|
HC STENT NEURO FORM 3
|
Facility
|
IP
|
$14,300.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909080045
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,860.00 |
| Max. Negotiated Rate |
$12,870.00 |
| Rate for Payer: Adventist Health Commercial |
$2,860.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,053.90
|
| Rate for Payer: Blue Shield of California EPN |
$7,207.20
|
| Rate for Payer: Cash Price |
$7,865.00
|
| Rate for Payer: Central Health Plan Commercial |
$11,440.00
|
| Rate for Payer: Cigna of CA HMO |
$10,010.00
|
| Rate for Payer: Cigna of CA PPO |
$10,010.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,720.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,720.00
|
| Rate for Payer: Galaxy Health WC |
$12,155.00
|
| Rate for Payer: Global Benefits Group Commercial |
$8,580.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,870.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,538.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,448.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,851.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,860.00
|
| Rate for Payer: Multiplan Commercial |
$10,725.00
|
| Rate for Payer: Networks By Design Commercial |
$7,150.00
|
| Rate for Payer: Prime Health Services Commercial |
$12,155.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,366.79
|
| Rate for Payer: United Healthcare All Other HMO |
$5,223.79
|
| Rate for Payer: United Healthcare HMO Rider |
$5,110.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,683.25
|
|
|
HC STENT NEURO FORM 3
|
Facility
|
OP
|
$14,300.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909080045
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,860.00 |
| Max. Negotiated Rate |
$12,870.00 |
| Rate for Payer: Adventist Health Commercial |
$2,860.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,155.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,865.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,725.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,529.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,917.91
|
| Rate for Payer: Blue Shield of California Commercial |
$11,053.90
|
| Rate for Payer: Blue Shield of California EPN |
$7,207.20
|
| Rate for Payer: Cash Price |
$7,865.00
|
| Rate for Payer: Central Health Plan Commercial |
$11,440.00
|
| Rate for Payer: Cigna of CA HMO |
$10,010.00
|
| Rate for Payer: Cigna of CA PPO |
$10,010.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,155.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$12,155.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12,155.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,720.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,720.00
|
| Rate for Payer: Galaxy Health WC |
$12,155.00
|
| Rate for Payer: Global Benefits Group Commercial |
$8,580.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,870.00
|
| Rate for Payer: InnovAge PACE Commercial |
$7,150.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,538.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,448.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,851.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,860.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,010.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,010.00
|
| Rate for Payer: Multiplan Commercial |
$10,725.00
|
| Rate for Payer: Networks By Design Commercial |
$7,150.00
|
| Rate for Payer: Prime Health Services Commercial |
$12,155.00
|
| Rate for Payer: Riverside University Health System MISP |
$5,720.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,580.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8,580.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,366.79
|
| Rate for Payer: United Healthcare All Other HMO |
$5,223.79
|
| Rate for Payer: United Healthcare HMO Rider |
$5,110.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,683.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,155.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12,155.00
|
| Rate for Payer: Vantage Medical Group Senior |
$12,155.00
|
|
|
HC STENT PALMAZ
|
Facility
|
OP
|
$1,963.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909081209
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$392.60 |
| Max. Negotiated Rate |
$1,766.70 |
| Rate for Payer: Adventist Health Commercial |
$392.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,668.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,079.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,472.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$896.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,086.91
|
| Rate for Payer: Blue Shield of California Commercial |
$1,517.40
|
| Rate for Payer: Blue Shield of California EPN |
$989.35
|
| Rate for Payer: Cash Price |
$1,079.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,570.40
|
| Rate for Payer: Cigna of CA HMO |
$1,374.10
|
| Rate for Payer: Cigna of CA PPO |
$1,374.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,668.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,668.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,668.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$785.20
|
| Rate for Payer: EPIC Health Plan Senior |
$785.20
|
| Rate for Payer: Galaxy Health WC |
$1,668.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,177.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,766.70
|
| Rate for Payer: InnovAge PACE Commercial |
$981.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,309.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$747.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,215.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$392.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,374.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,374.10
|
| Rate for Payer: Multiplan Commercial |
$1,472.25
|
| Rate for Payer: Networks By Design Commercial |
$981.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,668.55
|
| Rate for Payer: Riverside University Health System MISP |
