|
HC STENT GENESIS XLG
|
Facility
|
OP
|
$4,500.00
|
|
|
Service Code
|
CPT C1877
|
| Hospital Charge Code |
909020091
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$900.00 |
| Max. Negotiated Rate |
$4,050.00 |
| Rate for Payer: Adventist Health Commercial |
$900.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,825.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,475.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,375.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,054.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,491.65
|
| Rate for Payer: Blue Shield of California Commercial |
$3,478.50
|
| Rate for Payer: Blue Shield of California EPN |
$2,268.00
|
| Rate for Payer: Cash Price |
$2,475.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,600.00
|
| Rate for Payer: Cigna of CA HMO |
$3,150.00
|
| Rate for Payer: Cigna of CA PPO |
$3,150.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,825.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,825.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,825.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,800.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,800.00
|
| Rate for Payer: Galaxy Health WC |
$3,825.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,700.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,050.00
|
| Rate for Payer: InnovAge PACE Commercial |
$2,250.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,001.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,714.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,785.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$900.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,150.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,150.00
|
| Rate for Payer: Multiplan Commercial |
$3,375.00
|
| Rate for Payer: Networks By Design Commercial |
$2,250.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,825.00
|
| Rate for Payer: Riverside University Health System MISP |
$1,800.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,700.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,700.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,688.85
|
| Rate for Payer: United Healthcare All Other HMO |
$1,643.85
|
| Rate for Payer: United Healthcare HMO Rider |
$1,608.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,473.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,825.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,825.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,825.00
|
|
|
HC STENT ILIAC
|
Facility
|
OP
|
$24,200.00
|
|
|
Service Code
|
CPT 37221
|
| Hospital Charge Code |
906820145
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$148.56 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$4,840.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$14,409.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,409.33
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,581.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$22,958.69
|
| Rate for Payer: Blue Shield of California Commercial |
$5,999.40
|
| Rate for Payer: Blue Shield of California EPN |
$3,914.40
|
| Rate for Payer: Cash Price |
$13,310.00
|
| Rate for Payer: Cash Price |
$13,310.00
|
| Rate for Payer: Cash Price |
$13,310.00
|
| Rate for Payer: Central Health Plan Commercial |
$19,360.00
|
| Rate for Payer: Cigna of CA HMO |
$15,488.00
|
| Rate for Payer: Cigna of CA PPO |
$17,908.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,850.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,409.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,452.60
|
| Rate for Payer: EPIC Health Plan Senior |
$14,409.33
|
| Rate for Payer: Galaxy Health WC |
$20,570.00
|
| Rate for Payer: Global Benefits Group Commercial |
$14,520.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$21,780.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23,631.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$148.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,409.33
|
| Rate for Payer: InnovAge PACE Commercial |
$21,613.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,141.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$164.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,409.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,840.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19,308.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,308.50
|
| Rate for Payer: Multiplan Commercial |
$18,150.00
|
| Rate for Payer: Multiplan WC |
$22,958.69
|
| Rate for Payer: Networks By Design Commercial |
$15,730.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14,409.33
|
| Rate for Payer: Preferred Health Network WC |
$23,427.23
|
| Rate for Payer: Prime Health Services Commercial |
$20,570.00
|
| Rate for Payer: Prime Health Services Medicare |
$15,273.89
|
| Rate for Payer: Prime Health Services WC |
$22,724.41
|
| Rate for Payer: Riverside University Health System MISP |
$15,850.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14,520.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$31,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$14,409.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Vantage Medical Group Senior |
$14,409.33
|
|
|
HC STENT ILIAC
|
Facility
|
IP
|
$24,200.00
|
|
|
Service Code
|
CPT 37221
|
| Hospital Charge Code |
906820145
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,840.00 |
| Max. Negotiated Rate |
$21,780.00 |
| Rate for Payer: Adventist Health Commercial |
$4,840.00
|
| Rate for Payer: Cash Price |
$13,310.00
|
| Rate for Payer: Central Health Plan Commercial |
$19,360.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,680.00
|
| Rate for Payer: EPIC Health Plan Senior |
$9,680.00
|
| Rate for Payer: Galaxy Health WC |
$20,570.00
|
| Rate for Payer: Global Benefits Group Commercial |
