|
HC STNT BILRY SMRT CORD NIT 40/60
|
Facility
|
IP
|
$4,350.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909081429
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$870.00 |
| Max. Negotiated Rate |
$3,915.00 |
| Rate for Payer: Blue Shield of California EPN |
$2,322.90
|
| Rate for Payer: Cash Price |
$1,957.50
|
| Rate for Payer: Central Health Plan Commercial |
$3,480.00
|
| Rate for Payer: Cigna of CA HMO |
$3,045.00
|
| Rate for Payer: Cigna of CA PPO |
$3,045.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,740.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,740.00
|
| Rate for Payer: Galaxy Health WC |
$3,697.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,610.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,915.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,901.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,657.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$870.00
|
| Rate for Payer: Multiplan Commercial |
$3,262.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,697.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,642.56
|
| Rate for Payer: United Healthcare All Other HMO |
$1,604.28
|
| Rate for Payer: United Healthcare HMO Rider |
$1,569.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,435.50
|
|
|
HC STNT BILRY SMRT CORD NIT 40/60
|
Facility
|
OP
|
$4,350.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909081429
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$870.00 |
| Max. Negotiated Rate |
$3,915.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,697.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,392.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,392.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,986.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,422.95
|
| Rate for Payer: Blue Distinction Transplant |
$2,610.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,262.50
|
| Rate for Payer: Blue Shield of California EPN |
$2,366.40
|
| Rate for Payer: Cash Price |
$1,957.50
|
| Rate for Payer: Central Health Plan Commercial |
$3,480.00
|
| Rate for Payer: Cigna of CA HMO |
$3,045.00
|
| Rate for Payer: Cigna of CA PPO |
$3,045.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,697.50
|
| Rate for Payer: Dignity Health Media |
$3,697.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,697.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,740.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,740.00
|
| Rate for Payer: Galaxy Health WC |
$3,697.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,610.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,915.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,262.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,522.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,901.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,657.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$870.00
|
| Rate for Payer: Multiplan Commercial |
$3,262.50
|
| Rate for Payer: Networks By Design Commercial |
$2,175.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,697.50
|
| Rate for Payer: Riverside University Health System MISP |
$1,740.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,610.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,610.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,175.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,175.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,175.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,175.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,697.50
|
| Rate for Payer: Vantage Medical Group Senior |
$3,697.50
|
|
|
HC STNT BILRY SMRT CORD NITINL 80
|
Facility
|
OP
|
$3,900.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909081430
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,510.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,145.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,145.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,780.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,172.30
|
| Rate for Payer: Blue Distinction Transplant |
$2,340.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,925.00
|
| Rate for Payer: Blue Shield of California EPN |
$2,121.60
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.00
|
| Rate for Payer: Cigna of CA HMO |
$2,730.00
|
| Rate for Payer: Cigna of CA PPO |
$2,730.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Dignity Health Media |
$3,315.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,315.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,510.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,925.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,365.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$780.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: Networks By Design Commercial |
$1,950.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| Rate for Payer: Riverside University Health System MISP |
$1,560.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,340.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,340.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,950.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,950.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,950.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,950.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,315.00
|
|
|
HC STNT BILRY SMRT CORD NITINL 80
|
Facility
|
IP
|
$3,900.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909081430
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,510.00 |
| Rate for Payer: Blue Shield of California EPN |
$2,082.60
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.00
|
| Rate for Payer: Cigna of CA HMO |
$2,730.00
|
| Rate for Payer: Cigna of CA PPO |
$2,730.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,510.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$780.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,472.64
|
| Rate for Payer: United Healthcare All Other HMO |
$1,438.32
|
| Rate for Payer: United Healthcare HMO Rider |
$1,407.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,287.00
|
|
|
HC STNT COATED/COVERED W DELIVER
|
Facility
|
IP
|
$8,900.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
909081446
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,780.00 |
| Max. Negotiated Rate |
$8,010.00 |
| Rate for Payer: Blue Shield of California EPN |
$4,752.60
|
| Rate for Payer: Cash Price |
$4,005.00
|
