|
HC STENT SCHNEIDER WALL
|
Facility
IP
|
$1,717.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
900803702
|
|
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 SCHNEIDER WALL
|
Facility
OP
|
$1,717.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
900803702
|
|
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 SUPERA
|
Facility
IP
|
$3,987.50
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020142
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$797.50 |
| Max. Negotiated Rate |
$3,588.75 |
| Rate for Payer: Blue Shield of California EPN |
$2,129.32
|
| Rate for Payer: Cash Price |
$1,794.38
|
| Rate for Payer: Central Health Plan Commercial |
$3,190.00
|
| Rate for Payer: Cigna of CA HMO |
$2,791.25
|
| Rate for Payer: Cigna of CA PPO |
$2,791.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,595.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,595.00
|
| Rate for Payer: Galaxy Health WC |
$3,389.38
|
| Rate for Payer: Global Benefits Group Commercial |
$2,392.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,588.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,659.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$797.50
|
| Rate for Payer: Multiplan Commercial |
$2,990.62
|
| Rate for Payer: Prime Health Services Commercial |
$3,389.38
|
|
|
HC STENT SUPERA
|
Facility
OP
|
$3,987.50
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020142
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$797.50 |
| Max. Negotiated Rate |
$8,941.56 |
| Rate for Payer: Aetna of CA HMO/PPO |
$8,941.56
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,389.38
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,193.12
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,193.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,820.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,221.04
|
| Rate for Payer: BCBS Transplant Transplant |
$2,392.50
|
| Rate for Payer: Blue Shield of California Commercial |
$2,990.62
|
| Rate for Payer: Blue Shield of California EPN |
$2,169.20
|
| Rate for Payer: Cash Price |
$1,794.38
|
| Rate for Payer: Cash Price |
$1,794.38
|
| Rate for Payer: Central Health Plan Commercial |
$3,190.00
|
| Rate for Payer: Cigna of CA HMO |
$2,791.25
|
| Rate for Payer: Cigna of CA PPO |
$2,791.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,389.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,595.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,595.00
|
| Rate for Payer: Galaxy Health WC |
$3,389.38
|
| Rate for Payer: Global Benefits Group Commercial |
$2,392.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,588.75
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,990.62
|
| Rate for Payer: IEHP medi-cal |
$1,395.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,659.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$797.50
|
| Rate for Payer: Multiplan Commercial |
$2,990.62
|
| Rate for Payer: Networks By Design Commercial |
$1,993.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,389.38
|
| Rate for Payer: Riverside University Health MISP |
$1,595.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,392.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,392.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,993.75
|
| Rate for Payer: United Healthcare All Other HMO |
$1,993.75
|
| Rate for Payer: United Healthcare HMO Rider |
$1,993.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,993.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,389.38
|
| Rate for Payer: Vantage Medical Group Senior |
$3,389.38
|
|
|
HC STENT TIBIOPERONEAL
|
Facility
OP
|
$28,001.00
|
|
|
Service Code
|
CPT 37230
|
| Hospital Charge Code |
909020071
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,183.44 |
| Max. Negotiated Rate |
$48,045.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$21,908.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$32,863.44
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$24,099.86
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$21,908.96
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,572.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,017.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$29,952.68
|
| Rate for Payer: BCBS Transplant Transplant |
$16,800.60
|
| Rate for Payer: Blue Shield of California Commercial |
$5,824.53
|
| Rate for Payer: Blue Shield of California EPN |
$4,183.44
|
| Rate for Payer: Caremore Medicare Advantage |
$21,908.96
|
| Rate for Payer: Cash Price |
$12,600.45
|
| Rate for Payer: Cash Price |
$12,600.45
|
| Rate for Payer: Central Health Plan Commercial |
$22,400.80
|
| Rate for Payer: Cigna of CA PPO |
$20,720.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32,863.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$29,577.10
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$21,908.96
|
| Rate for Payer: EPIC Health Plan Transplant |
$21,908.96
|
| Rate for Payer: Galaxy Health WC |
$23,800.85
|
| Rate for Payer: Global Benefits Group Commercial |
$16,800.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$25,200.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$21,000.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$35,930.69
|
| Rate for Payer: IEHP medi-cal |
$36,149.78
|
| Rate for Payer: IEHP Medicare Advantage |
$21,908.96
|
