|
HC STENT BILIARY 8.5FRX12CM
|
Facility
|
IP
|
$290.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
900100382
|
|
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 BILIARY 8.5FRX12CM
|
Facility
|
OP
|
$290.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
900100382
|
|
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 SMART CORIDS 2-6
|
Facility
|
IP
|
$2,880.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909081208
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$576.00 |
| Max. Negotiated Rate |
$2,592.00 |
| Rate for Payer: Adventist Health Commercial |
$576.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,226.24
|
| Rate for Payer: Blue Shield of California EPN |
$1,451.52
|
| Rate for Payer: Cash Price |
$1,584.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,304.00
|
| Rate for Payer: Cigna of CA HMO |
$2,016.00
|
| Rate for Payer: Cigna of CA PPO |
$2,016.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,152.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,152.00
|
| Rate for Payer: Galaxy Health WC |
$2,448.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,728.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,592.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,920.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,097.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,782.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$576.00
|
| Rate for Payer: Multiplan Commercial |
$2,160.00
|
| Rate for Payer: Networks By Design Commercial |
$1,440.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,448.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,080.86
|
| Rate for Payer: United Healthcare All Other HMO |
$1,052.06
|
| Rate for Payer: United Healthcare HMO Rider |
$1,029.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$943.20
|
|
|
HC STENT BILIARY SMART CORIDS 2-6
|
Facility
|
OP
|
$2,880.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909081208
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$576.00 |
| Max. Negotiated Rate |
$2,592.00 |
| Rate for Payer: Adventist Health Commercial |
$576.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,448.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,584.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,160.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,315.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,594.66
|
| Rate for Payer: Blue Shield of California Commercial |
$2,226.24
|
| Rate for Payer: Blue Shield of California EPN |
$1,451.52
|
| Rate for Payer: Cash Price |
$1,584.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,304.00
|
| Rate for Payer: Cigna of CA HMO |
$2,016.00
|
| Rate for Payer: Cigna of CA PPO |
$2,016.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,448.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,448.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,448.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,152.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,152.00
|
| Rate for Payer: Galaxy Health WC |
$2,448.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,728.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,592.00
|
| Rate for Payer: InnovAge PACE Commercial |
$1,440.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,920.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,097.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,782.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$576.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,016.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,016.00
|
| Rate for Payer: Multiplan Commercial |
$2,160.00
|
| Rate for Payer: Networks By Design Commercial |
$1,440.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,448.00
|
| Rate for Payer: Riverside University Health System MISP |
$1,152.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,728.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,728.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,080.86
|
| Rate for Payer: United Healthcare All Other HMO |
$1,052.06
|
| Rate for Payer: United Healthcare HMO Rider |
$1,029.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$943.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,448.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,448.00
|
| Rate for Payer: Vantage Medical Group Senior |
$2,448.00
|
|
|
HC STENT BILIARY ZILVER 10 X 4
|
Facility
|
OP
|
$3,705.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
900100370
|
|
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 ZILVER 10 X 4
|
Facility
|
IP
|
$3,705.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
900100370
|
|
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 BSTN BILI 0.035IN 10FRX10CM
|
Facility
|
IP
|
$462.25
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
900100371
|
|
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 BSTN BILI 0.035IN 10FRX10CM
|
Facility
|
OP
|
$462.25
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
900100371
|
|
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 BSTN BILI 0.035IN 10FRX15CM
|
Facility
|
IP
|
$462.25
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
900100372
|
|
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 BSTN BILI 0.035IN 10FRX15CM
|
Facility
|
OP
|
$462.25
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
900100372
|
|
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 BSTN BILI 0.035IN 10FRX5CM
|
Facility
|
OP
|
$462.25
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
900100373
|
|
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 BSTN BILI 0.035IN 10FRX5CM
|
Facility
|
IP
|
$462.25
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
900100373
|
|
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 CAROTID UNCVRD
|
Facility
|
IP
|
