|
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: Aetna of CA HMO/PPO |
$1,086.63
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,145.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,145.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,780.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,172.30
|
| Rate for Payer: BCBS Transplant Transplant |
$2,340.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,925.00
|
| Rate for Payer: Blue Shield of California EPN |
$2,121.60
|
| Rate for Payer: Cash Price |
$1,755.00
|
| 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: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$2,925.00
|
| Rate for Payer: IEHP medi-cal |
$1,365.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| 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: Riverside University Health 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 |
$1,950.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,950.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,950.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,950.00
|
| 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: Blue Shield of California EPN |
$2,082.60
|
| 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: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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 Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$780.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
|
|
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: Blue Shield of California EPN |
$2,403.00
|
| 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: EPIC Health Plan Commercial |
$1,800.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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 Permanente of CA Commercial/Self Funded |
$3,001.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$900.00
|
| Rate for Payer: Multiplan Commercial |
$3,375.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,825.00
|
|
|
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: Aetna of CA HMO/PPO |
$1,086.63
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,825.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,475.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,475.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,054.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,506.50
|
| Rate for Payer: BCBS Transplant Transplant |
$2,700.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,375.00
|
| Rate for Payer: Blue Shield of California EPN |
$2,448.00
|
| Rate for Payer: Cash Price |
$2,025.00
|
| 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: EPIC Health Plan Commercial |
$1,800.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$3,375.00
|
| Rate for Payer: IEHP medi-cal |
$1,575.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,001.50
|
| 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: Riverside University Health 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 |
$2,250.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,250.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,250.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,250.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,825.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,825.00
|
|
|
HC STENT ILIAC
|
Facility
IP
|
$25,474.00
|
|
|
Service Code
|
CPT 37221
|
| Hospital Charge Code |
906820145
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,094.80 |
| Max. Negotiated Rate |
$22,926.60 |
| Rate for Payer: Cash Price |
$11,463.30
|
| Rate for Payer: Central Health Plan Commercial |
$20,379.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,189.60
|
| Rate for Payer: Galaxy Health WC |
$21,652.90
|
| Rate for Payer: Global Benefits Group Commercial |
$15,284.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$22,926.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,991.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,094.80
|
| Rate for Payer: Multiplan Commercial |
$19,105.50
|
| Rate for Payer: Networks By Design Commercial |
$16,558.10
|
| Rate for Payer: Prime Health Services Commercial |
$21,652.90
|
|
|
HC STENT ILIAC
|
Facility
OP
|
$25,474.00
|
|
|
Service Code
|
CPT 37221
|
| Hospital Charge Code |
906820145
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,183.44 |
| Max. Negotiated Rate |
$48,045.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$13,745.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$20,617.83
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$15,119.74
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13,745.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,830.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$18,791.68
|
| Rate for Payer: BCBS Transplant Transplant |
$15,284.40
|
| Rate for Payer: Blue Shield of California Commercial |
$5,824.53
|
| Rate for Payer: Blue Shield of California EPN |
$4,183.44
|
| Rate for Payer: Caremore Medicare Advantage |
$13,745.22
|
| Rate for Payer: Cash Price |
$11,463.30
|
| Rate for Payer: Cash Price |
$11,463.30
|
| Rate for Payer: Central Health Plan Commercial |
$20,379.20
|
| Rate for Payer: Cigna of CA PPO |
$18,850.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20,617.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,556.05
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$13,745.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$13,745.22
|
| Rate for Payer: Galaxy Health WC |
$21,652.90
|
| Rate for Payer: Global Benefits Group Commercial |
$15,284.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$22,926.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$19,105.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22,542.16
|
| Rate for Payer: IEHP medi-cal |
$22,679.61
|
| Rate for Payer: IEHP Medicare Advantage |
$13,745.22
|
| Rate for Payer: Innovage PACE Commercial |
$20,617.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,991.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,745.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,094.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,418.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18,418.59
|
| Rate for Payer: Multiplan Commercial |
$19,105.50
|
