|
HC STENT ENTERPRISE
|
Facility
|
OP
|
$13,000.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020034
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,600.00 |
| Max. Negotiated Rate |
$11,700.00 |
| Rate for Payer: Adventist Health Commercial |
$2,600.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,050.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,150.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,750.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,935.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,129.20
|
| Rate for Payer: Blue Shield of California Commercial |
$10,426.00
|
| Rate for Payer: Blue Shield of California EPN |
$6,552.00
|
| Rate for Payer: Cash Price |
$5,850.00
|
| Rate for Payer: Central Health Plan Commercial |
$10,400.00
|
| Rate for Payer: Cigna of CA HMO |
$9,100.00
|
| Rate for Payer: Cigna of CA PPO |
$9,100.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,050.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,050.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11,050.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,100.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,200.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,200.00
|
| Rate for Payer: Galaxy Health WC |
$11,050.00
|
| Rate for Payer: Global Benefits Group Commercial |
$7,800.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,700.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,255.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,719.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,670.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,600.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9,100.00
|
| Rate for Payer: Multiplan Commercial |
$9,750.00
|
| Rate for Payer: Networks By Design Commercial |
$6,500.00
|
| Rate for Payer: Prime Health Services Commercial |
$11,050.00
|
| Rate for Payer: Riverside University Health System MISP |
$5,200.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,800.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,800.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,878.90
|
| Rate for Payer: United Healthcare All Other HMO |
$4,748.90
|
| Rate for Payer: United Healthcare HMO Rider |
$4,646.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,257.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,050.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,050.00
|
| Rate for Payer: Vantage Medical Group Senior |
$11,050.00
|
|
|
HC STENT ENTERPRISE
|
Facility
|
IP
|
$13,000.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020034
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,600.00 |
| Max. Negotiated Rate |
$11,700.00 |
| Rate for Payer: Adventist Health Commercial |
$2,600.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,426.00
|
| Rate for Payer: Blue Shield of California EPN |
$6,552.00
|
| Rate for Payer: Cash Price |
$5,850.00
|
| Rate for Payer: Central Health Plan Commercial |
$10,400.00
|
| Rate for Payer: Cigna of CA HMO |
$9,100.00
|
| Rate for Payer: Cigna of CA PPO |
$9,100.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,100.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,200.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,200.00
|
| Rate for Payer: Galaxy Health WC |
$11,050.00
|
| Rate for Payer: Global Benefits Group Commercial |
$7,800.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,700.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,255.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,670.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,600.00
|
| Rate for Payer: Multiplan Commercial |
$9,750.00
|
| Rate for Payer: Networks By Design Commercial |
$6,500.00
|
| Rate for Payer: Prime Health Services Commercial |
$11,050.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,878.90
|
| Rate for Payer: United Healthcare All Other HMO |
$4,748.90
|
| Rate for Payer: United Healthcare HMO Rider |
$4,646.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,257.50
|
|
|
HC STENT EV3 VISI PRO
|
Facility
|
OP
|
$3,705.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020092
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$741.00 |
| Max. Negotiated Rate |
$3,334.50 |
| Rate for Payer: Adventist Health Commercial |
$741.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,149.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,037.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,778.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,691.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,031.82
|
| Rate for Payer: Blue Shield of California Commercial |
$2,971.41
|
| Rate for Payer: Blue Shield of California EPN |
$1,867.32
|
| Rate for Payer: Cash Price |
$1,667.25
|
| Rate for Payer: Central Health Plan Commercial |
$2,964.00
|
| Rate for Payer: Cigna of CA HMO |
$2,593.50
|
| Rate for Payer: Cigna of CA PPO |
$2,593.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,149.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,149.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,149.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,593.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,482.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,482.00
|
| Rate for Payer: Galaxy Health WC |
$3,149.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,223.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,334.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,352.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,344.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,185.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$741.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,593.50
