|
HC STNT BILRY SMRT CORD NITINL 80
|
Facility
|
OP
|
$3,900.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909081430
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,315.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,145.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,925.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,360.67
|
| 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 STNT BILRY SMRT CORD NITINL 80
|
Facility
|
IP
|
$3,900.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909081430
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$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 STNT COATED/COVERED W DELIVER
|
Facility
|
IP
|
$8,900.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
909081446
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,780.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$1,780.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$4,005.00
|
| Rate for Payer: Cash Price |
$4,005.00
|
| Rate for Payer: Cigna of CA HMO |
$6,230.00
|
| Rate for Payer: Cigna of CA PPO |
$6,230.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,230.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,560.00
|
| Rate for Payer: Galaxy Health WC |
$7,565.00
|
| Rate for Payer: Global Benefits Group Commercial |
$5,340.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,651.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,251.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,136.00
|
| Rate for Payer: Multiplan Commercial |
$7,120.00
|
| Rate for Payer: Networks By Design Commercial |
$4,450.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,565.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,340.17
|
| Rate for Payer: United Healthcare All Other HMO |
$3,251.17
|
| Rate for Payer: United Healthcare HMO Rider |
$3,180.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,914.75
|
|
|
HC STNT COATED/COVERED W DELIVER
|
Facility
|
OP
|
$8,900.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
909081446
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,780.00 |
| Max. Negotiated Rate |
$7,565.00 |
| Rate for Payer: Adventist Health Commercial |
$1,780.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,565.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,895.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,675.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,387.17
|
| Rate for Payer: Blue Shield of California Commercial |
$4,512.30
|
| Rate for Payer: Blue Shield of California Commercial |
$6,844.10
|
| Rate for Payer: Cash Price |
$4,005.00
|
| Rate for Payer: Cigna of CA HMO |
$6,230.00
|
| Rate for Payer: Cigna of CA PPO |
$6,230.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,565.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,565.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,565.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,230.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,560.00
|
| Rate for Payer: Galaxy Health WC |
$7,565.00
|
| Rate for Payer: Global Benefits Group Commercial |
$5,340.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,651.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,251.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,136.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,230.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,230.00
|
| Rate for Payer: Multiplan Commercial |
$7,120.00
|
| Rate for Payer: Networks By Design Commercial |
$4,450.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,565.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,340.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,340.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,340.17
|
| Rate for Payer: United Healthcare All Other HMO |
$3,251.17
|
| Rate for Payer: United Healthcare HMO Rider |
$3,180.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,914.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,565.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,565.00
|
| Rate for Payer: Vantage Medical Group Senior |
$7,565.00
|
|
|
HC STNT NO COAT/COVER W DEL SYS
|
Facility
|
IP
|
$3,900.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909081403
|
|
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 STNT NO COAT/COVER W DEL SYS
|
Facility
|
OP
|
$3,900.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909081403
|
|
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 STNT PLCMT CNTRL DIALYSIS SEG
|
Facility
|
OP
|
$8,335.00
|
|
|
Service Code
|
CPT 36908
|
| Hospital Charge Code |
909036908
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,000.00 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,667.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,084.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,584.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,251.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| 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 |
$3,750.75
|
| Rate for Payer: Cash Price |
$3,750.75
|
| Rate for Payer: Cash Price |
$3,750.75
|
| Rate for Payer: Cigna of CA HMO |
$5,334.40
|
| Rate for Payer: Cigna of CA PPO |
$6,167.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,084.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,084.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,084.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,834.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,334.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,334.00
|
| Rate for Payer: Galaxy Health WC |
$7,084.75
|
| Rate for Payer: Global Benefits Group Commercial |
$5,001.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4,169.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,292.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,716.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,917.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,000.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,834.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,834.50
|
| Rate for Payer: Multiplan Commercial |
$6,668.00
|
| Rate for Payer: Networks By Design Commercial |
$5,417.75
|
