|
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
|
|
|
HC STENT RETRIEVER TREVO
|
Facility
|
IP
|
$19,488.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909000006
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,897.60 |
| Max. Negotiated Rate |
$17,539.20 |
| Rate for Payer: Adventist Health Commercial |
$3,897.60
|
| Rate for Payer: Blue Shield of California Commercial |
$15,064.22
|
| Rate for Payer: Blue Shield of California EPN |
$9,821.95
|
| Rate for Payer: Cash Price |
$10,718.40
|
| Rate for Payer: Central Health Plan Commercial |
$15,590.40
|
| Rate for Payer: Cigna of CA HMO |
$13,641.60
|
| Rate for Payer: Cigna of CA PPO |
$13,641.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,795.20
|
| Rate for Payer: EPIC Health Plan Senior |
$7,795.20
|
| Rate for Payer: Galaxy Health WC |
$16,564.80
|
| Rate for Payer: Global Benefits Group Commercial |
$11,692.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$17,539.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,998.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,424.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,063.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,897.60
|
| Rate for Payer: Multiplan Commercial |
$14,616.00
|
| Rate for Payer: Networks By Design Commercial |
$9,744.00
|
| Rate for Payer: Prime Health Services Commercial |
$16,564.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,313.85
|
| Rate for Payer: United Healthcare All Other HMO |
$7,118.97
|
| Rate for Payer: United Healthcare HMO Rider |
$6,965.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,382.32
|
|
|
HC STENT RETRIEVER TREVO
|
Facility
|
OP
|
$19,488.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909000006
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,897.60 |
| Max. Negotiated Rate |
$17,539.20 |
| Rate for Payer: Adventist Health Commercial |
$3,897.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16,564.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,718.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,616.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8,898.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,790.51
|
| Rate for Payer: Blue Shield of California Commercial |
$15,064.22
|
| Rate for Payer: Blue Shield of California EPN |
$9,821.95
|
| Rate for Payer: Cash Price |
$10,718.40
|
| Rate for Payer: Central Health Plan Commercial |
$15,590.40
|
| Rate for Payer: Cigna of CA HMO |
$13,641.60
|
| Rate for Payer: Cigna of CA PPO |
$13,641.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16,564.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$16,564.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16,564.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,795.20
|
| Rate for Payer: EPIC Health Plan Senior |
$7,795.20
|
| Rate for Payer: Galaxy Health WC |
$16,564.80
|
| Rate for Payer: Global Benefits Group Commercial |
$11,692.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$17,539.20
|
| Rate for Payer: InnovAge PACE Commercial |
$9,744.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,998.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,424.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,063.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,897.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13,641.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13,641.60
|
| Rate for Payer: Multiplan Commercial |
$14,616.00
|
| Rate for Payer: Networks By Design Commercial |
$9,744.00
|
| Rate for Payer: Prime Health Services Commercial |
$16,564.80
|
| Rate for Payer: Riverside University Health System MISP |
$7,795.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11,692.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11,692.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,313.85
|
| Rate for Payer: United Healthcare All Other HMO |
$7,118.97
|
| Rate for Payer: United Healthcare HMO Rider |
$6,965.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,382.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16,564.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16,564.80
|
| Rate for Payer: Vantage Medical Group Senior |
$16,564.80
|
|
|
HC STENT RUSCH Y
|
Facility
|
OP
|
$1,725.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
900803703
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$345.00 |
| Max. Negotiated Rate |
$1,552.50 |
| Rate for Payer: Adventist Health Commercial |
$345.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,466.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$948.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,293.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$787.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$955.13
|
| Rate for Payer: Blue Shield of California Commercial |
$1,333.42
|
| Rate for Payer: Blue Shield of California EPN |
$869.40
|
| Rate for Payer: Cash Price |
$948.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,380.00
|
| Rate for Payer: Cigna of CA HMO |
$1,207.50
|
| Rate for Payer: Cigna of CA PPO |
$1,207.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,466.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,466.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,466.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$690.00