$14,520.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$21,780.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,141.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,220.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,979.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,840.00
|
| Rate for Payer: Multiplan Commercial |
$18,150.00
|
| Rate for Payer: Networks By Design Commercial |
$15,730.00
|
| Rate for Payer: Prime Health Services Commercial |
$20,570.00
|
|
|
HC STENT ILIAC
|
Facility
|
IP
|
$20,570.00
|
|
|
Service Code
|
CPT 37221
|
| Hospital Charge Code |
909020062
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,114.00 |
| Max. Negotiated Rate |
$18,513.00 |
| Rate for Payer: Adventist Health Commercial |
$4,114.00
|
| Rate for Payer: Cash Price |
$11,313.50
|
| Rate for Payer: Central Health Plan Commercial |
$16,456.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,228.00
|
| Rate for Payer: EPIC Health Plan Senior |
$8,228.00
|
| Rate for Payer: Galaxy Health WC |
$17,484.50
|
| Rate for Payer: Global Benefits Group Commercial |
$12,342.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$18,513.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,720.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,837.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,732.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,114.00
|
| Rate for Payer: Multiplan Commercial |
$15,427.50
|
| Rate for Payer: Networks By Design Commercial |
$13,370.50
|
| Rate for Payer: Prime Health Services Commercial |
$17,484.50
|
|
|
HC STENT ILIAC
|
Facility
|
OP
|
$20,570.00
|
|
|
Service Code
|
CPT 37221
|
| Hospital Charge Code |
909020062
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$148.56 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$4,114.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$14,409.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,409.33
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,581.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$22,958.69
|
| Rate for Payer: Blue Shield of California Commercial |
$5,999.40
|
| Rate for Payer: Blue Shield of California EPN |
$3,914.40
|
| Rate for Payer: Cash Price |
$11,313.50
|
| Rate for Payer: Cash Price |
$11,313.50
|
| Rate for Payer: Cash Price |
$11,313.50
|
| Rate for Payer: Central Health Plan Commercial |
$16,456.00
|
| Rate for Payer: Cigna of CA HMO |
$13,164.80
|
| Rate for Payer: Cigna of CA PPO |
$15,221.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,850.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,409.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,452.60
|
| Rate for Payer: EPIC Health Plan Senior |
$14,409.33
|
| Rate for Payer: Galaxy Health WC |
$17,484.50
|
| Rate for Payer: Global Benefits Group Commercial |
$12,342.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$18,513.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23,631.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$148.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,409.33
|
| Rate for Payer: InnovAge PACE Commercial |
$21,613.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,720.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$164.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,409.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,114.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19,308.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,308.50
|
| Rate for Payer: Multiplan Commercial |
$15,427.50
|
| Rate for Payer: Multiplan WC |
$22,958.69
|
| Rate for Payer: Networks By Design Commercial |
$13,370.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14,409.33
|
| Rate for Payer: Preferred Health Network WC |
$23,427.23
|
| Rate for Payer: Prime Health Services Commercial |
$17,484.50
|
| Rate for Payer: Prime Health Services Medicare |
$15,273.89
|
| Rate for Payer: Prime Health Services WC |
$22,724.41
|
| Rate for Payer: Riverside University Health System MISP |
$15,850.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12,342.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$31,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$14,409.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Vantage Medical Group Senior |
$14,409.33
|
|
|
HC STENT ILIAC EA ADDL
|
Facility
|
IP
|
$14,548.00
|
|
|
Service Code
|
CPT 37223
|
| Hospital Charge Code |
906820147
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,909.60 |
| Max. Negotiated Rate |
$13,093.20 |
| Rate for Payer: Adventist Health Commercial |
$2,909.60
|
| Rate for Payer: Cash Price |
$8,001.40
|
| Rate for Payer: Central Health Plan Commercial |
$11,638.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,819.20
|
| Rate for Payer: EPIC Health Plan Senior |
$5,819.20
|
| Rate for Payer: Galaxy Health WC |
$12,365.80
|
| Rate for Payer: Global Benefits Group Commercial |
$8,728.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,093.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,703.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,542.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,005.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,909.60
|
| Rate for Payer: Multiplan Commercial |
$10,911.00
|
| Rate for Payer: Networks By Design Commercial |
$9,456.20
|
| Rate for Payer: Prime Health Services Commercial |
$12,365.80
|
|
|
HC STENT ILIAC EA ADDL
|
Facility
|
OP
|
$14,548.00
|
|
|
Service Code
|
CPT 37223
|
| Hospital Charge Code |
906820147
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$62.76 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$2,909.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,365.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,001.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,911.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,581.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,999.40
|
| Rate for Payer: Blue Shield of California EPN |