| Rate for Payer: Central Health Plan Commercial |
$7,120.00
|
| Rate for Payer: Cigna of CA HMO |
$6,230.00
|
| Rate for Payer: Cigna of CA PPO |
$6,230.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,560.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,560.00
|
| Rate for Payer: Galaxy Health WC |
$7,565.00
|
| Rate for Payer: Global Benefits Group Commercial |
$5,340.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,010.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,936.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,390.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,780.00
|
| Rate for Payer: Multiplan Commercial |
$6,675.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,565.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,360.64
|
| Rate for Payer: United Healthcare All Other HMO |
$3,282.32
|
| Rate for Payer: United Healthcare HMO Rider |
$3,211.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,937.00
|
|
|
HC STNT COATED/COVERED W DELIVER
|
Facility
|
OP
|
$8,900.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
909081446
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,780.00 |
| Max. Negotiated Rate |
$8,010.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,565.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,895.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,895.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,063.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,957.30
|
| Rate for Payer: Blue Distinction Transplant |
$5,340.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,675.00
|
| Rate for Payer: Blue Shield of California EPN |
$4,841.60
|
| Rate for Payer: Cash Price |
$4,005.00
|
| Rate for Payer: Central Health Plan Commercial |
$7,120.00
|
| Rate for Payer: Cigna of CA HMO |
$6,230.00
|
| Rate for Payer: Cigna of CA PPO |
$6,230.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,565.00
|
| Rate for Payer: Dignity Health Media |
$7,565.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,565.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,560.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,560.00
|
| Rate for Payer: Galaxy Health WC |
$7,565.00
|
| Rate for Payer: Global Benefits Group Commercial |
$5,340.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,010.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6,675.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,115.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,936.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,780.00
|
| Rate for Payer: Multiplan Commercial |
$6,675.00
|
| Rate for Payer: Networks By Design Commercial |
$4,450.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,565.00
|
| Rate for Payer: Riverside University Health System MISP |
$3,560.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,340.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,340.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,450.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,450.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,450.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,450.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,565.00
|
| Rate for Payer: Vantage Medical Group Senior |
$7,565.00
|
|
|
HC STNT NO COAT/COVER W DEL SYS
|
Facility
|
IP
|
$3,900.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909081403
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,510.00 |
| Rate for Payer: Blue Shield of California EPN |
$2,082.60
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.00
|
| Rate for Payer: Cigna of CA HMO |
$2,730.00
|
| Rate for Payer: Cigna of CA PPO |
$2,730.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,510.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$780.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,472.64
|
| Rate for Payer: United Healthcare All Other HMO |
$1,438.32
|
| Rate for Payer: United Healthcare HMO Rider |
$1,407.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,287.00
|
|
|
HC STNT NO COAT/COVER W DEL SYS
|
Facility
|
OP
|
$3,900.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909081403
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,510.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,145.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,145.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,780.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,172.30
|
| Rate for Payer: Blue Distinction Transplant |
$2,340.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,925.00
|
| Rate for Payer: Blue Shield of California EPN |
$2,121.60
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.00
|
| Rate for Payer: Cigna of CA HMO |
$2,730.00
|
| Rate for Payer: Cigna of CA PPO |
$2,730.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Dignity Health Media |
$3,315.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,315.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,510.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,925.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,365.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$780.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: Networks By Design Commercial |
$1,950.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| Rate for Payer: Riverside University Health System MISP |
$1,560.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,340.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,340.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,950.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,950.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,950.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,950.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,315.00
|
|
|
HC STNT PLCMT CNTRL DIALYSIS SEG
|
Facility
|
IP
|
$8,527.00
|
|
|
Service Code
|
CPT 36908
|
| Hospital Charge Code |
909036908
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,705.40 |
| Max. Negotiated Rate |
$7,674.30 |
| Rate for Payer: Cash Price |
$3,837.15
|
| Rate for Payer: Central Health Plan Commercial |
$6,821.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,410.80
|
| Rate for Payer: Galaxy Health WC |
$7,247.95
|
| Rate for Payer: Global Benefits Group Commercial |
$5,116.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,674.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,687.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,248.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,705.40
