.62
|
|
|
HC STENT VIATORR/COVERED
|
Facility
|
IP
|
$9,412.50
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
909081419
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,882.50 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$1,882.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$4,235.62
|
| Rate for Payer: Cash Price |
$4,235.62
|
| Rate for Payer: Cigna of CA HMO |
$6,588.75
|
| Rate for Payer: Cigna of CA PPO |
$6,588.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,588.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,765.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,765.00
|
| Rate for Payer: Galaxy Health WC |
$8,000.62
|
| Rate for Payer: Global Benefits Group Commercial |
$5,647.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,976.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,553.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,259.00
|
| Rate for Payer: Multiplan Commercial |
$7,530.00
|
| Rate for Payer: Networks By Design Commercial |
$4,706.25
|
| Rate for Payer: Prime Health Services Commercial |
$8,000.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,532.51
|
| Rate for Payer: United Healthcare All Other HMO |
$3,438.39
|
| Rate for Payer: United Healthcare HMO Rider |
$3,364.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,082.59
|
|
|
HC STENT WINGSPAN
|
Facility
|
IP
|
$15,287.50
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020055
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,057.50 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$3,057.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$6,879.38
|
| Rate for Payer: Cash Price |
$6,879.38
|
| Rate for Payer: Cigna of CA HMO |
$10,701.25
|
| Rate for Payer: Cigna of CA PPO |
$10,701.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,701.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,115.00
|
| Rate for Payer: EPIC Health Plan Senior |
$6,115.00
|
| Rate for Payer: Galaxy Health WC |
$12,994.38
|
| Rate for Payer: Global Benefits Group Commercial |
$9,172.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9,707.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9,019.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,669.00
|
| Rate for Payer: Multiplan Commercial |
$12,230.00
|
| Rate for Payer: Networks By Design Commercial |
$7,643.75
|
| Rate for Payer: Prime Health Services Commercial |
$12,994.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,737.40
|
| Rate for Payer: United Healthcare All Other HMO |
$5,584.52
|
| Rate for Payer: United Healthcare HMO Rider |
$5,463.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,006.66
|
|
|
HC STENT WINGSPAN
|
Facility
|
OP
|
$15,287.50
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020055
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,057.50 |
| Max. Negotiated Rate |
$12,994.38 |
| Rate for Payer: Adventist Health Commercial |
$3,057.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,994.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,408.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11,465.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,253.52
|
| Rate for Payer: Blue Shield of California Commercial |
$11,756.09
|
| Rate for Payer: Blue Shield of California Commercial |
$7,750.76
|
| Rate for Payer: Cash Price |
$6,879.38
|
| Rate for Payer: Cigna of CA HMO |
$10,701.25
|
| Rate for Payer: Cigna of CA PPO |
$10,701.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,994.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$12,994.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12,994.38
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,701.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,115.00
|
| Rate for Payer: EPIC Health Plan Senior |
$6,115.00
|
| Rate for Payer: Galaxy Health WC |
$12,994.38
|
| Rate for Payer: Global Benefits Group Commercial |
$9,172.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9,707.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5,549.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9,019.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,669.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,701.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,701.25
|
| Rate for Payer: Multiplan Commercial |
$12,230.00
|
| Rate for Payer: Networks By Design Commercial |
$7,643.75
|
| Rate for Payer: Prime Health Services Commercial |
$12,994.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,172.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,172.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,737.40
|
| Rate for Payer: United Healthcare All Other HMO |
$5,584.52
|
| Rate for Payer: United Healthcare HMO Rider |
$5,463.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,006.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,994.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12,994.38
|
| Rate for Payer: Vantage Medical Group Senior |
$12,994.38
|
|
|
HC STEREOTACTIC PROBE 11 GA
|
Facility
|
OP
|
$774.00
|
|
| Hospital Charge Code |
909001127
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$154.80 |
| Max. Negotiated Rate |
$657.90 |
| Rate for Payer: Adventist Health Commercial |
$154.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$507.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$657.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$425.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$580.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$496.68
|
| Rate for Payer: Cash Price |
$348.30
|
| Rate for Payer: Cigna of CA HMO |
$495.36
|
| Rate for Payer: Cigna of CA PPO |
$572.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$657.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$657.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$657.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$541.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$309.60
|
| Rate for Payer: EPIC Health Plan Senior |
$309.60
|
| Rate for Payer: Galaxy Health WC |
$657.90
|
| Rate for Payer: Global Benefits Group Commercial |
$464.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$491.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$280.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$456.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$541.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$541.80
|
| Rate for Payer: Multiplan Commercial |
$619.20
|
| Rate for Payer: Networks By Design Commercial |
$503.10
|