$3,914.40
|
| Rate for Payer: Cash Price |
$8,001.40
|
| Rate for Payer: Cash Price |
$8,001.40
|
| Rate for Payer: Cash Price |
$8,001.40
|
| Rate for Payer: Central Health Plan Commercial |
$11,638.40
|
| Rate for Payer: Cigna of CA HMO |
$9,310.72
|
| Rate for Payer: Cigna of CA PPO |
$10,765.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,365.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$12,365.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12,365.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,819.20
|
| Rate for Payer: EPIC Health Plan Senior |
$5,819.20
|
| Rate for Payer: Galaxy Health WC |
$12,365.80
|
| Rate for Payer: Global Benefits Group Commercial |
$8,728.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,093.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$62.76
|
| Rate for Payer: InnovAge PACE Commercial |
$7,274.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,703.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$69.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,005.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,909.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,183.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,183.60
|
| Rate for Payer: Multiplan Commercial |
$10,911.00
|
| Rate for Payer: Networks By Design Commercial |
$9,456.20
|
| Rate for Payer: Prime Health Services Commercial |
$12,365.80
|
| Rate for Payer: Riverside University Health System MISP |
$5,819.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,728.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,712.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,365.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12,365.80
|
| Rate for Payer: Vantage Medical Group Senior |
$12,365.80
|
|
|
HC STENT ILIAC EA ADDL
|
Facility
|
IP
|
$12,366.00
|
|
|
Service Code
|
CPT 37223
|
| Hospital Charge Code |
909020064
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,473.20 |
| Max. Negotiated Rate |
$11,129.40 |
| Rate for Payer: Adventist Health Commercial |
$2,473.20
|
| Rate for Payer: Cash Price |
$6,801.30
|
| Rate for Payer: Central Health Plan Commercial |
$9,892.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,946.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,946.40
|
| Rate for Payer: Galaxy Health WC |
$10,511.10
|
| Rate for Payer: Global Benefits Group Commercial |
$7,419.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,129.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,248.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,711.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,654.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,473.20
|
| Rate for Payer: Multiplan Commercial |
$9,274.50
|
| Rate for Payer: Networks By Design Commercial |
$8,037.90
|
| Rate for Payer: Prime Health Services Commercial |
$10,511.10
|
|
|
HC STENT ILIAC EA ADDL
|
Facility
|
OP
|
$12,366.00
|
|
|
Service Code
|
CPT 37223
|
| Hospital Charge Code |
909020064
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$62.76 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$2,473.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,511.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,801.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,274.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,581.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,999.40
|
| Rate for Payer: Blue Shield of California EPN |
$3,914.40
|
| Rate for Payer: Cash Price |
$6,801.30
|
| Rate for Payer: Cash Price |
$6,801.30
|
| Rate for Payer: Cash Price |
$6,801.30
|
| Rate for Payer: Central Health Plan Commercial |
$9,892.80
|
| Rate for Payer: Cigna of CA HMO |
$7,914.24
|
| Rate for Payer: Cigna of CA PPO |
$9,150.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,511.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,511.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,511.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,946.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,946.40
|
| Rate for Payer: Galaxy Health WC |
$10,511.10
|
| Rate for Payer: Global Benefits Group Commercial |
$7,419.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,129.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$62.76
|
| Rate for Payer: InnovAge PACE Commercial |
$6,183.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,248.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$69.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,654.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,473.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,656.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,656.20
|
| Rate for Payer: Multiplan Commercial |
$9,274.50
|
| Rate for Payer: Networks By Design Commercial |
$8,037.90
|
| Rate for Payer: Prime Health Services Commercial |
$10,511.10
|
| Rate for Payer: Riverside University Health System MISP |
$4,946.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,419.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,712.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,511.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,511.10
|
| Rate for Payer: Vantage Medical Group Senior |
$10,511.10
|
|
|
HC STENT INSERTION INDWELLING DBL
|
Facility
|
OP
|
$13,506.00
|
|
|
Service Code
|
CPT 52332
|
| Hospital Charge Code |
909020042
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$947.08 |
| Max. Negotiated Rate |
$16,122.00 |
| Rate for Payer: Adventist Health Commercial |
$2,701.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,382.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,573.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,820.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,382.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,982.34
|
| Rate for Payer: Blue Shield of California Commercial |
$4,245.30
