|
HC STENT COARCT NOT INCL LSCA
|
Facility
|
IP
|
$32,757.00
|
|
|
Service Code
|
CPT 33881
|
| Hospital Charge Code |
906820202
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,551.40 |
| Max. Negotiated Rate |
$29,481.30 |
| Rate for Payer: Adventist Health Commercial |
$6,551.40
|
| Rate for Payer: Cash Price |
$18,016.35
|
| Rate for Payer: Central Health Plan Commercial |
$26,205.60
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$21,848.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,480.42
|
| 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: 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
|
|
|
HC STENT COARCT NOT INCL LSCA
|
Facility
|
OP
|
$27,843.00
|
|
|
Service Code
|
CPT 33881
|
| Hospital Charge Code |
906811493
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$441.85 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$5,568.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23,666.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,313.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20,882.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$13,481.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16,352.19
|
| 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 |
$15,313.65
|
| Rate for Payer: Cash Price |
$15,313.65
|
| Rate for Payer: Cash Price |
$15,313.65
|
| Rate for Payer: Central Health Plan Commercial |
$22,274.40
|
| Rate for Payer: Cigna of CA HMO |
$17,819.52
|
| Rate for Payer: Cigna of CA PPO |
$20,603.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23,666.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$23,666.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23,666.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,137.20
|
| Rate for Payer: EPIC Health Plan Senior |
$11,137.20
|
| Rate for Payer: Galaxy Health WC |
$23,666.55
|
| Rate for Payer: Global Benefits Group Commercial |
$16,705.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$25,058.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$441.85
|
| Rate for Payer: InnovAge PACE Commercial |
$13,921.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18,571.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$488.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17,234.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,568.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19,490.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,490.10
|
| Rate for Payer: Multiplan Commercial |
$20,882.25
|
| Rate for Payer: Networks By Design Commercial |
$18,097.95
|
| Rate for Payer: Prime Health Services Commercial |
$23,666.55
|
| Rate for Payer: Riverside University Health System MISP |
$11,137.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16,705.80
|
| 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 |
$23,666.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23,666.55
|
| Rate for Payer: Vantage Medical Group Senior |
$23,666.55
|
|
|
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
|
|
|
HC STENT COLONIC 0.035IN 25-30MMX9X230CM 10FR
|
Facility
|
OP
|
$6,375.00
|
|
|
Service Code
|
CPT C2625
|
| Hospital Charge Code |
900100401
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,275.00 |
| Max. Negotiated Rate |
$5,737.50 |
| Rate for Payer: Adventist Health Commercial |
$1,275.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,418.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,506.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,781.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,910.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,529.84
|
| Rate for Payer: Blue Shield of California Commercial |
$4,927.88
|
| Rate for Payer: Blue Shield of California EPN |
$3,213.00
|
| Rate for Payer: Cash Price |
$3,506.25
|
| Rate for Payer: Central Health Plan Commercial |
$5,100.00
|
| Rate for Payer: Cigna of CA HMO |
$4,462.50
|
| Rate for Payer: Cigna of CA PPO |
$4,462.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,418.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,418.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,418.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,550.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,550.00
|
| Rate for Payer: Galaxy Health WC |
$5,418.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,825.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,737.50
|
| Rate for Payer: InnovAge PACE Commercial |
$3,187.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,252.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,428.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,946.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,275.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,462.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,462.50
|
| Rate for Payer: Multiplan Commercial |
$4,781.25
|
| Rate for Payer: Networks By Design Commercial |
$3,187.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,418.75
|
| Rate for Payer: Riverside University Health System MISP |
$2,550.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,825.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,825.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,392.54
|
| Rate for Payer: United Healthcare All Other HMO |
$2,328.79
|
| Rate for Payer: United Healthcare HMO Rider |
$2,278.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,087.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,418.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,418.75
|
| Rate for Payer: Vantage Medical Group Senior |
$5,418.75
|
|
|
HC STENT COLONIC 0.035IN 25-30MMX9X230CM 10FR
|
Facility
|
IP
|
$6,375.00
|
|
|
Service Code
|
CPT C2625
|
| Hospital Charge Code |
900100401
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,275.00 |
