|
HC STENT BILI 10FRX10CM
|
Facility
|
IP
|
$290.00
|
|
| Hospital Charge Code |
900100378
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$58.00 |
| Max. Negotiated Rate |
$261.00 |
| Rate for Payer: Adventist Health Commercial |
$58.00
|
| Rate for Payer: Cash Price |
$159.50
|
| Rate for Payer: Central Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$116.00
|
| Rate for Payer: EPIC Health Plan Senior |
$116.00
|
| Rate for Payer: Galaxy Health WC |
$246.50
|
| Rate for Payer: Global Benefits Group Commercial |
$174.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$261.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$193.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$110.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$179.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.00
|
| Rate for Payer: Multiplan Commercial |
$217.50
|
| Rate for Payer: Networks By Design Commercial |
$188.50
|
| Rate for Payer: Prime Health Services Commercial |
$246.50
|
|
|
HC STENT BILI 10FRX12CM
|
Facility
|
OP
|
$290.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
900100379
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$58.00 |
| Max. Negotiated Rate |
$261.00 |
| Rate for Payer: Adventist Health Commercial |
$58.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$176.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$246.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$159.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$217.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$140.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$170.32
|
| Rate for Payer: Blue Shield of California Commercial |
$177.19
|
| Rate for Payer: Blue Shield of California EPN |
$115.71
|
| Rate for Payer: Cash Price |
$159.50
|
| Rate for Payer: Central Health Plan Commercial |
$232.00
|
| Rate for Payer: Cigna of CA HMO |
$185.60
|
| Rate for Payer: Cigna of CA PPO |
$214.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$246.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$246.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$246.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$116.00
|
| Rate for Payer: EPIC Health Plan Senior |
$116.00
|
| Rate for Payer: Galaxy Health WC |
$246.50
|
| Rate for Payer: Global Benefits Group Commercial |
$174.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$261.00
|
| Rate for Payer: InnovAge PACE Commercial |
$145.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$193.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$110.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$179.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$203.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$203.00
|
| Rate for Payer: Multiplan Commercial |
$217.50
|
| Rate for Payer: Networks By Design Commercial |
$188.50
|
| Rate for Payer: Prime Health Services Commercial |
$246.50
|
| Rate for Payer: Riverside University Health System MISP |
$116.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$174.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$174.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$145.00
|
| Rate for Payer: United Healthcare All Other HMO |
$145.00
|
| Rate for Payer: United Healthcare HMO Rider |
$145.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$145.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$246.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$246.50
|
| Rate for Payer: Vantage Medical Group Senior |
$246.50
|
|
|
HC STENT BILI 10FRX12CM
|
Facility
|
IP
|
$290.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
900100379
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$58.00 |
| Max. Negotiated Rate |
$261.00 |
| Rate for Payer: Adventist Health Commercial |
$58.00
|
| Rate for Payer: Cash Price |
$159.50
|
| Rate for Payer: Central Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$116.00
|
| Rate for Payer: EPIC Health Plan Senior |
$116.00
|
| Rate for Payer: Galaxy Health WC |
$246.50
|
| Rate for Payer: Global Benefits Group Commercial |
$174.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$261.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$193.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$110.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$179.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.00
|
| Rate for Payer: Multiplan Commercial |
$217.50
|
| Rate for Payer: Networks By Design Commercial |
$188.50
|
| Rate for Payer: Prime Health Services Commercial |
$246.50
|
|
|
HC STENT BILI 10FRX5CM
|
Facility
|
OP
|
$290.00
|
|
| Hospital Charge Code |
900100377
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$58.00 |
| Max. Negotiated Rate |
$261.00 |
| Rate for Payer: Adventist Health Commercial |
$58.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$176.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$246.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$159.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$217.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$140.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$170.32
|
| Rate for Payer: Blue Shield of California Commercial |
$177.19
|
| Rate for Payer: Blue Shield of California EPN |
$115.71
|
| Rate for Payer: Cash Price |
$159.50
|
| Rate for Payer: Central Health Plan Commercial |
$232.00
|
| Rate for Payer: Cigna of CA HMO |
$185.60
|
| Rate for Payer: Cigna of CA PPO |
$214.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$246.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$246.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$246.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$116.00
|
| Rate for Payer: EPIC Health Plan Senior |
$116.00
|
| Rate for Payer: Galaxy Health WC |
$246.50
|
| Rate for Payer: Global Benefits Group Commercial |
$174.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$261.00
|
| Rate for Payer: InnovAge PACE Commercial |
$145.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$193.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$110.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$179.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$203.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$203.00