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$7,428.30
|
| Rate for Payer: Cash Price |
$7,428.30
|
| Rate for Payer: Cash Price |
$7,428.30
|
| Rate for Payer: Central Health Plan Commercial |
$10,804.80
|
| Rate for Payer: Cigna of CA HMO |
$8,643.84
|
| Rate for Payer: Cigna of CA PPO |
$9,994.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,573.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,820.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,382.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,916.05
|
| Rate for Payer: EPIC Health Plan Senior |
$4,382.26
|
| Rate for Payer: Galaxy Health WC |
$11,480.10
|
| Rate for Payer: Global Benefits Group Commercial |
$8,103.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,155.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,186.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$947.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,382.26
|
| Rate for Payer: InnovAge PACE Commercial |
$6,573.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,008.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,046.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,382.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,701.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,872.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,872.23
|
| Rate for Payer: Multiplan Commercial |
$10,129.50
|
| Rate for Payer: Multiplan WC |
$6,982.34
|
| Rate for Payer: Networks By Design Commercial |
$8,778.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,382.26
|
| Rate for Payer: Preferred Health Network WC |
$7,124.84
|
| Rate for Payer: Prime Health Services Commercial |
$11,480.10
|
| Rate for Payer: Prime Health Services Medicare |
$4,645.20
|
| Rate for Payer: Prime Health Services WC |
$6,911.09
|
| Rate for Payer: Riverside University Health System MISP |
$4,820.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,103.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,984.00
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,382.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,573.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,820.49
|
| Rate for Payer: Vantage Medical Group Senior |
$4,382.26
|
|
|
HC STENT INSERTION INDWELLING DBL
|
Facility
|
IP
|
$13,506.00
|
|
|
Service Code
|
CPT 52332
|
| Hospital Charge Code |
909020042
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,701.20 |
| Max. Negotiated Rate |
$12,155.40 |
| Rate for Payer: Adventist Health Commercial |
$2,701.20
|
| Rate for Payer: Cash Price |
$7,428.30
|
| Rate for Payer: Central Health Plan Commercial |
$10,804.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,402.40
|
| Rate for Payer: EPIC Health Plan Senior |
$5,402.40
|
| Rate for Payer: Galaxy Health WC |
$11,480.10
|
| Rate for Payer: Global Benefits Group Commercial |
$8,103.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,155.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,008.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,145.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,360.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,701.20
|
| Rate for Payer: Multiplan Commercial |
$10,129.50
|
| Rate for Payer: Networks By Design Commercial |
$8,778.90
|
| Rate for Payer: Prime Health Services Commercial |
$11,480.10
|
|
|
HC STENT INTRACRAN ATHERO STENOSI
|
Facility
|
IP
|
$11,708.00
|
|
|
Service Code
|
CPT 61635
|
| Hospital Charge Code |
909081014
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,341.60 |
| Max. Negotiated Rate |
$10,537.20 |
| Rate for Payer: Adventist Health Commercial |
$2,341.60
|
| Rate for Payer: Cash Price |
$6,439.40
|
| Rate for Payer: Central Health Plan Commercial |
$9,366.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,683.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,683.20
|
| Rate for Payer: Galaxy Health WC |
$9,951.80
|
| Rate for Payer: Global Benefits Group Commercial |
$7,024.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,537.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,809.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,460.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,247.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,341.60
|
| Rate for Payer: Multiplan Commercial |
$8,781.00
|
| Rate for Payer: Networks By Design Commercial |
$7,610.20
|
| Rate for Payer: Prime Health Services Commercial |
$9,951.80
|
|
|
HC STENT INTRACRAN ATHERO STENOSI
|
Facility
|
OP
|
$11,708.00
|
|
|
Service Code
|
CPT 61635
|
| Hospital Charge Code |
909081014
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,341.60 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$2,341.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,951.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,439.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,781.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,669.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,876.11
|
| 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 |
$6,439.40
|
| Rate for Payer: Cash Price |
$6,439.40
|
| Rate for Payer: Central Health Plan Commercial |
$9,366.40
|
| Rate for Payer: Cigna of CA HMO |
$7,493.12
|
| Rate for Payer: Cigna of CA PPO |
$8,663.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,951.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,951.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,951.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,683.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,683.20
|
| Rate for Payer: Galaxy Health WC |
$9,951.80
|
| Rate for Payer: Global Benefits Group Commercial |
$7,024.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,537.20
|
| Rate for Payer: InnovAge PACE Commercial |
$5,854.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,809.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,247.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,341.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,195.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,195.60