| Max. Negotiated Rate |
$5,737.50 |
| Rate for Payer: Adventist Health Commercial |
$1,275.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,927.88
|
| Rate for Payer: Blue Shield of California EPN |
$3,213.00
|
| Rate for Payer: Cash Price |
$3,506.25
|
| Rate for Payer: Central Health Plan Commercial |
$5,100.00
|
| Rate for Payer: Cigna of CA HMO |
$4,462.50
|
| Rate for Payer: Cigna of CA PPO |
$4,462.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,550.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,550.00
|
| Rate for Payer: Galaxy Health WC |
$5,418.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,825.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,737.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,252.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,428.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,946.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,275.00
|
| Rate for Payer: Multiplan Commercial |
$4,781.25
|
| Rate for Payer: Networks By Design Commercial |
$3,187.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,418.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,392.54
|
| Rate for Payer: United Healthcare All Other HMO |
$2,328.79
|
| Rate for Payer: United Healthcare HMO Rider |
$2,278.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,087.81
|
|
|
HC STENT COVERED I CAST
|
Facility
|
IP
|
$6,437.50
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
909020087
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,287.50 |
| Max. Negotiated Rate |
$5,793.75 |
| Rate for Payer: Adventist Health Commercial |
$1,287.50
|
| Rate for Payer: Blue Shield of California Commercial |
$4,976.19
|
| Rate for Payer: Blue Shield of California EPN |
$3,244.50
|
| Rate for Payer: Cash Price |
$3,540.63
|
| Rate for Payer: Central Health Plan Commercial |
$5,150.00
|
| Rate for Payer: Cigna of CA HMO |
$4,506.25
|
| Rate for Payer: Cigna of CA PPO |
$4,506.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,575.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,575.00
|
| Rate for Payer: Galaxy Health WC |
$5,471.88
|
| Rate for Payer: Global Benefits Group Commercial |
$3,862.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,793.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,293.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,452.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,984.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,287.50
|
| Rate for Payer: Multiplan Commercial |
$4,828.12
|
| Rate for Payer: Networks By Design Commercial |
$3,218.75
|
| Rate for Payer: Prime Health Services Commercial |
$5,471.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,415.99
|
| Rate for Payer: United Healthcare All Other HMO |
$2,351.62
|
| Rate for Payer: United Healthcare HMO Rider |
$2,300.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,108.28
|
|
|
HC STENT COVERED I CAST
|
Facility
|
OP
|
$6,437.50
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
909020087
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,287.50 |
| Max. Negotiated Rate |
$5,793.75 |
| Rate for Payer: Adventist Health Commercial |
$1,287.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,471.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,540.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,828.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,939.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,564.44
|
| Rate for Payer: Blue Shield of California Commercial |
$4,976.19
|
| Rate for Payer: Blue Shield of California EPN |
$3,244.50
|
| Rate for Payer: Cash Price |
$3,540.63
|
| Rate for Payer: Central Health Plan Commercial |
$5,150.00
|
| Rate for Payer: Cigna of CA HMO |
$4,506.25
|
| Rate for Payer: Cigna of CA PPO |
$4,506.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,471.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,471.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,471.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,575.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,575.00
|
| Rate for Payer: Galaxy Health WC |
$5,471.88
|
| Rate for Payer: Global Benefits Group Commercial |
$3,862.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,793.75
|
| Rate for Payer: InnovAge PACE Commercial |
$3,218.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,293.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,984.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,287.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,506.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,506.25
|
| Rate for Payer: Multiplan Commercial |
$4,828.12
|
| Rate for Payer: Networks By Design Commercial |
$3,218.75
|
| Rate for Payer: Prime Health Services Commercial |
$5,471.88
|
| Rate for Payer: Riverside University Health System MISP |
$2,575.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,862.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,862.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,415.99
|
| Rate for Payer: United Healthcare All Other HMO |
$2,351.62
|
| Rate for Payer: United Healthcare HMO Rider |
$2,300.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,108.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,471.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,471.88
|
| Rate for Payer: Vantage Medical Group Senior |
$5,471.88
|
|
|
HC STENT DBL PIGTAIL 10FRX10CM
|
Facility
|
OP
|
$483.00
|
|
|
Service Code
|
CPT C2625
|
| Hospital Charge Code |
900100355
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$96.60 |
| Max. Negotiated Rate |
$434.70 |
| Rate for Payer: Adventist Health Commercial |