|
| Rate for Payer: Multiplan Commercial |
$2,778.75
|
| Rate for Payer: Networks By Design Commercial |
$1,852.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,149.25
|
| Rate for Payer: Riverside University Health System MISP |
$1,482.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,223.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,223.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,390.49
|
| Rate for Payer: United Healthcare All Other HMO |
$1,353.44
|
| Rate for Payer: United Healthcare HMO Rider |
$1,324.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,213.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,149.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,149.25
|
| Rate for Payer: Vantage Medical Group Senior |
$3,149.25
|
|
|
HC STENT EV3 VISI PRO
|
Facility
|
IP
|
$3,705.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020092
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$741.00 |
| Max. Negotiated Rate |
$3,334.50 |
| Rate for Payer: Adventist Health Commercial |
$741.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,971.41
|
| Rate for Payer: Blue Shield of California EPN |
$1,867.32
|
| Rate for Payer: Cash Price |
$1,667.25
|
| Rate for Payer: Central Health Plan Commercial |
$2,964.00
|
| Rate for Payer: Cigna of CA HMO |
$2,593.50
|
| Rate for Payer: Cigna of CA PPO |
$2,593.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,593.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,482.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,482.00
|
| Rate for Payer: Galaxy Health WC |
$3,149.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,223.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,334.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,352.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,185.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$741.00
|
| Rate for Payer: Multiplan Commercial |
$2,778.75
|
| Rate for Payer: Networks By Design Commercial |
$1,852.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,149.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,390.49
|
| Rate for Payer: United Healthcare All Other HMO |
$1,353.44
|
| Rate for Payer: United Healthcare HMO Rider |
$1,324.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,213.39
|
|
|
HC STENT FEM/POP
|
Facility
|
OP
|
$16,959.00
|
|
|
Service Code
|
CPT 37226
|
| Hospital Charge Code |
909020067
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,391.80 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$3,391.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14,415.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,327.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12,719.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,924.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$22,958.69
|
| Rate for Payer: Blue Shield of California Commercial |
$6,228.07
|
| Rate for Payer: Blue Shield of California EPN |
$3,914.40
|
| Rate for Payer: Cash Price |
$7,631.55
|
| Rate for Payer: Cash Price |
$7,631.55
|
| Rate for Payer: Cash Price |
$7,631.55
|
| Rate for Payer: Central Health Plan Commercial |
$13,567.20
|
| Rate for Payer: Cigna of CA HMO |
$10,853.76
|
| Rate for Payer: Cigna of CA PPO |
$12,549.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14,415.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$14,415.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,415.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11,871.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,783.60
|
| Rate for Payer: EPIC Health Plan Senior |
$6,783.60
|
| Rate for Payer: Galaxy Health WC |
$14,415.15
|
| Rate for Payer: Global Benefits Group Commercial |
$10,175.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,263.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10,768.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6,156.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,005.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,391.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$11,871.30
|
| Rate for Payer: Multiplan Commercial |
$12,719.25
|
| Rate for Payer: Multiplan WC |
$22,958.69
|
| Rate for Payer: Networks By Design Commercial |
$11,023.35
|
| Rate for Payer: Preferred Health Network WC |
$23,427.23
|
| Rate for Payer: Prime Health Services Commercial |
$14,415.15
|
| Rate for Payer: Prime Health Services WC |
$22,724.41
|
| Rate for Payer: Riverside University Health System MISP |
$6,783.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,175.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,479.50
|
| 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 |
$14,415.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14,415.15
|
| Rate for Payer: Vantage Medical Group Senior |
$14,415.15
|
|
|
HC STENT FEM/POP
|
Facility
|
IP
|
$16,959.00
|
|
|
Service Code
|
CPT 37226
|
| Hospital Charge Code |
909020067
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,391.80 |
| Max. Negotiated Rate |
$15,263.10 |
| Rate for Payer: Adventist Health Commercial |
$3,391.80
|
| Rate for Payer: Cash Price |
$7,631.55
|
| Rate for Payer: Central Health Plan Commercial |
$13,567.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11,871.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,783.60
|
| Rate for Payer: EPIC Health Plan Senior |
$6,783.60
|
| Rate for Payer: Galaxy Health WC |