$6,825.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020141
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,365.00 |
| Max. Negotiated Rate |
$6,142.50 |
| Rate for Payer: Adventist Health Commercial |
$1,365.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,275.73
|
| Rate for Payer: Blue Shield of California EPN |
$3,439.80
|
| Rate for Payer: Cash Price |
$3,753.75
|
| Rate for Payer: Central Health Plan Commercial |
$5,460.00
|
| Rate for Payer: Cigna of CA HMO |
$4,777.50
|
| Rate for Payer: Cigna of CA PPO |
$4,777.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,730.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,730.00
|
| Rate for Payer: Galaxy Health WC |
$5,801.25
|
| Rate for Payer: Global Benefits Group Commercial |
$4,095.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,142.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,552.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,600.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,224.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,365.00
|
| Rate for Payer: Multiplan Commercial |
$5,118.75
|
| Rate for Payer: Networks By Design Commercial |
$3,412.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,801.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,561.42
|
| Rate for Payer: United Healthcare All Other HMO |
$2,493.17
|
| Rate for Payer: United Healthcare HMO Rider |
$2,439.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,235.19
|
|
|
HC STENT CAROTID UNCVRD
|
Facility
|
OP
|
$6,825.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020141
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,365.00 |
| Max. Negotiated Rate |
$6,142.50 |
| Rate for Payer: Adventist Health Commercial |
$1,365.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,801.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,753.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,118.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,116.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,779.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,275.73
|
| Rate for Payer: Blue Shield of California EPN |
$3,439.80
|
| Rate for Payer: Cash Price |
$3,753.75
|
| Rate for Payer: Central Health Plan Commercial |
$5,460.00
|
| Rate for Payer: Cigna of CA HMO |
$4,777.50
|
| Rate for Payer: Cigna of CA PPO |
$4,777.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,801.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,801.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,801.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,730.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,730.00
|
| Rate for Payer: Galaxy Health WC |
$5,801.25
|
| Rate for Payer: Global Benefits Group Commercial |
$4,095.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,142.50
|
| Rate for Payer: InnovAge PACE Commercial |
$3,412.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,552.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,600.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,224.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,365.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,777.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,777.50
|
| Rate for Payer: Multiplan Commercial |
$5,118.75
|
| Rate for Payer: Networks By Design Commercial |
$3,412.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,801.25
|
| Rate for Payer: Riverside University Health System MISP |
$2,730.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,095.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,095.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,561.42
|
| Rate for Payer: United Healthcare All Other HMO |
$2,493.17
|
| Rate for Payer: United Healthcare HMO Rider |
$2,439.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,235.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,801.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,801.25
|
| Rate for Payer: Vantage Medical Group Senior |
$5,801.25
|
|
|
HC STENT, CCA W EPD
|
Facility
|
OP
|
$23,575.00
|
|
|
Service Code
|
CPT 37215
|
| Hospital Charge Code |
909080026
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,053.38 |
| Max. Negotiated Rate |
$21,217.50 |
| Rate for Payer: Adventist Health Commercial |
$4,715.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20,038.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12,966.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17,681.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,415.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,845.60
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$12,966.25
|
| Rate for Payer: Cash Price |
$12,966.25
|
| Rate for Payer: Cash Price |
$12,966.25
|
| Rate for Payer: Central Health Plan Commercial |
$18,860.00
|
| Rate for Payer: Cigna of CA HMO |
$15,088.00
|
| Rate for Payer: Cigna of CA PPO |
$17,445.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20,038.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$20,038.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20,038.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,430.00
|
| Rate for Payer: EPIC Health Plan Senior |
$9,430.00
|
| Rate for Payer: Galaxy Health WC |
$20,038.75
|
| Rate for Payer: Global Benefits Group Commercial |
$14,145.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$21,217.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,053.38
|
| Rate for Payer: InnovAge PACE Commercial |
$11,787.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15,724.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,163.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,592.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,715.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16,502.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16,502.50
|
| Rate for Payer: Multiplan Commercial |