| Rate for Payer: Prime Health Services Commercial |
$7,084.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,001.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,167.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,084.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,084.75
|
| Rate for Payer: Vantage Medical Group Senior |
$7,084.75
|
|
|
HC STNT PLCMT CNTRL DIALYSIS SEG
|
Facility
|
IP
|
$8,335.00
|
|
|
Service Code
|
CPT 36908
|
| Hospital Charge Code |
909036908
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,667.00 |
| Max. Negotiated Rate |
$7,084.75 |
| Rate for Payer: Adventist Health Commercial |
$1,667.00
|
| Rate for Payer: Cash Price |
$3,750.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,834.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,334.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,334.00
|
| Rate for Payer: Galaxy Health WC |
$7,084.75
|
| Rate for Payer: Global Benefits Group Commercial |
$5,001.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,292.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,917.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,000.40
|
| Rate for Payer: Multiplan Commercial |
$6,668.00
|
| Rate for Payer: Networks By Design Commercial |
$5,417.75
|
| Rate for Payer: Prime Health Services Commercial |
$7,084.75
|
|
|
HC STNT TRACHEO WALLGRFT W/UNI 20
|
Facility
|
OP
|
$9,420.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909081433
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,884.00 |
| Max. Negotiated Rate |
$8,007.00 |
| Rate for Payer: Adventist Health Commercial |
$1,884.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,007.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,181.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,065.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,701.93
|
| Rate for Payer: Blue Shield of California Commercial |
$4,775.94
|
| Rate for Payer: Blue Shield of California Commercial |
$7,243.98
|
| Rate for Payer: Cash Price |
$4,239.00
|
| Rate for Payer: Cigna of CA HMO |
$6,594.00
|
| Rate for Payer: Cigna of CA PPO |
$6,594.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,007.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,007.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,007.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,594.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,768.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,768.00
|
| Rate for Payer: Galaxy Health WC |
$8,007.00
|
| Rate for Payer: Global Benefits Group Commercial |
$5,652.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,981.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,419.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,557.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,260.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,594.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,594.00
|
| Rate for Payer: Multiplan Commercial |
$7,536.00
|
| Rate for Payer: Networks By Design Commercial |
$4,710.00
|
| Rate for Payer: Prime Health Services Commercial |
$8,007.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,652.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,652.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,535.33
|
| Rate for Payer: United Healthcare All Other HMO |
$3,441.13
|
| Rate for Payer: United Healthcare HMO Rider |
$3,366.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,085.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,007.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,007.00
|
| Rate for Payer: Vantage Medical Group Senior |
$8,007.00
|
|
|
HC STNT TRACHEO WALLGRFT W/UNI 20
|
Facility
|
IP
|
$9,420.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909081433
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,884.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$1,884.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$4,239.00
|
| Rate for Payer: Cash Price |
$4,239.00
|
| Rate for Payer: Cigna of CA HMO |
$6,594.00
|
| Rate for Payer: Cigna of CA PPO |
$6,594.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,594.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,768.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,768.00
|
| Rate for Payer: Galaxy Health WC |
$8,007.00
|
| Rate for Payer: Global Benefits Group Commercial |
$5,652.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,981.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,557.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,260.80
|
| Rate for Payer: Multiplan Commercial |
$7,536.00
|
| Rate for Payer: Networks By Design Commercial |
$4,710.00
|
| Rate for Payer: Prime Health Services Commercial |
$8,007.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,535.33
|
| Rate for Payer: United Healthcare All Other HMO |
$3,441.13
|
| Rate for Payer: United Healthcare HMO Rider |
$3,366.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,085.05
|
|
|
HC STNT WALL CAROTID
|
Facility
|
IP
|
$6,425.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909000023
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,285.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$1,285.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$2,891.25
|
| Rate for Payer: Cash Price |
$2,891.25
|
| Rate for Payer: Cigna of CA HMO |
$4,497.50
|
| Rate for Payer: Cigna of CA PPO |
$4,497.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,497.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,570.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,570.00
|
| Rate for Payer: Galaxy Health WC |
$5,461.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,855.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,079.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,790.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,542.00
|
| Rate for Payer: Multiplan Commercial |
$5,140.00
|
| Rate for Payer: Networks By Design Commercial |
$3,212.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,461.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,411.30
|
| Rate for Payer: United Healthcare All Other HMO |
$2,347.05
|
| Rate for Payer: United Healthcare HMO Rider |