$785.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,177.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,177.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$736.71
|
| Rate for Payer: United Healthcare All Other HMO |
$717.08
|
| Rate for Payer: United Healthcare HMO Rider |
$701.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$642.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,668.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,668.55
|
| Rate for Payer: Vantage Medical Group Senior |
$1,668.55
|
|
|
HC STENT PALMAZ
|
Facility
|
IP
|
$1,963.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909081209
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$392.60 |
| Max. Negotiated Rate |
$1,766.70 |
| Rate for Payer: Adventist Health Commercial |
$392.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,517.40
|
| Rate for Payer: Blue Shield of California EPN |
$989.35
|
| Rate for Payer: Cash Price |
$1,079.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,570.40
|
| Rate for Payer: Cigna of CA HMO |
$1,374.10
|
| Rate for Payer: Cigna of CA PPO |
$1,374.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$785.20
|
| Rate for Payer: EPIC Health Plan Senior |
$785.20
|
| Rate for Payer: Galaxy Health WC |
$1,668.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,177.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,766.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,309.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$747.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,215.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$392.60
|
| Rate for Payer: Multiplan Commercial |
$1,472.25
|
| Rate for Payer: Networks By Design Commercial |
$981.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,668.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$736.71
|
| Rate for Payer: United Healthcare All Other HMO |
$717.08
|
| Rate for Payer: United Healthcare HMO Rider |
$701.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$642.88
|
|
|
HC STENT PALMAZ BALLOON EXPAND
|
Facility
|
IP
|
$1,717.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
900803700
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$343.40 |
| Max. Negotiated Rate |
$1,545.30 |
| Rate for Payer: Adventist Health Commercial |
$343.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,327.24
|
| Rate for Payer: Blue Shield of California EPN |
$865.37
|
| Rate for Payer: Cash Price |
$944.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,373.60
|
| Rate for Payer: Cigna of CA HMO |
$1,201.90
|
| Rate for Payer: Cigna of CA PPO |
$1,201.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$686.80
|
| Rate for Payer: EPIC Health Plan Senior |
$686.80
|
| Rate for Payer: Galaxy Health WC |
$1,459.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,030.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,545.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,145.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$654.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,062.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$343.40
|
| Rate for Payer: Multiplan Commercial |
$1,287.75
|
| Rate for Payer: Networks By Design Commercial |
$858.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,459.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$644.39
|
| Rate for Payer: United Healthcare All Other HMO |
$627.22
|
| Rate for Payer: United Healthcare HMO Rider |
$613.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$562.32
|
|
|
HC STENT PALMAZ BALLOON EXPAND
|
Facility
|
OP
|
$1,717.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
900803700
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$343.40 |
| Max. Negotiated Rate |
$1,545.30 |
| Rate for Payer: Adventist Health Commercial |
$343.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,459.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$944.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,287.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$783.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$950.70
|
| Rate for Payer: Blue Shield of California Commercial |
$1,327.24
|
| Rate for Payer: Blue Shield of California EPN |
$865.37
|
| Rate for Payer: Cash Price |
$944.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,373.60
|
| Rate for Payer: Cigna of CA HMO |
$1,201.90
|
| Rate for Payer: Cigna of CA PPO |
$1,201.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,459.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,459.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,459.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$686.80
|
| Rate for Payer: EPIC Health Plan Senior |
$686.80
|
| Rate for Payer: Galaxy Health WC |
$1,459.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,030.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,545.30
|
| Rate for Payer: InnovAge PACE Commercial |
$858.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,145.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,062.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$343.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,201.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,201.90
|
| Rate for Payer: Multiplan Commercial |
$1,287.75
|
| Rate for Payer: Networks By Design Commercial |
$858.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,459.45
|
| Rate for Payer: Riverside University Health System MISP |
$686.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,030.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,030.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$644.39
|
| Rate for Payer: United Healthcare All Other HMO |
$627.22
|
| Rate for Payer: United Healthcare HMO Rider |
$613.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$562.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,459.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,459.45
|
| Rate for Payer: Vantage Medical Group Senior |
$1,459.45
|
|
|
HC STENT PANCREATIC 0.035IN 5FRX3X170CM
|
Facility
|
IP
|
$290.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
900100405
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$58.00 |
