|
HC STNT BILRY SMART CORDIS NIT 20
|
Facility
|
IP
|
$1,800.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909081428
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$360.00 |
| Max. Negotiated Rate |
$1,620.00 |
| Rate for Payer: Adventist Health Commercial |
$360.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,391.40
|
| Rate for Payer: Blue Shield of California EPN |
$907.20
|
| Rate for Payer: Cash Price |
$990.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,440.00
|
| Rate for Payer: Cigna of CA HMO |
$1,260.00
|
| Rate for Payer: Cigna of CA PPO |
$1,260.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$720.00
|
| Rate for Payer: EPIC Health Plan Senior |
$720.00
|
| Rate for Payer: Galaxy Health WC |
$1,530.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,080.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,620.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,200.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$685.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,114.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$360.00
|
| Rate for Payer: Multiplan Commercial |
$1,350.00
|
| Rate for Payer: Networks By Design Commercial |
$900.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,530.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$675.54
|
| Rate for Payer: United Healthcare All Other HMO |
$657.54
|
| Rate for Payer: United Healthcare HMO Rider |
$643.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$589.50
|
|
|
HC STNT BILRY SMART CORDIS NIT 20
|
Facility
|
OP
|
$1,800.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909081428
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$360.00 |
| Max. Negotiated Rate |
$1,620.00 |
| Rate for Payer: Adventist Health Commercial |
$360.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,530.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$990.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,350.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$821.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$996.66
|
| Rate for Payer: Blue Shield of California Commercial |
$1,391.40
|
| Rate for Payer: Blue Shield of California EPN |
$907.20
|
| Rate for Payer: Cash Price |
$990.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,440.00
|
| Rate for Payer: Cigna of CA HMO |
$1,260.00
|
| Rate for Payer: Cigna of CA PPO |
$1,260.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,530.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,530.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,530.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$720.00
|
| Rate for Payer: EPIC Health Plan Senior |
$720.00
|
| Rate for Payer: Galaxy Health WC |
$1,530.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,080.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,620.00
|
| Rate for Payer: InnovAge PACE Commercial |
$900.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,200.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$685.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,114.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$360.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,260.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,260.00
|
| Rate for Payer: Multiplan Commercial |
$1,350.00
|
| Rate for Payer: Networks By Design Commercial |
$900.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,530.00
|
| Rate for Payer: Riverside University Health System MISP |
$720.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,080.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,080.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$675.54
|
| Rate for Payer: United Healthcare All Other HMO |
$657.54
|
| Rate for Payer: United Healthcare HMO Rider |
$643.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$589.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,530.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,530.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,530.00
|
|
|
HC STNT BILRY SMRT CORD NIT 40/60
|
Facility
|
IP
|
$4,350.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909081429
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$870.00 |
| Max. Negotiated Rate |
$3,915.00 |
| Rate for Payer: Adventist Health Commercial |
$870.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,362.55
|
| Rate for Payer: Blue Shield of California EPN |
$2,192.40
|
| Rate for Payer: Cash Price |
$2,392.50
|
| Rate for Payer: Central Health Plan Commercial |
$3,480.00
|
| Rate for Payer: Cigna of CA HMO |
$3,045.00
|
| Rate for Payer: Cigna of CA PPO |
$3,045.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,740.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,740.00
|
| Rate for Payer: Galaxy Health WC |
$3,697.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,610.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,915.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,901.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,657.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,692.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$870.00
|
| Rate for Payer: Multiplan Commercial |
$3,262.50
|
| Rate for Payer: Networks By Design Commercial |
$2,175.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,697.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,632.56
|
| Rate for Payer: United Healthcare All Other HMO |
$1,589.06
|
| Rate for Payer: United Healthcare HMO Rider |
$1,554.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,424.62
|
|
|
HC STNT BILRY SMRT CORD NIT 40/60
|
Facility
|
OP
|
$4,350.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909081429
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$870.00 |
| Max. Negotiated Rate |
$3,915.00 |
| Rate for Payer: Adventist Health Commercial |
$870.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,697.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,392.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,262.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,986.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,408.59
|
| Rate for Payer: Blue Shield of California Commercial |
$3,362.55
|
| Rate for Payer: Blue Shield of California EPN |
$2,192.40
|
| Rate for Payer: Cash Price |
$2,392.50
|
| Rate for Payer: Central Health Plan Commercial |
$3,480.00
|
| Rate for Payer: Cigna of CA HMO |
$3,045.00
|
| Rate for Payer: Cigna of CA PPO |
$3,045.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,697.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,697.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,697.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,740.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,740.00
|
| Rate for Payer: Galaxy Health WC |
$3,697.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,610.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,915.00
|
| Rate for Payer: InnovAge PACE Commercial |