$96.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$410.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$265.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$362.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$220.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$267.44
|
| Rate for Payer: Blue Shield of California Commercial |
$373.36
|
| Rate for Payer: Blue Shield of California EPN |
$243.43
|
| Rate for Payer: Cash Price |
$265.65
|
| Rate for Payer: Central Health Plan Commercial |
$386.40
|
| Rate for Payer: Cigna of CA HMO |
$338.10
|
| Rate for Payer: Cigna of CA PPO |
$338.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$410.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$410.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$410.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$193.20
|
| Rate for Payer: EPIC Health Plan Senior |
$193.20
|
| Rate for Payer: Galaxy Health WC |
$410.55
|
| Rate for Payer: Global Benefits Group Commercial |
$289.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$434.70
|
| Rate for Payer: InnovAge PACE Commercial |
$241.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$322.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$184.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$298.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$338.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$338.10
|
| Rate for Payer: Multiplan Commercial |
$362.25
|
| Rate for Payer: Networks By Design Commercial |
$241.50
|
| Rate for Payer: Prime Health Services Commercial |
$410.55
|
| Rate for Payer: Riverside University Health System MISP |
$193.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$289.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$289.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$181.27
|
| Rate for Payer: United Healthcare All Other HMO |
$176.44
|
| Rate for Payer: United Healthcare HMO Rider |
$172.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$158.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$410.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$410.55
|
| Rate for Payer: Vantage Medical Group Senior |
$410.55
|
|
|
HC STENT DBL PIGTAIL 10FRX10CM
|
Facility
|
IP
|
$483.00
|
|
|
Service Code
|
CPT C2625
|
| Hospital Charge Code |
900100355
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$96.60 |
| Max. Negotiated Rate |
$434.70 |
| Rate for Payer: Adventist Health Commercial |
$96.60
|
| Rate for Payer: Blue Shield of California Commercial |
$373.36
|
| Rate for Payer: Blue Shield of California EPN |
$243.43
|
| Rate for Payer: Cash Price |
$265.65
|
| Rate for Payer: Central Health Plan Commercial |
$386.40
|
| Rate for Payer: Cigna of CA HMO |
$338.10
|
| Rate for Payer: Cigna of CA PPO |
$338.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$193.20
|
| Rate for Payer: EPIC Health Plan Senior |
$193.20
|
| Rate for Payer: Galaxy Health WC |
$410.55
|
| Rate for Payer: Global Benefits Group Commercial |
$289.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$434.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$322.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$184.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$298.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.60
|
| Rate for Payer: Multiplan Commercial |
$362.25
|
| Rate for Payer: Networks By Design Commercial |
$241.50
|
| Rate for Payer: Prime Health Services Commercial |
$410.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$181.27
|
| Rate for Payer: United Healthcare All Other HMO |
$176.44
|
| Rate for Payer: United Healthcare HMO Rider |
$172.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$158.18
|
|
|
HC STENT DBL PIGTAIL 10FRX12CM
|
Facility
|
OP
|
$483.00
|
|
|
Service Code
|
CPT C2625
|
| Hospital Charge Code |
900100356
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$96.60 |
| Max. Negotiated Rate |
$434.70 |
| Rate for Payer: Adventist Health Commercial |
$96.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$410.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$265.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$362.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$220.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$267.44
|
| Rate for Payer: Blue Shield of California Commercial |
$373.36
|
| Rate for Payer: Blue Shield of California EPN |
$243.43
|
| Rate for Payer: Cash Price |
$265.65
|
| Rate for Payer: Central Health Plan Commercial |
$386.40
|
| Rate for Payer: Cigna of CA HMO |
$338.10
|
| Rate for Payer: Cigna of CA PPO |
$338.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$410.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$410.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$410.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$193.20
|
| Rate for Payer: EPIC Health Plan Senior |
$193.20
|
| Rate for Payer: Galaxy Health WC |
$410.55
|
| Rate for Payer: Global Benefits Group Commercial |
$289.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$434.70
|
| Rate for Payer: InnovAge PACE Commercial |
$241.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$322.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$184.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$298.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$338.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$338.10
|
| Rate for Payer: Multiplan Commercial |
$362.25
|
| Rate for Payer: Networks By Design Commercial |
$241.50
|
| Rate for Payer: Prime Health Services Commercial |
$410.55
|
| Rate for Payer: Riverside University Health System MISP |
$193.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$289.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$289.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$181.27
|
| Rate for Payer: United Healthcare All Other HMO |