|
| Rate for Payer: Multiplan Commercial |
$8,781.00
|
| Rate for Payer: Networks By Design Commercial |
$7,610.20
|
| Rate for Payer: Prime Health Services Commercial |
$9,951.80
|
| Rate for Payer: Riverside University Health System MISP |
$4,683.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,024.80
|
| 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 |
$9,951.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,951.80
|
| Rate for Payer: Vantage Medical Group Senior |
$9,951.80
|
|
|
HC STENT LIFE
|
Facility
|
IP
|
$2,828.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909000008
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$565.60 |
| Max. Negotiated Rate |
$2,545.20 |
| Rate for Payer: Adventist Health Commercial |
$565.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,186.04
|
| Rate for Payer: Blue Shield of California EPN |
$1,425.31
|
| Rate for Payer: Cash Price |
$1,555.40
|
| Rate for Payer: Central Health Plan Commercial |
$2,262.40
|
| Rate for Payer: Cigna of CA HMO |
$1,979.60
|
| Rate for Payer: Cigna of CA PPO |
$1,979.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,131.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,131.20
|
| Rate for Payer: Galaxy Health WC |
$2,403.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,696.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,545.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,886.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,077.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,750.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$565.60
|
| Rate for Payer: Multiplan Commercial |
$2,121.00
|
| Rate for Payer: Networks By Design Commercial |
$1,414.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,403.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,061.35
|
| Rate for Payer: United Healthcare All Other HMO |
$1,033.07
|
| Rate for Payer: United Healthcare HMO Rider |
$1,010.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$926.17
|
|
|
HC STENT LIFE
|
Facility
|
OP
|
$2,828.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909000008
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$565.60 |
| Max. Negotiated Rate |
$2,545.20 |
| Rate for Payer: Adventist Health Commercial |
$565.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,403.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,555.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,121.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,291.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,565.86
|
| Rate for Payer: Blue Shield of California Commercial |
$2,186.04
|
| Rate for Payer: Blue Shield of California EPN |
$1,425.31
|
| Rate for Payer: Cash Price |
$1,555.40
|
| Rate for Payer: Central Health Plan Commercial |
$2,262.40
|
| Rate for Payer: Cigna of CA HMO |
$1,979.60
|
| Rate for Payer: Cigna of CA PPO |
$1,979.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,403.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,403.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,403.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,131.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,131.20
|
| Rate for Payer: Galaxy Health WC |
$2,403.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,696.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,545.20
|
| Rate for Payer: InnovAge PACE Commercial |
$1,414.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,886.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,077.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,750.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$565.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,979.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,979.60
|
| Rate for Payer: Multiplan Commercial |
$2,121.00
|
| Rate for Payer: Networks By Design Commercial |
$1,414.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,403.80
|
| Rate for Payer: Riverside University Health System MISP |
$1,131.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,696.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,696.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,061.35
|
| Rate for Payer: United Healthcare All Other HMO |
$1,033.07
|
| Rate for Payer: United Healthcare HMO Rider |
$1,010.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$926.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,403.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,403.80
|
| Rate for Payer: Vantage Medical Group Senior |
$2,403.80
|
|
|
HC STENT LVIS
|
Facility
|
OP
|
$20,313.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909001876
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,062.60 |
| Max. Negotiated Rate |
$18,281.70 |
| Rate for Payer: Adventist Health Commercial |
$4,062.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17,266.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11,172.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15,234.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9,274.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,247.31
|
| Rate for Payer: Blue Shield of California Commercial |
$15,701.95
|
| Rate for Payer: Blue Shield of California EPN |
$10,237.75
|
| Rate for Payer: Cash Price |
$11,172.15
|
| Rate for Payer: Central Health Plan Commercial |
$16,250.40
|
| Rate for Payer: Cigna of CA HMO |
$14,219.10
|
| Rate for Payer: Cigna of CA PPO |
$14,219.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17,266.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$17,266.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17,266.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,125.20
|
| Rate for Payer: EPIC Health Plan Senior |
$8,125.20
|
| Rate for Payer: Galaxy Health WC |