|
| Rate for Payer: Multiplan Commercial |
$217.50
|
| Rate for Payer: Networks By Design Commercial |
$188.50
|
| Rate for Payer: Prime Health Services Commercial |
$246.50
|
| Rate for Payer: Riverside University Health System MISP |
$116.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$174.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$174.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$145.00
|
| Rate for Payer: United Healthcare All Other HMO |
$145.00
|
| Rate for Payer: United Healthcare HMO Rider |
$145.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$145.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$246.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$246.50
|
| Rate for Payer: Vantage Medical Group Senior |
$246.50
|
|
|
HC STENT BILI 10FRX5CM
|
Facility
|
IP
|
$290.00
|
|
| Hospital Charge Code |
900100377
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$58.00 |
| Max. Negotiated Rate |
$261.00 |
| Rate for Payer: Adventist Health Commercial |
$58.00
|
| Rate for Payer: Cash Price |
$159.50
|
| Rate for Payer: Central Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$116.00
|
| Rate for Payer: EPIC Health Plan Senior |
$116.00
|
| Rate for Payer: Galaxy Health WC |
$246.50
|
| Rate for Payer: Global Benefits Group Commercial |
$174.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$261.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$193.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$110.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$179.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.00
|
| Rate for Payer: Multiplan Commercial |
$217.50
|
| Rate for Payer: Networks By Design Commercial |
$188.50
|
| Rate for Payer: Prime Health Services Commercial |
$246.50
|
|
|
HC STENTBILI 10MMX6CM 8.5FR UNCOVERED
|
Facility
|
OP
|
$4,125.00
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
900100384
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$825.00 |
| Max. Negotiated Rate |
$3,712.50 |
| Rate for Payer: Adventist Health Commercial |
$825.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,506.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,268.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,093.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,883.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,284.01
|
| Rate for Payer: Blue Shield of California Commercial |
$3,188.62
|
| Rate for Payer: Blue Shield of California EPN |
$2,079.00
|
| Rate for Payer: Cash Price |
$2,268.75
|
| Rate for Payer: Central Health Plan Commercial |
$3,300.00
|
| Rate for Payer: Cigna of CA HMO |
$2,887.50
|
| Rate for Payer: Cigna of CA PPO |
$2,887.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,506.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,506.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,506.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,650.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,650.00
|
| Rate for Payer: Galaxy Health WC |
$3,506.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,475.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,712.50
|
| Rate for Payer: InnovAge PACE Commercial |
$2,062.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,751.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,571.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,553.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$825.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,887.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,887.50
|
| Rate for Payer: Multiplan Commercial |
$3,093.75
|
| Rate for Payer: Networks By Design Commercial |
$2,062.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,506.25
|
| Rate for Payer: Riverside University Health System MISP |
$1,650.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,475.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,475.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,548.11
|
| Rate for Payer: United Healthcare All Other HMO |
$1,506.86
|
| Rate for Payer: United Healthcare HMO Rider |
$1,474.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,350.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,506.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,506.25
|
| Rate for Payer: Vantage Medical Group Senior |
$3,506.25
|
|
|
HC STENTBILI 10MMX6CM 8.5FR UNCOVERED
|
Facility
|
IP
|
$4,125.00
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
900100384
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$825.00 |
| Max. Negotiated Rate |
$3,712.50 |
| Rate for Payer: Adventist Health Commercial |
$825.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,188.62
|
| Rate for Payer: Blue Shield of California EPN |
$2,079.00
|
| Rate for Payer: Cash Price |
$2,268.75
|
| Rate for Payer: Central Health Plan Commercial |
$3,300.00
|
| Rate for Payer: Cigna of CA HMO |
$2,887.50
|
| Rate for Payer: Cigna of CA PPO |
$2,887.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,650.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,650.00
|
| Rate for Payer: Galaxy Health WC |
$3,506.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,475.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,712.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,751.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,571.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,553.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$825.00
|
| Rate for Payer: Multiplan Commercial |
$3,093.75
|
| Rate for Payer: Networks By Design Commercial |
$2,062.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,506.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,548.11
|
| Rate for Payer: United Healthcare All Other HMO |
$1,506.86
|
| Rate for Payer: United Healthcare HMO Rider |
$1,474.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,350.94
|
|
|
HC STENT BILI 7FRX12CM
|
Facility
|
IP
|
$290.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