$17,681.25
|
| Rate for Payer: Networks By Design Commercial |
$15,323.75
|
| Rate for Payer: Prime Health Services Commercial |
$20,038.75
|
| Rate for Payer: Riverside University Health System MISP |
$9,430.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14,145.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20,038.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20,038.75
|
| Rate for Payer: Vantage Medical Group Senior |
$20,038.75
|
|
|
HC STENT, CCA W EPD
|
Facility
|
OP
|
$20,500.00
|
|
|
Service Code
|
CPT 37215
|
| Hospital Charge Code |
906820166
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,053.38 |
| Max. Negotiated Rate |
$18,450.00 |
| Rate for Payer: Adventist Health Commercial |
$4,100.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17,425.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11,275.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15,375.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9,926.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,039.65
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$11,275.00
|
| Rate for Payer: Cash Price |
$11,275.00
|
| Rate for Payer: Cash Price |
$11,275.00
|
| Rate for Payer: Central Health Plan Commercial |
$16,400.00
|
| Rate for Payer: Cigna of CA HMO |
$13,120.00
|
| Rate for Payer: Cigna of CA PPO |
$15,170.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17,425.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$17,425.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17,425.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,200.00
|
| Rate for Payer: EPIC Health Plan Senior |
$8,200.00
|
| Rate for Payer: Galaxy Health WC |
$17,425.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12,300.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$18,450.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,053.38
|
| Rate for Payer: InnovAge PACE Commercial |
$10,250.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,673.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,163.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,689.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,100.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14,350.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14,350.00
|
| Rate for Payer: Multiplan Commercial |
$15,375.00
|
| Rate for Payer: Networks By Design Commercial |
$13,325.00
|
| Rate for Payer: Prime Health Services Commercial |
$17,425.00
|
| Rate for Payer: Riverside University Health System MISP |
$8,200.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12,300.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17,425.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17,425.00
|
| Rate for Payer: Vantage Medical Group Senior |
$17,425.00
|
|
|
HC STENT, CCA W EPD
|
Facility
|
IP
|
$20,500.00
|
|
|
Service Code
|
CPT 37215
|
| Hospital Charge Code |
906820166
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,100.00 |
| Max. Negotiated Rate |
$18,450.00 |
| Rate for Payer: Adventist Health Commercial |
$4,100.00
|
| Rate for Payer: Cash Price |
$11,275.00
|
| Rate for Payer: Central Health Plan Commercial |
$16,400.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,200.00
|
| Rate for Payer: EPIC Health Plan Senior |
$8,200.00
|
| Rate for Payer: Galaxy Health WC |
$17,425.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12,300.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$18,450.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,673.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,810.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,689.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,100.00
|
| Rate for Payer: Multiplan Commercial |
$15,375.00
|
| Rate for Payer: Networks By Design Commercial |
$13,325.00
|
| Rate for Payer: Prime Health Services Commercial |
$17,425.00
|
|
|
HC STENT, CCA W EPD
|
Facility
|
IP
|
$23,575.00
|
|
|
Service Code
|
CPT 37215
|
| Hospital Charge Code |
909080026
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,715.00 |
| Max. Negotiated Rate |
$21,217.50 |
| Rate for Payer: Adventist Health Commercial |
$4,715.00
|
| Rate for Payer: Cash Price |
$12,966.25
|
| Rate for Payer: Central Health Plan Commercial |
$18,860.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,430.00
|
| Rate for Payer: EPIC Health Plan Senior |
$9,430.00
|
| Rate for Payer: Galaxy Health WC |
$20,038.75
|
| Rate for Payer: Global Benefits Group Commercial |
$14,145.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$21,217.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15,724.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,982.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,592.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,715.00
|
| Rate for Payer: Multiplan Commercial |
$17,681.25
|
| Rate for Payer: Networks By Design Commercial |
$15,323.75
|
| Rate for Payer: Prime Health Services Commercial |
$20,038.75
|
|
|
HC STENT CCA W/O EPD
|
Facility
|
IP
|
$27,549.00
|
|
|
Service Code
|
CPT 37216
|
| Hospital Charge Code |
909080027
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,509.80 |
| Max. Negotiated Rate |
$24,794.10 |
| Rate for Payer: Adventist Health Commercial |
$5,509.80
|
| Rate for Payer: Cash Price |
$15,151.95
|
| Rate for Payer: Central Health Plan Commercial |
$22,039.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,019.60
|
| Rate for Payer: EPIC Health Plan Senior |
$11,019.60
|
| Rate for Payer: Galaxy Health WC |
$23,416.65
|
| Rate for Payer: Global Benefits Group Commercial |
$16,529.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$24,794.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18,375.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,496.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17,052.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,509.80