|
| Rate for Payer: EPIC Health Plan Senior |
$690.00
|
| Rate for Payer: Galaxy Health WC |
$1,466.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,035.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,552.50
|
| Rate for Payer: InnovAge PACE Commercial |
$862.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,150.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,067.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$345.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,207.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,207.50
|
| Rate for Payer: Multiplan Commercial |
$1,293.75
|
| Rate for Payer: Networks By Design Commercial |
$862.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,466.25
|
| Rate for Payer: Riverside University Health System MISP |
$690.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,035.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,035.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$647.39
|
| Rate for Payer: United Healthcare All Other HMO |
$630.14
|
| Rate for Payer: United Healthcare HMO Rider |
$616.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$564.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,466.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,466.25
|
| Rate for Payer: Vantage Medical Group Senior |
$1,466.25
|
|
|
HC STENT RUSCH Y
|
Facility
|
IP
|
$1,725.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
900803703
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$345.00 |
| Max. Negotiated Rate |
$1,552.50 |
| Rate for Payer: Adventist Health Commercial |
$345.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,333.42
|
| Rate for Payer: Blue Shield of California EPN |
$869.40
|
| Rate for Payer: Cash Price |
$948.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,380.00
|
| Rate for Payer: Cigna of CA HMO |
$1,207.50
|
| Rate for Payer: Cigna of CA PPO |
$1,207.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$690.00
|
| Rate for Payer: EPIC Health Plan Senior |
$690.00
|
| Rate for Payer: Galaxy Health WC |
$1,466.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,035.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,552.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,150.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$657.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,067.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$345.00
|
| Rate for Payer: Multiplan Commercial |
$1,293.75
|
| Rate for Payer: Networks By Design Commercial |
$862.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,466.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$647.39
|
| Rate for Payer: United Healthcare All Other HMO |
$630.14
|
| Rate for Payer: United Healthcare HMO Rider |
$616.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$564.94
|
|
|
HC STENT SCHNEIDER WALL
|
Facility
|
IP
|
$1,717.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
900803702
|
|
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 SCHNEIDER WALL
|
Facility
|
OP
|
$1,717.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
900803702
|
|
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 SUPERA
|
Facility
|
IP
|
$3,987.50
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020142
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$797.50 |
| Max. Negotiated Rate |
$3,588.75 |
| Rate for Payer: Adventist Health Commercial |
$797.50
|
| Rate for Payer: Blue Shield of California Commercial |
$3,082.34
|
| Rate for Payer: Blue Shield of California EPN |
$2,009.70
|
| Rate for Payer: Cash Price |
$2,193.12
|
| Rate for Payer: Central Health Plan Commercial |
$3,190.00
|
| Rate for Payer: Cigna of CA HMO |
$2,791.25
|
| Rate for Payer: Cigna of CA PPO |
$2,791.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,595.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,595.00
|
| Rate for Payer: Galaxy Health WC |
$3,389.38
|
| Rate for Payer: Global Benefits Group Commercial |
$2,392.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,588.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,659.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,519.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,468.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$797.50
|
| Rate for Payer: Multiplan Commercial |
$2,990.62
|
| Rate for Payer: Networks By Design Commercial |
$1,993.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,389.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,496.51
|
| Rate for Payer: United Healthcare All Other HMO |
$1,456.63
|
| Rate for Payer: United Healthcare HMO Rider |
$1,425.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,305.91
|
|
|
HC STENT SUPERA
|
Facility
|
OP
|
$3,987.50
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020142
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$797.50 |
| Max. Negotiated Rate |
$3,588.75 |
| Rate for Payer: Adventist Health Commercial |
$797.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,389.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,193.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,990.62
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,820.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,207.88
|
| Rate for Payer: Blue Shield of California Commercial |
$3,082.34