| Max. Negotiated Rate |
$261.00 |
| Rate for Payer: Adventist Health Commercial |
$58.00
|
| Rate for Payer: Blue Shield of California Commercial |
$224.17
|
| Rate for Payer: Blue Shield of California EPN |
$146.16
|
| Rate for Payer: Cash Price |
$159.50
|
| Rate for Payer: Central Health Plan Commercial |
$232.00
|
| Rate for Payer: Cigna of CA HMO |
$203.00
|
| Rate for Payer: Cigna of CA PPO |
$203.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$116.00
|
| Rate for Payer: EPIC Health Plan Senior |
$116.00
|
| Rate for Payer: Galaxy Health WC |
$246.50
|
| Rate for Payer: Global Benefits Group Commercial |
$174.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$261.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$193.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$110.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$179.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.00
|
| Rate for Payer: Multiplan Commercial |
$217.50
|
| Rate for Payer: Networks By Design Commercial |
$145.00
|
| Rate for Payer: Prime Health Services Commercial |
$246.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$108.84
|
| Rate for Payer: United Healthcare All Other HMO |
$105.94
|
| Rate for Payer: United Healthcare HMO Rider |
$103.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$94.97
|
|
|
HC STENT PANCREATIC 0.035IN 5FRX3X170CM
|
Facility
|
OP
|
$290.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
900100405
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$58.00 |
| Max. Negotiated Rate |
$261.00 |
| Rate for Payer: Adventist Health Commercial |
$58.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$246.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$159.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$217.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$132.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$160.57
|
| Rate for Payer: Blue Shield of California Commercial |
$224.17
|
| Rate for Payer: Blue Shield of California EPN |
$146.16
|
| Rate for Payer: Cash Price |
$159.50
|
| Rate for Payer: Central Health Plan Commercial |
$232.00
|
| Rate for Payer: Cigna of CA HMO |
$203.00
|
| Rate for Payer: Cigna of CA PPO |
$203.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$246.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$246.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$246.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$116.00
|
| Rate for Payer: EPIC Health Plan Senior |
$116.00
|
| Rate for Payer: Galaxy Health WC |
$246.50
|
| Rate for Payer: Global Benefits Group Commercial |
$174.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$261.00
|
| Rate for Payer: InnovAge PACE Commercial |
$145.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$193.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$110.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$179.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$203.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$203.00
|
| Rate for Payer: Multiplan Commercial |
$217.50
|
| Rate for Payer: Networks By Design Commercial |
$145.00
|
| Rate for Payer: Prime Health Services Commercial |
$246.50
|
| Rate for Payer: Riverside University Health System MISP |
$116.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$174.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$174.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$108.84
|
| Rate for Payer: United Healthcare All Other HMO |
$105.94
|
| Rate for Payer: United Healthcare HMO Rider |
$103.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$94.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$246.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$246.50
|
| Rate for Payer: Vantage Medical Group Senior |
$246.50
|
|
|
HC STENT PANCREATIC 0.035IN 5FRX5X170CM
|
Facility
|
OP
|
$290.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
900100406
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$58.00 |
| Max. Negotiated Rate |
$261.00 |
| Rate for Payer: Adventist Health Commercial |
$58.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$246.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$159.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$217.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$132.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$160.57
|
| Rate for Payer: Blue Shield of California Commercial |
$224.17
|
| Rate for Payer: Blue Shield of California EPN |
$146.16
|
| Rate for Payer: Cash Price |
$159.50
|
| Rate for Payer: Central Health Plan Commercial |
$232.00
|
| Rate for Payer: Cigna of CA HMO |
$203.00
|
| Rate for Payer: Cigna of CA PPO |
$203.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$246.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$246.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$246.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$116.00
|
| Rate for Payer: EPIC Health Plan Senior |
$116.00
|
| Rate for Payer: Galaxy Health WC |
$246.50
|
| Rate for Payer: Global Benefits Group Commercial |
$174.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$261.00
|
| Rate for Payer: InnovAge PACE Commercial |
$145.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$193.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$110.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$179.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$203.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$203.00
|
| Rate for Payer: Multiplan Commercial |
$217.50
|
| Rate for Payer: Networks By Design Commercial |
$145.00
|
| Rate for Payer: Prime Health Services Commercial |
$246.50
|
| Rate for Payer: Riverside University Health System MISP |
$116.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$174.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$174.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$108.84
|
| Rate for Payer: United Healthcare All Other HMO |
$105.94
|
| Rate for Payer: United Healthcare HMO Rider |
$103.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$94.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$246.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$246.50