$2,175.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,901.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,657.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,692.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$870.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,045.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,045.00
|
| Rate for Payer: Multiplan Commercial |
$3,262.50
|
| Rate for Payer: Networks By Design Commercial |
$2,175.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,697.50
|
| Rate for Payer: Riverside University Health System MISP |
$1,740.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,610.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,610.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,632.56
|
| Rate for Payer: United Healthcare All Other HMO |
$1,589.06
|
| Rate for Payer: United Healthcare HMO Rider |
$1,554.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,424.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,697.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,697.50
|
| Rate for Payer: Vantage Medical Group Senior |
$3,697.50
|
|
|
HC STNT BILRY SMRT CORD NITINL 80
|
Facility
|
IP
|
$3,900.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909081430
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,510.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,014.70
|
| Rate for Payer: Blue Shield of California EPN |
$1,965.60
|
| Rate for Payer: Cash Price |
$2,145.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.00
|
| Rate for Payer: Cigna of CA HMO |
$2,730.00
|
| Rate for Payer: Cigna of CA PPO |
$2,730.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,510.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$780.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: Networks By Design Commercial |
$1,950.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,463.67
|
| Rate for Payer: United Healthcare All Other HMO |
$1,424.67
|
| Rate for Payer: United Healthcare HMO Rider |
$1,393.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,277.25
|
|
|
HC STNT BILRY SMRT CORD NITINL 80
|
Facility
|
OP
|
$3,900.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909081430
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,510.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,145.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,925.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,780.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,159.43
|
| Rate for Payer: Blue Shield of California Commercial |
$3,014.70
|
| Rate for Payer: Blue Shield of California EPN |
$1,965.60
|
| Rate for Payer: Cash Price |
$2,145.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.00
|
| Rate for Payer: Cigna of CA HMO |
$2,730.00
|
| Rate for Payer: Cigna of CA PPO |
$2,730.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,315.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,315.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,510.00
|
| Rate for Payer: InnovAge PACE Commercial |
$1,950.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$780.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,730.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,730.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: Networks By Design Commercial |
$1,950.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| Rate for Payer: Riverside University Health System MISP |
$1,560.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,340.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,340.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,463.67
|
| Rate for Payer: United Healthcare All Other HMO |
$1,424.67
|
| Rate for Payer: United Healthcare HMO Rider |
$1,393.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,277.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,315.00
|
|
|
HC STNT BRUAN CP COVERED PREMOUNT
|
Facility
|
OP
|
$16,500.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
906812586
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,300.00 |
| Max. Negotiated Rate |
$14,850.00 |
| Rate for Payer: Adventist Health Commercial |
$3,300.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14,025.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,075.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12,375.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7,533.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,136.05
|
| Rate for Payer: Blue Shield of California Commercial |
$12,754.50
|
| Rate for Payer: Blue Shield of California EPN |
$8,316.00
|
| Rate for Payer: Cash Price |
$9,075.00
|
| Rate for Payer: Central Health Plan Commercial |
$13,200.00
|
| Rate for Payer: Cigna of CA HMO |
$11,550.00
|
| Rate for Payer: Cigna of CA PPO |
$11,550.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14,025.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$14,025.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,025.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,600.00
|
| Rate for Payer: EPIC Health Plan Senior |
$6,600.00
|
| Rate for Payer: Galaxy Health WC |
$14,025.00
|
| Rate for Payer: Global Benefits Group Commercial |
$9,900.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,850.00
|
| Rate for Payer: InnovAge PACE Commercial |
$8,250.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,005.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,286.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,213.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,300.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,550.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,550.00
|
| Rate for Payer: Multiplan Commercial |
$12,375.00
|
| Rate for Payer: Networks By Design Commercial |
$8,250.00
|
| Rate for Payer: Prime Health Services Commercial |
$14,025.00
|
| Rate for Payer: Riverside University Health System MISP |
$6,600.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,900.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,900.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,192.45
|
| Rate for Payer: United Healthcare All Other HMO |
$6,027.45
|
| Rate for Payer: United Healthcare HMO Rider |
$5,897.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,403.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14,025.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14,025.00
|
| Rate for Payer: Vantage Medical Group Senior |
$14,025.00
|
|
|
HC STNT BRUAN CP COVERED PREMOUNT
|
Facility
|
IP
|
$16,500.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
906812586
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,300.00 |
| Max. Negotiated Rate |
$14,850.00 |
| Rate for Payer: Adventist Health Commercial |
$3,300.00
|
| Rate for Payer: Blue Shield of California Commercial |
$12,754.50
|
| Rate for Payer: Blue Shield of California EPN |
$8,316.00
|
| Rate for Payer: Cash Price |
$9,075.00
|
| Rate for Payer: Central Health Plan Commercial |
$13,200.00
|
| Rate for Payer: Cigna of CA HMO |
$11,550.00
|
| Rate for Payer: Cigna of CA PPO |
$11,550.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,600.00
|
| Rate for Payer: EPIC Health Plan Senior |
$6,600.00
|