900100380
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$58.00 |
| Max. Negotiated Rate |
$261.00 |
| Rate for Payer: Adventist Health Commercial |
$58.00
|
| Rate for Payer: Blue Shield of California Commercial |
$224.17
|
| Rate for Payer: Blue Shield of California EPN |
$146.16
|
| Rate for Payer: Cash Price |
$159.50
|
| Rate for Payer: Central Health Plan Commercial |
$232.00
|
| Rate for Payer: Cigna of CA HMO |
$203.00
|
| Rate for Payer: Cigna of CA PPO |
$203.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$116.00
|
| Rate for Payer: EPIC Health Plan Senior |
$116.00
|
| Rate for Payer: Galaxy Health WC |
$246.50
|
| Rate for Payer: Global Benefits Group Commercial |
$174.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$261.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$193.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$110.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$179.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.00
|
| Rate for Payer: Multiplan Commercial |
$217.50
|
| Rate for Payer: Networks By Design Commercial |
$145.00
|
| Rate for Payer: Prime Health Services Commercial |
$246.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$108.84
|
| Rate for Payer: United Healthcare All Other HMO |
$105.94
|
| Rate for Payer: United Healthcare HMO Rider |
$103.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$94.97
|
|
|
HC STENT BILI 7FRX12CM
|
Facility
|
OP
|
$290.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
900100380
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$58.00 |
| Max. Negotiated Rate |
$261.00 |
| Rate for Payer: Adventist Health Commercial |
$58.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$246.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$159.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$217.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$132.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$160.57
|
| Rate for Payer: Blue Shield of California Commercial |
$224.17
|
| Rate for Payer: Blue Shield of California EPN |
$146.16
|
| Rate for Payer: Cash Price |
$159.50
|
| Rate for Payer: Central Health Plan Commercial |
$232.00
|
| Rate for Payer: Cigna of CA HMO |
$203.00
|
| Rate for Payer: Cigna of CA PPO |
$203.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$246.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$246.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$246.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$116.00
|
| Rate for Payer: EPIC Health Plan Senior |
$116.00
|
| Rate for Payer: Galaxy Health WC |
$246.50
|
| Rate for Payer: Global Benefits Group Commercial |
$174.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$261.00
|
| Rate for Payer: InnovAge PACE Commercial |
$145.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$193.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$110.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$179.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$203.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$203.00
|
| Rate for Payer: Multiplan Commercial |
$217.50
|
| Rate for Payer: Networks By Design Commercial |
$145.00
|
| Rate for Payer: Prime Health Services Commercial |
$246.50
|
| Rate for Payer: Riverside University Health System MISP |
$116.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$174.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$174.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$108.84
|
| Rate for Payer: United Healthcare All Other HMO |
$105.94
|
| Rate for Payer: United Healthcare HMO Rider |
$103.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$94.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$246.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$246.50
|
| Rate for Payer: Vantage Medical Group Senior |
$246.50
|
|
|
HC STENT BILI 8.5FRX10CM
|
Facility
|
IP
|
$290.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
900100381
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$58.00 |
| Max. Negotiated Rate |
$261.00 |
| Rate for Payer: Adventist Health Commercial |
$58.00
|
| Rate for Payer: Blue Shield of California Commercial |
$224.17
|
| Rate for Payer: Blue Shield of California EPN |
$146.16
|
| Rate for Payer: Cash Price |
$159.50
|
| Rate for Payer: Central Health Plan Commercial |
$232.00
|
| Rate for Payer: Cigna of CA HMO |
$203.00
|
| Rate for Payer: Cigna of CA PPO |
$203.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$116.00
|
| Rate for Payer: EPIC Health Plan Senior |
$116.00
|
| Rate for Payer: Galaxy Health WC |
$246.50
|
| Rate for Payer: Global Benefits Group Commercial |
$174.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$261.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$193.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$110.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$179.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.00
|
| Rate for Payer: Multiplan Commercial |
$217.50
|
| Rate for Payer: Networks By Design Commercial |
$145.00
|
| Rate for Payer: Prime Health Services Commercial |
$246.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$108.84
|
| Rate for Payer: United Healthcare All Other HMO |
$105.94
|
| Rate for Payer: United Healthcare HMO Rider |
$103.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$94.97
|
|
|
HC STENT BILI 8.5FRX10CM
|
Facility
|
OP
|
$290.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
900100381
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$58.00 |
| Max. Negotiated Rate |
$261.00 |
| Rate for Payer: Adventist Health Commercial |
$58.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$246.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$159.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$217.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$132.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$160.57
|
| Rate for Payer: Blue Shield of California Commercial |
$224.17
|
| Rate for Payer: Blue Shield of California EPN |
$146.16
|
| Rate for Payer: Cash Price |
$159.50