|
| Rate for Payer: Blue Shield of California EPN |
$2,009.70
|
| Rate for Payer: Cash Price |
$2,193.12
|
| Rate for Payer: Central Health Plan Commercial |
$3,190.00
|
| Rate for Payer: Cigna of CA HMO |
$2,791.25
|
| Rate for Payer: Cigna of CA PPO |
$2,791.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,389.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,389.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,389.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,595.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,595.00
|
| Rate for Payer: Galaxy Health WC |
$3,389.38
|
| Rate for Payer: Global Benefits Group Commercial |
$2,392.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,588.75
|
| Rate for Payer: InnovAge PACE Commercial |
$1,993.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,659.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,519.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,468.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$797.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,791.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,791.25
|
| Rate for Payer: Multiplan Commercial |
$2,990.62
|
| Rate for Payer: Networks By Design Commercial |
$1,993.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,389.38
|
| Rate for Payer: Riverside University Health System MISP |
$1,595.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,392.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,392.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,496.51
|
| Rate for Payer: United Healthcare All Other HMO |
$1,456.63
|
| Rate for Payer: United Healthcare HMO Rider |
$1,425.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,305.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,389.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,389.38
|
| Rate for Payer: Vantage Medical Group Senior |
$3,389.38
|
|
|
HC STENT TIBIOPERONEAL
|
Facility
|
IP
|
$22,611.00
|
|
|
Service Code
|
CPT 37230
|
| Hospital Charge Code |
909020071
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,522.20 |
| Max. Negotiated Rate |
$20,349.90 |
| Rate for Payer: Adventist Health Commercial |
$4,522.20
|
| Rate for Payer: Cash Price |
$12,436.05
|
| Rate for Payer: Central Health Plan Commercial |
$18,088.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,044.40
|
| Rate for Payer: EPIC Health Plan Senior |
$9,044.40
|
| Rate for Payer: Galaxy Health WC |
$19,219.35
|
| Rate for Payer: Global Benefits Group Commercial |
$13,566.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$20,349.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15,081.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,614.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,996.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,522.20
|
| Rate for Payer: Multiplan Commercial |
$16,958.25
|
| Rate for Payer: Networks By Design Commercial |
$14,697.15
|
| Rate for Payer: Prime Health Services Commercial |
$19,219.35
|
|
|
HC STENT TIBIOPERONEAL
|
Facility
|
IP
|
$26,601.00
|
|
|
Service Code
|
CPT 37230
|
| Hospital Charge Code |
906820154
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,320.20 |
| Max. Negotiated Rate |
$23,940.90 |
| Rate for Payer: Adventist Health Commercial |
$5,320.20
|
| Rate for Payer: Cash Price |
$14,630.55
|
| Rate for Payer: Central Health Plan Commercial |
$21,280.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,640.40
|
| Rate for Payer: EPIC Health Plan Senior |
$10,640.40
|
| Rate for Payer: Galaxy Health WC |
$22,610.85
|
| Rate for Payer: Global Benefits Group Commercial |
$15,960.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$23,940.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17,742.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,134.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,466.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,320.20
|
| Rate for Payer: Multiplan Commercial |
$19,950.75
|
| Rate for Payer: Networks By Design Commercial |
$17,290.65
|
| Rate for Payer: Prime Health Services Commercial |
$22,610.85
|
|
|
HC STENT TIBIOPERONEAL
|
Facility
|
OP
|
$22,611.00
|
|
|
Service Code
|
CPT 37230
|
| Hospital Charge Code |
909020071
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,022.64 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$4,522.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$22,815.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22,815.81
|
| 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 |
$36,352.92
|
| 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 |
$12,436.05
|
| Rate for Payer: Cash Price |
$12,436.05
|
| Rate for Payer: Cash Price |
$12,436.05
|
| Rate for Payer: Central Health Plan Commercial |
$18,088.80
|
| Rate for Payer: Cigna of CA HMO |
$14,471.04
|
| Rate for Payer: Cigna of CA PPO |
$16,732.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,097.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22,815.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$30,801.34
|
| Rate for Payer: EPIC Health Plan Senior |
$22,815.81
|
| Rate for Payer: Galaxy Health WC |
$19,219.35
|
| Rate for Payer: Global Benefits Group Commercial |