| Rate for Payer: Multiplan WC |
$18,791.68
|
| Rate for Payer: Networks By Design Commercial |
$16,558.10
|
| Rate for Payer: Preferred Health Network WC |
$19,175.18
|
| Rate for Payer: Prime Health Services Commercial |
$21,652.90
|
| Rate for Payer: Prime Health Services Medicare |
$14,569.93
|
| Rate for Payer: Prime Health Services WC |
$18,599.92
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$15,284.40
|
| Rate for Payer: Riverside University Health MISP |
$15,119.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15,284.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$29,673.00
|
| Rate for Payer: United Healthcare All Other HMO |
$48,045.00
|
| Rate for Payer: United Healthcare HMO Rider |
$31,101.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28,895.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,119.74
|
| Rate for Payer: Vantage Medical Group Senior |
$13,745.22
|
|
|
HC STENT ILIAC
|
Facility
IP
|
$25,474.00
|
|
|
Service Code
|
CPT 37221
|
| Hospital Charge Code |
909020062
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,094.80 |
| Max. Negotiated Rate |
$22,926.60 |
| Rate for Payer: Cash Price |
$11,463.30
|
| Rate for Payer: Central Health Plan Commercial |
$20,379.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,189.60
|
| Rate for Payer: Galaxy Health WC |
$21,652.90
|
| Rate for Payer: Global Benefits Group Commercial |
$15,284.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$22,926.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,991.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,094.80
|
| Rate for Payer: Multiplan Commercial |
$19,105.50
|
| Rate for Payer: Networks By Design Commercial |
$16,558.10
|
| Rate for Payer: Prime Health Services Commercial |
$21,652.90
|
|
|
HC STENT ILIAC
|
Facility
OP
|
$25,474.00
|
|
|
Service Code
|
CPT 37221
|
| Hospital Charge Code |
909020062
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,183.44 |
| Max. Negotiated Rate |
$48,045.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$13,745.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$20,617.83
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$15,119.74
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13,745.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,830.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$18,791.68
|
| Rate for Payer: BCBS Transplant Transplant |
$15,284.40
|
| Rate for Payer: Blue Shield of California Commercial |
$5,824.53
|
| Rate for Payer: Blue Shield of California EPN |
$4,183.44
|
| Rate for Payer: Caremore Medicare Advantage |
$13,745.22
|
| Rate for Payer: Cash Price |
$11,463.30
|
| Rate for Payer: Cash Price |
$11,463.30
|
| Rate for Payer: Central Health Plan Commercial |
$20,379.20
|
| Rate for Payer: Cigna of CA PPO |
$18,850.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20,617.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,556.05
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$13,745.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$13,745.22
|
| Rate for Payer: Galaxy Health WC |
$21,652.90
|
| Rate for Payer: Global Benefits Group Commercial |
$15,284.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$22,926.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$19,105.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22,542.16
|
| Rate for Payer: IEHP medi-cal |
$22,679.61
|
| Rate for Payer: IEHP Medicare Advantage |
$13,745.22
|
| Rate for Payer: Innovage PACE Commercial |
$20,617.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,991.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,745.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,094.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,418.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18,418.59
|
| Rate for Payer: Multiplan Commercial |
$19,105.50
|
| Rate for Payer: Multiplan WC |
$18,791.68
|
| Rate for Payer: Networks By Design Commercial |
$16,558.10
|
| Rate for Payer: Preferred Health Network WC |
$19,175.18
|
| Rate for Payer: Prime Health Services Commercial |
$21,652.90
|
| Rate for Payer: Prime Health Services Medicare |
$14,569.93
|
| Rate for Payer: Prime Health Services WC |
$18,599.92
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$15,284.40
|
| Rate for Payer: Riverside University Health MISP |
$15,119.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15,284.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$29,673.00
|
| Rate for Payer: United Healthcare All Other HMO |
$48,045.00
|
| Rate for Payer: United Healthcare HMO Rider |
$31,101.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28,895.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,119.74
|
| Rate for Payer: Vantage Medical Group Senior |
$13,745.22
|
|
|
HC STENT ILIAC EA ADDL
|
Facility
OP
|
$15,314.00
|
|
|
Service Code
|
CPT 37223
|
| Hospital Charge Code |
906820147
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,901.00 |
| Max. Negotiated Rate |
$27,445.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$13,016.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8,422.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8,422.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: BCBS Transplant Transplant |
$9,188.40
|
| Rate for Payer: Blue Shield of California Commercial |
$5,824.53
|
| Rate for Payer: Blue Shield of California EPN |
$4,183.44
|
| Rate for Payer: Cash Price |
$6,891.30
|
| Rate for Payer: Cash Price |
$6,891.30
|
| Rate for Payer: Central Health Plan Commercial |
$12,251.20
|
| Rate for Payer: Cigna of CA PPO |
$11,332.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,016.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,125.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$6,125.60
|
| Rate for Payer: Galaxy Health WC |
$13,016.90
|
| Rate for Payer: Global Benefits Group Commercial |
$9,188.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,782.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$11,485.50
|
| Rate for Payer: IEHP medi-cal |
$5,359.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,214.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,062.80
|
| Rate for Payer: Multiplan Commercial |
$11,485.50
|
| Rate for Payer: Networks By Design Commercial |