|
| Rate for Payer: Central Health Plan Commercial |
$232.00
|
| Rate for Payer: Cigna of CA HMO |
$203.00
|
| Rate for Payer: Cigna of CA PPO |
$203.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$246.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$246.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$246.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$116.00
|
| Rate for Payer: EPIC Health Plan Senior |
$116.00
|
| Rate for Payer: Galaxy Health WC |
$246.50
|
| Rate for Payer: Global Benefits Group Commercial |
$174.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$261.00
|
| Rate for Payer: InnovAge PACE Commercial |
$145.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$193.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$110.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$179.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$203.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$203.00
|
| Rate for Payer: Multiplan Commercial |
$217.50
|
| Rate for Payer: Networks By Design Commercial |
$145.00
|
| Rate for Payer: Prime Health Services Commercial |
$246.50
|
| Rate for Payer: Riverside University Health System MISP |
$116.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$174.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$174.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$108.84
|
| Rate for Payer: United Healthcare All Other HMO |
$105.94
|
| Rate for Payer: United Healthcare HMO Rider |
$103.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$94.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$246.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$246.50
|
| Rate for Payer: Vantage Medical Group Senior |
$246.50
|
|
|
HC STENT BILIARY 0.035IN 10MMX6X208CM 7FR
|
Facility
|
OP
|
$3,705.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
900100392
|
|
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 |
$2,051.46
|
| Rate for Payer: Blue Shield of California Commercial |
$2,863.97
|
| Rate for Payer: Blue Shield of California EPN |
$1,867.32
|
| Rate for Payer: Cash Price |
$2,037.75
|
| 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: 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: InnovAge PACE Commercial |
$1,852.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,471.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,411.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,293.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$741.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,593.50
|
| Rate for Payer: Molina Healthcare of CA 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 BILIARY 0.035IN 10MMX6X208CM 7FR
|
Facility
|
IP
|
$3,705.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
900100392
|
|
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 |
$2,863.97
|
| Rate for Payer: Blue Shield of California EPN |
$1,867.32
|
| Rate for Payer: Cash Price |
$2,037.75
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$2,471.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,411.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,293.39
|
| 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 BILIARY 0.035IN 10MMX8X208CM 7FR
|
Facility
|
OP
|
$3,705.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
900100393
|
|
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 |
$2,051.46
|
| Rate for Payer: Blue Shield of California Commercial |
$2,863.97
|
| Rate for Payer: Blue Shield of California EPN |
$1,867.32
|
| Rate for Payer: Cash Price |
$2,037.75
|
| 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: 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: InnovAge PACE Commercial |
$1,852.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,471.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,411.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,293.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$741.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,593.50
|
| Rate for Payer: Molina Healthcare of CA 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 BILIARY 0.035IN 10MMX8X208CM 7FR
|
Facility
|
IP
|
$3,705.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
900100393
|
|
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 |
$2,863.97
|
| Rate for Payer: Blue Shield of California EPN |
$1,867.32
|
| Rate for Payer: Cash Price |
$2,037.75
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$2,471.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,411.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,293.39
|
| 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 BILIARY 0.035 IN OD10 FR X L7 CM
|
Facility
|
OP
|
$462.25
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
900100369
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$92.45 |
| Max. Negotiated Rate |
$416.02 |
| Rate for Payer: Adventist Health Commercial |
$92.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$280.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$392.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$254.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$346.69
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$223.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$271.48
|
| Rate for Payer: Blue Shield of California Commercial |
$282.43
|
| Rate for Payer: Blue Shield of California EPN |
$184.44
|
| Rate for Payer: Cash Price |
$254.24
|
| Rate for Payer: Central Health Plan Commercial |
$369.80
|
| Rate for Payer: Cigna of CA HMO |
$295.84
|
| Rate for Payer: Cigna of CA PPO |
$342.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$392.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$392.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$392.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.90
|
| Rate for Payer: EPIC Health Plan Senior |
$184.90
|
| Rate for Payer: Galaxy Health WC |
$392.91
|
| Rate for Payer: Global Benefits Group Commercial |
$277.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$416.02
|
| Rate for Payer: InnovAge PACE Commercial |