$14,415.15
|
| Rate for Payer: Global Benefits Group Commercial |
$10,175.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,263.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10,768.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,005.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,391.80
|
| Rate for Payer: Multiplan Commercial |
$12,719.25
|
| Rate for Payer: Networks By Design Commercial |
$11,023.35
|
| Rate for Payer: Prime Health Services Commercial |
$14,415.15
|
|
|
HC STENT FLAIR
|
Facility
|
OP
|
$6,250.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020120
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,250.00 |
| Max. Negotiated Rate |
$5,625.00 |
| Rate for Payer: Adventist Health Commercial |
$1,250.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,312.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,437.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,687.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,853.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,427.50
|
| Rate for Payer: Blue Shield of California Commercial |
$5,012.50
|
| Rate for Payer: Blue Shield of California EPN |
$3,150.00
|
| Rate for Payer: Cash Price |
$2,812.50
|
| Rate for Payer: Central Health Plan Commercial |
$5,000.00
|
| Rate for Payer: Cigna of CA HMO |
$4,375.00
|
| Rate for Payer: Cigna of CA PPO |
$4,375.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,312.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,312.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,312.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,375.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,500.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,500.00
|
| Rate for Payer: Galaxy Health WC |
$5,312.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,750.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,625.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,968.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,268.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,687.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,250.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,375.00
|
| Rate for Payer: Multiplan Commercial |
$4,687.50
|
| Rate for Payer: Networks By Design Commercial |
$3,125.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,312.50
|
| Rate for Payer: Riverside University Health System MISP |
$2,500.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,750.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,750.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,345.62
|
| Rate for Payer: United Healthcare All Other HMO |
$2,283.12
|
| Rate for Payer: United Healthcare HMO Rider |
$2,233.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,046.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,312.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,312.50
|
| Rate for Payer: Vantage Medical Group Senior |
$5,312.50
|
|
|
HC STENT FLAIR
|
Facility
|
IP
|
$6,250.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020120
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,250.00 |
| Max. Negotiated Rate |
$5,625.00 |
| Rate for Payer: Adventist Health Commercial |
$1,250.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,012.50
|
| Rate for Payer: Blue Shield of California EPN |
$3,150.00
|
| Rate for Payer: Cash Price |
$2,812.50
|
| Rate for Payer: Central Health Plan Commercial |
$5,000.00
|
| Rate for Payer: Cigna of CA HMO |
$4,375.00
|
| Rate for Payer: Cigna of CA PPO |
$4,375.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,375.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,500.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,500.00
|
| Rate for Payer: Galaxy Health WC |
$5,312.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,750.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,625.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,968.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,687.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,250.00
|
| Rate for Payer: Multiplan Commercial |
$4,687.50
|
| Rate for Payer: Networks By Design Commercial |
$3,125.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,312.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,345.62
|
| Rate for Payer: United Healthcare All Other HMO |
$2,283.12
|
| Rate for Payer: United Healthcare HMO Rider |
$2,233.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,046.88
|
|
|
HC STENT GENESIS MOUNTED
|
Facility
|
IP
|
$3,900.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020089
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,510.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,127.80
|
| Rate for Payer: Blue Shield of California EPN |
$1,965.60
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.00
|
| 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: Health Management Network EPO/PPO |
$3,510.00
|
| 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 |
$780.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: Networks By Design Commercial |
$1,950.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,463.67
|
| Rate for Payer: United Healthcare All Other HMO |
$1,424.67
|
| Rate for Payer: United Healthcare HMO Rider |
$1,393.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,277.25
|
|
|
HC STENT GENESIS MOUNTED
|
Facility
|
OP
|
$3,900.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020089
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,510.00 |
| 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 Exchange |