|
| Rate for Payer: Multiplan Commercial |
$6,395.25
|
| Rate for Payer: Networks By Design Commercial |
$5,542.55
|
| Rate for Payer: Prime Health Services Commercial |
$7,247.95
|
|
|
HC STNT PLCMT CNTRL DIALYSIS SEG
|
Facility
|
OP
|
$8,527.00
|
|
|
Service Code
|
CPT 36908
|
| Hospital Charge Code |
906820283
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$951.00 |
| Max. Negotiated Rate |
$7,674.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,247.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,689.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,689.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$5,116.20
|
| Rate for Payer: Blue Shield of California Commercial |
$5,824.53
|
| Rate for Payer: Blue Shield of California EPN |
$4,183.44
|
| Rate for Payer: Cash Price |
$3,837.15
|
| Rate for Payer: Cash Price |
$3,837.15
|
| Rate for Payer: Central Health Plan Commercial |
$6,821.60
|
| Rate for Payer: Cigna of CA PPO |
$6,309.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,247.95
|
| Rate for Payer: Dignity Health Media |
$7,247.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,247.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,410.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,410.80
|
| Rate for Payer: Galaxy Health WC |
$7,247.95
|
| Rate for Payer: Global Benefits Group Commercial |
$5,116.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,674.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6,395.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,984.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,687.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,716.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,705.40
|
| Rate for Payer: Multiplan Commercial |
$6,395.25
|
| Rate for Payer: Networks By Design Commercial |
$5,542.55
|
| Rate for Payer: Prime Health Services Commercial |
$7,247.95
|
| Rate for Payer: Riverside University Health System MISP |
$3,410.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,116.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,247.95
|
| Rate for Payer: Vantage Medical Group Senior |
$7,247.95
|
|
|
HC STNT PLCMT CNTRL DIALYSIS SEG
|
Facility
|
OP
|
$8,527.00
|
|
|
Service Code
|
CPT 36908
|
| Hospital Charge Code |
909036908
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$951.00 |
| Max. Negotiated Rate |
$7,674.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,247.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,689.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,689.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$5,116.20
|
| Rate for Payer: Blue Shield of California Commercial |
$5,824.53
|
| Rate for Payer: Blue Shield of California EPN |
$4,183.44
|
| Rate for Payer: Cash Price |
$3,837.15
|
| Rate for Payer: Cash Price |
$3,837.15
|
| Rate for Payer: Central Health Plan Commercial |
$6,821.60
|
| Rate for Payer: Cigna of CA PPO |
$6,309.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,247.95
|
| Rate for Payer: Dignity Health Media |
$7,247.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,247.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,410.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,410.80
|
| Rate for Payer: Galaxy Health WC |
$7,247.95
|
| Rate for Payer: Global Benefits Group Commercial |
$5,116.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,674.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6,395.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,984.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,687.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,716.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,705.40
|
| Rate for Payer: Multiplan Commercial |
$6,395.25
|
| Rate for Payer: Networks By Design Commercial |
$5,542.55
|
| Rate for Payer: Prime Health Services Commercial |
$7,247.95
|
| Rate for Payer: Riverside University Health System MISP |
$3,410.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,116.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,247.95
|
| Rate for Payer: Vantage Medical Group Senior |
$7,247.95
|
|
|
HC STNT PLCMT CNTRL DIALYSIS SEG
|
Facility
|
IP
|
$8,527.00
|
|
|
Service Code
|
CPT 36908
|
| Hospital Charge Code |
906820283
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,705.40 |
| Max. Negotiated Rate |
$7,674.30 |
| Rate for Payer: Cash Price |
$3,837.15
|
| Rate for Payer: Central Health Plan Commercial |
$6,821.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,410.80
|
| Rate for Payer: Galaxy Health WC |
$7,247.95
|
| Rate for Payer: Global Benefits Group Commercial |
$5,116.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,674.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,687.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,248.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,705.40
|
| Rate for Payer: Multiplan Commercial |
$6,395.25
|
| Rate for Payer: Networks By Design Commercial |
$5,542.55
|
| Rate for Payer: Prime Health Services Commercial |
$7,247.95
|
|
|
HC STNT TRACHEO WALLGRFT W/UNI 20
|
Facility
|
IP
|
$9,420.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909081433
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,884.00 |
| Max. Negotiated Rate |
$8,478.00 |
| Rate for Payer: Blue Shield of California EPN |
$5,030.28
|
| Rate for Payer: Cash Price |
$4,239.00
|
| Rate for Payer: Central Health Plan Commercial |
$7,536.00
|
| Rate for Payer: Cigna of CA HMO |
$6,594.00
|
| Rate for Payer: Cigna of CA PPO |
$6,594.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,768.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,768.00
|
| Rate for Payer: Galaxy Health WC |
$8,007.00
|
| Rate for Payer: Global Benefits Group Commercial |
$5,652.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,478.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,283.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,589.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,884.00
|
| Rate for Payer: Multiplan Commercial |
$7,065.00
|
| Rate for Payer: Prime Health Services Commercial |
$8,007.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,556.99
|
| Rate for Payer: United Healthcare All Other HMO |
$3,474.10
|
| Rate for Payer: United Healthcare HMO Rider |
$3,398.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,108.60
|
|
|
HC STNT TRACHEO WALLGRFT W/UNI 20
|
Facility
|
OP
|
$9,420.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909081433