|
| Rate for Payer: Vantage Medical Group Senior |
$246.50
|
|
|
HC STENT PANCREATIC 0.035IN 5FRX5X170CM
|
Facility
|
IP
|
$290.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
900100406
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$58.00 |
| Max. Negotiated Rate |
$261.00 |
| Rate for Payer: Adventist Health Commercial |
$58.00
|
| Rate for Payer: Blue Shield of California Commercial |
$224.17
|
| Rate for Payer: Blue Shield of California EPN |
$146.16
|
| Rate for Payer: Cash Price |
$159.50
|
| Rate for Payer: Central Health Plan Commercial |
$232.00
|
| Rate for Payer: Cigna of CA HMO |
$203.00
|
| Rate for Payer: Cigna of CA PPO |
$203.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$116.00
|
| Rate for Payer: EPIC Health Plan Senior |
$116.00
|
| Rate for Payer: Galaxy Health WC |
$246.50
|
| Rate for Payer: Global Benefits Group Commercial |
$174.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$261.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$193.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$110.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$179.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.00
|
| Rate for Payer: Multiplan Commercial |
$217.50
|
| Rate for Payer: Networks By Design Commercial |
$145.00
|
| Rate for Payer: Prime Health Services Commercial |
$246.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$108.84
|
| Rate for Payer: United Healthcare All Other HMO |
$105.94
|
| Rate for Payer: United Healthcare HMO Rider |
$103.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$94.97
|
|
|
HC STENT PANCREATIC 0.035IN 5FRX7X170CM
|
Facility
|
IP
|
$290.00
|
|
|
Service Code
|
CPT C2625
|
| Hospital Charge Code |
900100407
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$58.00 |
| Max. Negotiated Rate |
$261.00 |
| Rate for Payer: Adventist Health Commercial |
$58.00
|
| Rate for Payer: Blue Shield of California Commercial |
$224.17
|
| Rate for Payer: Blue Shield of California EPN |
$146.16
|
| Rate for Payer: Cash Price |
$159.50
|
| Rate for Payer: Central Health Plan Commercial |
$232.00
|
| Rate for Payer: Cigna of CA HMO |
$203.00
|
| Rate for Payer: Cigna of CA PPO |
$203.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$116.00
|
| Rate for Payer: EPIC Health Plan Senior |
$116.00
|
| Rate for Payer: Galaxy Health WC |
$246.50
|
| Rate for Payer: Global Benefits Group Commercial |
$174.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$261.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$193.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$110.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$179.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.00
|
| Rate for Payer: Multiplan Commercial |
$217.50
|
| Rate for Payer: Networks By Design Commercial |
$145.00
|
| Rate for Payer: Prime Health Services Commercial |
$246.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$108.84
|
| Rate for Payer: United Healthcare All Other HMO |
$105.94
|
| Rate for Payer: United Healthcare HMO Rider |
$103.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$94.97
|
|
|
HC STENT PANCREATIC 0.035IN 5FRX7X170CM
|
Facility
|
OP
|
$290.00
|
|
|
Service Code
|
CPT C2625
|
| Hospital Charge Code |
900100407
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$58.00 |
| Max. Negotiated Rate |
$261.00 |
| Rate for Payer: Adventist Health Commercial |
$58.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$246.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$159.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$217.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$132.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$160.57
|
| Rate for Payer: Blue Shield of California Commercial |
$224.17
|
| Rate for Payer: Blue Shield of California EPN |
$146.16
|
| Rate for Payer: Cash Price |
$159.50
|
| Rate for Payer: Central Health Plan Commercial |
$232.00
|
| Rate for Payer: Cigna of CA HMO |
$203.00
|
| Rate for Payer: Cigna of CA PPO |
$203.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$246.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$246.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$246.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$116.00
|
| Rate for Payer: EPIC Health Plan Senior |
$116.00
|
| Rate for Payer: Galaxy Health WC |
$246.50
|
| Rate for Payer: Global Benefits Group Commercial |
$174.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$261.00
|
| Rate for Payer: InnovAge PACE Commercial |
$145.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$193.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$110.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$179.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$203.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$203.00
|
| Rate for Payer: Multiplan Commercial |
$217.50
|
| Rate for Payer: Networks By Design Commercial |
$145.00
|
| Rate for Payer: Prime Health Services Commercial |
$246.50
|
| Rate for Payer: Riverside University Health System MISP |
$116.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$174.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$174.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$108.84
|
| Rate for Payer: United Healthcare All Other HMO |
$105.94
|
| Rate for Payer: United Healthcare HMO Rider |
$103.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$94.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$246.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$246.50
|
| Rate for Payer: Vantage Medical Group Senior |
$246.50
|
|
|
HC STENT PANCREATIC 0.035IN 7FRX10X170CM
|
Facility
|
IP
|
$290.00
|
|
|
Service Code
|
CPT C2625
|
| Hospital Charge Code |
900100408
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$58.00 |
| Max. Negotiated Rate |
$261.00 |
| Rate for Payer: Adventist Health Commercial |
$58.00
|
| Rate for Payer: Blue Shield of California Commercial |
$224.17
|
| Rate for Payer: Blue Shield of California EPN |
$146.16
|
| Rate for Payer: Cash Price |
$159.50
|
| Rate for Payer: Central Health Plan Commercial |