$9,954.10
|
| Rate for Payer: Prime Health Services Commercial |
$13,016.90
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$9,188.40
|
| Rate for Payer: Riverside University Health MISP |
$6,125.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,188.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$16,813.00
|
| Rate for Payer: United Healthcare All Other HMO |
$27,445.00
|
| Rate for Payer: United Healthcare HMO Rider |
$17,214.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,742.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13,016.90
|
| Rate for Payer: Vantage Medical Group Senior |
$13,016.90
|
|
|
HC STENT ILIAC EA ADDL
|
Facility
IP
|
$15,314.00
|
|
|
Service Code
|
CPT 37223
|
| Hospital Charge Code |
909020064
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,062.80 |
| Max. Negotiated Rate |
$13,782.60 |
| Rate for Payer: Cash Price |
$6,891.30
|
| Rate for Payer: Central Health Plan Commercial |
$12,251.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,125.60
|
| Rate for Payer: Galaxy Health WC |
$13,016.90
|
| Rate for Payer: Global Benefits Group Commercial |
$9,188.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,782.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,214.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,062.80
|
| Rate for Payer: Multiplan Commercial |
$11,485.50
|
| Rate for Payer: Networks By Design Commercial |
$9,954.10
|
| Rate for Payer: Prime Health Services Commercial |
$13,016.90
|
|
|
HC STENT ILIAC EA ADDL
|
Facility
OP
|
$15,314.00
|
|
|
Service Code
|
CPT 37223
|
| Hospital Charge Code |
909020064
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,901.00 |
| Max. Negotiated Rate |
$27,445.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$13,016.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8,422.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8,422.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: BCBS Transplant Transplant |
$9,188.40
|
| Rate for Payer: Blue Shield of California Commercial |
$5,824.53
|
| Rate for Payer: Blue Shield of California EPN |
$4,183.44
|
| Rate for Payer: Cash Price |
$6,891.30
|
| Rate for Payer: Cash Price |
$6,891.30
|
| Rate for Payer: Central Health Plan Commercial |
$12,251.20
|
| Rate for Payer: Cigna of CA PPO |
$11,332.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,016.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,125.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$6,125.60
|
| Rate for Payer: Galaxy Health WC |
$13,016.90
|
| Rate for Payer: Global Benefits Group Commercial |
$9,188.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,782.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$11,485.50
|
| Rate for Payer: IEHP medi-cal |
$5,359.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,214.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,062.80
|
| Rate for Payer: Multiplan Commercial |
$11,485.50
|
| Rate for Payer: Networks By Design Commercial |
$9,954.10
|
| Rate for Payer: Prime Health Services Commercial |
$13,016.90
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$9,188.40
|
| Rate for Payer: Riverside University Health MISP |
$6,125.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,188.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$16,813.00
|
| Rate for Payer: United Healthcare All Other HMO |
$27,445.00
|
| Rate for Payer: United Healthcare HMO Rider |
$17,214.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,742.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13,016.90
|
| Rate for Payer: Vantage Medical Group Senior |
$13,016.90
|
|
|
HC STENT ILIAC EA ADDL
|
Facility
IP
|
$15,314.00
|
|
|
Service Code
|
CPT 37223
|
| Hospital Charge Code |
906820147
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,062.80 |
| Max. Negotiated Rate |
$13,782.60 |
| Rate for Payer: Cash Price |
$6,891.30
|
| Rate for Payer: Central Health Plan Commercial |
$12,251.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,125.60
|
| Rate for Payer: Galaxy Health WC |
$13,016.90
|
| Rate for Payer: Global Benefits Group Commercial |
$9,188.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,782.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,214.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,062.80
|
| Rate for Payer: Multiplan Commercial |
$11,485.50
|
| Rate for Payer: Networks By Design Commercial |
$9,954.10
|
| Rate for Payer: Prime Health Services Commercial |
$13,016.90
|
|
|
HC STENT INSERTION INDWELLING DBL
|
Facility
OP
|
$11,468.00
|
|
|
Service Code
|
CPT 52332
|
| Hospital Charge Code |
909020042
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,293.60 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,355.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,533.58
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,791.29
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,355.72
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: BCBS Transplant Transplant |
$6,880.80
|
| Rate for Payer: Blue Shield of California Commercial |
$4,121.55
|
| Rate for Payer: Blue Shield of California EPN |
$2,960.28
|
| Rate for Payer: Caremore Medicare Advantage |
$4,355.72
|
| Rate for Payer: Cash Price |
$5,160.60
|
| Rate for Payer: Cash Price |
$5,160.60
|
| Rate for Payer: Central Health Plan Commercial |
$9,174.40
|
| Rate for Payer: Cigna of CA PPO |
$8,486.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,533.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,880.22
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,355.72
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,355.72
|
| Rate for Payer: Galaxy Health WC |
$9,747.80
|
| Rate for Payer: Global Benefits Group Commercial |
$6,880.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,321.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$8,601.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,143.38
|
| Rate for Payer: IEHP medi-cal |
$7,186.94
|
| Rate for Payer: IEHP Medicare Advantage |
$4,355.72
|
| Rate for Payer: Innovage PACE Commercial |
$6,533.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,649.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,355.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,293.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,836.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,836.66