$13,566.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$20,349.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$37,417.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,022.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,815.81
|
| Rate for Payer: InnovAge PACE Commercial |
$34,223.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15,081.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,129.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,815.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,522.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30,573.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30,573.19
|
| Rate for Payer: Multiplan Commercial |
$16,958.25
|
| Rate for Payer: Multiplan WC |
$36,352.92
|
| Rate for Payer: Networks By Design Commercial |
$14,697.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$22,815.81
|
| Rate for Payer: Preferred Health Network WC |
$37,094.82
|
| Rate for Payer: Prime Health Services Commercial |
$19,219.35
|
| Rate for Payer: Prime Health Services Medicare |
$24,184.76
|
| Rate for Payer: Prime Health Services WC |
$35,981.98
|
| Rate for Payer: Riverside University Health System MISP |
$25,097.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13,566.60
|
| 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 |
$22,815.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Vantage Medical Group Senior |
$22,815.81
|
|
|
HC STENT TIBIOPERONEAL
|
Facility
|
OP
|
$26,601.00
|
|
|
Service Code
|
CPT 37230
|
| Hospital Charge Code |
906820154
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,022.64 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$5,320.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$22,815.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22,815.81
|
| 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 |
$36,352.92
|
| 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 |
$14,630.55
|
| Rate for Payer: Cash Price |
$14,630.55
|
| Rate for Payer: Cash Price |
$14,630.55
|
| Rate for Payer: Central Health Plan Commercial |
$21,280.80
|
| Rate for Payer: Cigna of CA HMO |
$17,024.64
|
| Rate for Payer: Cigna of CA PPO |
$19,684.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,097.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22,815.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$30,801.34
|
| Rate for Payer: EPIC Health Plan Senior |
$22,815.81
|
| Rate for Payer: Galaxy Health WC |
$22,610.85
|
| Rate for Payer: Global Benefits Group Commercial |
$15,960.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$23,940.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$37,417.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,022.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,815.81
|
| Rate for Payer: InnovAge PACE Commercial |
$34,223.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17,742.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,129.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,815.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,320.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30,573.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30,573.19
|
| Rate for Payer: Multiplan Commercial |
$19,950.75
|
| Rate for Payer: Multiplan WC |
$36,352.92
|
| Rate for Payer: Networks By Design Commercial |
$17,290.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$22,815.81
|
| Rate for Payer: Preferred Health Network WC |
$37,094.82
|
| Rate for Payer: Prime Health Services Commercial |
$22,610.85
|
| Rate for Payer: Prime Health Services Medicare |
$24,184.76
|
| Rate for Payer: Prime Health Services WC |
$35,981.98
|
| Rate for Payer: Riverside University Health System MISP |
$25,097.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15,960.60
|
| 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 |
$22,815.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Vantage Medical Group Senior |
$22,815.81
|
|
|
HC STENT TIBIOPERONEAL EA ADDL
|
Facility
|
OP
|
$13,017.00
|
|
|
Service Code
|
CPT 37234
|
| Hospital Charge Code |
909020075
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$405.35 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$2,603.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,064.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,159.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,762.75
|
| 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 |
$7,159.35
|
| Rate for Payer: Cash Price |
$7,159.35
|
| Rate for Payer: Cash Price |
$7,159.35
|
| Rate for Payer: Central Health Plan Commercial |
$10,413.60
|
| Rate for Payer: Cigna of CA HMO |
$8,330.88
|
| Rate for Payer: Cigna of CA PPO |
$9,632.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,064.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,064.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11,064.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,206.80
|
| Rate for Payer: EPIC Health Plan Senior |
$5,206.80
|
| Rate for Payer: Galaxy Health WC |
$11,064.45
|
| Rate for Payer: Global Benefits Group Commercial |
$7,810.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,715.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$405.35
|
| Rate for Payer: InnovAge PACE Commercial |