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,884.00 |
| Max. Negotiated Rate |
$8,478.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,007.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,181.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,181.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,301.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,246.94
|
| Rate for Payer: Blue Distinction Transplant |
$5,652.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,065.00
|
| Rate for Payer: Blue Shield of California EPN |
$5,124.48
|
| Rate for Payer: Cash Price |
$4,239.00
|
| Rate for Payer: Central Health Plan Commercial |
$7,536.00
|
| Rate for Payer: Cigna of CA HMO |
$6,594.00
|
| Rate for Payer: Cigna of CA PPO |
$6,594.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,007.00
|
| Rate for Payer: Dignity Health Media |
$8,007.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,007.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,768.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,768.00
|
| Rate for Payer: Galaxy Health WC |
$8,007.00
|
| Rate for Payer: Global Benefits Group Commercial |
$5,652.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,478.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7,065.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,297.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,283.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,589.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,884.00
|
| Rate for Payer: Multiplan Commercial |
$7,065.00
|
| Rate for Payer: Networks By Design Commercial |
$4,710.00
|
| Rate for Payer: Prime Health Services Commercial |
$8,007.00
|
| Rate for Payer: Riverside University Health System MISP |
$3,768.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,652.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,652.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,710.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,710.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,710.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,710.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,007.00
|
| Rate for Payer: Vantage Medical Group Senior |
$8,007.00
|
|
|
HC STNT WALL CAROTID
|
Facility
|
OP
|
$6,425.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909000023
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,285.00 |
| Max. Negotiated Rate |
$5,782.50 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,461.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,533.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,533.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,933.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,578.72
|
| Rate for Payer: Blue Distinction Transplant |
$3,855.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,818.75
|
| Rate for Payer: Blue Shield of California EPN |
$3,495.20
|
| Rate for Payer: Cash Price |
$2,891.25
|
| Rate for Payer: Central Health Plan Commercial |
$5,140.00
|
| Rate for Payer: Cigna of CA HMO |
$4,497.50
|
| Rate for Payer: Cigna of CA PPO |
$4,497.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,461.25
|
| Rate for Payer: Dignity Health Media |
$5,461.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,461.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,570.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,570.00
|
| Rate for Payer: Galaxy Health WC |
$5,461.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,855.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,782.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,818.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,248.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,285.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,447.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,285.00
|
| Rate for Payer: Multiplan Commercial |
$4,818.75
|
| Rate for Payer: Networks By Design Commercial |
$3,212.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,461.25
|
| Rate for Payer: Riverside University Health System MISP |
$2,570.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,855.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,855.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,212.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,212.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,212.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,212.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,461.25
|
| Rate for Payer: Vantage Medical Group Senior |
$5,461.25
|
|
|
HC STNT WALL CAROTID
|
Facility
|
IP
|
$6,425.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909000023
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,285.00 |
| Max. Negotiated Rate |
$5,782.50 |
| Rate for Payer: Blue Shield of California EPN |
$3,430.95
|
| Rate for Payer: Cash Price |
$2,891.25
|
| Rate for Payer: Central Health Plan Commercial |
$5,140.00
|
| Rate for Payer: Cigna of CA HMO |
$4,497.50
|
| Rate for Payer: Cigna of CA PPO |
$4,497.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,570.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,570.00
|
| Rate for Payer: Galaxy Health WC |
$5,461.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,855.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,782.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,285.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,447.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,285.00
|
| Rate for Payer: Multiplan Commercial |
$4,818.75
|
| Rate for Payer: Prime Health Services Commercial |
$5,461.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,426.08
|
| Rate for Payer: United Healthcare All Other HMO |
$2,369.54
|
| Rate for Payer: United Healthcare HMO Rider |
$2,318.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,120.25
|
|
|
HC STNT WALL RP BILRY W/UNI 20,40
|
Facility
|
OP
|
$5,665.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909081426
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,133.00 |
| Max. Negotiated Rate |
$5,098.50 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,815.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,115.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,115.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,586.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,155.40
|
| Rate for Payer: Blue Distinction Transplant |
$3,399.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,248.75