| Rate for Payer: Innovage PACE Commercial |
$32,863.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18,676.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21,908.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,600.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29,358.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29,358.01
|
| Rate for Payer: Multiplan Commercial |
$21,000.75
|
| Rate for Payer: Multiplan WC |
$29,952.68
|
| Rate for Payer: Networks By Design Commercial |
$18,200.65
|
| Rate for Payer: Preferred Health Network WC |
$30,563.96
|
| Rate for Payer: Prime Health Services Commercial |
$23,800.85
|
| Rate for Payer: Prime Health Services Medicare |
$23,223.50
|
| Rate for Payer: Prime Health Services WC |
$29,647.04
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$16,800.60
|
| Rate for Payer: Riverside University Health MISP |
$24,099.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16,800.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$29,673.00
|
| Rate for Payer: United Healthcare All Other HMO |
$48,045.00
|
| Rate for Payer: United Healthcare HMO Rider |
$31,101.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28,895.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24,099.86
|
| Rate for Payer: Vantage Medical Group Senior |
$21,908.96
|
|
|
HC STENT TIBIOPERONEAL
|
Facility
IP
|
$28,001.00
|
|
|
Service Code
|
CPT 37230
|
| Hospital Charge Code |
909020071
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,600.20 |
| Max. Negotiated Rate |
$25,200.90 |
| Rate for Payer: Cash Price |
$12,600.45
|
| Rate for Payer: Central Health Plan Commercial |
$22,400.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,200.40
|
| Rate for Payer: Galaxy Health WC |
$23,800.85
|
| Rate for Payer: Global Benefits Group Commercial |
$16,800.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$25,200.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18,676.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,600.20
|
| Rate for Payer: Multiplan Commercial |
$21,000.75
|
| Rate for Payer: Networks By Design Commercial |
$18,200.65
|
| Rate for Payer: Prime Health Services Commercial |
$23,800.85
|
|
|
HC STENT TIBIOPERONEAL
|
Facility
OP
|
$28,001.00
|
|
|
Service Code
|
CPT 37230
|
| Hospital Charge Code |
906820154
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,183.44 |
| Max. Negotiated Rate |
$48,045.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$21,908.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$32,863.44
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$24,099.86
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$21,908.96
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,572.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,017.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$29,952.68
|
| Rate for Payer: BCBS Transplant Transplant |
$16,800.60
|
| Rate for Payer: Blue Shield of California Commercial |
$5,824.53
|
| Rate for Payer: Blue Shield of California EPN |
$4,183.44
|
| Rate for Payer: Caremore Medicare Advantage |
$21,908.96
|
| Rate for Payer: Cash Price |
$12,600.45
|
| Rate for Payer: Cash Price |
$12,600.45
|
| Rate for Payer: Central Health Plan Commercial |
$22,400.80
|
| Rate for Payer: Cigna of CA PPO |
$20,720.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32,863.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$29,577.10
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$21,908.96
|
| Rate for Payer: EPIC Health Plan Transplant |
$21,908.96
|
| Rate for Payer: Galaxy Health WC |
$23,800.85
|
| Rate for Payer: Global Benefits Group Commercial |
$16,800.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$25,200.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$21,000.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$35,930.69
|
| Rate for Payer: IEHP medi-cal |
$36,149.78
|
| Rate for Payer: IEHP Medicare Advantage |
$21,908.96
|
| Rate for Payer: Innovage PACE Commercial |
$32,863.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18,676.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21,908.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,600.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29,358.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29,358.01
|
| Rate for Payer: Multiplan Commercial |
$21,000.75
|
| Rate for Payer: Multiplan WC |
$29,952.68
|
| Rate for Payer: Networks By Design Commercial |
$18,200.65
|
| Rate for Payer: Preferred Health Network WC |
$30,563.96
|
| Rate for Payer: Prime Health Services Commercial |
$23,800.85
|
| Rate for Payer: Prime Health Services Medicare |
$23,223.50
|
| Rate for Payer: Prime Health Services WC |
$29,647.04
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$16,800.60
|
| Rate for Payer: Riverside University Health MISP |
$24,099.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16,800.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$29,673.00
|
| Rate for Payer: United Healthcare All Other HMO |
$48,045.00
|
| Rate for Payer: United Healthcare HMO Rider |
$31,101.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28,895.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24,099.86
|
| Rate for Payer: Vantage Medical Group Senior |
$21,908.96
|
|
|
HC STENT TIBIOPERONEAL
|
Facility
IP
|
$28,001.00
|
|
|
Service Code
|
CPT 37230
|