$1,780.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,138.76
|
| Rate for Payer: Blue Shield of California Commercial |
$3,127.80
|
| Rate for Payer: Blue Shield of California EPN |
$1,965.60
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.00
|
| 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: Health Management Network EPO/PPO |
$3,510.00
|
| 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 |
$780.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,730.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: Networks By Design Commercial |
$1,950.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| Rate for Payer: Riverside University Health System MISP |
$1,560.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,340.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,340.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,463.67
|
| Rate for Payer: United Healthcare All Other HMO |
$1,424.67
|
| Rate for Payer: United Healthcare HMO Rider |
$1,393.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,277.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,315.00
|
|
|
HC STENT GENESIS UNMOUNTED
|
Facility
|
IP
|
$3,900.00
|
|
|
Service Code
|
CPT C1877
|
| Hospital Charge Code |
909020090
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,510.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,127.80
|
| Rate for Payer: Blue Shield of California EPN |
$1,965.60
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.00
|
| 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: Health Management Network EPO/PPO |
$3,510.00
|
| 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 |
$780.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: Networks By Design Commercial |
$1,950.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,463.67
|
| Rate for Payer: United Healthcare All Other HMO |
$1,424.67
|
| Rate for Payer: United Healthcare HMO Rider |
$1,393.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,277.25
|
|
|
HC STENT GENESIS UNMOUNTED
|
Facility
|
OP
|
$3,900.00
|
|
|
Service Code
|
CPT C1877
|
| Hospital Charge Code |
909020090
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,510.00 |
| 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 Exchange |
$1,780.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,138.76
|
| Rate for Payer: Blue Shield of California Commercial |
$3,127.80
|
| Rate for Payer: Blue Shield of California EPN |
$1,965.60
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.00
|
| 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: Health Management Network EPO/PPO |
$3,510.00
|
| 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 |
$780.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,730.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: Networks By Design Commercial |
$1,950.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| Rate for Payer: Riverside University Health System MISP |
$1,560.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,340.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,340.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,463.67
|
| Rate for Payer: United Healthcare All Other HMO |
$1,424.67
|
| Rate for Payer: United Healthcare HMO Rider |
$1,393.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,277.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,315.00
|
|
|
HC STENT GENESIS XLG
|
Facility
|
OP
|
$4,500.00
|
|
|
Service Code
|
CPT C1877
|
| Hospital Charge Code |
909020091
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$900.00 |
| Max. Negotiated Rate |
$4,050.00 |
| Rate for Payer: Adventist Health Commercial |
$900.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,825.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,475.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,375.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,054.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,467.80
|
| Rate for Payer: Blue Shield of California Commercial |
$3,609.00
|
| Rate for Payer: Blue Shield of California EPN |
$2,268.00
|
| Rate for Payer: Cash Price |
$2,025.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,600.00
|
| Rate for Payer: Cigna of CA HMO |
$3,150.00
|
| Rate for Payer: Cigna of CA PPO |
$3,150.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,825.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,825.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,825.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,150.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,800.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,800.00
|
| Rate for Payer: Galaxy Health WC |
$3,825.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,700.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,050.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,857.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,633.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,655.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$900.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,150.00
|
| Rate for Payer: Multiplan Commercial |
$3,375.00
|
| Rate for Payer: Networks By Design Commercial |
$2,250.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,825.00
|
| Rate for Payer: Riverside University Health System MISP |
$1,800.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,700.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,700.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,688.85
|
| Rate for Payer: United Healthcare All Other HMO |
$1,643.85