$231.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$308.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$176.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$286.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$323.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$323.57
|
| Rate for Payer: Multiplan Commercial |
$346.69
|
| Rate for Payer: Networks By Design Commercial |
$300.46
|
| Rate for Payer: Prime Health Services Commercial |
$392.91
|
| Rate for Payer: Riverside University Health System MISP |
$184.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$277.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$277.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$231.12
|
| Rate for Payer: United Healthcare All Other HMO |
$231.12
|
| Rate for Payer: United Healthcare HMO Rider |
$231.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$231.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$392.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$392.91
|
| Rate for Payer: Vantage Medical Group Senior |
$392.91
|
|
|
HC STENT BILIARY 0.035 IN OD10 FR X L7 CM
|
Facility
|
IP
|
$462.25
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
900100369
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$92.45 |
| Max. Negotiated Rate |
$416.02 |
| Rate for Payer: Adventist Health Commercial |
$92.45
|
| Rate for Payer: Cash Price |
$254.24
|
| Rate for Payer: Central Health Plan Commercial |
$369.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.90
|
| Rate for Payer: EPIC Health Plan Senior |
$184.90
|
| Rate for Payer: Galaxy Health WC |
$392.91
|
| Rate for Payer: Global Benefits Group Commercial |
$277.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$416.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$308.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$176.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$286.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.45
|
| Rate for Payer: Multiplan Commercial |
$346.69
|
| Rate for Payer: Networks By Design Commercial |
$300.46
|
| Rate for Payer: Prime Health Services Commercial |
$392.91
|
|
|
HC STENT BILIARY 10X11MMX4CM 8.5FR UNCOVERED
|
Facility
|
OP
|
$3,379.25
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
900100385
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$675.85 |
| Max. Negotiated Rate |
$3,041.32 |
| Rate for Payer: Adventist Health Commercial |
$675.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,872.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,858.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,534.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,542.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,871.09
|
| Rate for Payer: Blue Shield of California Commercial |
$2,612.16
|
| Rate for Payer: Blue Shield of California EPN |
$1,703.14
|
| Rate for Payer: Cash Price |
$1,858.59
|
| Rate for Payer: Central Health Plan Commercial |
$2,703.40
|
| Rate for Payer: Cigna of CA HMO |
$2,365.47
|
| Rate for Payer: Cigna of CA PPO |
$2,365.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,872.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,872.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,872.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,351.70
|
| Rate for Payer: EPIC Health Plan Senior |
$1,351.70
|
| Rate for Payer: Galaxy Health WC |
$2,872.36
|
| Rate for Payer: Global Benefits Group Commercial |
$2,027.55
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,041.32
|
| Rate for Payer: InnovAge PACE Commercial |
$1,689.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,253.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,287.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,091.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$675.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,365.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,365.47
|
| Rate for Payer: Multiplan Commercial |
$2,534.44
|
| Rate for Payer: Networks By Design Commercial |
$1,689.62
|
| Rate for Payer: Prime Health Services Commercial |
$2,872.36
|
| Rate for Payer: Riverside University Health System MISP |
$1,351.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,027.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,027.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,268.23
|
| Rate for Payer: United Healthcare All Other HMO |
$1,234.44
|
| Rate for Payer: United Healthcare HMO Rider |
$1,207.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,106.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,872.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,872.36
|
| Rate for Payer: Vantage Medical Group Senior |
$2,872.36
|
|
|
HC STENT BILIARY 10X11MMX4CM 8.5FR UNCOVERED
|
Facility
|
IP
|
$3,379.25
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
900100385
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$675.85 |
| Max. Negotiated Rate |
$3,041.32 |
| Rate for Payer: Adventist Health Commercial |
$675.85
|
| Rate for Payer: Blue Shield of California Commercial |
$2,612.16
|
| Rate for Payer: Blue Shield of California EPN |
$1,703.14
|
| Rate for Payer: Cash Price |
$1,858.59
|
| Rate for Payer: Central Health Plan Commercial |
$2,703.40
|
| Rate for Payer: Cigna of CA HMO |
$2,365.47
|
| Rate for Payer: Cigna of CA PPO |
$2,365.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,351.70
|
| Rate for Payer: EPIC Health Plan Senior |
$1,351.70
|
| Rate for Payer: Galaxy Health WC |
$2,872.36
|
| Rate for Payer: Global Benefits Group Commercial |
$2,027.55
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,041.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,253.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,287.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,091.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$675.85
|
| Rate for Payer: Multiplan Commercial |
$2,534.44
|
| Rate for Payer: Networks By Design Commercial |
$1,689.62
|
| Rate for Payer: Prime Health Services Commercial |
$2,872.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,268.23
|
| Rate for Payer: United Healthcare All Other HMO |