| Hospital Charge Code |
906820154
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,600.20 |
| Max. Negotiated Rate |
$25,200.90 |
| Rate for Payer: Cash Price |
$12,600.45
|
| Rate for Payer: Central Health Plan Commercial |
$22,400.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,200.40
|
| Rate for Payer: Galaxy Health WC |
$23,800.85
|
| Rate for Payer: Global Benefits Group Commercial |
$16,800.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$25,200.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18,676.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,600.20
|
| Rate for Payer: Multiplan Commercial |
$21,000.75
|
| Rate for Payer: Networks By Design Commercial |
$18,200.65
|
| Rate for Payer: Prime Health Services Commercial |
$23,800.85
|
|
|
HC STENT TIBIOPERONEAL EA ADDL
|
Facility
IP
|
$16,120.00
|
|
|
Service Code
|
CPT 37234
|
| Hospital Charge Code |
906820158
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,224.00 |
| Max. Negotiated Rate |
$14,508.00 |
| Rate for Payer: Cash Price |
$7,254.00
|
| Rate for Payer: Central Health Plan Commercial |
$12,896.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,448.00
|
| Rate for Payer: Galaxy Health WC |
$13,702.00
|
| Rate for Payer: Global Benefits Group Commercial |
$9,672.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,508.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,752.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,224.00
|
| Rate for Payer: Multiplan Commercial |
$12,090.00
|
| Rate for Payer: Networks By Design Commercial |
$10,478.00
|
| Rate for Payer: Prime Health Services Commercial |
$13,702.00
|
|
|
HC STENT TIBIOPERONEAL EA ADDL
|
Facility
OP
|
$16,120.00
|
|
|
Service Code
|
CPT 37234
|
| Hospital Charge Code |
906820158
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,901.00 |
| Max. Negotiated Rate |
$27,445.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$13,702.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8,866.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8,866.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: BCBS Transplant Transplant |
$9,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,824.53
|
| Rate for Payer: Blue Shield of California EPN |
$4,183.44
|
| Rate for Payer: Cash Price |
$7,254.00
|
| Rate for Payer: Cash Price |
$7,254.00
|
| Rate for Payer: Central Health Plan Commercial |
$12,896.00
|
| Rate for Payer: Cigna of CA PPO |
$11,928.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,702.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,448.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$6,448.00
|
| Rate for Payer: Galaxy Health WC |
$13,702.00
|
| Rate for Payer: Global Benefits Group Commercial |
$9,672.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,508.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$12,090.00
|
| Rate for Payer: IEHP medi-cal |
$5,642.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,752.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,224.00
|
| Rate for Payer: Multiplan Commercial |
$12,090.00
|
| Rate for Payer: Networks By Design Commercial |
$10,478.00
|
| Rate for Payer: Prime Health Services Commercial |
$13,702.00
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$9,672.00
|
| Rate for Payer: Riverside University Health MISP |
$6,448.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,672.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$16,813.00
|
| Rate for Payer: United Healthcare All Other HMO |
$27,445.00
|
| Rate for Payer: United Healthcare HMO Rider |
$17,214.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,742.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13,702.00
|
| Rate for Payer: Vantage Medical Group Senior |
$13,702.00
|
|
|
HC STENT TIBIOPERONEAL EA ADDL
|
Facility
IP
|
$16,120.00
|
|
|
Service Code
|
CPT 37234
|
| Hospital Charge Code |
909020075
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,224.00 |
| Max. Negotiated Rate |
$14,508.00 |
| Rate for Payer: Cash Price |
$7,254.00
|
| Rate for Payer: Central Health Plan Commercial |
$12,896.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,448.00
|
| Rate for Payer: Galaxy Health WC |
$13,702.00
|
| Rate for Payer: Global Benefits Group Commercial |
$9,672.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,508.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,752.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,224.00
|
| Rate for Payer: Multiplan Commercial |
$12,090.00
|
| Rate for Payer: Networks By Design Commercial |
$10,478.00
|
| Rate for Payer: Prime Health Services Commercial |
$13,702.00
|
|
|
HC STENT TIBIOPERONEAL EA ADDL
|
Facility
OP
|
$16,120.00
|
|
|
Service Code
|
CPT 37234
|
| Hospital Charge Code |
909020075
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,901.00 |
| Max. Negotiated Rate |
$27,445.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$13,702.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8,866.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8,866.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: BCBS Transplant Transplant |
$9,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,824.53
|
| Rate for Payer: Blue Shield of California EPN |
$4,183.44
|
| Rate for Payer: Cash Price |
$7,254.00
|
| Rate for Payer: Cash Price |
$7,254.00
|