|
| Rate for Payer: United Healthcare HMO Rider |
$1,608.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,473.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,825.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,825.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,825.00
|
|
|
HC STENT GENESIS XLG
|
Facility
|
IP
|
$4,500.00
|
|
|
Service Code
|
CPT C1877
|
| Hospital Charge Code |
909020091
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$900.00 |
| Max. Negotiated Rate |
$4,050.00 |
| Rate for Payer: Adventist Health Commercial |
$900.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,609.00
|
| Rate for Payer: Blue Shield of California EPN |
$2,268.00
|
| Rate for Payer: Cash Price |
$2,025.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,600.00
|
| Rate for Payer: Cigna of CA HMO |
$3,150.00
|
| Rate for Payer: Cigna of CA PPO |
$3,150.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,150.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,800.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,800.00
|
| Rate for Payer: Galaxy Health WC |
$3,825.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,700.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,050.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,857.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,655.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$900.00
|
| Rate for Payer: Multiplan Commercial |
$3,375.00
|
| Rate for Payer: Networks By Design Commercial |
$2,250.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,825.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,688.85
|
| Rate for Payer: United Healthcare All Other HMO |
$1,643.85
|
| Rate for Payer: United Healthcare HMO Rider |
$1,608.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,473.75
|
|
|
HC STENT ILIAC
|
Facility
|
IP
|
$20,570.00
|
|
|
Service Code
|
CPT 37221
|
| Hospital Charge Code |
909020062
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,114.00 |
| Max. Negotiated Rate |
$18,513.00 |
| Rate for Payer: Adventist Health Commercial |
$4,114.00
|
| Rate for Payer: Cash Price |
$9,256.50
|
| Rate for Payer: Central Health Plan Commercial |
$16,456.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14,399.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,228.00
|
| Rate for Payer: EPIC Health Plan Senior |
$8,228.00
|
| Rate for Payer: Galaxy Health WC |
$17,484.50
|
| Rate for Payer: Global Benefits Group Commercial |
$12,342.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$18,513.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13,061.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12,136.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,114.00
|
| Rate for Payer: Multiplan Commercial |
$15,427.50
|
| Rate for Payer: Networks By Design Commercial |
$13,370.50
|
| Rate for Payer: Prime Health Services Commercial |
$17,484.50
|
|
|
HC STENT ILIAC
|
Facility
|
OP
|
$20,570.00
|
|
|
Service Code
|
CPT 37221
|
| Hospital Charge Code |
909020062
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,914.40 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$4,114.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17,484.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11,313.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15,427.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,924.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$22,958.69
|
| Rate for Payer: Blue Shield of California Commercial |
$6,228.07
|
| Rate for Payer: Blue Shield of California EPN |
$3,914.40
|
| Rate for Payer: Cash Price |
$9,256.50
|
| Rate for Payer: Cash Price |
$9,256.50
|
| Rate for Payer: Cash Price |
$9,256.50
|
| Rate for Payer: Central Health Plan Commercial |
$16,456.00
|
| Rate for Payer: Cigna of CA HMO |
$13,164.80
|
| Rate for Payer: Cigna of CA PPO |
$15,221.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17,484.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$17,484.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17,484.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14,399.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,228.00
|
| Rate for Payer: EPIC Health Plan Senior |
$8,228.00
|
| Rate for Payer: Galaxy Health WC |
$17,484.50
|
| Rate for Payer: Global Benefits Group Commercial |
$12,342.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$18,513.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13,061.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7,466.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12,136.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,114.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$14,399.00
|
| Rate for Payer: Multiplan Commercial |
$15,427.50
|
| Rate for Payer: Multiplan WC |
$22,958.69
|
| Rate for Payer: Networks By Design Commercial |
$13,370.50
|
| Rate for Payer: Preferred Health Network WC |
$23,427.23
|
| Rate for Payer: Prime Health Services Commercial |
$17,484.50
|
| Rate for Payer: Prime Health Services WC |
$22,724.41
|
| Rate for Payer: Riverside University Health System MISP |
$8,228.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12,342.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,285.00
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17,484.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17,484.50
|
| Rate for Payer: Vantage Medical Group Senior |
$17,484.50
|
|
|
HC STENT ILIAC EA ADDL
|
Facility
|
IP
|
$12,366.00
|
|
|
Service Code
|
CPT 37223
|
| Hospital Charge Code |
909020064