$232.00
|
| Rate for Payer: Cigna of CA HMO |
$203.00
|
| Rate for Payer: Cigna of CA PPO |
$203.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$116.00
|
| Rate for Payer: EPIC Health Plan Senior |
$116.00
|
| Rate for Payer: Galaxy Health WC |
$246.50
|
| Rate for Payer: Global Benefits Group Commercial |
$174.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$261.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$193.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$110.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$179.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.00
|
| Rate for Payer: Multiplan Commercial |
$217.50
|
| Rate for Payer: Networks By Design Commercial |
$145.00
|
| Rate for Payer: Prime Health Services Commercial |
$246.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$108.84
|
| Rate for Payer: United Healthcare All Other HMO |
$105.94
|
| Rate for Payer: United Healthcare HMO Rider |
$103.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$94.97
|
|
|
HC STENT PANCREATIC 0.035IN 7FRX10X170CM
|
Facility
|
OP
|
$290.00
|
|
|
Service Code
|
CPT C2625
|
| Hospital Charge Code |
900100408
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$58.00 |
| Max. Negotiated Rate |
$261.00 |
| Rate for Payer: Adventist Health Commercial |
$58.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$246.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$159.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$217.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$132.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$160.57
|
| Rate for Payer: Blue Shield of California Commercial |
$224.17
|
| Rate for Payer: Blue Shield of California EPN |
$146.16
|
| Rate for Payer: Cash Price |
$159.50
|
| Rate for Payer: Central Health Plan Commercial |
$232.00
|
| Rate for Payer: Cigna of CA HMO |
$203.00
|
| Rate for Payer: Cigna of CA PPO |
$203.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$246.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$246.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$246.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$116.00
|
| Rate for Payer: EPIC Health Plan Senior |
$116.00
|
| Rate for Payer: Galaxy Health WC |
$246.50
|
| Rate for Payer: Global Benefits Group Commercial |
$174.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$261.00
|
| Rate for Payer: InnovAge PACE Commercial |
$145.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$193.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$110.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$179.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$203.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$203.00
|
| Rate for Payer: Multiplan Commercial |
$217.50
|
| Rate for Payer: Networks By Design Commercial |
$145.00
|
| Rate for Payer: Prime Health Services Commercial |
$246.50
|
| Rate for Payer: Riverside University Health System MISP |
$116.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$174.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$174.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$108.84
|
| Rate for Payer: United Healthcare All Other HMO |
$105.94
|
| Rate for Payer: United Healthcare HMO Rider |
$103.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$94.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$246.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$246.50
|
| Rate for Payer: Vantage Medical Group Senior |
$246.50
|
|
|
HC STENT PANCREATIC 0.035IN 7FRX3X170CM
|
Facility
|
IP
|
$290.00
|
|
|
Service Code
|
CPT C2625
|
| Hospital Charge Code |
900100409
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$58.00 |
| Max. Negotiated Rate |
$261.00 |
| Rate for Payer: Adventist Health Commercial |
$58.00
|
| Rate for Payer: Blue Shield of California Commercial |
$224.17
|
| Rate for Payer: Blue Shield of California EPN |
$146.16
|
| Rate for Payer: Cash Price |
$159.50
|
| Rate for Payer: Central Health Plan Commercial |
$232.00
|
| Rate for Payer: Cigna of CA HMO |
$203.00
|
| Rate for Payer: Cigna of CA PPO |
$203.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$116.00
|
| Rate for Payer: EPIC Health Plan Senior |
$116.00
|
| Rate for Payer: Galaxy Health WC |
$246.50
|
| Rate for Payer: Global Benefits Group Commercial |
$174.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$261.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$193.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$110.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$179.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.00
|
| Rate for Payer: Multiplan Commercial |
$217.50
|
| Rate for Payer: Networks By Design Commercial |
$145.00
|
| Rate for Payer: Prime Health Services Commercial |
$246.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$108.84
|
| Rate for Payer: United Healthcare All Other HMO |
$105.94
|
| Rate for Payer: United Healthcare HMO Rider |
$103.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$94.97
|
|
|
HC STENT PANCREATIC 0.035IN 7FRX3X170CM
|
Facility
|
OP
|
$290.00
|
|
|
Service Code
|
CPT C2625
|
| Hospital Charge Code |
900100409
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$58.00 |
| Max. Negotiated Rate |
$261.00 |
| Rate for Payer: Adventist Health Commercial |
$58.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$246.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$159.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$217.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$132.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$160.57
|
| Rate for Payer: Blue Shield of California Commercial |
$224.17
|
| Rate for Payer: Blue Shield of California EPN |
$146.16
|
| Rate for Payer: Cash Price |
$159.50
|
| Rate for Payer: Central Health Plan Commercial |
$232.00
|
| Rate for Payer: Cigna of CA HMO |
$203.00
|
| Rate for Payer: Cigna of CA PPO |
$203.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$246.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$246.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$246.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$116.00