|
| Rate for Payer: Blue Shield of California EPN |
$3,081.76
|
| Rate for Payer: Cash Price |
$2,549.25
|
| Rate for Payer: Central Health Plan Commercial |
$4,532.00
|
| Rate for Payer: Cigna of CA HMO |
$3,965.50
|
| Rate for Payer: Cigna of CA PPO |
$3,965.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,815.25
|
| Rate for Payer: Dignity Health Media |
$4,815.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,815.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,266.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,266.00
|
| Rate for Payer: Galaxy Health WC |
$4,815.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,399.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,098.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,248.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,982.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,778.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,158.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,133.00
|
| Rate for Payer: Multiplan Commercial |
$4,248.75
|
| Rate for Payer: Networks By Design Commercial |
$2,832.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,815.25
|
| Rate for Payer: Riverside University Health System MISP |
$2,266.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,399.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,399.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,832.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,832.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,832.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,832.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,815.25
|
| Rate for Payer: Vantage Medical Group Senior |
$4,815.25
|
|
|
HC STNT WALL RP BILRY W/UNI 20,40
|
Facility
|
IP
|
$5,665.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909081426
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,133.00 |
| Max. Negotiated Rate |
$5,098.50 |
| Rate for Payer: Blue Shield of California EPN |
$3,025.11
|
| Rate for Payer: Cash Price |
$2,549.25
|
| Rate for Payer: Central Health Plan Commercial |
$4,532.00
|
| Rate for Payer: Cigna of CA HMO |
$3,965.50
|
| Rate for Payer: Cigna of CA PPO |
$3,965.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,266.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,266.00
|
| Rate for Payer: Galaxy Health WC |
$4,815.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,399.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,098.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,778.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,158.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,133.00
|
| Rate for Payer: Multiplan Commercial |
$4,248.75
|
| Rate for Payer: Prime Health Services Commercial |
$4,815.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,139.10
|
| Rate for Payer: United Healthcare All Other HMO |
$2,089.25
|
| Rate for Payer: United Healthcare HMO Rider |
$2,043.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,869.45
|
|
|
HC STNT WALL RP BILRY W/UNI 80,94
|
Facility
|
IP
|
$2,825.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909081427
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$565.00 |
| Max. Negotiated Rate |
$2,542.50 |
| Rate for Payer: Blue Shield of California EPN |
$1,508.55
|
| Rate for Payer: Cash Price |
$1,271.25
|
| Rate for Payer: Central Health Plan Commercial |
$2,260.00
|
| Rate for Payer: Cigna of CA HMO |
$1,977.50
|
| Rate for Payer: Cigna of CA PPO |
$1,977.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,130.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,130.00
|
| Rate for Payer: Galaxy Health WC |
$2,401.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,695.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,542.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,884.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,076.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$565.00
|
| Rate for Payer: Multiplan Commercial |
$2,118.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,401.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,066.72
|
| Rate for Payer: United Healthcare All Other HMO |
$1,041.86
|
| Rate for Payer: United Healthcare HMO Rider |
$1,019.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$932.25
|
|
|
HC STNT WALL RP BILRY W/UNI 80,94
|
Facility
|
OP
|
$2,825.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909081427
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$565.00 |
| Max. Negotiated Rate |
$2,542.50 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,401.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,553.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,553.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,289.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,573.52
|
| Rate for Payer: Blue Distinction Transplant |
$1,695.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,118.75
|
| Rate for Payer: Blue Shield of California EPN |
$1,536.80
|
| Rate for Payer: Cash Price |
$1,271.25
|
| Rate for Payer: Central Health Plan Commercial |
$2,260.00
|
| Rate for Payer: Cigna of CA HMO |
$1,977.50
|
| Rate for Payer: Cigna of CA PPO |
$1,977.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,401.25
|
| Rate for Payer: Dignity Health Media |
$2,401.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,401.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,130.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,130.00
|
| Rate for Payer: Galaxy Health WC |
$2,401.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,695.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,542.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,118.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$988.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,884.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,076.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$565.00
|
| Rate for Payer: Multiplan Commercial |
$2,118.75
|
| Rate for Payer: Networks By Design Commercial |
$1,412.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,401.25
|
| Rate for Payer: Riverside University Health System MISP |
$1,130.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,695.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,695.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,412.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,412.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,412.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,412.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,401.25