|
| Rate for Payer: Multiplan Commercial |
$8,601.00
|
| Rate for Payer: Networks By Design Commercial |
$7,454.20
|
| Rate for Payer: Prime Health Services Commercial |
$9,747.80
|
| Rate for Payer: Prime Health Services Medicare |
$4,617.06
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$6,880.80
|
| Rate for Payer: Riverside University Health MISP |
$4,791.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,880.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15,354.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,681.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,852.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,533.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,791.29
|
| Rate for Payer: Vantage Medical Group Senior |
$4,355.72
|
|
|
HC STENT INSERTION INDWELLING DBL
|
Facility
IP
|
$11,468.00
|
|
|
Service Code
|
CPT 52332
|
| Hospital Charge Code |
909020042
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,293.60 |
| Max. Negotiated Rate |
$10,321.20 |
| Rate for Payer: Cash Price |
$5,160.60
|
| Rate for Payer: Central Health Plan Commercial |
$9,174.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,587.20
|
| Rate for Payer: Galaxy Health WC |
$9,747.80
|
| Rate for Payer: Global Benefits Group Commercial |
$6,880.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,321.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,649.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,293.60
|
| Rate for Payer: Multiplan Commercial |
$8,601.00
|
| Rate for Payer: Networks By Design Commercial |
$7,454.20
|
| Rate for Payer: Prime Health Services Commercial |
$9,747.80
|
|
|
HC STENT INTRACRAN ATHERO STENOSI
|
Facility
IP
|
$8,853.00
|
|
|
Service Code
|
CPT 61635
|
| Hospital Charge Code |
909081014
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,770.60 |
| Max. Negotiated Rate |
$7,967.70 |
| Rate for Payer: Cash Price |
$3,983.85
|
| Rate for Payer: Central Health Plan Commercial |
$7,082.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,541.20
|
| Rate for Payer: Galaxy Health WC |
$7,525.05
|
| Rate for Payer: Global Benefits Group Commercial |
$5,311.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,967.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,904.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,770.60
|
| Rate for Payer: Multiplan Commercial |
$6,639.75
|
| Rate for Payer: Networks By Design Commercial |
$5,754.45
|
| Rate for Payer: Prime Health Services Commercial |
$7,525.05
|
|
|
HC STENT INTRACRAN ATHERO STENOSI
|
Facility
OP
|
$8,853.00
|
|
|
Service Code
|
CPT 61635
|
| Hospital Charge Code |
909081014
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,770.60 |
| Max. Negotiated Rate |
$7,967.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,244.61
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7,525.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,869.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,869.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,830.00
|
| Rate for Payer: BCBS Transplant Transplant |
$5,311.80
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$3,983.85
|
| Rate for Payer: Cash Price |
$3,983.85
|
| Rate for Payer: Cash Price |
$3,983.85
|
| Rate for Payer: Central Health Plan Commercial |
$7,082.40
|
| Rate for Payer: Cigna of CA PPO |
$6,551.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,525.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,541.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,541.20
|
| Rate for Payer: Galaxy Health WC |
$7,525.05
|
| Rate for Payer: Global Benefits Group Commercial |
$5,311.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,967.70
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6,639.75
|
| Rate for Payer: IEHP medi-cal |
$3,098.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,904.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,770.60
|
| Rate for Payer: Multiplan Commercial |
$6,639.75
|
| Rate for Payer: Networks By Design Commercial |
$5,754.45
|
| Rate for Payer: Prime Health Services Commercial |
$7,525.05
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$5,311.80
|
| Rate for Payer: Riverside University Health MISP |
$3,541.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,311.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,525.05
|
| Rate for Payer: Vantage Medical Group Senior |
$7,525.05
|
|
|
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: Blue Shield of California EPN |
$1,510.15
|
| 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: EPIC Health Plan Commercial |
$1,131.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$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 Permanente of CA Commercial/Self Funded |
$1,886.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$565.60
|
| Rate for Payer: Multiplan Commercial |
$2,121.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,403.80
|
|
|
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 |
$8,941.56 |
| Rate for Payer: Aetna of CA HMO/PPO |
$8,941.56
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,403.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,555.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,555.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,291.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,575.20
|
| Rate for Payer: BCBS Transplant Transplant |
$1,696.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2,121.00
|
| Rate for Payer: Blue Shield of California EPN |
$1,538.43
|
| Rate for Payer: Cash Price |
$1,272.60
|
| 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: EPIC Health Plan Commercial |
$1,131.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$2,121.00
|
| Rate for Payer: IEHP medi-cal |
$989.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,886.28
|
| 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: Riverside University Health 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 |
$1,414.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,414.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,414.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,414.00