| Rate for Payer: Central Health Plan Commercial |
$12,896.00
|
| Rate for Payer: Cigna of CA PPO |
$11,928.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,702.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,448.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$6,448.00
|
| Rate for Payer: Galaxy Health WC |
$13,702.00
|
| Rate for Payer: Global Benefits Group Commercial |
$9,672.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,508.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$12,090.00
|
| Rate for Payer: IEHP medi-cal |
$5,642.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,752.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,224.00
|
| Rate for Payer: Multiplan Commercial |
$12,090.00
|
| Rate for Payer: Networks By Design Commercial |
$10,478.00
|
| Rate for Payer: Prime Health Services Commercial |
$13,702.00
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$9,672.00
|
| Rate for Payer: Riverside University Health MISP |
$6,448.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,672.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$16,813.00
|
| Rate for Payer: United Healthcare All Other HMO |
$27,445.00
|
| Rate for Payer: United Healthcare HMO Rider |
$17,214.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,742.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13,702.00
|
| Rate for Payer: Vantage Medical Group Senior |
$13,702.00
|
|
|
HC STENT ULTRAFLEX T-B COV W/DEL
|
Facility
IP
|
$3,053.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
900803704
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$610.60 |
| Max. Negotiated Rate |
$2,747.70 |
| Rate for Payer: Blue Shield of California EPN |
$1,630.30
|
| Rate for Payer: Cash Price |
$1,373.85
|
| Rate for Payer: Central Health Plan Commercial |
$2,442.40
|
| Rate for Payer: Cigna of CA HMO |
$2,137.10
|
| Rate for Payer: Cigna of CA PPO |
$2,137.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,221.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,221.20
|
| Rate for Payer: Galaxy Health WC |
$2,595.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,831.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,747.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,036.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$610.60
|
| Rate for Payer: Multiplan Commercial |
$2,289.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,595.05
|
|
|
HC STENT ULTRAFLEX T-B COV W/DEL
|
Facility
OP
|
$3,053.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
900803704
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$610.60 |
| 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 |
$2,595.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,679.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,679.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,394.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,700.52
|
| Rate for Payer: BCBS Transplant Transplant |
$1,831.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2,289.75
|
| Rate for Payer: Blue Shield of California EPN |
$1,660.83
|
| Rate for Payer: Cash Price |
$1,373.85
|
| Rate for Payer: Cash Price |
$1,373.85
|
| Rate for Payer: Central Health Plan Commercial |
$2,442.40
|
| Rate for Payer: Cigna of CA HMO |
$2,137.10
|
| Rate for Payer: Cigna of CA PPO |
$2,137.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,595.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,221.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,221.20
|
| Rate for Payer: Galaxy Health WC |
$2,595.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,831.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,747.70
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,289.75
|
| Rate for Payer: IEHP medi-cal |
$1,068.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,036.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$610.60
|
| Rate for Payer: Multiplan Commercial |
$2,289.75
|
| Rate for Payer: Networks By Design Commercial |
$1,526.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,595.05
|
| Rate for Payer: Riverside University Health MISP |
$1,221.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,831.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,831.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,526.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,526.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,526.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,526.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,595.05
|
| Rate for Payer: Vantage Medical Group Senior |
$2,595.05
|
|
|
HC STENT ULTRAFLEX T-B NON-COV W/
|
Facility
IP
|
$3,053.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
900803705
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$610.60 |
| Max. Negotiated Rate |
$2,747.70 |
| Rate for Payer: Blue Shield of California EPN |
$1,630.30
|
| Rate for Payer: Cash Price |
$1,373.85
|
| Rate for Payer: Central Health Plan Commercial |
$2,442.40
|
| Rate for Payer: Cigna of CA HMO |
$2,137.10
|
| Rate for Payer: Cigna of CA PPO |
$2,137.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,221.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,221.20
|
| Rate for Payer: Galaxy Health WC |
$2,595.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,831.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,747.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,036.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$610.60