$6,508.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,682.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$447.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,057.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,603.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,111.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,111.90
|
| Rate for Payer: Multiplan Commercial |
$9,762.75
|
| Rate for Payer: Networks By Design Commercial |
$8,461.05
|
| Rate for Payer: Prime Health Services Commercial |
$11,064.45
|
| Rate for Payer: Riverside University Health System MISP |
$5,206.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,810.20
|
| 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 |
$11,064.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,064.45
|
| Rate for Payer: Vantage Medical Group Senior |
$11,064.45
|
|
|
HC STENT TIBIOPERONEAL EA ADDL
|
Facility
|
IP
|
$13,017.00
|
|
|
Service Code
|
CPT 37234
|
| Hospital Charge Code |
909020075
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,603.40 |
| Max. Negotiated Rate |
$11,715.30 |
| Rate for Payer: Adventist Health Commercial |
$2,603.40
|
| Rate for Payer: Cash Price |
$7,159.35
|
| Rate for Payer: Central Health Plan Commercial |
$10,413.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,206.80
|
| Rate for Payer: EPIC Health Plan Senior |
$5,206.80
|
| Rate for Payer: Galaxy Health WC |
$11,064.45
|
| Rate for Payer: Global Benefits Group Commercial |
$7,810.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,715.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,682.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,959.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,057.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,603.40
|
| Rate for Payer: Multiplan Commercial |
$9,762.75
|
| Rate for Payer: Networks By Design Commercial |
$8,461.05
|
| Rate for Payer: Prime Health Services Commercial |
$11,064.45
|
|
|
HC STENT TIBIOPERONEAL EA ADDL
|
Facility
|
OP
|
$15,314.00
|
|
|
Service Code
|
CPT 37234
|
| Hospital Charge Code |
906820158
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$405.35 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$3,062.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,016.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,422.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11,485.50
|
| 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 |
$8,422.70
|
| Rate for Payer: Cash Price |
$8,422.70
|
| Rate for Payer: Cash Price |
$8,422.70
|
| Rate for Payer: Central Health Plan Commercial |
$12,251.20
|
| Rate for Payer: Cigna of CA HMO |
$9,800.96
|
| Rate for Payer: Cigna of CA PPO |
$11,332.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,016.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$13,016.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13,016.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,125.60
|
| Rate for Payer: EPIC Health Plan Senior |
$6,125.60
|
| Rate for Payer: Galaxy Health WC |
$13,016.90
|
| Rate for Payer: Global Benefits Group Commercial |
$9,188.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,782.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$405.35
|
| Rate for Payer: InnovAge PACE Commercial |
$7,657.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,214.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$447.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,479.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,062.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,719.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,719.80
|
| Rate for Payer: Multiplan Commercial |
$11,485.50
|
| Rate for Payer: Networks By Design Commercial |
$9,954.10
|
| Rate for Payer: Prime Health Services Commercial |
$13,016.90
|
| Rate for Payer: Riverside University Health System MISP |
$6,125.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,188.40
|
| 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 |
$13,016.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13,016.90
|
| Rate for Payer: Vantage Medical Group Senior |
$13,016.90
|
|
|
HC STENT TIBIOPERONEAL EA ADDL
|
Facility
|
IP
|
$15,314.00
|
|
|
Service Code
|
CPT 37234
|
| Hospital Charge Code |
906820158
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,062.80 |
| Max. Negotiated Rate |
$13,782.60 |
| Rate for Payer: Adventist Health Commercial |
$3,062.80
|
| Rate for Payer: Cash Price |
$8,422.70
|
| Rate for Payer: Central Health Plan Commercial |
$12,251.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,125.60
|
| Rate for Payer: EPIC Health Plan Senior |
$6,125.60
|
| Rate for Payer: Galaxy Health WC |
$13,016.90
|
| Rate for Payer: Global Benefits Group Commercial |
$9,188.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,782.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,214.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,834.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,479.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,062.80
|
| Rate for Payer: Multiplan Commercial |
$11,485.50
|
| Rate for Payer: Networks By Design Commercial |
$9,954.10
|
| Rate for Payer: Prime Health Services Commercial |
$13,016.90
|
|
|
HC STENT ULTRAFLEX T-B COV W/DEL
|
Facility
|
OP
|
$3,053.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
900803704
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$610.60 |