|
| 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: Aetna of CA HMO/PPO |
$8,941.56
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$17,266.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$11,172.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$11,172.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9,274.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,314.34
|
| Rate for Payer: BCBS Transplant Transplant |
$12,187.80
|
| Rate for Payer: Blue Shield of California Commercial |
$15,234.75
|
| Rate for Payer: Blue Shield of California EPN |
$11,050.27
|
| Rate for Payer: Cash Price |
$9,140.85
|
| 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: EPIC Health Plan Commercial |
$8,125.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$15,234.75
|
| Rate for Payer: IEHP medi-cal |
$7,109.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,548.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,062.60
|
| 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 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 |
$10,156.50
|
| Rate for Payer: United Healthcare All Other HMO |
$10,156.50
|
| Rate for Payer: United Healthcare HMO Rider |
$10,156.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10,156.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17,266.05
|
| Rate for Payer: Vantage Medical Group Senior |
$17,266.05
|
|
|
HC STENT LVIS
|
Facility
IP
|
$20,313.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909001876
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,062.60 |
| Max. Negotiated Rate |
$18,281.70 |
| Rate for Payer: Blue Shield of California EPN |
$10,847.14
|
| 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: EPIC Health Plan Commercial |
$8,125.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$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 Permanente of CA Commercial/Self Funded |
$13,548.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,062.60
|
| Rate for Payer: Multiplan Commercial |
$15,234.75
|
| Rate for Payer: Prime Health Services Commercial |
$17,266.05
|
|
|
HC STENT MEDTRONIC BALN EXPAND
|
Facility
IP
|
$3,900.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020115
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,510.00 |
| Rate for Payer: Blue Shield of California EPN |
$2,082.60
|
| 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: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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 Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$780.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
|
|
HC STENT MEDTRONIC BALN EXPAND
|
Facility
OP
|
$3,900.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020115
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$8,941.56 |
| Rate for Payer: Aetna of CA HMO/PPO |
$8,941.56
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,145.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,145.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,780.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,172.30
|
| Rate for Payer: BCBS Transplant Transplant |
$2,340.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,925.00
|
| Rate for Payer: Blue Shield of California EPN |
$2,121.60
|
| Rate for Payer: Cash Price |
$1,755.00
|
| 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: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$2,925.00
|
| Rate for Payer: IEHP medi-cal |
$1,365.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| 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: Riverside University Health 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 |
$1,950.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,950.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,950.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,950.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,315.00
|
|
|
HC STENT MEDTRONIC SE 12-150
|
Facility
IP
|
$3,900.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020114
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,510.00 |
| Rate for Payer: Blue Shield of California EPN |
$2,082.60
|
| 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: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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 Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$780.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
|
|
HC STENT MEDTRONIC SE 12-150
|
Facility
OP
|
$3,900.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020114
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$8,941.56 |
| Rate for Payer: Aetna of CA HMO/PPO |
$8,941.56
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,145.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,145.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,780.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,172.30
|
| Rate for Payer: BCBS Transplant Transplant |
$2,340.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,925.00
|
| Rate for Payer: Blue Shield of California EPN |
$2,121.60
|
| Rate for Payer: Cash Price |
$1,755.00
|
| 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: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$2,925.00
|
| Rate for Payer: IEHP medi-cal |
$1,365.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| 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: Riverside University Health 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 |
$1,950.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,950.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,950.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,950.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,315.00
|
|
|
HC STENT MEDTRONIC SE 40-100
|
Facility
IP
|
$3,900.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020113
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,510.00 |
| Rate for Payer: Blue Shield of California EPN |
$2,082.60
|
| 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: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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 Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$780.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
|