|
| Rate for Payer: Multiplan Commercial |
$2,289.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,595.05
|
|
|
HC STENT ULTRAFLEX T-B NON-COV W/
|
Facility
OP
|
$3,053.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
900803705
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$610.60 |
| Max. Negotiated Rate |
$8,941.56 |
| Rate for Payer: Aetna of CA HMO/PPO |
$8,941.56
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,595.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,679.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,679.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,394.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,700.52
|
| Rate for Payer: BCBS Transplant Transplant |
$1,831.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2,289.75
|
| Rate for Payer: Blue Shield of California EPN |
$1,660.83
|
| Rate for Payer: Cash Price |
$1,373.85
|
| Rate for Payer: Cash Price |
$1,373.85
|
| Rate for Payer: Central Health Plan Commercial |
$2,442.40
|
| Rate for Payer: Cigna of CA HMO |
$2,137.10
|
| Rate for Payer: Cigna of CA PPO |
$2,137.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,595.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,221.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,221.20
|
| Rate for Payer: Galaxy Health WC |
$2,595.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,831.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,747.70
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,289.75
|
| Rate for Payer: IEHP medi-cal |
$1,068.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,036.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$610.60
|
| Rate for Payer: Multiplan Commercial |
$2,289.75
|
| Rate for Payer: Networks By Design Commercial |
$1,526.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,595.05
|
| Rate for Payer: Riverside University Health MISP |
$1,221.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,831.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,831.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,526.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,526.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,526.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,526.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,595.05
|
| Rate for Payer: Vantage Medical Group Senior |
$2,595.05
|
|
|
HC STENT VIABAHN
|
Facility
IP
|
$7,625.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
909020094
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,525.00 |
| Max. Negotiated Rate |
$6,862.50 |
| Rate for Payer: Blue Shield of California EPN |
$4,071.75
|
| Rate for Payer: Cash Price |
$3,431.25
|
| Rate for Payer: Central Health Plan Commercial |
$6,100.00
|
| Rate for Payer: Cigna of CA HMO |
$5,337.50
|
| Rate for Payer: Cigna of CA PPO |
$5,337.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,050.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,050.00
|
| Rate for Payer: Galaxy Health WC |
$6,481.25
|
| Rate for Payer: Global Benefits Group Commercial |
$4,575.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,862.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,085.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,525.00
|
| Rate for Payer: Multiplan Commercial |
$5,718.75
|
| Rate for Payer: Prime Health Services Commercial |
$6,481.25
|
|
|
HC STENT VIABAHN
|
Facility
OP
|
$7,625.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
909020094
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,525.00 |
| 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 |
$6,481.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,193.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,193.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,481.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,247.12
|
| Rate for Payer: BCBS Transplant Transplant |
$4,575.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,718.75
|
| Rate for Payer: Blue Shield of California EPN |
$4,148.00
|
| Rate for Payer: Cash Price |
$3,431.25
|
| Rate for Payer: Cash Price |
$3,431.25
|
| Rate for Payer: Central Health Plan Commercial |
$6,100.00
|
| Rate for Payer: Cigna of CA HMO |
$5,337.50
|
| Rate for Payer: Cigna of CA PPO |
$5,337.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,481.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,050.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,050.00
|
| Rate for Payer: Galaxy Health WC |
$6,481.25
|
| Rate for Payer: Global Benefits Group Commercial |
$4,575.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,862.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5,718.75
|
| Rate for Payer: IEHP medi-cal |
$2,668.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,085.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,525.00
|
| Rate for Payer: Multiplan Commercial |
$5,718.75
|
| Rate for Payer: Networks By Design Commercial |
$3,812.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,481.25
|
| Rate for Payer: Riverside University Health MISP |