$17,266.05
|
| Rate for Payer: Global Benefits Group Commercial |
$12,187.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$18,281.70
|
| Rate for Payer: InnovAge PACE Commercial |
$10,156.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,548.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,739.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,573.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,062.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14,219.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14,219.10
|
| Rate for Payer: Multiplan Commercial |
$15,234.75
|
| Rate for Payer: Networks By Design Commercial |
$10,156.50
|
| Rate for Payer: Prime Health Services Commercial |
$17,266.05
|
| Rate for Payer: Riverside University Health System MISP |
$8,125.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12,187.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12,187.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,623.47
|
| Rate for Payer: United Healthcare All Other HMO |
$7,420.34
|
| Rate for Payer: United Healthcare HMO Rider |
$7,259.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,652.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17,266.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17,266.05
|
| Rate for Payer: Vantage Medical Group Senior |
$17,266.05
|
|
|
HC STENT LVIS
|
Facility
|
IP
|
$20,313.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909001876
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,062.60 |
| Max. Negotiated Rate |
$18,281.70 |
| Rate for Payer: Adventist Health Commercial |
$4,062.60
|
| Rate for Payer: Blue Shield of California Commercial |
$15,701.95
|
| Rate for Payer: Blue Shield of California EPN |
$10,237.75
|
| Rate for Payer: Cash Price |
$11,172.15
|
| Rate for Payer: Central Health Plan Commercial |
$16,250.40
|
| Rate for Payer: Cigna of CA HMO |
$14,219.10
|
| Rate for Payer: Cigna of CA PPO |
$14,219.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,125.20
|
| Rate for Payer: EPIC Health Plan Senior |
$8,125.20
|
| Rate for Payer: Galaxy Health WC |
$17,266.05
|
| Rate for Payer: Global Benefits Group Commercial |
$12,187.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$18,281.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,548.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,739.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,573.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,062.60
|
| Rate for Payer: Multiplan Commercial |
$15,234.75
|
| Rate for Payer: Networks By Design Commercial |
$10,156.50
|
| Rate for Payer: Prime Health Services Commercial |
$17,266.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,623.47
|
| Rate for Payer: United Healthcare All Other HMO |
$7,420.34
|
| Rate for Payer: United Healthcare HMO Rider |
$7,259.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,652.51
|
|
|
HC STENT MEDTRONIC BALN EXPAND
|
Facility
|
IP
|
$3,900.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020115
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,510.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,014.70
|
| Rate for Payer: Blue Shield of California EPN |
$1,965.60
|
| Rate for Payer: Cash Price |
$2,145.00
|
| 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 Senior |
$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: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| 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: United Healthcare All Other Commercial |
$1,463.67
|
| Rate for Payer: United Healthcare All Other HMO |
$1,424.67
|
| Rate for Payer: United Healthcare HMO Rider |
$1,393.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,277.25
|
|
|
HC STENT MEDTRONIC BALN EXPAND
|
Facility
|
OP
|
$3,900.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020115
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,510.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| 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 |
$2,925.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,780.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,159.43
|
| Rate for Payer: Blue Shield of California Commercial |
$3,014.70
|
| Rate for Payer: Blue Shield of California EPN |
$1,965.60
|
| Rate for Payer: Cash Price |
$2,145.00
|
| 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 Medi-Cal |
$3,315.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,315.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$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: InnovAge PACE Commercial |
$1,950.00
|
| 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: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$780.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,730.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,730.00
|
| 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 |
$1,463.67
|
| Rate for Payer: United Healthcare All Other HMO |
$1,424.67
|
| Rate for Payer: United Healthcare HMO Rider |
$1,393.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,277.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,315.00
|
|
|
HC STENT MEDTRONIC SE 12-150
|
Facility
|
OP
|
$3,900.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020114
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,510.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| 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 |
$2,925.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,780.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,159.43
|
| Rate for Payer: Blue Shield of California Commercial |
$3,014.70
|
| Rate for Payer: Blue Shield of California EPN |
$1,965.60
|
| Rate for Payer: Cash Price |
$2,145.00
|
| 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 Medi-Cal |
$3,315.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,315.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$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: InnovAge PACE Commercial |