$176.44
|
| Rate for Payer: United Healthcare HMO Rider |
$172.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$158.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$410.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$410.55
|
| Rate for Payer: Vantage Medical Group Senior |
$410.55
|
|
|
HC STENT DBL PIGTAIL 10FRX12CM
|
Facility
|
IP
|
$483.00
|
|
|
Service Code
|
CPT C2625
|
| Hospital Charge Code |
900100356
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$96.60 |
| Max. Negotiated Rate |
$434.70 |
| Rate for Payer: Adventist Health Commercial |
$96.60
|
| Rate for Payer: Blue Shield of California Commercial |
$373.36
|
| Rate for Payer: Blue Shield of California EPN |
$243.43
|
| Rate for Payer: Cash Price |
$265.65
|
| Rate for Payer: Central Health Plan Commercial |
$386.40
|
| Rate for Payer: Cigna of CA HMO |
$338.10
|
| Rate for Payer: Cigna of CA PPO |
$338.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$193.20
|
| Rate for Payer: EPIC Health Plan Senior |
$193.20
|
| Rate for Payer: Galaxy Health WC |
$410.55
|
| Rate for Payer: Global Benefits Group Commercial |
$289.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$434.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$322.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$184.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$298.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.60
|
| Rate for Payer: Multiplan Commercial |
$362.25
|
| Rate for Payer: Networks By Design Commercial |
$241.50
|
| Rate for Payer: Prime Health Services Commercial |
$410.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$181.27
|
| Rate for Payer: United Healthcare All Other HMO |
$176.44
|
| Rate for Payer: United Healthcare HMO Rider |
$172.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$158.18
|
|
|
HC STENT DUMONT TRACHEOBRONCHIAL
|
Facility
|
OP
|
$1,717.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
900803701
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$343.40 |
| Max. Negotiated Rate |
$1,545.30 |
| Rate for Payer: Adventist Health Commercial |
$343.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,459.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$944.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,287.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$783.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$950.70
|
| Rate for Payer: Blue Shield of California Commercial |
$1,327.24
|
| Rate for Payer: Blue Shield of California EPN |
$865.37
|
| Rate for Payer: Cash Price |
$944.35
|
| 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: Dignity Health Medi-Cal |
$1,459.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,459.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$686.80
|
| Rate for Payer: EPIC Health Plan Senior |
$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: InnovAge PACE Commercial |
$858.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,145.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$654.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,062.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$343.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,201.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,201.90
|
| 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 System 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 |
$644.39
|
| Rate for Payer: United Healthcare All Other HMO |
$627.22
|
| Rate for Payer: United Healthcare HMO Rider |
$613.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$562.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,459.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,459.45
|
| Rate for Payer: Vantage Medical Group Senior |
$1,459.45
|
|
|
HC STENT DUMONT TRACHEOBRONCHIAL
|
Facility
|
IP
|
$1,717.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
900803701
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$343.40 |
| Max. Negotiated Rate |
$1,545.30 |
| Rate for Payer: Adventist Health Commercial |
$343.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,327.24
|
| Rate for Payer: Blue Shield of California EPN |
$865.37
|
| Rate for Payer: Cash Price |
$944.35
|
| 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 Senior |
$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: Kaiser Permanente of CA Medi-Cal |
$654.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,062.82
|
| 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: United Healthcare All Other Commercial |
$644.39
|
| Rate for Payer: United Healthcare All Other HMO |
$627.22
|
| Rate for Payer: United Healthcare HMO Rider |
$613.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$562.32
|
|
|
HC STENT DUODENAL 0.035IN 22-27MMX12X230CM 10FR
|
Facility
|
OP
|
$6,375.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
900100402
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,275.00 |
| Max. Negotiated Rate |
$5,737.50 |
| Rate for Payer: Adventist Health Commercial |
$1,275.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,418.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,506.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,781.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,910.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,529.84
|
| Rate for Payer: Blue Shield of California Commercial |
$4,927.88
|
| Rate for Payer: Blue Shield of California EPN |
$3,213.00
|
| Rate for Payer: Cash Price |
$3,506.25
|
| Rate for Payer: Central Health Plan Commercial |
$5,100.00
|
| Rate for Payer: Cigna of CA HMO |
$4,462.50
|
| Rate for Payer: Cigna of CA PPO |
$4,462.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,418.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,418.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,418.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,550.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,550.00