|
| Rate for Payer: EPIC Health Plan Senior |
$116.00
|
| Rate for Payer: Galaxy Health WC |
$246.50
|
| Rate for Payer: Global Benefits Group Commercial |
$174.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$261.00
|
| Rate for Payer: InnovAge PACE Commercial |
$145.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$193.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$110.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$179.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$203.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$203.00
|
| Rate for Payer: Multiplan Commercial |
$217.50
|
| Rate for Payer: Networks By Design Commercial |
$145.00
|
| Rate for Payer: Prime Health Services Commercial |
$246.50
|
| Rate for Payer: Riverside University Health System MISP |
$116.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$174.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$174.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$108.84
|
| Rate for Payer: United Healthcare All Other HMO |
$105.94
|
| Rate for Payer: United Healthcare HMO Rider |
$103.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$94.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$246.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$246.50
|
| Rate for Payer: Vantage Medical Group Senior |
$246.50
|
|
|
HC STENT PLACEMT RETRO CAROTID
|
Facility
|
IP
|
$16,625.00
|
|
|
Service Code
|
CPT 37217
|
| Hospital Charge Code |
906820026
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,325.00 |
| Max. Negotiated Rate |
$14,962.50 |
| Rate for Payer: Adventist Health Commercial |
$3,325.00
|
| Rate for Payer: Cash Price |
$9,143.75
|
| Rate for Payer: Central Health Plan Commercial |
$13,300.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,650.00
|
| Rate for Payer: EPIC Health Plan Senior |
$6,650.00
|
| Rate for Payer: Galaxy Health WC |
$14,131.25
|
| Rate for Payer: Global Benefits Group Commercial |
$9,975.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,962.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,088.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,334.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,290.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,325.00
|
| Rate for Payer: Multiplan Commercial |
$12,468.75
|
| Rate for Payer: Networks By Design Commercial |
$10,806.25
|
| Rate for Payer: Prime Health Services Commercial |
$14,131.25
|
|
|
HC STENT PLACEMT RETRO CAROTID
|
Facility
|
IP
|
$14,131.00
|
|
|
Service Code
|
CPT 37217
|
| Hospital Charge Code |
909037217
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,826.20 |
| Max. Negotiated Rate |
$12,717.90 |
| Rate for Payer: Adventist Health Commercial |
$2,826.20
|
| Rate for Payer: Cash Price |
$7,772.05
|
| Rate for Payer: Central Health Plan Commercial |
$11,304.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,652.40
|
| Rate for Payer: EPIC Health Plan Senior |
$5,652.40
|
| Rate for Payer: Galaxy Health WC |
$12,011.35
|
| Rate for Payer: Global Benefits Group Commercial |
$8,478.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,717.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,425.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,383.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,747.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,826.20
|
| Rate for Payer: Multiplan Commercial |
$10,598.25
|
| Rate for Payer: Networks By Design Commercial |
$9,185.15
|
| Rate for Payer: Prime Health Services Commercial |
$12,011.35
|
|
|
HC STENT PLACEMT RETRO CAROTID
|
Facility
|
OP
|
$14,131.00
|
|
|
Service Code
|
CPT 37217
|
| Hospital Charge Code |
909037217
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$639.21 |
| Max. Negotiated Rate |
$12,717.90 |
| Rate for Payer: Adventist Health Commercial |
$2,826.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,011.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,772.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,598.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,842.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,299.14
|
| Rate for Payer: Blue Shield of California Commercial |
$979.68
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$7,772.05
|
| Rate for Payer: Cash Price |
$7,772.05
|
| Rate for Payer: Cash Price |
$7,772.05
|
| Rate for Payer: Central Health Plan Commercial |
$11,304.80
|
| Rate for Payer: Cigna of CA HMO |
$9,043.84
|
| Rate for Payer: Cigna of CA PPO |
$10,456.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,011.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$12,011.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12,011.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,652.40
|
| Rate for Payer: EPIC Health Plan Senior |
$5,652.40
|
| Rate for Payer: Galaxy Health WC |
$12,011.35
|
| Rate for Payer: Global Benefits Group Commercial |
$8,478.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,717.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,631.63
|
| Rate for Payer: InnovAge PACE Commercial |
$7,065.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,425.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,802.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,747.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,826.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,891.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,891.70
|
| Rate for Payer: Multiplan Commercial |
$10,598.25
|
| Rate for Payer: Networks By Design Commercial |
$9,185.15
|
| Rate for Payer: Prime Health Services Commercial |
$12,011.35
|
| Rate for Payer: Riverside University Health System MISP |
$5,652.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,478.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,011.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12,011.35
|
| Rate for Payer: Vantage Medical Group Senior |
$12,011.35
|
|
|
HC STENT PLACEMT RETRO CAROTID
|
Facility
|
OP
|
$16,625.00
|
|
|
Service Code
|
CPT 37217
|
| Hospital Charge Code |
906820026
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$639.21 |