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,473.20 |
| Max. Negotiated Rate |
$11,129.40 |
| Rate for Payer: Adventist Health Commercial |
$2,473.20
|
| Rate for Payer: Cash Price |
$5,564.70
|
| Rate for Payer: Central Health Plan Commercial |
$9,892.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,656.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,946.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,946.40
|
| Rate for Payer: Galaxy Health WC |
$10,511.10
|
| Rate for Payer: Global Benefits Group Commercial |
$7,419.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,129.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,852.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,295.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,473.20
|
| Rate for Payer: Multiplan Commercial |
$9,274.50
|
| Rate for Payer: Networks By Design Commercial |
$8,037.90
|
| Rate for Payer: Prime Health Services Commercial |
$10,511.10
|
|
|
HC STENT ILIAC EA ADDL
|
Facility
|
OP
|
$12,366.00
|
|
|
Service Code
|
CPT 37223
|
| Hospital Charge Code |
909020064
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,473.20 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$2,473.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,511.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,801.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,274.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,228.07
|
| Rate for Payer: Blue Shield of California EPN |
$3,914.40
|
| Rate for Payer: Cash Price |
$5,564.70
|
| Rate for Payer: Cash Price |
$5,564.70
|
| Rate for Payer: Central Health Plan Commercial |
$9,892.80
|
| Rate for Payer: Cigna of CA HMO |
$7,914.24
|
| Rate for Payer: Cigna of CA PPO |
$9,150.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,511.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,511.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,511.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,656.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,946.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,946.40
|
| Rate for Payer: Galaxy Health WC |
$10,511.10
|
| Rate for Payer: Global Benefits Group Commercial |
$7,419.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,129.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,852.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,488.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,295.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,473.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8,656.20
|
| Rate for Payer: Multiplan Commercial |
$9,274.50
|
| Rate for Payer: Networks By Design Commercial |
$8,037.90
|
| Rate for Payer: Prime Health Services Commercial |
$10,511.10
|
| Rate for Payer: Riverside University Health System MISP |
$4,946.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,419.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,183.00
|
| 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 |
$10,511.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,511.10
|
| Rate for Payer: Vantage Medical Group Senior |
$10,511.10
|
|
|
HC STENT INSERTION INDWELLING DBL
|
Facility
|
OP
|
$13,506.00
|
|
|
Service Code
|
CPT 52332
|
| Hospital Charge Code |
909020042
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$947.08 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$2,701.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,533.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,800.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,987.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,533.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,982.34
|
| Rate for Payer: Blue Shield of California Commercial |
$4,407.11
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$6,077.70
|
| Rate for Payer: Cash Price |
$6,077.70
|
| Rate for Payer: Cash Price |
$6,077.70
|
| Rate for Payer: Central Health Plan Commercial |
$10,804.80
|
| Rate for Payer: Cigna of CA HMO |
$8,643.84
|
| Rate for Payer: Cigna of CA PPO |
$9,994.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,800.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,987.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,533.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,454.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,480.62
|
| Rate for Payer: EPIC Health Plan Senior |
$4,987.08
|
| Rate for Payer: Galaxy Health WC |
$11,480.10
|
| Rate for Payer: Global Benefits Group Commercial |
$8,103.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,155.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,435.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$947.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,533.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,576.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,046.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,347.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,701.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,075.17
|
| Rate for Payer: Multiplan Commercial |
$10,129.50
|
| Rate for Payer: Multiplan WC |
$6,982.34
|
| Rate for Payer: Networks By Design Commercial |
$8,778.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,533.71
|
| Rate for Payer: Preferred Health Network WC |
$7,124.84
|
| Rate for Payer: Prime Health Services Commercial |
$11,480.10
|
| Rate for Payer: Prime Health Services Medicare |
$4,805.73
|
| Rate for Payer: Prime Health Services WC |
$6,911.09
|
| Rate for Payer: Riverside University Health System MISP |