| Max. Negotiated Rate |
$2,747.70 |
| Rate for Payer: Adventist Health Commercial |
$610.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,595.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,679.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,289.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,394.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,690.45
|
| Rate for Payer: Blue Shield of California Commercial |
$2,359.97
|
| Rate for Payer: Blue Shield of California EPN |
$1,538.71
|
| Rate for Payer: Cash Price |
$1,679.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,442.40
|
| Rate for Payer: Cigna of CA HMO |
$2,137.10
|
| Rate for Payer: Cigna of CA PPO |
$2,137.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,595.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,595.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,595.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,221.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,221.20
|
| Rate for Payer: Galaxy Health WC |
$2,595.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,831.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,747.70
|
| Rate for Payer: InnovAge PACE Commercial |
$1,526.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,036.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,889.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$610.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,137.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,137.10
|
| Rate for Payer: Multiplan Commercial |
$2,289.75
|
| Rate for Payer: Networks By Design Commercial |
$1,526.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,595.05
|
| Rate for Payer: Riverside University Health System MISP |
$1,221.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,831.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,831.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,145.79
|
| Rate for Payer: United Healthcare All Other HMO |
$1,115.26
|
| Rate for Payer: United Healthcare HMO Rider |
$1,091.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$999.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,595.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,595.05
|
| Rate for Payer: Vantage Medical Group Senior |
$2,595.05
|
|
|
HC STENT ULTRAFLEX T-B COV W/DEL
|
Facility
|
IP
|
$3,053.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
900803704
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$610.60 |
| Max. Negotiated Rate |
$2,747.70 |
| Rate for Payer: Adventist Health Commercial |
$610.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,359.97
|
| Rate for Payer: Blue Shield of California EPN |
$1,538.71
|
| Rate for Payer: Cash Price |
$1,679.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,442.40
|
| Rate for Payer: Cigna of CA HMO |
$2,137.10
|
| Rate for Payer: Cigna of CA PPO |
$2,137.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,221.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,221.20
|
| Rate for Payer: Galaxy Health WC |
$2,595.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,831.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,747.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,036.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,163.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,889.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$610.60
|
| Rate for Payer: Multiplan Commercial |
$2,289.75
|
| Rate for Payer: Networks By Design Commercial |
$1,526.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,595.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,145.79
|
| Rate for Payer: United Healthcare All Other HMO |
$1,115.26
|
| Rate for Payer: United Healthcare HMO Rider |
$1,091.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$999.86
|
|
|
HC STENT ULTRAFLEX T-B NON-COV W/
|
Facility
|
IP
|
$3,053.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
900803705
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$610.60 |
| Max. Negotiated Rate |
$2,747.70 |
| Rate for Payer: Adventist Health Commercial |
$610.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,359.97
|
| Rate for Payer: Blue Shield of California EPN |
$1,538.71
|
| Rate for Payer: Cash Price |
$1,679.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,442.40
|
| Rate for Payer: Cigna of CA HMO |
$2,137.10
|
| Rate for Payer: Cigna of CA PPO |
$2,137.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,221.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,221.20
|
| Rate for Payer: Galaxy Health WC |
$2,595.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,831.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,747.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,036.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,163.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,889.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$610.60
|
| Rate for Payer: Multiplan Commercial |
$2,289.75
|
| Rate for Payer: Networks By Design Commercial |
$1,526.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,595.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,145.79
|
| Rate for Payer: United Healthcare All Other HMO |
$1,115.26
|
| Rate for Payer: United Healthcare HMO Rider |
$1,091.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$999.86