$3,050.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,575.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,575.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,812.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,812.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,812.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,812.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,481.25
|
| Rate for Payer: Vantage Medical Group Senior |
$6,481.25
|
|
|
HC STENT VIATORR/COVERED
|
Facility
OP
|
$9,412.50
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
909081419
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,882.50 |
| 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 |
$8,000.62
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5,176.88
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5,176.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,297.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,242.76
|
| Rate for Payer: BCBS Transplant Transplant |
$5,647.50
|
| Rate for Payer: Blue Shield of California Commercial |
$7,059.38
|
| Rate for Payer: Blue Shield of California EPN |
$5,120.40
|
| Rate for Payer: Cash Price |
$4,235.63
|
| Rate for Payer: Cash Price |
$4,235.63
|
| Rate for Payer: Central Health Plan Commercial |
$7,530.00
|
| Rate for Payer: Cigna of CA HMO |
$6,588.75
|
| Rate for Payer: Cigna of CA PPO |
$6,588.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,000.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,765.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,765.00
|
| Rate for Payer: Galaxy Health WC |
$8,000.62
|
| Rate for Payer: Global Benefits Group Commercial |
$5,647.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,471.25
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$7,059.38
|
| Rate for Payer: IEHP medi-cal |
$3,294.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,278.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,882.50
|
| Rate for Payer: Multiplan Commercial |
$7,059.38
|
| Rate for Payer: Networks By Design Commercial |
$4,706.25
|
| Rate for Payer: Prime Health Services Commercial |
$8,000.62
|
| Rate for Payer: Riverside University Health MISP |
$3,765.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,647.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,647.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,706.25
|
| Rate for Payer: United Healthcare All Other HMO |
$4,706.25
|
| Rate for Payer: United Healthcare HMO Rider |
$4,706.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,706.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,000.62
|
| Rate for Payer: Vantage Medical Group Senior |
$8,000.62
|
|
|
HC STENT VIATORR/COVERED
|
Facility
IP
|
$9,412.50
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
909081419
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,882.50 |
| Max. Negotiated Rate |
$8,471.25 |
| Rate for Payer: Blue Shield of California EPN |
$5,026.28
|
| Rate for Payer: Cash Price |
$4,235.63
|
| Rate for Payer: Central Health Plan Commercial |
$7,530.00
|
| Rate for Payer: Cigna of CA HMO |
$6,588.75
|
| Rate for Payer: Cigna of CA PPO |
$6,588.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,765.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,765.00
|
| Rate for Payer: Galaxy Health WC |
$8,000.62
|
| Rate for Payer: Global Benefits Group Commercial |
$5,647.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,471.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,278.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,882.50
|
| Rate for Payer: Multiplan Commercial |
$7,059.38
|
| Rate for Payer: Prime Health Services Commercial |
$8,000.62
|
|
|
HC STENT WINGSPAN
|
Facility
OP
|
$15,287.50
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020055
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,057.50 |
| Max. Negotiated Rate |
$13,758.75 |
| Rate for Payer: Aetna of CA HMO/PPO |
$8,941.56
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$12,994.38
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8,408.12
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8,408.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,980.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,515.14
|
| Rate for Payer: BCBS Transplant Transplant |
$9,172.50
|
| Rate for Payer: Blue Shield of California Commercial |
$11,465.62
|
| Rate for Payer: Blue Shield of California EPN |
$8,316.40
|
| Rate for Payer: Cash Price |
$6,879.38
|
| Rate for Payer: Cash Price |
$6,879.38
|
| Rate for Payer: Central Health Plan Commercial |
$12,230.00
|
| Rate for Payer: Cigna of CA HMO |
$10,701.25
|
| Rate for Payer: Cigna of CA PPO |
$10,701.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,994.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,115.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$6,115.00
|
| Rate for Payer: Galaxy Health WC |
$12,994.38
|
| Rate for Payer: Global Benefits Group Commercial |
$9,172.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,758.75
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$11,465.62
|
| Rate for Payer: IEHP medi-cal |
$5,350.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,196.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,057.50
|
| Rate for Payer: Multiplan Commercial |
$11,465.62
|
| Rate for Payer: Networks By Design Commercial |
$7,643.75
|
| Rate for Payer: Prime Health Services Commercial |
$12,994.38
|
| Rate for Payer: Riverside University Health MISP |