$4,987.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,103.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,753.00
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,533.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,800.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,987.08
|
| Rate for Payer: Vantage Medical Group Senior |
$4,533.71
|
|
|
HC STENT INSERTION INDWELLING DBL
|
Facility
|
IP
|
$13,506.00
|
|
|
Service Code
|
CPT 52332
|
| Hospital Charge Code |
909020042
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,701.20 |
| Max. Negotiated Rate |
$12,155.40 |
| Rate for Payer: Adventist Health Commercial |
$2,701.20
|
| Rate for Payer: Cash Price |
$6,077.70
|
| Rate for Payer: Central Health Plan Commercial |
$10,804.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,454.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,402.40
|
| Rate for Payer: EPIC Health Plan Senior |
$5,402.40
|
| Rate for Payer: Galaxy Health WC |
$11,480.10
|
| Rate for Payer: Global Benefits Group Commercial |
$8,103.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,155.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,576.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,968.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,701.20
|
| Rate for Payer: Multiplan Commercial |
$10,129.50
|
| Rate for Payer: Networks By Design Commercial |
$8,778.90
|
| Rate for Payer: Prime Health Services Commercial |
$11,480.10
|
|
|
HC STENT INTRACRAN ATHERO STENOSI
|
Facility
|
IP
|
$11,708.00
|
|
|
Service Code
|
CPT 61635
|
| Hospital Charge Code |
909081014
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,341.60 |
| Max. Negotiated Rate |
$10,537.20 |
| Rate for Payer: Adventist Health Commercial |
$2,341.60
|
| Rate for Payer: Cash Price |
$5,268.60
|
| Rate for Payer: Central Health Plan Commercial |
$9,366.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,195.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,683.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,683.20
|
| Rate for Payer: Galaxy Health WC |
$9,951.80
|
| Rate for Payer: Global Benefits Group Commercial |
$7,024.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,537.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,434.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,907.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,341.60
|
| Rate for Payer: Multiplan Commercial |
$8,781.00
|
| Rate for Payer: Networks By Design Commercial |
$7,610.20
|
| Rate for Payer: Prime Health Services Commercial |
$9,951.80
|
|
|
HC STENT INTRACRAN ATHERO STENOSI
|
Facility
|
OP
|
$11,708.00
|
|
|
Service Code
|
CPT 61635
|
| Hospital Charge Code |
909081014
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,341.60 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$2,341.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,951.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,439.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,781.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,924.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$5,268.60
|
| Rate for Payer: Cash Price |
$5,268.60
|
| Rate for Payer: Central Health Plan Commercial |
$9,366.40
|
| Rate for Payer: Cigna of CA HMO |
$7,493.12
|
| Rate for Payer: Cigna of CA PPO |
$8,663.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,951.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,951.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,951.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,195.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,683.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,683.20
|
| Rate for Payer: Galaxy Health WC |
$9,951.80
|
| Rate for Payer: Global Benefits Group Commercial |
$7,024.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,537.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,434.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,907.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,341.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8,195.60
|
| Rate for Payer: Multiplan Commercial |
$8,781.00
|
| Rate for Payer: Networks By Design Commercial |
$7,610.20
|
| Rate for Payer: Prime Health Services Commercial |
$9,951.80
|
| Rate for Payer: Riverside University Health System MISP |
$4,683.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,024.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,854.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,951.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,951.80
|
| Rate for Payer: Vantage Medical Group Senior |
$9,951.80
|
|
|
HC STENT LIFE
|
Facility
|
IP
|
$2,828.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909000008
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$565.60 |
| Max. Negotiated Rate |
$2,545.20 |
| Rate for Payer: Adventist Health Commercial |
$565.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,268.06
|
| Rate for Payer: Blue Shield of California EPN |
$1,425.31
|
| Rate for Payer: Cash Price |
$1,272.60
|
| Rate for Payer: Central Health Plan Commercial |
$2,262.40
|
| Rate for Payer: Cigna of CA HMO |
$1,979.60
|
| Rate for Payer: Cigna of CA PPO |
$1,979.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,979.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,131.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,131.20
|
| Rate for Payer: Galaxy Health WC |
$2,403.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,696.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,545.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,795.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,668.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$565.60