|
| Rate for Payer: Multiplan Commercial |
$20,661.75
|
| Rate for Payer: Networks By Design Commercial |
$17,906.85
|
| Rate for Payer: Prime Health Services Commercial |
$23,416.65
|
|
|
HC STENT CCA W/O EPD
|
Facility
|
IP
|
$23,956.00
|
|
|
Service Code
|
CPT 37216
|
| Hospital Charge Code |
906820167
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,791.20 |
| Max. Negotiated Rate |
$21,560.40 |
| Rate for Payer: Adventist Health Commercial |
$4,791.20
|
| Rate for Payer: Cash Price |
$13,175.80
|
| Rate for Payer: Central Health Plan Commercial |
$19,164.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,582.40
|
| Rate for Payer: EPIC Health Plan Senior |
$9,582.40
|
| Rate for Payer: Galaxy Health WC |
$20,362.60
|
| Rate for Payer: Global Benefits Group Commercial |
$14,373.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$21,560.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15,978.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,127.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,828.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,791.20
|
| Rate for Payer: Multiplan Commercial |
$17,967.00
|
| Rate for Payer: Networks By Design Commercial |
$15,571.40
|
| Rate for Payer: Prime Health Services Commercial |
$20,362.60
|
|
|
HC STENT CCA W/O EPD
|
Facility
|
OP
|
$27,549.00
|
|
|
Service Code
|
CPT 37216
|
| Hospital Charge Code |
909080027
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$202.36 |
| Max. Negotiated Rate |
$24,794.10 |
| Rate for Payer: Adventist Health Commercial |
$5,509.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23,416.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,151.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20,661.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$13,339.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16,179.53
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$15,151.95
|
| Rate for Payer: Cash Price |
$15,151.95
|
| Rate for Payer: Cash Price |
$15,151.95
|
| Rate for Payer: Central Health Plan Commercial |
$22,039.20
|
| Rate for Payer: Cigna of CA HMO |
$17,631.36
|
| Rate for Payer: Cigna of CA PPO |
$20,386.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23,416.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$23,416.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23,416.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,019.60
|
| Rate for Payer: EPIC Health Plan Senior |
$11,019.60
|
| Rate for Payer: Galaxy Health WC |
$23,416.65
|
| Rate for Payer: Global Benefits Group Commercial |
$16,529.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$24,794.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$202.36
|
| Rate for Payer: InnovAge PACE Commercial |
$13,774.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18,375.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$223.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17,052.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,509.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19,284.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,284.30
|
| Rate for Payer: Multiplan Commercial |
$20,661.75
|
| Rate for Payer: Networks By Design Commercial |
$17,906.85
|
| Rate for Payer: Prime Health Services Commercial |
$23,416.65
|
| Rate for Payer: Riverside University Health System MISP |
$11,019.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16,529.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23,416.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23,416.65
|
| Rate for Payer: Vantage Medical Group Senior |
$23,416.65
|
|
|
HC STENT CCA W/O EPD
|
Facility
|
OP
|
$23,956.00
|
|
|
Service Code
|
CPT 37216
|
| Hospital Charge Code |
906820167
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$202.36 |
| Max. Negotiated Rate |
$21,560.40 |
| Rate for Payer: Adventist Health Commercial |
$4,791.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20,362.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13,175.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17,967.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,599.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,069.36
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$13,175.80
|
| Rate for Payer: Cash Price |
$13,175.80
|
| Rate for Payer: Cash Price |
$13,175.80
|
| Rate for Payer: Central Health Plan Commercial |
$19,164.80
|
| Rate for Payer: Cigna of CA HMO |
$15,331.84
|
| Rate for Payer: Cigna of CA PPO |
$17,727.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20,362.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$20,362.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20,362.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,582.40
|
| Rate for Payer: EPIC Health Plan Senior |
$9,582.40
|
| Rate for Payer: Galaxy Health WC |
$20,362.60
|
| Rate for Payer: Global Benefits Group Commercial |
$14,373.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$21,560.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$202.36
|
| Rate for Payer: InnovAge PACE Commercial |
$11,978.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15,978.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$223.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,828.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,791.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16,769.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16,769.20
|
| Rate for Payer: Multiplan Commercial |
$17,967.00
|
| Rate for Payer: Networks By Design Commercial |
$15,571.40
|
| Rate for Payer: Prime Health Services Commercial |
$20,362.60
|
| Rate for Payer: Riverside University Health System MISP |
$9,582.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14,373.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20,362.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20,362.60