$2,296.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,104.19
|
|
|
HC STNT WALL CAROTID
|
Facility
|
OP
|
$6,425.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909000023
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,285.00 |
| Max. Negotiated Rate |
$5,461.25 |
| Rate for Payer: Adventist Health Commercial |
$1,285.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,461.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,533.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,818.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,889.05
|
| Rate for Payer: Blue Shield of California Commercial |
$3,257.47
|
| Rate for Payer: Blue Shield of California Commercial |
$4,940.82
|
| Rate for Payer: Cash Price |
$2,891.25
|
| Rate for Payer: Cigna of CA HMO |
$4,497.50
|
| Rate for Payer: Cigna of CA PPO |
$4,497.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,461.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,461.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,461.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,497.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,570.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,570.00
|
| Rate for Payer: Galaxy Health WC |
$5,461.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,855.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,079.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,332.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,790.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,542.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,497.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,497.50
|
| Rate for Payer: Multiplan Commercial |
$5,140.00
|
| Rate for Payer: Networks By Design Commercial |
$3,212.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,461.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,855.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,855.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,411.30
|
| Rate for Payer: United Healthcare All Other HMO |
$2,347.05
|
| Rate for Payer: United Healthcare HMO Rider |
$2,296.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,104.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,461.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,461.25
|
| Rate for Payer: Vantage Medical Group Senior |
$5,461.25
|
|
|
HC STNT WALL RP BILRY W/UNI 20,40
|
Facility
|
OP
|
$5,665.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909081426
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,133.00 |
| Max. Negotiated Rate |
$4,815.25 |
| Rate for Payer: Adventist Health Commercial |
$1,133.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,815.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,115.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,248.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,429.02
|
| Rate for Payer: Blue Shield of California Commercial |
$2,872.16
|
| Rate for Payer: Blue Shield of California Commercial |
$4,356.39
|
| Rate for Payer: Cash Price |
$2,549.25
|
| Rate for Payer: Cigna of CA HMO |
$3,965.50
|
| Rate for Payer: Cigna of CA PPO |
$3,965.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,815.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,815.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,815.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,965.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,266.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,266.00
|
| Rate for Payer: Galaxy Health WC |
$4,815.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,399.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,597.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,056.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,342.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,359.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,965.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,965.50
|
| Rate for Payer: Multiplan Commercial |
$4,532.00
|
| Rate for Payer: Networks By Design Commercial |
$2,832.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,815.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,399.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,399.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,126.07
|
| Rate for Payer: United Healthcare All Other HMO |
$2,069.42
|
| Rate for Payer: United Healthcare HMO Rider |
$2,024.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,855.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,815.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,815.25
|
| Rate for Payer: Vantage Medical Group Senior |
$4,815.25
|
|
|
HC STNT WALL RP BILRY W/UNI 20,40
|
Facility
|
IP
|
$5,665.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909081426
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,133.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$1,133.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$2,549.25
|
| Rate for Payer: Cash Price |
$2,549.25
|
| Rate for Payer: Cigna of CA HMO |
$3,965.50
|
| Rate for Payer: Cigna of CA PPO |
$3,965.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,965.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,266.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,266.00
|
| Rate for Payer: Galaxy Health WC |
$4,815.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,399.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,597.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,342.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,359.60
|
| Rate for Payer: Multiplan Commercial |
$4,532.00
|
| Rate for Payer: Networks By Design Commercial |
$2,832.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,815.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,126.07
|
| Rate for Payer: United Healthcare All Other HMO |
$2,069.42
|
| Rate for Payer: United Healthcare HMO Rider |
$2,024.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,855.29
|
|
|
HC STNT WALL RP BILRY W/UNI 80,94
|
Facility
|
IP
|
$2,825.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909081427
