|
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
|
|
|
HC STENT METAL URETERAL
|
Facility
IP
|
$3,900.00
|
|
|
Service Code
|
CPT C2617
|
| Hospital Charge Code |
909020039
|
|
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 METAL URETERAL
|
Facility
OP
|
$3,900.00
|
|
|
Service Code
|
CPT C2617
|
| Hospital Charge Code |
909020039
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,510.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$822.12
|
| 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 NEURO FORM 3
|
Facility
OP
|
$14,300.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909080045
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,860.00 |
| Max. Negotiated Rate |
$12,870.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$8,941.56
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$12,155.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7,865.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7,865.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,529.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,965.10
|
| Rate for Payer: BCBS Transplant Transplant |
$8,580.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,725.00
|
| Rate for Payer: Blue Shield of California EPN |
$7,779.20
|
| Rate for Payer: Cash Price |
$6,435.00
|
| Rate for Payer: Cash Price |
$6,435.00
|
| Rate for Payer: Central Health Plan Commercial |
$11,440.00
|
| Rate for Payer: Cigna of CA HMO |
$10,010.00
|
| Rate for Payer: Cigna of CA PPO |
$10,010.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,155.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,720.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$5,720.00
|
| Rate for Payer: Galaxy Health WC |
$12,155.00
|
| Rate for Payer: Global Benefits Group Commercial |
$8,580.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,870.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$10,725.00
|
| Rate for Payer: IEHP medi-cal |
$5,005.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,538.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,860.00
|
| Rate for Payer: Multiplan Commercial |
$10,725.00
|
| Rate for Payer: Networks By Design Commercial |
$7,150.00
|
| Rate for Payer: Prime Health Services Commercial |
$12,155.00
|
| Rate for Payer: Riverside University Health MISP |
$5,720.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,580.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8,580.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,150.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,150.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,150.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,150.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12,155.00
|
| Rate for Payer: Vantage Medical Group Senior |
$12,155.00
|
|
|
HC STENT NEURO FORM 3
|
Facility
IP
|
$14,300.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909080045
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,860.00 |
| Max. Negotiated Rate |
$12,870.00 |
| Rate for Payer: Blue Shield of California EPN |
$7,636.20
|
| Rate for Payer: Cash Price |
$6,435.00
|
| Rate for Payer: Central Health Plan Commercial |
$11,440.00
|
| Rate for Payer: Cigna of CA HMO |
$10,010.00
|
| Rate for Payer: Cigna of CA PPO |
$10,010.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,720.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$5,720.00
|
| Rate for Payer: Galaxy Health WC |
$12,155.00
|
| Rate for Payer: Global Benefits Group Commercial |
$8,580.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,870.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,538.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,860.00
|
| Rate for Payer: Multiplan Commercial |
$10,725.00
|
| Rate for Payer: Prime Health Services Commercial |
$12,155.00
|
|
|
HC STENT PALMAZ
|
Facility
OP
|
$1,963.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909081209
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$392.60 |
| 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 |
$1,668.55
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,079.65
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,079.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$896.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,093.39
|
| Rate for Payer: BCBS Transplant Transplant |
$1,177.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,472.25
|
| Rate for Payer: Blue Shield of California EPN |
$1,067.87
|
| Rate for Payer: Cash Price |
$883.35
|
| Rate for Payer: Cash Price |
$883.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,570.40
|
| Rate for Payer: Cigna of CA HMO |
$1,374.10
|
| Rate for Payer: Cigna of CA PPO |
$1,374.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,668.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$785.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$785.20
|
| Rate for Payer: Galaxy Health WC |
$1,668.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,177.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,766.70
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,472.25
|
| Rate for Payer: IEHP medi-cal |
$687.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,309.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$392.60
|
| Rate for Payer: Multiplan Commercial |
$1,472.25
|
| Rate for Payer: Networks By Design Commercial |
$981.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,668.55
|
| Rate for Payer: Riverside University Health MISP |
$785.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,177.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,177.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$981.50
|
| Rate for Payer: United Healthcare All Other HMO |