|
| Rate for Payer: Galaxy Health WC |
$5,418.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,825.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,737.50
|
| Rate for Payer: InnovAge PACE Commercial |
$3,187.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,252.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,428.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,946.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,275.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,462.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,462.50
|
| Rate for Payer: Multiplan Commercial |
$4,781.25
|
| Rate for Payer: Networks By Design Commercial |
$3,187.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,418.75
|
| Rate for Payer: Riverside University Health System MISP |
$2,550.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,825.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,825.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,392.54
|
| Rate for Payer: United Healthcare All Other HMO |
$2,328.79
|
| Rate for Payer: United Healthcare HMO Rider |
$2,278.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,087.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,418.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,418.75
|
| Rate for Payer: Vantage Medical Group Senior |
$5,418.75
|
|
|
HC STENT DUODENAL 0.035IN 22-27MMX12X230CM 10FR
|
Facility
|
IP
|
$6,375.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
900100402
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,275.00 |
| Max. Negotiated Rate |
$5,737.50 |
| Rate for Payer: Adventist Health Commercial |
$1,275.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,927.88
|
| Rate for Payer: Blue Shield of California EPN |
$3,213.00
|
| Rate for Payer: Cash Price |
$3,506.25
|
| Rate for Payer: Central Health Plan Commercial |
$5,100.00
|
| Rate for Payer: Cigna of CA HMO |
$4,462.50
|
| Rate for Payer: Cigna of CA PPO |
$4,462.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,550.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,550.00
|
| Rate for Payer: Galaxy Health WC |
$5,418.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,825.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,737.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,252.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,428.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,946.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,275.00
|
| Rate for Payer: Multiplan Commercial |
$4,781.25
|
| Rate for Payer: Networks By Design Commercial |
$3,187.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,418.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,392.54
|
| Rate for Payer: United Healthcare All Other HMO |
$2,328.79
|
| Rate for Payer: United Healthcare HMO Rider |
$2,278.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,087.81
|
|
|
HC STENT DUODENAL 0.035IN 22-27MMX9X230CM 10FR
|
Facility
|
IP
|
$6,375.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
900100403
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,275.00 |
| Max. Negotiated Rate |
$5,737.50 |
| Rate for Payer: Adventist Health Commercial |
$1,275.00
|
| Rate for Payer: Cash Price |
$3,506.25
|
| Rate for Payer: Central Health Plan Commercial |
$5,100.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,550.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,550.00
|
| Rate for Payer: Galaxy Health WC |
$5,418.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,825.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,737.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,252.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,428.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,946.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,275.00
|
| Rate for Payer: Multiplan Commercial |
$4,781.25
|
| Rate for Payer: Networks By Design Commercial |
$4,143.75
|
| Rate for Payer: Prime Health Services Commercial |
$5,418.75
|
|
|
HC STENT DUODENAL 0.035IN 22-27MMX9X230CM 10FR
|
Facility
|
OP
|
$6,375.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
900100403
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,275.00 |
| Max. Negotiated Rate |
$5,737.50 |
| Rate for Payer: Adventist Health Commercial |
$1,275.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,871.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,418.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,506.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,781.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,086.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,744.04
|
| Rate for Payer: Blue Shield of California Commercial |
$3,895.12
|
| Rate for Payer: Blue Shield of California EPN |
$2,543.62
|
| Rate for Payer: Cash Price |
$3,506.25
|
| Rate for Payer: Central Health Plan Commercial |
$5,100.00
|
| Rate for Payer: Cigna of CA HMO |
$4,080.00
|
| Rate for Payer: Cigna of CA PPO |
$4,717.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,418.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,418.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,418.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,550.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,550.00
|
| Rate for Payer: Galaxy Health WC |
$5,418.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,825.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,737.50
|
| Rate for Payer: InnovAge PACE Commercial |