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$565.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$565.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$1,271.25
|
| Rate for Payer: Cash Price |
$1,271.25
|
| Rate for Payer: Cigna of CA HMO |
$1,977.50
|
| Rate for Payer: Cigna of CA PPO |
$1,977.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,977.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,130.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,130.00
|
| Rate for Payer: Galaxy Health WC |
$2,401.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,695.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,793.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,666.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$678.00
|
| Rate for Payer: Multiplan Commercial |
$2,260.00
|
| Rate for Payer: Networks By Design Commercial |
$1,412.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,401.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,060.22
|
| Rate for Payer: United Healthcare All Other HMO |
$1,031.97
|
| Rate for Payer: United Healthcare HMO Rider |
$1,009.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$925.19
|
|
|
HC STNT WALL RP BILRY W/UNI 80,94
|
Facility
|
OP
|
$2,825.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909081427
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$565.00 |
| Max. Negotiated Rate |
$2,401.25 |
| Rate for Payer: Adventist Health Commercial |
$565.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,401.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,553.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,118.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,709.97
|
| Rate for Payer: Blue Shield of California Commercial |
$1,432.28
|
| Rate for Payer: Blue Shield of California Commercial |
$2,172.43
|
| Rate for Payer: Cash Price |
$1,271.25
|
| Rate for Payer: Cigna of CA HMO |
$1,977.50
|
| Rate for Payer: Cigna of CA PPO |
$1,977.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,401.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,401.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,401.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,977.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,130.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,130.00
|
| Rate for Payer: Galaxy Health WC |
$2,401.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,695.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,793.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,025.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,666.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$678.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,977.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,977.50
|
| Rate for Payer: Multiplan Commercial |
$2,260.00
|
| Rate for Payer: Networks By Design Commercial |
$1,412.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,401.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,695.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,695.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,060.22
|
| Rate for Payer: United Healthcare All Other HMO |
$1,031.97
|
| Rate for Payer: United Healthcare HMO Rider |
$1,009.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$925.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,401.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,401.25
|
| Rate for Payer: Vantage Medical Group Senior |
$2,401.25
|
|
|
HC STOCKING GRIPS (4)
|
Facility
|
OP
|
$84.00
|
|
|
Service Code
|
CPT L0982
|
| Hospital Charge Code |
915350982
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$11.96 |
| Max. Negotiated Rate |
$71.40 |
| Rate for Payer: Adventist Health Commercial |
$34.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$71.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$46.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$63.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$50.85
|
| Rate for Payer: Blue Shield of California Commercial |
$64.60
|
| Rate for Payer: Blue Shield of California Commercial |
$42.59
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cigna of CA HMO |
$58.80
|
| Rate for Payer: Cigna of CA PPO |
$58.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$71.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$71.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$71.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$58.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.60
|
| Rate for Payer: EPIC Health Plan Senior |
$33.60
|
| Rate for Payer: Galaxy Health WC |
$71.40
|
| Rate for Payer: Global Benefits Group Commercial |
$50.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$53.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$49.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$58.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$58.80
|
| Rate for Payer: Multiplan Commercial |
$67.20
|
| Rate for Payer: Networks By Design Commercial |
$42.00
|
| Rate for Payer: Prime Health Services Commercial |
$71.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$50.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$50.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$31.53
|
| Rate for Payer: United Healthcare All Other HMO |
$30.69
|
| Rate for Payer: United Healthcare HMO Rider |
$30.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$71.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$71.40
|
| Rate for Payer: Vantage Medical Group Senior |
$71.40
|
|
|
HC STOCKING GRIPS (4)
|
Facility
|
OP
|
$84.00
|
|
|
Service Code
|
CPT L0982
|
| Hospital Charge Code |
905350982
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$11.96 |
| Max. Negotiated Rate |
$71.40 |
| Rate for Payer: Adventist Health Commercial |
$34.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$71.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$46.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$63.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$50.85
|
| Rate for Payer: Blue Shield of California Commercial |
$64.60
|
| Rate for Payer: Blue Shield of California Commercial |
$42.59
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cigna of CA HMO |