|
| Rate for Payer: Multiplan Commercial |
$2,121.00
|
| Rate for Payer: Networks By Design Commercial |
$1,414.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,403.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,061.35
|
| Rate for Payer: United Healthcare All Other HMO |
$1,033.07
|
| Rate for Payer: United Healthcare HMO Rider |
$1,010.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$926.17
|
|
|
HC STENT LIFE
|
Facility
|
OP
|
$2,828.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909000008
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$565.60 |
| Max. Negotiated Rate |
$2,545.20 |
| Rate for Payer: Adventist Health Commercial |
$565.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,403.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,555.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,121.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,291.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,550.88
|
| Rate for Payer: Blue Shield of California Commercial |
$2,268.06
|
| Rate for Payer: Blue Shield of California EPN |
$1,425.31
|
| Rate for Payer: Cash Price |
$1,272.60
|
| Rate for Payer: Central Health Plan Commercial |
$2,262.40
|
| Rate for Payer: Cigna of CA HMO |
$1,979.60
|
| Rate for Payer: Cigna of CA PPO |
$1,979.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,403.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,403.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,403.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,979.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,131.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,131.20
|
| Rate for Payer: Galaxy Health WC |
$2,403.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,696.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,545.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,795.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,026.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,668.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$565.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,979.60
|
| Rate for Payer: Multiplan Commercial |
$2,121.00
|
| Rate for Payer: Networks By Design Commercial |
$1,414.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,403.80
|
| Rate for Payer: Riverside University Health System MISP |
$1,131.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,696.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,696.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,061.35
|
| Rate for Payer: United Healthcare All Other HMO |
$1,033.07
|
| Rate for Payer: United Healthcare HMO Rider |
$1,010.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$926.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,403.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,403.80
|
| Rate for Payer: Vantage Medical Group Senior |
$2,403.80
|
|
|
HC STENT LVIS
|
Facility
|
OP
|
$20,313.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909001876
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,062.60 |
| Max. Negotiated Rate |
$18,281.70 |
| Rate for Payer: Adventist Health Commercial |
$4,062.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17,266.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11,172.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15,234.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9,274.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,139.65
|
| Rate for Payer: Blue Shield of California Commercial |
$16,291.03
|
| Rate for Payer: Blue Shield of California EPN |
$10,237.75
|
| Rate for Payer: Cash Price |
$9,140.85
|
| Rate for Payer: Central Health Plan Commercial |
$16,250.40
|
| Rate for Payer: Cigna of CA HMO |
$14,219.10
|
| Rate for Payer: Cigna of CA PPO |
$14,219.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17,266.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$17,266.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17,266.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14,219.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,125.20
|
| Rate for Payer: EPIC Health Plan Senior |
$8,125.20
|
| Rate for Payer: Galaxy Health WC |
$17,266.05
|
| Rate for Payer: Global Benefits Group Commercial |
$12,187.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$18,281.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12,898.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7,373.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11,984.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,062.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$14,219.10
|
| Rate for Payer: Multiplan Commercial |
$15,234.75
|
| Rate for Payer: Networks By Design Commercial |
$10,156.50
|
| Rate for Payer: Prime Health Services Commercial |
$17,266.05
|
| Rate for Payer: Riverside University Health System MISP |
$8,125.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12,187.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12,187.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,623.47
|
| Rate for Payer: United Healthcare All Other HMO |
$7,420.34
|
| Rate for Payer: United Healthcare HMO Rider |
$7,259.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,652.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17,266.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17,266.05
|
| Rate for Payer: Vantage Medical Group Senior |
$17,266.05
|
|