$6,115.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,172.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,172.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,643.75
|
| Rate for Payer: United Healthcare All Other HMO |
$7,643.75
|
| Rate for Payer: United Healthcare HMO Rider |
$7,643.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,643.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12,994.38
|
| Rate for Payer: Vantage Medical Group Senior |
$12,994.38
|
|
|
HC STENT WINGSPAN
|
Facility
IP
|
$15,287.50
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020055
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,057.50 |
| Max. Negotiated Rate |
$13,758.75 |
| Rate for Payer: Blue Shield of California EPN |
$8,163.52
|
| Rate for Payer: Cash Price |
$6,879.38
|
| Rate for Payer: Central Health Plan Commercial |
$12,230.00
|
| Rate for Payer: Cigna of CA HMO |
$10,701.25
|
| Rate for Payer: Cigna of CA PPO |
$10,701.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,115.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$6,115.00
|
| Rate for Payer: Galaxy Health WC |
$12,994.38
|
| Rate for Payer: Global Benefits Group Commercial |
$9,172.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,758.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,196.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,057.50
|
| Rate for Payer: Multiplan Commercial |
$11,465.62
|
| Rate for Payer: Prime Health Services Commercial |
$12,994.38
|
|
|
HC STEREOTACTIC PROBE 11 GA
|
Facility
OP
|
$774.00
|
|
| Hospital Charge Code |
909001127
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$154.80 |
| Max. Negotiated Rate |
$696.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$470.05
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$657.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$425.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$425.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$374.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.28
|
| Rate for Payer: BCBS Transplant Transplant |
$464.40
|
| Rate for Payer: Blue Shield of California Commercial |
$486.85
|
| Rate for Payer: Blue Shield of California EPN |
$378.49
|
| Rate for Payer: Cash Price |
$348.30
|
| Rate for Payer: Central Health Plan Commercial |
$619.20
|
| Rate for Payer: Cigna of CA HMO |
$495.36
|
| Rate for Payer: Cigna of CA PPO |
$572.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$657.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$309.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$309.60
|
| Rate for Payer: Galaxy Health WC |
$657.90
|
| Rate for Payer: Global Benefits Group Commercial |
$464.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$696.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$580.50
|
| Rate for Payer: IEHP medi-cal |
$270.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$516.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$154.80
|
| Rate for Payer: Multiplan Commercial |
$580.50
|
| Rate for Payer: Networks By Design Commercial |
$503.10
|
| Rate for Payer: Prime Health Services Commercial |
$657.90
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$464.40
|
| Rate for Payer: Riverside University Health MISP |
$309.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$464.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$464.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$387.00
|
| Rate for Payer: United Healthcare All Other HMO |
$387.00
|
| Rate for Payer: United Healthcare HMO Rider |
$387.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$387.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$657.90
|
| Rate for Payer: Vantage Medical Group Senior |
$657.90
|
|
|
HC STEREOTACTIC PROBE 11 GA
|
Facility
IP
|
$774.00
|
|
| Hospital Charge Code |
909001127
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$154.80 |
| Max. Negotiated Rate |
$696.60 |
| Rate for Payer: Cash Price |
$348.30
|
| Rate for Payer: Central Health Plan Commercial |
$619.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$309.60
|
| Rate for Payer: Galaxy Health WC |
$657.90
|
| Rate for Payer: Global Benefits Group Commercial |
$464.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$696.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$516.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$154.80
|
| Rate for Payer: Multiplan Commercial |
$580.50
|
| Rate for Payer: Networks By Design Commercial |
$503.10
|
| Rate for Payer: Prime Health Services Commercial |
$657.90
|
|
|
HC STEREOTACTIC PROBE 8 GA
|
Facility
IP
|
$921.00
|
|
| Hospital Charge Code |
909001128
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$184.20 |
| Max. Negotiated Rate |
$828.90 |
| Rate for Payer: Cash Price |
$414.45
|
| Rate for Payer: Central Health Plan Commercial |
$736.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$368.40
|
| Rate for Payer: Galaxy Health WC |
$782.85
|
| Rate for Payer: Global Benefits Group Commercial |
$552.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$828.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$614.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$184.20
|
| Rate for Payer: Multiplan Commercial |
$690.75
|
| Rate for Payer: Networks By Design Commercial |
$598.65
|
| Rate for Payer: Prime Health Services Commercial |
$782.85
|
|