$3,187.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,252.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,428.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,946.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,275.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,462.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,462.50
|
| Rate for Payer: Multiplan Commercial |
$4,781.25
|
| Rate for Payer: Networks By Design Commercial |
$4,143.75
|
| Rate for Payer: Prime Health Services Commercial |
$5,418.75
|
| Rate for Payer: Riverside University Health System MISP |
$2,550.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,825.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,825.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,187.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,187.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,187.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,187.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,418.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,418.75
|
| Rate for Payer: Vantage Medical Group Senior |
$5,418.75
|
|
|
HC STENT DUODENAL 22MMX12CM UNCOVERED
|
Facility
|
OP
|
$5,200.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
900100386
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,040.00 |
| Max. Negotiated Rate |
$4,680.00 |
| Rate for Payer: Adventist Health Commercial |
$1,040.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,420.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,860.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,900.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,374.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,879.24
|
| Rate for Payer: Blue Shield of California Commercial |
$4,019.60
|
| Rate for Payer: Blue Shield of California EPN |
$2,620.80
|
| Rate for Payer: Cash Price |
$2,860.00
|
| Rate for Payer: Central Health Plan Commercial |
$4,160.00
|
| Rate for Payer: Cigna of CA HMO |
$3,640.00
|
| Rate for Payer: Cigna of CA PPO |
$3,640.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,420.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,420.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,420.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,080.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,080.00
|
| Rate for Payer: Galaxy Health WC |
$4,420.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,120.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,680.00
|
| Rate for Payer: InnovAge PACE Commercial |
$2,600.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,468.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,981.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,218.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,040.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,640.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,640.00
|
| Rate for Payer: Multiplan Commercial |
$3,900.00
|
| Rate for Payer: Networks By Design Commercial |
$2,600.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,420.00
|
| Rate for Payer: Riverside University Health System MISP |
$2,080.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,120.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,120.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,951.56
|
| Rate for Payer: United Healthcare All Other HMO |
$1,899.56
|
| Rate for Payer: United Healthcare HMO Rider |
$1,858.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,703.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,420.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,420.00
|
| Rate for Payer: Vantage Medical Group Senior |
$4,420.00
|
|
|
HC STENT DUODENAL 22MMX12CM UNCOVERED
|
Facility
|
IP
|
$5,200.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
900100386
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,040.00 |
| Max. Negotiated Rate |
$4,680.00 |
| Rate for Payer: Adventist Health Commercial |
$1,040.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,019.60
|
| Rate for Payer: Blue Shield of California EPN |
$2,620.80
|
| Rate for Payer: Cash Price |
$2,860.00
|
| Rate for Payer: Central Health Plan Commercial |
$4,160.00
|
| Rate for Payer: Cigna of CA HMO |
$3,640.00
|
| Rate for Payer: Cigna of CA PPO |
$3,640.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,080.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,080.00
|
| Rate for Payer: Galaxy Health WC |
$4,420.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,120.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,680.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,468.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,981.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,218.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,040.00
|
| Rate for Payer: Multiplan Commercial |
$3,900.00
|
| Rate for Payer: Networks By Design Commercial |
$2,600.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,420.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,951.56
|
| Rate for Payer: United Healthcare All Other HMO |
$1,899.56
|
| Rate for Payer: United Healthcare HMO Rider |
$1,858.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,703.00
|
|
|
HC STENT ENTERPRISE
|
Facility
|
OP
|
$13,000.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020034
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,600.00 |
| Max. Negotiated Rate |
$11,700.00 |
| Rate for Payer: Adventist Health Commercial |
$2,600.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,050.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,150.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,750.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,935.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,198.10
|
| Rate for Payer: Blue Shield of California Commercial |
$10,049.00
|
| Rate for Payer: Blue Shield of California EPN |
$6,552.00
|
| Rate for Payer: Cash Price |