$981.50
|
| Rate for Payer: United Healthcare HMO Rider |
$981.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$981.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,668.55
|
| Rate for Payer: Vantage Medical Group Senior |
$1,668.55
|
|
|
HC STENT PALMAZ
|
Facility
IP
|
$1,963.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909081209
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$392.60 |
| Max. Negotiated Rate |
$1,766.70 |
| Rate for Payer: Blue Shield of California EPN |
$1,048.24
|
| Rate for Payer: Cash Price |
$883.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,570.40
|
| Rate for Payer: Cigna of CA HMO |
$1,374.10
|
| Rate for Payer: Cigna of CA PPO |
$1,374.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$785.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$785.20
|
| Rate for Payer: Galaxy Health WC |
$1,668.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,177.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,766.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,309.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$392.60
|
| Rate for Payer: Multiplan Commercial |
$1,472.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,668.55
|
|
|
HC STENT PALMAZ BALLOON EXPAND
|
Facility
IP
|
$1,717.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
900803700
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$343.40 |
| Max. Negotiated Rate |
$1,545.30 |
| Rate for Payer: Blue Shield of California EPN |
$916.88
|
| Rate for Payer: Cash Price |
$772.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,373.60
|
| Rate for Payer: Cigna of CA HMO |
$1,201.90
|
| Rate for Payer: Cigna of CA PPO |
$1,201.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$686.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$686.80
|
| Rate for Payer: Galaxy Health WC |
$1,459.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,030.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,545.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,145.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$343.40
|
| Rate for Payer: Multiplan Commercial |
$1,287.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,459.45
|
|
|
HC STENT PALMAZ BALLOON EXPAND
|
Facility
OP
|
$1,717.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
900803700
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$343.40 |
| Max. Negotiated Rate |
$17,854.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$17,854.40
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,459.45
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$944.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$944.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$783.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$956.37
|
| Rate for Payer: BCBS Transplant Transplant |
$1,030.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,287.75
|
| Rate for Payer: Blue Shield of California EPN |
$934.05
|
| Rate for Payer: Cash Price |
$772.65
|
| Rate for Payer: Cash Price |
$772.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,373.60
|
| Rate for Payer: Cigna of CA HMO |
$1,201.90
|
| Rate for Payer: Cigna of CA PPO |
$1,201.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,459.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$686.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$686.80
|
| Rate for Payer: Galaxy Health WC |
$1,459.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,030.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,545.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,287.75
|
| Rate for Payer: IEHP medi-cal |
$600.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,145.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$343.40
|
| Rate for Payer: Multiplan Commercial |
$1,287.75
|
| Rate for Payer: Networks By Design Commercial |
$858.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,459.45
|
| Rate for Payer: Riverside University Health MISP |
$686.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,030.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,030.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$858.50
|
| Rate for Payer: United Healthcare All Other HMO |
$858.50
|
| Rate for Payer: United Healthcare HMO Rider |
$858.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$858.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,459.45
|
| Rate for Payer: Vantage Medical Group Senior |
$1,459.45
|
|
|
HC STENT PLACEMT RETRO CAROTID
|
Facility
IP
|
$17,500.00
|
|
|
Service Code
|
CPT 37217
|
| Hospital Charge Code |
909037217
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,500.00 |
| Max. Negotiated Rate |
$120,000.00 |
| Rate for Payer: Cash Price |
$7,875.00
|
| Rate for Payer: Cash Price |
$7,875.00
|
| Rate for Payer: Central Health Plan Commercial |
$14,000.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,000.00
|
| Rate for Payer: Galaxy Health WC |
$14,875.00
|
| Rate for Payer: Global Benefits Group Commercial |
$10,500.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,750.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,672.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,500.00
|
| Rate for Payer: Multiplan Commercial |
$13,125.00
|
| Rate for Payer: Networks By Design Commercial |
$120,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$14,875.00
|
|
|
HC STENT PLACEMT RETRO CAROTID
|
Facility
OP
|
$17,500.00
|
|
|
Service Code
|
CPT 37217
|
| Hospital Charge Code |
909037217
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$683.14 |
| Max. Negotiated Rate |