|
|
|
HC STENT ULTRAFLEX T-B NON-COV W/
|
Facility
|
OP
|
$3,053.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
900803705
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$610.60 |
| Max. Negotiated Rate |
$2,747.70 |
| Rate for Payer: Adventist Health Commercial |
$610.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,595.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,679.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,289.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,394.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,690.45
|
| Rate for Payer: Blue Shield of California Commercial |
$2,359.97
|
| Rate for Payer: Blue Shield of California EPN |
$1,538.71
|
| Rate for Payer: Cash Price |
$1,679.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,442.40
|
| Rate for Payer: Cigna of CA HMO |
$2,137.10
|
| Rate for Payer: Cigna of CA PPO |
$2,137.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,595.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,595.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,595.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,221.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,221.20
|
| Rate for Payer: Galaxy Health WC |
$2,595.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,831.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,747.70
|
| Rate for Payer: InnovAge PACE Commercial |
$1,526.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,036.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,163.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,889.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$610.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,137.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,137.10
|
| Rate for Payer: Multiplan Commercial |
$2,289.75
|
| Rate for Payer: Networks By Design Commercial |
$1,526.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,595.05
|
| Rate for Payer: Riverside University Health System MISP |
$1,221.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,831.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,831.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,145.79
|
| Rate for Payer: United Healthcare All Other HMO |
$1,115.26
|
| Rate for Payer: United Healthcare HMO Rider |
$1,091.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$999.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,595.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,595.05
|
| Rate for Payer: Vantage Medical Group Senior |
$2,595.05
|
|
|
HC STENT VIABAHN
|
Facility
|
OP
|
$7,625.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
909020094
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,525.00 |
| Max. Negotiated Rate |
$6,862.50 |
| Rate for Payer: Adventist Health Commercial |
$1,525.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,481.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,193.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,718.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,481.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,221.96
|
| Rate for Payer: Blue Shield of California Commercial |
$5,894.12
|
| Rate for Payer: Blue Shield of California EPN |
$3,843.00
|
| Rate for Payer: Cash Price |
$4,193.75
|
| Rate for Payer: Central Health Plan Commercial |
$6,100.00
|
| Rate for Payer: Cigna of CA HMO |
$5,337.50
|
| Rate for Payer: Cigna of CA PPO |
$5,337.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,481.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,481.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,481.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,050.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,050.00
|
| Rate for Payer: Galaxy Health WC |
$6,481.25
|
| Rate for Payer: Global Benefits Group Commercial |
$4,575.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,862.50
|
| Rate for Payer: InnovAge PACE Commercial |
$3,812.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,085.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,719.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,525.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,337.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,337.50
|
| Rate for Payer: Multiplan Commercial |
$5,718.75
|
| Rate for Payer: Networks By Design Commercial |
$3,812.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,481.25
|
| Rate for Payer: Riverside University Health System MISP |
$3,050.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,575.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,575.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,861.66
|
| Rate for Payer: United Healthcare All Other HMO |
$2,785.41
|
| Rate for Payer: United Healthcare HMO Rider |
$2,725.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,497.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,481.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,481.25
|
| Rate for Payer: Vantage Medical Group Senior |
$6,481.25
|
|
|
HC STENT VIABAHN
|
Facility
|
IP
|
$7,625.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
909020094
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,525.00 |
| Max. Negotiated Rate |
$6,862.50 |
| Rate for Payer: Adventist Health Commercial |