$7,150.00
|
| Rate for Payer: Central Health Plan Commercial |
$10,400.00
|
| Rate for Payer: Cigna of CA HMO |
$9,100.00
|
| Rate for Payer: Cigna of CA PPO |
$9,100.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,050.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,050.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11,050.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,200.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,200.00
|
| Rate for Payer: Galaxy Health WC |
$11,050.00
|
| Rate for Payer: Global Benefits Group Commercial |
$7,800.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,700.00
|
| Rate for Payer: InnovAge PACE Commercial |
$6,500.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,671.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,953.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,047.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,600.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,100.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,100.00
|
| Rate for Payer: Multiplan Commercial |
$9,750.00
|
| Rate for Payer: Networks By Design Commercial |
$6,500.00
|
| Rate for Payer: Prime Health Services Commercial |
$11,050.00
|
| Rate for Payer: Riverside University Health System MISP |
$5,200.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,800.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,800.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,878.90
|
| Rate for Payer: United Healthcare All Other HMO |
$4,748.90
|
| Rate for Payer: United Healthcare HMO Rider |
$4,646.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,257.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,050.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,050.00
|
| Rate for Payer: Vantage Medical Group Senior |
$11,050.00
|
|
|
HC STENT ENTERPRISE
|
Facility
|
IP
|
$13,000.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020034
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,600.00 |
| Max. Negotiated Rate |
$11,700.00 |
| Rate for Payer: Adventist Health Commercial |
$2,600.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,049.00
|
| Rate for Payer: Blue Shield of California EPN |
$6,552.00
|
| Rate for Payer: Cash Price |
$7,150.00
|
| Rate for Payer: Central Health Plan Commercial |
$10,400.00
|
| Rate for Payer: Cigna of CA HMO |
$9,100.00
|
| Rate for Payer: Cigna of CA PPO |
$9,100.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,200.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,200.00
|
| Rate for Payer: Galaxy Health WC |
$11,050.00
|
| Rate for Payer: Global Benefits Group Commercial |
$7,800.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,700.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,671.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,953.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,047.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,600.00
|
| Rate for Payer: Multiplan Commercial |
$9,750.00
|
| Rate for Payer: Networks By Design Commercial |
$6,500.00
|
| Rate for Payer: Prime Health Services Commercial |
$11,050.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,878.90
|
| Rate for Payer: United Healthcare All Other HMO |
$4,748.90
|
| Rate for Payer: United Healthcare HMO Rider |
$4,646.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,257.50
|
|
|
HC STENT ESOPHAGEAL 20MMX12.5CM PARTIALLY COVERED
|
Facility
|
OP
|
$3,800.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
900100387
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$760.00 |
| Max. Negotiated Rate |
$3,420.00 |
| Rate for Payer: Adventist Health Commercial |
$760.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,230.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,090.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,850.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,735.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,104.06
|
| Rate for Payer: Blue Shield of California Commercial |
$2,937.40
|
| Rate for Payer: Blue Shield of California EPN |
$1,915.20
|
| Rate for Payer: Cash Price |
$2,090.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,040.00
|
| Rate for Payer: Cigna of CA HMO |
$2,660.00
|
| Rate for Payer: Cigna of CA PPO |
$2,660.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,230.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,230.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,230.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,520.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,520.00
|
| Rate for Payer: Galaxy Health WC |
$3,230.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,280.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,420.00
|
| Rate for Payer: InnovAge PACE Commercial |
$1,900.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,534.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,447.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,352.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$760.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,660.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,660.00
|
| Rate for Payer: Multiplan Commercial |
$2,850.00
|
| Rate for Payer: Networks By Design Commercial |
$1,900.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,230.00
|
| Rate for Payer: Riverside University Health System MISP |
$1,520.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,280.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,280.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,426.14
|
| Rate for Payer: United Healthcare All Other HMO |
$1,388.14
|
| Rate for Payer: United Healthcare HMO Rider |