| Rate for Payer: Prime Health Services Commercial |
$657.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$464.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$464.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$387.00
|
| Rate for Payer: United Healthcare All Other HMO |
$387.00
|
| Rate for Payer: United Healthcare HMO Rider |
$387.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$387.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$657.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$657.90
|
| Rate for Payer: Vantage Medical Group Senior |
$657.90
|
|
|
HC STEREOTACTIC PROBE 11 GA
|
Facility
|
IP
|
$774.00
|
|
| Hospital Charge Code |
909001127
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$154.80 |
| Max. Negotiated Rate |
$657.90 |
| Rate for Payer: Adventist Health Commercial |
$154.80
|
| Rate for Payer: Cash Price |
$348.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$541.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$309.60
|
| Rate for Payer: EPIC Health Plan Senior |
$309.60
|
| Rate for Payer: Galaxy Health WC |
$657.90
|
| Rate for Payer: Global Benefits Group Commercial |
$464.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$491.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$456.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.76
|
| Rate for Payer: Multiplan Commercial |
$619.20
|
| Rate for Payer: Networks By Design Commercial |
$503.10
|
| Rate for Payer: Prime Health Services Commercial |
$657.90
|
|
|
HC STEREOTACTIC PROBE 8 GA
|
Facility
|
OP
|
$921.00
|
|
| Hospital Charge Code |
909001128
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$184.20 |
| Max. Negotiated Rate |
$782.85 |
| Rate for Payer: Adventist Health Commercial |
$184.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$604.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$782.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$506.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$690.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$591.01
|
| Rate for Payer: Cash Price |
$414.45
|
| Rate for Payer: Cigna of CA HMO |
$589.44
|
| Rate for Payer: Cigna of CA PPO |
$681.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$782.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$782.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$782.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$644.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$368.40
|
| Rate for Payer: EPIC Health Plan Senior |
$368.40
|
| Rate for Payer: Galaxy Health WC |
$782.85
|
| Rate for Payer: Global Benefits Group Commercial |
$552.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$584.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$334.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$543.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$221.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$644.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$644.70
|
| Rate for Payer: Multiplan Commercial |
$736.80
|
| Rate for Payer: Networks By Design Commercial |
$598.65
|
| Rate for Payer: Prime Health Services Commercial |
$782.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$552.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$552.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$460.50
|
| Rate for Payer: United Healthcare All Other HMO |
$460.50
|
| Rate for Payer: United Healthcare HMO Rider |
$460.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$460.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$782.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$782.85
|
| Rate for Payer: Vantage Medical Group Senior |
$782.85
|
|
|
HC STEREOTACTIC PROBE 8 GA
|
Facility
|
IP
|
$921.00
|
|
| Hospital Charge Code |
909001128
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$184.20 |
| Max. Negotiated Rate |
$782.85 |
| Rate for Payer: Adventist Health Commercial |
$184.20
|
| Rate for Payer: Cash Price |
$414.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$644.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$368.40
|
| Rate for Payer: EPIC Health Plan Senior |
$368.40
|
| Rate for Payer: Galaxy Health WC |
$782.85
|
| Rate for Payer: Global Benefits Group Commercial |
$552.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$584.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$543.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$221.04
|
| Rate for Payer: Multiplan Commercial |
$736.80
|
| Rate for Payer: Networks By Design Commercial |
$598.65
|
| Rate for Payer: Prime Health Services Commercial |
$782.85
|
|
|
HC STERNOCLAVICLE REDUCTION
|
Facility
|
OP
|
$2,542.00
|
|
|
Service Code
|
CPT 23525
|
| Hospital Charge Code |
902890371
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$317.26 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$1,042.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,153.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$317.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$1,143.90
|
| Rate for Payer: Cash Price |
$1,143.90
|
| Rate for Payer: Cash Price |
$1,143.90
|
| Rate for Payer: Cigna of CA HMO |
$1,626.88
|
| Rate for Payer: Cigna of CA PPO |
$1,881.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$475.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$348.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$317.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,779.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$523.48
|
| Rate for Payer: EPIC Health Plan Senior |
$348.99
|
| Rate for Payer: Galaxy Health WC |
$2,160.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,525.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$520.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$317.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,614.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$341.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$610.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$399.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$425.13
|
| Rate for Payer: Multiplan Commercial |
$2,033.60
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$1,652.30
|
| Rate for Payer: Prime Health Services Commercial |
$2,160.70
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,525.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,525.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$317.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Vantage Medical Group Senior |
$317.26
|
|