|
| Rate for Payer: Vantage Medical Group Senior |
$20,362.60
|
|
|
HC STENT COARCT INCLUDING LSCA
|
Facility
|
OP
|
$4,533.00
|
|
|
Service Code
|
CPT 33880
|
| Hospital Charge Code |
906811485
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$906.60 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$906.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,853.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,493.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,399.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,194.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,662.23
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$2,493.15
|
| Rate for Payer: Cash Price |
$2,493.15
|
| Rate for Payer: Cash Price |
$2,493.15
|
| Rate for Payer: Central Health Plan Commercial |
$3,626.40
|
| Rate for Payer: Cigna of CA HMO |
$2,901.12
|
| Rate for Payer: Cigna of CA PPO |
$3,354.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,853.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,853.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,853.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,813.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,813.20
|
| Rate for Payer: Galaxy Health WC |
$3,853.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,719.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,079.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,570.39
|
| Rate for Payer: InnovAge PACE Commercial |
$2,266.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,023.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,839.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,805.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$906.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,173.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,173.10
|
| Rate for Payer: Multiplan Commercial |
$3,399.75
|
| Rate for Payer: Networks By Design Commercial |
$2,946.45
|
| Rate for Payer: Prime Health Services Commercial |
$3,853.05
|
| Rate for Payer: Riverside University Health System MISP |
$1,813.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,719.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,853.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,853.05
|
| Rate for Payer: Vantage Medical Group Senior |
$3,853.05
|
|
|
HC STENT COARCT INCLUDING LSCA
|
Facility
|
IP
|
$4,533.00
|
|
|
Service Code
|
CPT 33880
|
| Hospital Charge Code |
906811485
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$906.60 |
| Max. Negotiated Rate |
$4,079.70 |
| Rate for Payer: Adventist Health Commercial |
$906.60
|
| Rate for Payer: Cash Price |
$2,493.15
|
| Rate for Payer: Central Health Plan Commercial |
$3,626.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,813.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,813.20
|
| Rate for Payer: Galaxy Health WC |
$3,853.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,719.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,079.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,023.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,727.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,805.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$906.60
|
| Rate for Payer: Multiplan Commercial |
$3,399.75
|
| Rate for Payer: Networks By Design Commercial |
$2,946.45
|
| Rate for Payer: Prime Health Services Commercial |
$3,853.05
|
|
|
HC STENT COARCT NOT INCL LSCA
|
Facility
|
OP
|
$32,757.00
|
|
|
Service Code
|
CPT 33881
|
| Hospital Charge Code |
906820202
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$441.85 |
| Max. Negotiated Rate |
$29,481.30 |
| Rate for Payer: Adventist Health Commercial |
$6,551.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27,843.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18,016.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24,567.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$15,860.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19,238.19
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$18,016.35
|
| Rate for Payer: Cash Price |
$18,016.35
|
| Rate for Payer: Cash Price |
$18,016.35
|
| Rate for Payer: Central Health Plan Commercial |
$26,205.60
|
| Rate for Payer: Cigna of CA HMO |
$20,964.48
|
| Rate for Payer: Cigna of CA PPO |
$24,240.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27,843.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$27,843.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$27,843.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,102.80
|
| Rate for Payer: EPIC Health Plan Senior |
$13,102.80
|
| Rate for Payer: Galaxy Health WC |
$27,843.45
|
| Rate for Payer: Global Benefits Group Commercial |
$19,654.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$29,481.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$441.85
|
| Rate for Payer: InnovAge PACE Commercial |
$16,378.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21,848.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$488.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20,276.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,551.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22,929.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22,929.90
|
| Rate for Payer: Multiplan Commercial |
$24,567.75
|
| Rate for Payer: Networks By Design Commercial |
$21,292.05
|
| Rate for Payer: Prime Health Services Commercial |
$27,843.45
|
| Rate for Payer: Riverside University Health System MISP |
$13,102.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19,654.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27,843.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27,843.45
|
| Rate for Payer: Vantage Medical Group Senior |
$27,843.45
|
|