$15,750.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$14,875.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9,625.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9,625.00
|
| 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 |
$10,500.00
|
| Rate for Payer: Blue Shield of California Commercial |
$951.13
|
| Rate for Payer: Blue Shield of California EPN |
$683.14
|
| Rate for Payer: Cash Price |
$7,875.00
|
| Rate for Payer: Cash Price |
$7,875.00
|
| Rate for Payer: Central Health Plan Commercial |
$14,000.00
|
| Rate for Payer: Cigna of CA PPO |
$12,950.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14,875.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,000.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$7,000.00
|
| Rate for Payer: Galaxy Health WC |
$14,875.00
|
| Rate for Payer: Global Benefits Group Commercial |
$10,500.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,750.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$13,125.00
|
| Rate for Payer: IEHP medi-cal |
$6,125.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,672.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,500.00
|
| Rate for Payer: Multiplan Commercial |
$13,125.00
|
| Rate for Payer: Networks By Design Commercial |
$11,375.00
|
| Rate for Payer: Prime Health Services Commercial |
$14,875.00
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$10,500.00
|
| Rate for Payer: Riverside University Health MISP |
$7,000.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,500.00
|
| 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 |
$14,875.00
|
| Rate for Payer: Vantage Medical Group Senior |
$14,875.00
|
|
|
HC STENT PLACEMT RETRO CAROTID
|
Facility
OP
|
$17,500.00
|
|
|
Service Code
|
CPT 37217
|
| Hospital Charge Code |
906820026
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$683.14 |
| Max. Negotiated Rate |
$15,750.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$14,875.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9,625.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9,625.00
|
| 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 |
$10,500.00
|
| Rate for Payer: Blue Shield of California Commercial |
$951.13
|
| Rate for Payer: Blue Shield of California EPN |
$683.14
|
| Rate for Payer: Cash Price |
$7,875.00
|
| Rate for Payer: Cash Price |
$7,875.00
|
| Rate for Payer: Central Health Plan Commercial |
$14,000.00
|
| Rate for Payer: Cigna of CA PPO |
$12,950.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14,875.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,000.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$7,000.00
|
| Rate for Payer: Galaxy Health WC |
$14,875.00
|
| Rate for Payer: Global Benefits Group Commercial |
$10,500.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,750.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$13,125.00
|
| Rate for Payer: IEHP medi-cal |
$6,125.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,672.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,500.00
|
| Rate for Payer: Multiplan Commercial |
$13,125.00
|
| Rate for Payer: Networks By Design Commercial |
$11,375.00
|
| Rate for Payer: Prime Health Services Commercial |
$14,875.00
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$10,500.00
|
| Rate for Payer: Riverside University Health MISP |
$7,000.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,500.00
|
| 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 |
$14,875.00
|
| Rate for Payer: Vantage Medical Group Senior |
$14,875.00
|
|
|
HC STENT PLACEMT RETRO CAROTID
|
Facility
IP
|
$17,500.00
|
|
|
Service Code
|
CPT 37217
|
| Hospital Charge Code |
906820026
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,500.00 |
| Max. Negotiated Rate |
$120,000.00 |
| Rate for Payer: Cash Price |
$7,875.00
|
| Rate for Payer: Cash Price |
$7,875.00
|
| Rate for Payer: Central Health Plan Commercial |
$14,000.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,000.00
|
| Rate for Payer: Galaxy Health WC |
$14,875.00
|
| Rate for Payer: Global Benefits Group Commercial |
$10,500.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,750.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,672.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,500.00
|
| Rate for Payer: Multiplan Commercial |
$13,125.00
|
| Rate for Payer: Networks By Design Commercial |
$120,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$14,875.00
|
|
|
HC STENT PLACMNT ANTE CAROTID
|
Facility
IP
|
$17,500.00
|
|
|
Service Code
|
CPT 37218
|
| Hospital Charge Code |
909037218
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,500.00 |
| Max. Negotiated Rate |
$120,000.00 |
| Rate for Payer: Cash Price |
$7,875.00
|
| Rate for Payer: Cash Price |
$7,875.00
|
| Rate for Payer: Central Health Plan Commercial |
$14,000.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,000.00
|
| Rate for Payer: Galaxy Health WC |
$14,875.00
|
| Rate for Payer: Global Benefits Group Commercial |
$10,500.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,750.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,672.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,500.00
|
| Rate for Payer: Multiplan Commercial |
$13,125.00
|
| Rate for Payer: Networks By Design Commercial |
$120,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$14,875.00
|
|
|
HC STENT PLACMNT ANTE CAROTID
|
Facility
OP
|
$17,500.00
|
|
|
Service Code
|
CPT 37218
|
| Hospital Charge Code |
909037218
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$683.14 |
| Max. Negotiated Rate |
$15,750.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$14,875.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9,625.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9,625.00
|