$1,234.44
|
| Rate for Payer: United Healthcare HMO Rider |
$1,207.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,106.70
|
|
|
HC STENT BILIARY 10X4X200CM
|
Facility
|
OP
|
$5,145.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
900100398
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,029.00 |
| Max. Negotiated Rate |
$4,630.50 |
| Rate for Payer: Adventist Health Commercial |
$1,029.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,373.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,829.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,858.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,349.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,848.79
|
| Rate for Payer: Blue Shield of California Commercial |
$3,977.09
|
| Rate for Payer: Blue Shield of California EPN |
$2,593.08
|
| Rate for Payer: Cash Price |
$2,829.75
|
| Rate for Payer: Central Health Plan Commercial |
$4,116.00
|
| Rate for Payer: Cigna of CA HMO |
$3,601.50
|
| Rate for Payer: Cigna of CA PPO |
$3,601.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,373.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,373.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,373.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,058.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,058.00
|
| Rate for Payer: Galaxy Health WC |
$4,373.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,087.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,630.50
|
| Rate for Payer: InnovAge PACE Commercial |
$2,572.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,431.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,184.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,029.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,601.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,601.50
|
| Rate for Payer: Multiplan Commercial |
$3,858.75
|
| Rate for Payer: Networks By Design Commercial |
$2,572.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,373.25
|
| Rate for Payer: Riverside University Health System MISP |
$2,058.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,087.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,087.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,930.92
|
| Rate for Payer: United Healthcare All Other HMO |
$1,879.47
|
| Rate for Payer: United Healthcare HMO Rider |
$1,838.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,684.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,373.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,373.25
|
| Rate for Payer: Vantage Medical Group Senior |
$4,373.25
|
|
|
HC STENT BILIARY 10X4X200CM
|
Facility
|
IP
|
$5,145.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
900100398
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,029.00 |
| Max. Negotiated Rate |
$4,630.50 |
| Rate for Payer: Adventist Health Commercial |
$1,029.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,977.09
|
| Rate for Payer: Blue Shield of California EPN |
$2,593.08
|
| Rate for Payer: Cash Price |
$2,829.75
|
| Rate for Payer: Central Health Plan Commercial |
$4,116.00
|
| Rate for Payer: Cigna of CA HMO |
$3,601.50
|
| Rate for Payer: Cigna of CA PPO |
$3,601.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,058.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,058.00
|
| Rate for Payer: Galaxy Health WC |
$4,373.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,087.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,630.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,431.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,960.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,184.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,029.00
|
| Rate for Payer: Multiplan Commercial |
$3,858.75
|
| Rate for Payer: Networks By Design Commercial |
$2,572.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,373.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,930.92
|
| Rate for Payer: United Healthcare All Other HMO |
$1,879.47
|
| Rate for Payer: United Healthcare HMO Rider |
$1,838.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,684.99
|
|
|
HC STENT BILIARY 10X6X200CM
|
Facility
|
IP
|
$5,145.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
900100399
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,029.00 |
| Max. Negotiated Rate |
$4,630.50 |
| Rate for Payer: Adventist Health Commercial |
$1,029.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,977.09
|
| Rate for Payer: Blue Shield of California EPN |
$2,593.08
|
| Rate for Payer: Cash Price |
$2,829.75
|
| Rate for Payer: Central Health Plan Commercial |
$4,116.00
|
| Rate for Payer: Cigna of CA HMO |
$3,601.50
|
| Rate for Payer: Cigna of CA PPO |
$3,601.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,058.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,058.00
|
| Rate for Payer: Galaxy Health WC |
$4,373.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,087.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,630.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,431.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,960.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,184.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,029.00
|
| Rate for Payer: Multiplan Commercial |
$3,858.75
|
| Rate for Payer: Networks By Design Commercial |
$2,572.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,373.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,930.92
|
| Rate for Payer: United Healthcare All Other HMO |
$1,879.47
|
| Rate for Payer: United Healthcare HMO Rider |
$1,838.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,684.99
|
|
|
HC STENT BILIARY 10X6X200CM
|
Facility
|
OP
|
$5,145.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
900100399
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,029.00 |
| Max. Negotiated Rate |
$4,630.50 |
| Rate for Payer: Adventist Health Commercial |