$58.80
|
| Rate for Payer: Cigna of CA PPO |
$58.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$71.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$71.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$71.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$58.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.60
|
| Rate for Payer: EPIC Health Plan Senior |
$33.60
|
| Rate for Payer: Galaxy Health WC |
$71.40
|
| Rate for Payer: Global Benefits Group Commercial |
$50.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$53.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$49.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$58.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$58.80
|
| Rate for Payer: Multiplan Commercial |
$67.20
|
| Rate for Payer: Networks By Design Commercial |
$42.00
|
| Rate for Payer: Prime Health Services Commercial |
$71.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$50.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$50.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$31.53
|
| Rate for Payer: United Healthcare All Other HMO |
$30.69
|
| Rate for Payer: United Healthcare HMO Rider |
$30.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$71.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$71.40
|
| Rate for Payer: Vantage Medical Group Senior |
$71.40
|
|
|
HC STOCKING GRIPS (4)
|
Facility
|
IP
|
$84.00
|
|
|
Service Code
|
CPT L0982
|
| Hospital Charge Code |
905350982
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$16.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cigna of CA HMO |
$58.80
|
| Rate for Payer: Cigna of CA PPO |
$58.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$58.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.60
|
| Rate for Payer: EPIC Health Plan Senior |
$33.60
|
| Rate for Payer: Galaxy Health WC |
$71.40
|
| Rate for Payer: Global Benefits Group Commercial |
$50.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$53.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$49.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.16
|
| Rate for Payer: Multiplan Commercial |
$67.20
|
| Rate for Payer: Networks By Design Commercial |
$54.60
|
| Rate for Payer: Prime Health Services Commercial |
$71.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$31.53
|
| Rate for Payer: United Healthcare All Other HMO |
$30.69
|
| Rate for Payer: United Healthcare HMO Rider |
$30.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.51
|
|
|
HC STOCKING GRIPS (4)
|
Facility
|
IP
|
$84.00
|
|
|
Service Code
|
CPT L0982
|
| Hospital Charge Code |
915350982
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$16.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cigna of CA HMO |
$58.80
|
| Rate for Payer: Cigna of CA PPO |
$58.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$58.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.60
|
| Rate for Payer: EPIC Health Plan Senior |
$33.60
|
| Rate for Payer: Galaxy Health WC |
$71.40
|
| Rate for Payer: Global Benefits Group Commercial |
$50.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$53.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$49.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.16
|
| Rate for Payer: Multiplan Commercial |
$67.20
|
| Rate for Payer: Networks By Design Commercial |
$54.60
|
| Rate for Payer: Prime Health Services Commercial |
$71.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$31.53
|
| Rate for Payer: United Healthcare All Other HMO |
$30.69
|
| Rate for Payer: United Healthcare HMO Rider |
$30.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.51
|
|
|
HC STRAIGHT KNEE JT HEAVY DUTY ADDITION LE
|
Facility
|
OP
|
$290.00
|
|
|
Service Code
|
CPT L2385
|
| Hospital Charge Code |
905352385
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$69.60 |
| Max. Negotiated Rate |
$246.50 |
| Rate for Payer: Vantage Medical Group Senior |
$246.50
|
| Rate for Payer: Adventist Health Commercial |
$118.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$246.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$159.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$217.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$175.54
|
| Rate for Payer: Blue Shield of California Commercial |
$223.01
|
| Rate for Payer: Blue Shield of California Commercial |
$147.03
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cigna of CA HMO |
$203.00
|
| Rate for Payer: Cigna of CA PPO |
$203.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$246.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$246.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$246.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$203.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$116.00
|
| Rate for Payer: EPIC Health Plan Senior |
$116.00
|
| Rate for Payer: Galaxy Health WC |
$246.50
|
| Rate for Payer: Global Benefits Group Commercial |
$174.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$129.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$184.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$146.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$171.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$203.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$203.00
|
| Rate for Payer: Multiplan Commercial |
$232.00
|
| Rate for Payer: Networks By Design Commercial |
$145.00
|
| Rate for Payer: Prime Health Services Commercial |
$246.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$174.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$174.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$108.84
|
| Rate for Payer: United Healthcare All Other HMO |
$105.94
|
| Rate for Payer: United Healthcare HMO Rider |
$103.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$94.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$246.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$246.50
|
|
|
HC STRAIGHT KNEE JT HEAVY DUTY ADDITION LE
|
Facility
|
OP
|
$290.00
|
|
|
Service Code
|
CPT L2385
|
| Hospital Charge Code |
915352385
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$69.60 |
| Max. Negotiated Rate |