$1,358.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,244.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,230.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,230.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,230.00
|
|
|
HC STENT ESOPHAGEAL 20MMX12.5CM PARTIALLY COVERED
|
Facility
|
IP
|
$3,800.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
900100387
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$760.00 |
| Max. Negotiated Rate |
$3,420.00 |
| Rate for Payer: Adventist Health Commercial |
$760.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,937.40
|
| Rate for Payer: Blue Shield of California EPN |
$1,915.20
|
| Rate for Payer: Cash Price |
$2,090.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,040.00
|
| Rate for Payer: Cigna of CA HMO |
$2,660.00
|
| Rate for Payer: Cigna of CA PPO |
$2,660.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,520.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,520.00
|
| Rate for Payer: Galaxy Health WC |
$3,230.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,280.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,420.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,534.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,447.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,352.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$760.00
|
| Rate for Payer: Multiplan Commercial |
$2,850.00
|
| Rate for Payer: Networks By Design Commercial |
$1,900.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,230.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,426.14
|
| Rate for Payer: United Healthcare All Other HMO |
$1,388.14
|
| Rate for Payer: United Healthcare HMO Rider |
$1,358.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,244.50
|
|
|
HC STENT ESOPHAGEAL 20MMX15CM PARTIALLY COVERED
|
Facility
|
OP
|
$3,800.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
900100388
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$760.00 |
| Max. Negotiated Rate |
$3,420.00 |
| Rate for Payer: Adventist Health Commercial |
$760.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,230.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,090.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,850.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,735.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,104.06
|
| Rate for Payer: Blue Shield of California Commercial |
$2,937.40
|
| Rate for Payer: Blue Shield of California EPN |
$1,915.20
|
| Rate for Payer: Cash Price |
$2,090.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,040.00
|
| Rate for Payer: Cigna of CA HMO |
$2,660.00
|
| Rate for Payer: Cigna of CA PPO |
$2,660.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,230.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,230.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,230.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,520.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,520.00
|
| Rate for Payer: Galaxy Health WC |
$3,230.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,280.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,420.00
|
| Rate for Payer: InnovAge PACE Commercial |
$1,900.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,534.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,447.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,352.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$760.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,660.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,660.00
|
| Rate for Payer: Multiplan Commercial |
$2,850.00
|
| Rate for Payer: Networks By Design Commercial |
$1,900.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,230.00
|
| Rate for Payer: Riverside University Health System MISP |
$1,520.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,280.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,280.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,426.14
|
| Rate for Payer: United Healthcare All Other HMO |
$1,388.14
|
| Rate for Payer: United Healthcare HMO Rider |
$1,358.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,244.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,230.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,230.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,230.00
|
|
|
HC STENT ESOPHAGEAL 20MMX15CM PARTIALLY COVERED
|
Facility
|
IP
|
$3,800.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
900100388
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$760.00 |
| Max. Negotiated Rate |
$3,420.00 |
| Rate for Payer: Adventist Health Commercial |
$760.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,937.40
|
| Rate for Payer: Blue Shield of California EPN |
$1,915.20
|
| Rate for Payer: Cash Price |
$2,090.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,040.00
|
| Rate for Payer: Cigna of CA HMO |
$2,660.00
|
| Rate for Payer: Cigna of CA PPO |
$2,660.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,520.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,520.00
|
| Rate for Payer: Galaxy Health WC |
$3,230.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,280.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,420.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,534.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,447.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,352.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$760.00
|
| Rate for Payer: Multiplan Commercial |
$2,850.00
|
| Rate for Payer: Networks By Design Commercial |
$1,900.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,230.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,426.14
|
| Rate for Payer: United Healthcare All Other HMO |
$1,388.14
|
| Rate for Payer: United Healthcare HMO Rider |
$1,358.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,244.50
|
|