| 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 |
$10,500.00
|
| Rate for Payer: Blue Shield of California Commercial |
$951.13
|
| Rate for Payer: Blue Shield of California EPN |
$683.14
|
| Rate for Payer: Cash Price |
$7,875.00
|
| Rate for Payer: Cash Price |
$7,875.00
|
| Rate for Payer: Central Health Plan Commercial |
$14,000.00
|
| Rate for Payer: Cigna of CA PPO |
$12,950.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14,875.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,000.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$7,000.00
|
| Rate for Payer: Galaxy Health WC |
$14,875.00
|
| Rate for Payer: Global Benefits Group Commercial |
$10,500.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,750.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$13,125.00
|
| Rate for Payer: IEHP medi-cal |
$6,125.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,672.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,500.00
|
| Rate for Payer: Multiplan Commercial |
$13,125.00
|
| Rate for Payer: Networks By Design Commercial |
$11,375.00
|
| Rate for Payer: Prime Health Services Commercial |
$14,875.00
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$10,500.00
|
| Rate for Payer: Riverside University Health MISP |
$7,000.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,500.00
|
| 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 |
$14,875.00
|
| Rate for Payer: Vantage Medical Group Senior |
$14,875.00
|
|
|
HC STENT PLACMNT ANTE CAROTID
|
Facility
IP
|
$17,500.00
|
|
|
Service Code
|
CPT 37218
|
| Hospital Charge Code |
906820018
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,500.00 |
| Max. Negotiated Rate |
$120,000.00 |
| Rate for Payer: Cash Price |
$7,875.00
|
| Rate for Payer: Cash Price |
$7,875.00
|
| Rate for Payer: Central Health Plan Commercial |
$14,000.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,000.00
|
| Rate for Payer: Galaxy Health WC |
$14,875.00
|
| Rate for Payer: Global Benefits Group Commercial |
$10,500.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,750.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,672.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,500.00
|
| Rate for Payer: Multiplan Commercial |
$13,125.00
|
| Rate for Payer: Networks By Design Commercial |
$120,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$14,875.00
|
|
|
HC STENT PLACMNT ANTE CAROTID
|
Facility
OP
|
$17,500.00
|
|
|
Service Code
|
CPT 37218
|
| Hospital Charge Code |
906820018
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$683.14 |
| Max. Negotiated Rate |
$15,750.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$14,875.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9,625.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9,625.00
|
| 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 |
$10,500.00
|
| Rate for Payer: Blue Shield of California Commercial |
$951.13
|
| Rate for Payer: Blue Shield of California EPN |
$683.14
|
| Rate for Payer: Cash Price |
$7,875.00
|
| Rate for Payer: Cash Price |
$7,875.00
|
| Rate for Payer: Central Health Plan Commercial |
$14,000.00
|
| Rate for Payer: Cigna of CA PPO |
$12,950.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14,875.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,000.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$7,000.00
|
| Rate for Payer: Galaxy Health WC |
$14,875.00
|
| Rate for Payer: Global Benefits Group Commercial |
$10,500.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,750.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$13,125.00
|
| Rate for Payer: IEHP medi-cal |
$6,125.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,672.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,500.00
|
| Rate for Payer: Multiplan Commercial |
$13,125.00
|
| Rate for Payer: Networks By Design Commercial |
$11,375.00
|
| Rate for Payer: Prime Health Services Commercial |
$14,875.00
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$10,500.00
|
| Rate for Payer: Riverside University Health MISP |
$7,000.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,500.00
|
| 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 |
$14,875.00
|
| Rate for Payer: Vantage Medical Group Senior |
$14,875.00
|
|
|
HC STENT PROTEGE
|
Facility
IP
|
$6,050.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020030
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,210.00 |
| Max. Negotiated Rate |
$5,445.00 |
| Rate for Payer: Blue Shield of California EPN |
$3,230.70
|
| Rate for Payer: Cash Price |
$2,722.50
|
| Rate for Payer: Central Health Plan Commercial |
$4,840.00
|
| Rate for Payer: Cigna of CA HMO |
$4,235.00
|
| Rate for Payer: Cigna of CA PPO |
$4,235.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,420.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,420.00
|
| Rate for Payer: Galaxy Health WC |
$5,142.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,630.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,445.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,035.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,210.00
|
| Rate for Payer: Multiplan Commercial |
$4,537.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,142.50
|
|
|
HC STENT PROTEGE
|
Facility
OP
|
$6,050.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020030
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,210.00 |
| 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 |
$5,142.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3,327.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,327.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,762.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,369.85
|