| Max. Negotiated Rate |
$14,962.50 |
| Rate for Payer: Adventist Health Commercial |
$3,325.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14,131.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,143.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12,468.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8,049.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,763.86
|
| Rate for Payer: Blue Shield of California Commercial |
$979.68
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$9,143.75
|
| Rate for Payer: Cash Price |
$9,143.75
|
| Rate for Payer: Cash Price |
$9,143.75
|
| Rate for Payer: Central Health Plan Commercial |
$13,300.00
|
| Rate for Payer: Cigna of CA HMO |
$10,640.00
|
| Rate for Payer: Cigna of CA PPO |
$12,302.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14,131.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$14,131.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,131.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,650.00
|
| Rate for Payer: EPIC Health Plan Senior |
$6,650.00
|
| Rate for Payer: Galaxy Health WC |
$14,131.25
|
| Rate for Payer: Global Benefits Group Commercial |
$9,975.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,962.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,631.63
|
| Rate for Payer: InnovAge PACE Commercial |
$8,312.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,088.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,802.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,290.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,325.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,637.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,637.50
|
| Rate for Payer: Multiplan Commercial |
$12,468.75
|
| Rate for Payer: Networks By Design Commercial |
$10,806.25
|
| Rate for Payer: Prime Health Services Commercial |
$14,131.25
|
| Rate for Payer: Riverside University Health System MISP |
$6,650.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,975.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14,131.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14,131.25
|
| Rate for Payer: Vantage Medical Group Senior |
$14,131.25
|
|
|
HC STENT PLACMNT ANTE CAROTID
|
Facility
|
IP
|
$14,131.00
|
|
|
Service Code
|
CPT 37218
|
| Hospital Charge Code |
909037218
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,826.20 |
| Max. Negotiated Rate |
$12,717.90 |
| Rate for Payer: Adventist Health Commercial |
$2,826.20
|
| Rate for Payer: Cash Price |
$7,772.05
|
| Rate for Payer: Central Health Plan Commercial |
$11,304.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,652.40
|
| Rate for Payer: EPIC Health Plan Senior |
$5,652.40
|
| Rate for Payer: Galaxy Health WC |
$12,011.35
|
| Rate for Payer: Global Benefits Group Commercial |
$8,478.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,717.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,425.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,383.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,747.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,826.20
|
| Rate for Payer: Multiplan Commercial |
$10,598.25
|
| Rate for Payer: Networks By Design Commercial |
$9,185.15
|
| Rate for Payer: Prime Health Services Commercial |
$12,011.35
|
|
|
HC STENT PLACMNT ANTE CAROTID
|
Facility
|
OP
|
$14,131.00
|
|
|
Service Code
|
CPT 37218
|
| Hospital Charge Code |
909037218
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$243.33 |
| Max. Negotiated Rate |
$12,717.90 |
| Rate for Payer: Adventist Health Commercial |
$2,826.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,011.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,772.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,598.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,842.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,299.14
|
| Rate for Payer: Blue Shield of California Commercial |
$979.68
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$7,772.05
|
| Rate for Payer: Cash Price |
$7,772.05
|
| Rate for Payer: Cash Price |
$7,772.05
|
| Rate for Payer: Central Health Plan Commercial |
$11,304.80
|
| Rate for Payer: Cigna of CA HMO |
$9,043.84
|
| Rate for Payer: Cigna of CA PPO |
$10,456.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,011.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$12,011.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12,011.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,652.40
|
| Rate for Payer: EPIC Health Plan Senior |
$5,652.40
|
| Rate for Payer: Galaxy Health WC |
$12,011.35
|
| Rate for Payer: Global Benefits Group Commercial |
$8,478.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,717.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$243.33
|
| Rate for Payer: InnovAge PACE Commercial |
$7,065.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,425.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$268.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,747.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,826.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,891.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,891.70
|
| Rate for Payer: Multiplan Commercial |
$10,598.25
|
| Rate for Payer: Networks By Design Commercial |
$9,185.15
|
| Rate for Payer: Prime Health Services Commercial |
$12,011.35
|
| Rate for Payer: Riverside University Health System MISP |
$5,652.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,478.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,011.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12,011.35
|
| Rate for Payer: Vantage Medical Group Senior |
$12,011.35
|
|
|
HC STENT PROTEGE
|
Facility
|
OP
|
$6,050.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020030
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,210.00 |
| Max. Negotiated Rate |
$5,445.00 |
| Rate for Payer: Adventist Health Commercial |
$1,210.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,142.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,327.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,537.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,762.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,349.89