|
| Rate for Payer: Vantage Medical Group Senior |
$2,401.25
|
|
|
HC STRAIGHT KNEE JT HEAVY DUTY ADDITION LE
|
Facility
|
OP
|
$290.00
|
|
|
Service Code
|
CPT L2385
|
| Hospital Charge Code |
905352385
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$101.50 |
| Max. Negotiated Rate |
$261.00 |
| 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 |
$159.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$140.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$171.33
|
| Rate for Payer: Blue Distinction Transplant |
$174.00
|
| Rate for Payer: Blue Shield of California Commercial |
$217.50
|
| Rate for Payer: Blue Shield of California EPN |
$157.76
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cash Price |
$130.50
|
| 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 Media |
$246.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$246.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$116.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$217.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$101.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$193.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$146.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$118.90
|
| 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 |
$145.00
|
| Rate for Payer: United Healthcare All Other HMO |
$145.00
|
| Rate for Payer: United Healthcare HMO Rider |
$145.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$145.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$246.50
|
| Rate for Payer: Vantage Medical Group Senior |
$246.50
|
|
|
HC STRAIGHT KNEE JT HEAVY DUTY ADDITION LE
|
Facility
|
IP
|
$290.00
|
|
|
Service Code
|
CPT L2385
|
| Hospital Charge Code |
905352385
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$58.00 |
| Max. Negotiated Rate |
$261.00 |
| Rate for Payer: Blue Shield of California EPN |
$154.86
|
| Rate for Payer: Cash Price |
$130.50
|
| 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 Transplant |
$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: 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 |
$109.50
|
| Rate for Payer: United Healthcare All Other HMO |
$106.95
|
| Rate for Payer: United Healthcare HMO Rider |
$104.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$95.70
|
|
|
HC STRAIGHT PUSHABLE COIL
|
Facility
|
IP
|
$580.00
|
|
| Hospital Charge Code |
909081804
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Blue Shield of California EPN |
$309.72
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: Cigna of CA HMO |
$406.00
|
| Rate for Payer: Cigna of CA PPO |
$406.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$219.01
|
| Rate for Payer: United Healthcare All Other HMO |
$213.90
|
| Rate for Payer: United Healthcare HMO Rider |
$209.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$191.40
|
|
|
HC STRAIGHT PUSHABLE COIL
|
Facility
|
OP
|
$580.00
|
|
| Hospital Charge Code |
909081804
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$319.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$319.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$264.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$323.06
|
| Rate for Payer: Blue Distinction Transplant |
$348.00
|
| Rate for Payer: Blue Shield of California Commercial |
$435.00
|
| Rate for Payer: Blue Shield of California EPN |
$315.52
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: Cigna of CA HMO |
$406.00
|
| Rate for Payer: Cigna of CA PPO |
$406.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$493.00
|
| Rate for Payer: Dignity Health Media |
$493.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$435.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$203.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$290.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: Riverside University Health System MISP |
$232.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$348.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$348.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$290.00
|
| Rate for Payer: United Healthcare All Other HMO |
$290.00
|
| Rate for Payer: United Healthcare HMO Rider |
$290.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$290.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.00
|
| Rate for Payer: Vantage Medical Group Senior |
$493.00
|
|
|
HC STRAP CLAVICLE MEDIUM
|
Facility
|
OP
|
$37.31
|
|
|
Service Code
|
CPT L3650
|
| Hospital Charge Code |
901607796
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$13.06 |
| Max. Negotiated Rate |
$68.36 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.52
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$18.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.04
|
| Rate for Payer: Blue Distinction Transplant |
$22.39
|
| Rate for Payer: Blue Shield of California Commercial |
$27.98
|
| Rate for Payer: Blue Shield of California EPN |
$20.30
|
| Rate for Payer: Cash Price |
$16.79
|
| Rate for Payer: Cash Price |
$16.79
|
| Rate for Payer: Central Health Plan Commercial |
$29.85
|
| Rate for Payer: Cigna of CA HMO |
$26.12
|
| Rate for Payer: Cigna of CA PPO |
$26.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.71
|
| Rate for Payer: Dignity Health Media |
$31.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$31.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.92
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.92
|
| Rate for Payer: Galaxy Health WC |
$31.71
|
| Rate for Payer: Global Benefits Group Commercial |
$22.39
|
| Rate for Payer: Health Management Network EPO/PPO |
$33.58
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$27.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.30
|
| Rate for Payer: Multiplan Commercial |
$27.98
|
| Rate for Payer: Networks By Design Commercial |
$18.66
|
| Rate for Payer: Prime Health Services Commercial |
$31.71
|
| Rate for Payer: Riverside University Health System MISP |
$14.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.39
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.39
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.66
|
| Rate for Payer: United Healthcare All Other HMO |
$18.66
|
| Rate for Payer: United Healthcare HMO Rider |
$18.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31.71
|
| Rate for Payer: Vantage Medical Group Senior |
$31.71
|
|