| Rate for Payer: BCBS Transplant Transplant |
$3,630.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,537.50
|
| Rate for Payer: Blue Shield of California EPN |
$3,291.20
|
| Rate for Payer: Cash Price |
$2,722.50
|
| Rate for Payer: Cash Price |
$2,722.50
|
| Rate for Payer: Central Health Plan Commercial |
$4,840.00
|
| Rate for Payer: Cigna of CA HMO |
$4,235.00
|
| Rate for Payer: Cigna of CA PPO |
$4,235.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,142.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,420.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,420.00
|
| Rate for Payer: Galaxy Health WC |
$5,142.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,630.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,445.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4,537.50
|
| Rate for Payer: IEHP medi-cal |
$2,117.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,035.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,210.00
|
| Rate for Payer: Multiplan Commercial |
$4,537.50
|
| Rate for Payer: Networks By Design Commercial |
$3,025.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,142.50
|
| Rate for Payer: Riverside University Health MISP |
$2,420.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,630.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,630.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,025.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,025.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,025.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,025.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,142.50
|
| Rate for Payer: Vantage Medical Group Senior |
$5,142.50
|
|
|
HC STENT PROTEGE EVERFLEX
|
Facility
IP
|
$3,510.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020093
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$702.00 |
| Max. Negotiated Rate |
$3,159.00 |
| Rate for Payer: Blue Shield of California EPN |
$1,874.34
|
| Rate for Payer: Cash Price |
$1,579.50
|
| Rate for Payer: Central Health Plan Commercial |
$2,808.00
|
| Rate for Payer: Cigna of CA HMO |
$2,457.00
|
| Rate for Payer: Cigna of CA PPO |
$2,457.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,404.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,404.00
|
| Rate for Payer: Galaxy Health WC |
$2,983.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,106.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,159.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,341.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$702.00
|
| Rate for Payer: Multiplan Commercial |
$2,632.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,983.50
|
|
|
HC STENT PROTEGE EVERFLEX
|
Facility
OP
|
$3,510.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020093
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$702.00 |
| 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 |
$2,983.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,930.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,930.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,602.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,955.07
|
| Rate for Payer: BCBS Transplant Transplant |
$2,106.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,632.50
|
| Rate for Payer: Blue Shield of California EPN |
$1,909.44
|
| Rate for Payer: Cash Price |
$1,579.50
|
| Rate for Payer: Cash Price |
$1,579.50
|
| Rate for Payer: Central Health Plan Commercial |
$2,808.00
|
| Rate for Payer: Cigna of CA HMO |
$2,457.00
|
| Rate for Payer: Cigna of CA PPO |
$2,457.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,983.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,404.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,404.00
|
| Rate for Payer: Galaxy Health WC |
$2,983.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,106.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,159.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,632.50
|
| Rate for Payer: IEHP medi-cal |
$1,228.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,341.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$702.00
|
| Rate for Payer: Multiplan Commercial |
$2,632.50
|
| Rate for Payer: Networks By Design Commercial |
$1,755.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,983.50
|
| Rate for Payer: Riverside University Health MISP |
$1,404.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,106.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,106.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,755.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,755.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,755.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,755.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,983.50
|
| Rate for Payer: Vantage Medical Group Senior |
$2,983.50
|
|
|
HC STENT RETRIEVER TREVO
|
Facility
OP
|
$19,488.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909000006
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,897.60 |
| Max. Negotiated Rate |
$17,539.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5,717.49
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$16,564.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$10,718.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$10,718.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8,898.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,854.82
|
| Rate for Payer: BCBS Transplant Transplant |
$11,692.80
|
| Rate for Payer: Blue Shield of California Commercial |
$14,616.00
|
| Rate for Payer: Blue Shield of California EPN |
$10,601.47
|
| Rate for Payer: Cash Price |
$8,769.60
|
| Rate for Payer: Cash Price |
$8,769.60