|
| Rate for Payer: Blue Shield of California Commercial |
$4,676.65
|
| Rate for Payer: Blue Shield of California EPN |
$3,049.20
|
| Rate for Payer: Cash Price |
$3,327.50
|
| Rate for Payer: Central Health Plan Commercial |
$4,840.00
|
| Rate for Payer: Cigna of CA HMO |
$4,235.00
|
| Rate for Payer: Cigna of CA PPO |
$4,235.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,142.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,142.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,142.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,420.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,420.00
|
| Rate for Payer: Galaxy Health WC |
$5,142.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,630.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,445.00
|
| Rate for Payer: InnovAge PACE Commercial |
$3,025.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,035.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,305.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,744.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,210.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,235.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,235.00
|
| Rate for Payer: Multiplan Commercial |
$4,537.50
|
| Rate for Payer: Networks By Design Commercial |
$3,025.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,142.50
|
| Rate for Payer: Riverside University Health System MISP |
$2,420.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,630.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,630.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,270.57
|
| Rate for Payer: United Healthcare All Other HMO |
$2,210.07
|
| Rate for Payer: United Healthcare HMO Rider |
$2,162.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,981.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,142.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,142.50
|
| Rate for Payer: Vantage Medical Group Senior |
$5,142.50
|
|
|
HC STENT PROTEGE
|
Facility
|
IP
|
$6,050.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020030
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,210.00 |
| Max. Negotiated Rate |
$5,445.00 |
| Rate for Payer: Adventist Health Commercial |
$1,210.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,676.65
|
| Rate for Payer: Blue Shield of California EPN |
$3,049.20
|
| Rate for Payer: Cash Price |
$3,327.50
|
| Rate for Payer: Central Health Plan Commercial |
$4,840.00
|
| Rate for Payer: Cigna of CA HMO |
$4,235.00
|
| Rate for Payer: Cigna of CA PPO |
$4,235.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,420.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,420.00
|
| Rate for Payer: Galaxy Health WC |
$5,142.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,630.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,445.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,035.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,305.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,744.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,210.00
|
| Rate for Payer: Multiplan Commercial |
$4,537.50
|
| Rate for Payer: Networks By Design Commercial |
$3,025.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,142.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,270.57
|
| Rate for Payer: United Healthcare All Other HMO |
$2,210.07
|
| Rate for Payer: United Healthcare HMO Rider |
$2,162.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,981.38
|
|
|
HC STENT PROTEGE EVERFLEX
|
Facility
|
OP
|
$3,510.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020093
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$702.00 |
| Max. Negotiated Rate |
$3,159.00 |
| Rate for Payer: Adventist Health Commercial |
$702.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,983.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,930.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,632.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,602.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,943.49
|
| Rate for Payer: Blue Shield of California Commercial |
$2,713.23
|
| Rate for Payer: Blue Shield of California EPN |
$1,769.04
|
| Rate for Payer: Cash Price |
$1,930.50
|
| Rate for Payer: Central Health Plan Commercial |
$2,808.00
|
| Rate for Payer: Cigna of CA HMO |
$2,457.00
|
| Rate for Payer: Cigna of CA PPO |
$2,457.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,983.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,983.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,983.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,404.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,404.00
|
| Rate for Payer: Galaxy Health WC |
$2,983.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,106.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,159.00
|
| Rate for Payer: InnovAge PACE Commercial |
$1,755.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,341.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,337.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,172.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$702.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,457.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,457.00
|
| Rate for Payer: Multiplan Commercial |
$2,632.50
|
| Rate for Payer: Networks By Design Commercial |
$1,755.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,983.50
|
| Rate for Payer: Riverside University Health System MISP |
$1,404.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,106.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,106.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,317.30
|
| Rate for Payer: United Healthcare All Other HMO |
$1,282.20
|
| Rate for Payer: United Healthcare HMO Rider |
$1,254.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,149.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,983.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,983.50
|
| Rate for Payer: Vantage Medical Group Senior |
$2,983.50
|
|