$1,525.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,894.12
|
| Rate for Payer: Blue Shield of California EPN |
$3,843.00
|
| Rate for Payer: Cash Price |
$4,193.75
|
| Rate for Payer: Central Health Plan Commercial |
$6,100.00
|
| Rate for Payer: Cigna of CA HMO |
$5,337.50
|
| Rate for Payer: Cigna of CA PPO |
$5,337.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,050.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,050.00
|
| Rate for Payer: Galaxy Health WC |
$6,481.25
|
| Rate for Payer: Global Benefits Group Commercial |
$4,575.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,862.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,085.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,905.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,719.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,525.00
|
| Rate for Payer: Multiplan Commercial |
$5,718.75
|
| Rate for Payer: Networks By Design Commercial |
$3,812.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,481.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,861.66
|
| Rate for Payer: United Healthcare All Other HMO |
$2,785.41
|
| Rate for Payer: United Healthcare HMO Rider |
$2,725.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,497.19
|
|
|
HC STENT VIATORR/COVERED
|
Facility
|
OP
|
$9,412.50
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
909081419
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,882.50 |
| Max. Negotiated Rate |
$8,471.25 |
| Rate for Payer: Adventist Health Commercial |
$1,882.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,000.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,176.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,059.38
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,297.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,211.70
|
| Rate for Payer: Blue Shield of California Commercial |
$7,275.86
|
| Rate for Payer: Blue Shield of California EPN |
$4,743.90
|
| Rate for Payer: Cash Price |
$5,176.88
|
| Rate for Payer: Central Health Plan Commercial |
$7,530.00
|
| Rate for Payer: Cigna of CA HMO |
$6,588.75
|
| Rate for Payer: Cigna of CA PPO |
$6,588.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,000.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,000.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,000.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,765.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,765.00
|
| Rate for Payer: Galaxy Health WC |
$8,000.62
|
| Rate for Payer: Global Benefits Group Commercial |
$5,647.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,471.25
|
| Rate for Payer: InnovAge PACE Commercial |
$4,706.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,278.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,826.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,882.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,588.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,588.75
|
| Rate for Payer: Multiplan Commercial |
$7,059.38
|
| Rate for Payer: Networks By Design Commercial |
$4,706.25
|
| Rate for Payer: Prime Health Services Commercial |
$8,000.62
|
| Rate for Payer: Riverside University Health System MISP |
$3,765.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,647.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,647.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,532.51
|
| Rate for Payer: United Healthcare All Other HMO |
$3,438.39
|
| Rate for Payer: United Healthcare HMO Rider |
$3,364.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,082.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,000.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,000.62
|
| Rate for Payer: Vantage Medical Group Senior |
$8,000.62
|
|
|
HC STENT VIATORR/COVERED
|
Facility
|
IP
|
$9,412.50
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
909081419
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,882.50 |
| Max. Negotiated Rate |
$8,471.25 |
| Rate for Payer: Adventist Health Commercial |
$1,882.50
|
| Rate for Payer: Blue Shield of California Commercial |
$7,275.86
|
| Rate for Payer: Blue Shield of California EPN |
$4,743.90
|
| Rate for Payer: Cash Price |
$5,176.88
|
| Rate for Payer: Central Health Plan Commercial |
$7,530.00
|
| Rate for Payer: Cigna of CA HMO |
$6,588.75
|
| Rate for Payer: Cigna of CA PPO |
$6,588.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,765.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,765.00
|
| Rate for Payer: Galaxy Health WC |
$8,000.62
|
| Rate for Payer: Global Benefits Group Commercial |
$5,647.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,471.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,278.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,586.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,826.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,882.50
|
| Rate for Payer: Multiplan Commercial |
$7,059.38
|
| Rate for Payer: Networks By Design Commercial |
$4,706.25
|
| Rate for Payer: Prime Health Services Commercial |
$8,000.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,532.51
|
| Rate for Payer: United Healthcare All Other HMO |
$3,438.39
|
| Rate for Payer: United Healthcare HMO Rider |
$3,364.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,082.59
|
|