|
| Rate for Payer: Central Health Plan Commercial |
$15,590.40
|
| Rate for Payer: Cigna of CA HMO |
$13,641.60
|
| Rate for Payer: Cigna of CA PPO |
$13,641.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16,564.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,795.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$7,795.20
|
| Rate for Payer: Galaxy Health WC |
$16,564.80
|
| Rate for Payer: Global Benefits Group Commercial |
$11,692.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$17,539.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$14,616.00
|
| Rate for Payer: IEHP medi-cal |
$6,820.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,998.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,897.60
|
| Rate for Payer: Multiplan Commercial |
$14,616.00
|
| Rate for Payer: Networks By Design Commercial |
$9,744.00
|
| Rate for Payer: Prime Health Services Commercial |
$16,564.80
|
| Rate for Payer: Riverside University Health MISP |
$7,795.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11,692.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11,692.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,744.00
|
| Rate for Payer: United Healthcare All Other HMO |
$9,744.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,744.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,744.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16,564.80
|
| Rate for Payer: Vantage Medical Group Senior |
$16,564.80
|
|
|
HC STENT RETRIEVER TREVO
|
Facility
IP
|
$19,488.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909000006
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,897.60 |
| Max. Negotiated Rate |
$17,539.20 |
| Rate for Payer: Blue Shield of California EPN |
$10,406.59
|
| Rate for Payer: Cash Price |
$8,769.60
|
| Rate for Payer: Central Health Plan Commercial |
$15,590.40
|
| Rate for Payer: Cigna of CA HMO |
$13,641.60
|
| Rate for Payer: Cigna of CA PPO |
$13,641.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,795.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$7,795.20
|
| Rate for Payer: Galaxy Health WC |
$16,564.80
|
| Rate for Payer: Global Benefits Group Commercial |
$11,692.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$17,539.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,998.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,897.60
|
| Rate for Payer: Multiplan Commercial |
$14,616.00
|
| Rate for Payer: Prime Health Services Commercial |
$16,564.80
|
|
|
HC STENT RUSCH Y
|
Facility
IP
|
$1,725.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
900803703
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$345.00 |
| Max. Negotiated Rate |
$1,552.50 |
| Rate for Payer: Blue Shield of California EPN |
$921.15
|
| Rate for Payer: Cash Price |
$776.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,380.00
|
| Rate for Payer: Cigna of CA HMO |
$1,207.50
|
| Rate for Payer: Cigna of CA PPO |
$1,207.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$690.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$690.00
|
| Rate for Payer: Galaxy Health WC |
$1,466.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,035.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,552.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,150.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$345.00
|
| Rate for Payer: Multiplan Commercial |
$1,293.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,466.25
|
|
|
HC STENT RUSCH Y
|
Facility
OP
|
$1,725.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
900803703
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$345.00 |
| Max. Negotiated Rate |
$17,854.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$17,854.40
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,466.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$948.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$948.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$787.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$960.82
|
| Rate for Payer: BCBS Transplant Transplant |
$1,035.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,293.75
|
| Rate for Payer: Blue Shield of California EPN |
$938.40
|
| Rate for Payer: Cash Price |
$776.25
|
| Rate for Payer: Cash Price |
$776.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,380.00
|
| Rate for Payer: Cigna of CA HMO |
$1,207.50
|
| Rate for Payer: Cigna of CA PPO |
$1,207.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,466.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$690.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$690.00
|
| Rate for Payer: Galaxy Health WC |
$1,466.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,035.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,552.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,293.75
|
| Rate for Payer: IEHP medi-cal |
$603.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,150.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$345.00
|
| Rate for Payer: Multiplan Commercial |
$1,293.75
|
| Rate for Payer: Networks By Design Commercial |
$862.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,466.25
|
| Rate for Payer: Riverside University Health MISP |
$690.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,035.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,035.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$862.50
|
| Rate for Payer: United Healthcare All Other HMO |
$862.50
|
| Rate for Payer: United Healthcare HMO Rider |
$862.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$862.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,466.25
|
| Rate for Payer: Vantage Medical Group Senior |
$1,466.25
|
|