$246.50 |
| Rate for Payer: Adventist Health Commercial |
$118.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$246.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$159.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$217.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$175.54
|
| Rate for Payer: Blue Shield of California Commercial |
$223.01
|
| Rate for Payer: Blue Shield of California Commercial |
$147.03
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cigna of CA HMO |
$203.00
|
| Rate for Payer: Cigna of CA PPO |
$203.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$246.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$246.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$246.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$203.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$116.00
|
| Rate for Payer: EPIC Health Plan Senior |
$116.00
|
| Rate for Payer: Galaxy Health WC |
$246.50
|
| Rate for Payer: Global Benefits Group Commercial |
$174.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$129.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$184.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$146.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$171.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$203.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$203.00
|
| Rate for Payer: Multiplan Commercial |
$232.00
|
| Rate for Payer: Networks By Design Commercial |
$145.00
|
| Rate for Payer: Prime Health Services Commercial |
$246.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$174.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$174.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$108.84
|
| Rate for Payer: United Healthcare All Other HMO |
$105.94
|
| Rate for Payer: United Healthcare HMO Rider |
$103.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$94.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$246.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$246.50
|
| Rate for Payer: Vantage Medical Group Senior |
$246.50
|
|
|
HC STRAIGHT KNEE JT HEAVY DUTY ADDITION LE
|
Facility
|
IP
|
$290.00
|
|
|
Service Code
|
CPT L2385
|
| Hospital Charge Code |
915352385
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$58.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$58.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cigna of CA HMO |
$203.00
|
| Rate for Payer: Cigna of CA PPO |
$203.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$203.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$116.00
|
| Rate for Payer: EPIC Health Plan Senior |
$116.00
|
| Rate for Payer: Galaxy Health WC |
$246.50
|
| Rate for Payer: Global Benefits Group Commercial |
$174.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$184.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$171.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.60
|
| Rate for Payer: Multiplan Commercial |
$232.00
|
| Rate for Payer: Networks By Design Commercial |
$188.50
|
| Rate for Payer: Prime Health Services Commercial |
$246.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$108.84
|
| Rate for Payer: United Healthcare All Other HMO |
$105.94
|
| Rate for Payer: United Healthcare HMO Rider |
$103.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$94.97
|
|
|
HC STRAIGHT KNEE JT HEAVY DUTY ADDITION LE
|
Facility
|
IP
|
$290.00
|
|
|
Service Code
|
CPT L2385
|
| Hospital Charge Code |
905352385
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$58.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$58.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cigna of CA HMO |
$203.00
|
| Rate for Payer: Cigna of CA PPO |
$203.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$203.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$116.00
|
| Rate for Payer: EPIC Health Plan Senior |
$116.00
|
| Rate for Payer: Galaxy Health WC |
$246.50
|
| Rate for Payer: Global Benefits Group Commercial |
$174.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$184.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$171.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.60
|
| Rate for Payer: Multiplan Commercial |
$232.00
|
| Rate for Payer: Networks By Design Commercial |
$188.50
|
| Rate for Payer: Prime Health Services Commercial |
$246.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$108.84
|
| Rate for Payer: United Healthcare All Other HMO |
$105.94
|
| Rate for Payer: United Healthcare HMO Rider |
$103.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$94.97
|
|
|
HC STRAIGHT PUSHABLE COIL
|
Facility
|
OP
|
$580.00
|
|
| Hospital Charge Code |
909081804
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$493.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$319.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$435.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$351.07
|
| Rate for Payer: Blue Shield of California Commercial |
$294.06
|
| Rate for Payer: Blue Shield of California Commercial |
$446.02
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cigna of CA HMO |
$406.00
|
| Rate for Payer: Cigna of CA PPO |
$406.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$493.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$493.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$406.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$368.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$210.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$342.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$406.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$406.00
|
| Rate for Payer: Multiplan Commercial |
$464.00
|
| Rate for Payer: Networks By Design Commercial |
$290.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$348.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$348.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$217.67
|
| Rate for Payer: United Healthcare All Other HMO |
$211.87
|
| Rate for Payer: United Healthcare HMO Rider |
$207.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$189.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.00
|
| Rate for Payer: Vantage Medical Group Senior |
$493.00
|
|