$1,029.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,373.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,829.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,858.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,349.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,848.79
|
| Rate for Payer: Blue Shield of California Commercial |
$3,977.09
|
| Rate for Payer: Blue Shield of California EPN |
$2,593.08
|
| Rate for Payer: Cash Price |
$2,829.75
|
| Rate for Payer: Central Health Plan Commercial |
$4,116.00
|
| Rate for Payer: Cigna of CA HMO |
$3,601.50
|
| Rate for Payer: Cigna of CA PPO |
$3,601.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,373.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,373.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,373.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,058.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,058.00
|
| Rate for Payer: Galaxy Health WC |
$4,373.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,087.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,630.50
|
| Rate for Payer: InnovAge PACE Commercial |
$2,572.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,431.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,184.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,029.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,601.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,601.50
|
| Rate for Payer: Multiplan Commercial |
$3,858.75
|
| Rate for Payer: Networks By Design Commercial |
$2,572.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,373.25
|
| Rate for Payer: Riverside University Health System MISP |
$2,058.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,087.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,087.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,930.92
|
| Rate for Payer: United Healthcare All Other HMO |
$1,879.47
|
| Rate for Payer: United Healthcare HMO Rider |
$1,838.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,684.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,373.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,373.25
|
| Rate for Payer: Vantage Medical Group Senior |
$4,373.25
|
|
|
HC STENT BILIARY 10X8X200CM
|
Facility
|
OP
|
$5,145.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
900100400
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,029.00 |
| Max. Negotiated Rate |
$4,630.50 |
| Rate for Payer: Adventist Health Commercial |
$1,029.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,373.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,829.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,858.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,349.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,848.79
|
| Rate for Payer: Blue Shield of California Commercial |
$3,977.09
|
| Rate for Payer: Blue Shield of California EPN |
$2,593.08
|
| Rate for Payer: Cash Price |
$2,829.75
|
| Rate for Payer: Central Health Plan Commercial |
$4,116.00
|
| Rate for Payer: Cigna of CA HMO |
$3,601.50
|
| Rate for Payer: Cigna of CA PPO |
$3,601.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,373.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,373.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,373.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,058.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,058.00
|
| Rate for Payer: Galaxy Health WC |
$4,373.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,087.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,630.50
|
| Rate for Payer: InnovAge PACE Commercial |
$2,572.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,431.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,184.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,029.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,601.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,601.50
|
| Rate for Payer: Multiplan Commercial |
$3,858.75
|
| Rate for Payer: Networks By Design Commercial |
$2,572.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,373.25
|
| Rate for Payer: Riverside University Health System MISP |
$2,058.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,087.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,087.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,930.92
|
| Rate for Payer: United Healthcare All Other HMO |
$1,879.47
|
| Rate for Payer: United Healthcare HMO Rider |
$1,838.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,684.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,373.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,373.25
|
| Rate for Payer: Vantage Medical Group Senior |
$4,373.25
|
|
|
HC STENT BILIARY 10X8X200CM
|
Facility
|
IP
|
$5,145.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
900100400
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,029.00 |
| Max. Negotiated Rate |
$4,630.50 |
| Rate for Payer: Adventist Health Commercial |
$1,029.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,977.09
|
| Rate for Payer: Blue Shield of California EPN |
$2,593.08
|
| Rate for Payer: Cash Price |
$2,829.75
|
| Rate for Payer: Central Health Plan Commercial |
$4,116.00
|
| Rate for Payer: Cigna of CA HMO |
$3,601.50
|
| Rate for Payer: Cigna of CA PPO |
$3,601.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,058.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,058.00
|
| Rate for Payer: Galaxy Health WC |
$4,373.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,087.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,630.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,431.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,960.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,184.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,029.00
|
| Rate for Payer: Multiplan Commercial |
$3,858.75
|
| Rate for Payer: Networks By Design Commercial |
$2,572.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,373.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,930.92
|
| Rate for Payer: United Healthcare All Other HMO |
$1,879.47
|
| Rate for Payer: United Healthcare HMO Rider |
$1,838.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,684.99
|
|