$1,950.00
|
| 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: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$780.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,730.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,730.00
|
| 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 |
$1,463.67
|
| Rate for Payer: United Healthcare All Other HMO |
$1,424.67
|
| Rate for Payer: United Healthcare HMO Rider |
$1,393.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,277.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,315.00
|
|
|
HC STENT MEDTRONIC SE 12-150
|
Facility
|
IP
|
$3,900.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020114
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,510.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,014.70
|
| Rate for Payer: Blue Shield of California EPN |
$1,965.60
|
| Rate for Payer: Cash Price |
$2,145.00
|
| 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 Senior |
$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: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| 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: United Healthcare All Other Commercial |
$1,463.67
|
| Rate for Payer: United Healthcare All Other HMO |
$1,424.67
|
| Rate for Payer: United Healthcare HMO Rider |
$1,393.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,277.25
|
|
|
HC STENT MEDTRONIC SE 40-100
|
Facility
|
IP
|
$3,900.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020113
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,510.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,014.70
|
| Rate for Payer: Blue Shield of California EPN |
$1,965.60
|
| Rate for Payer: Cash Price |
$2,145.00
|
| 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 Senior |
$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: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| 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: United Healthcare All Other Commercial |
$1,463.67
|
| Rate for Payer: United Healthcare All Other HMO |
$1,424.67
|
| Rate for Payer: United Healthcare HMO Rider |
$1,393.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,277.25
|
|
|
HC STENT MEDTRONIC SE 40-100
|
Facility
|
OP
|
$3,900.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020113
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,510.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| 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 |
$2,925.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,780.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,159.43
|
| Rate for Payer: Blue Shield of California Commercial |
$3,014.70
|
| Rate for Payer: Blue Shield of California EPN |
$1,965.60
|
| Rate for Payer: Cash Price |
$2,145.00
|
| 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 Medi-Cal |
$3,315.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,315.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$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: InnovAge PACE Commercial |
$1,950.00
|
| 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: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$780.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,730.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,730.00
|
| 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 |
$1,463.67
|
| Rate for Payer: United Healthcare All Other HMO |
$1,424.67
|
| Rate for Payer: United Healthcare HMO Rider |
$1,393.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,277.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,315.00
|
|
|
HC STENT METAL URETERAL
|
Facility
|
IP
|
$3,900.00
|
|
|
Service Code
|
CPT C2617
|
| Hospital Charge Code |
909020039
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,510.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,014.70
|
| Rate for Payer: Blue Shield of California EPN |
$1,965.60
|
| Rate for Payer: Cash Price |
$2,145.00
|
| 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 Senior |
$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: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| 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: United Healthcare All Other Commercial |
$1,463.67
|
| Rate for Payer: United Healthcare All Other HMO |
$1,424.67
|
| Rate for Payer: United Healthcare HMO Rider |
$1,393.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,277.25
|
|
|
HC STENT METAL URETERAL
|
Facility
|
OP
|
$3,900.00
|
|
|
Service Code
|
CPT C2617
|
| Hospital Charge Code |
909020039
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,510.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| 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 |
$2,925.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,780.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,159.43
|
| Rate for Payer: Blue Shield of California Commercial |
$3,014.70
|
| Rate for Payer: Blue Shield of California EPN |
$1,965.60
|
| Rate for Payer: Cash Price |
$2,145.00
|
| 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 Medi-Cal |
$3,315.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,315.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$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: InnovAge PACE Commercial |
$1,950.00
|
| 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: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$780.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,730.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,730.00
|
| 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 |
$1,463.67
|
| Rate for Payer: United Healthcare All Other HMO |
$1,424.67
|
| Rate for Payer: United Healthcare HMO Rider |
$1,393.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,277.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,315.00
|
|