| Rate for Payer: Galaxy Health WC |
$14,025.00
|
| Rate for Payer: Global Benefits Group Commercial |
$9,900.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,850.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,005.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,286.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,213.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,300.00
|
| Rate for Payer: Multiplan Commercial |
$12,375.00
|
| Rate for Payer: Networks By Design Commercial |
$8,250.00
|
| Rate for Payer: Prime Health Services Commercial |
$14,025.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,192.45
|
| Rate for Payer: United Healthcare All Other HMO |
$6,027.45
|
| Rate for Payer: United Healthcare HMO Rider |
$5,897.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,403.75
|
|
|
HC STNT BRUAN CP COVERED UNMOUNT
|
Facility
|
IP
|
$10,000.00
|
|
|
Service Code
|
CPT C1877
|
| Hospital Charge Code |
906812587
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,000.00 |
| Max. Negotiated Rate |
$9,000.00 |
| Rate for Payer: Adventist Health Commercial |
$2,000.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,730.00
|
| Rate for Payer: Blue Shield of California EPN |
$5,040.00
|
| Rate for Payer: Cash Price |
$5,500.00
|
| Rate for Payer: Central Health Plan Commercial |
$8,000.00
|
| Rate for Payer: Cigna of CA HMO |
$7,000.00
|
| Rate for Payer: Cigna of CA PPO |
$7,000.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,000.00
|
| Rate for Payer: Galaxy Health WC |
$8,500.00
|
| Rate for Payer: Global Benefits Group Commercial |
$6,000.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,000.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,670.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,810.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,190.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,000.00
|
| Rate for Payer: Multiplan Commercial |
$7,500.00
|
| Rate for Payer: Networks By Design Commercial |
$5,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$8,500.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,753.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,653.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,574.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,275.00
|
|
|
HC STNT BRUAN CP COVERED UNMOUNT
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT C1877
|
| Hospital Charge Code |
906812587
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,000.00 |
| Max. Negotiated Rate |
$9,000.00 |
| Rate for Payer: Adventist Health Commercial |
$2,000.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,500.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,500.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,500.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,566.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,537.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,730.00
|
| Rate for Payer: Blue Shield of California EPN |
$5,040.00
|
| Rate for Payer: Cash Price |
$5,500.00
|
| Rate for Payer: Central Health Plan Commercial |
$8,000.00
|
| Rate for Payer: Cigna of CA HMO |
$7,000.00
|
| Rate for Payer: Cigna of CA PPO |
$7,000.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,500.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,500.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,500.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,000.00
|
| Rate for Payer: Galaxy Health WC |
$8,500.00
|
| Rate for Payer: Global Benefits Group Commercial |
$6,000.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,000.00
|
| Rate for Payer: InnovAge PACE Commercial |
$5,000.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,670.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,810.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,190.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,000.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,000.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,000.00
|
| Rate for Payer: Multiplan Commercial |
$7,500.00
|
| Rate for Payer: Networks By Design Commercial |
$5,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$8,500.00
|
| Rate for Payer: Riverside University Health System MISP |
$4,000.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,000.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,000.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,753.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,653.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,574.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,275.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,500.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,500.00
|
| Rate for Payer: Vantage Medical Group Senior |
$8,500.00
|
|
|
HC STNT B/S MONORAIL ION DES
|
Facility
|
IP
|
$4,187.50
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
906812431
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$837.50 |
| Max. Negotiated Rate |
$3,768.75 |
| Rate for Payer: Adventist Health Commercial |
$837.50
|
| Rate for Payer: Blue Shield of California Commercial |
$3,236.94
|
| Rate for Payer: Blue Shield of California EPN |
$2,110.50
|
| Rate for Payer: Cash Price |
$2,303.12
|
| Rate for Payer: Central Health Plan Commercial |
$3,350.00
|
| Rate for Payer: Cigna of CA HMO |
$2,931.25
|
| Rate for Payer: Cigna of CA PPO |
$2,931.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,675.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,675.00
|
| Rate for Payer: Galaxy Health WC |
$3,559.38
|
| Rate for Payer: Global Benefits Group Commercial |
$2,512.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,768.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,793.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,595.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,592.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$837.50
|
| Rate for Payer: Multiplan Commercial |
$3,140.62
|
| Rate for Payer: Networks By Design Commercial |
$2,093.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,559.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,571.57
|
| Rate for Payer: United Healthcare All Other HMO |
$1,529.69
|
| Rate for Payer: United Healthcare HMO Rider |
$1,496.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,371.41
|
|
|
HC STNT B/S MONORAIL ION DES
|
Facility
|
OP
|
$4,187.50
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
906812431
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$837.50 |
| Max. Negotiated Rate |
$3,768.75 |
| Rate for Payer: Adventist Health Commercial |
$837.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,559.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,303.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,140.62
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,912.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,318.62
|
| Rate for Payer: Blue Shield of California Commercial |
$3,236.94
|
| Rate for Payer: Blue Shield of California EPN |
$2,110.50
|
| Rate for Payer: Cash Price |
$2,303.12
|
| Rate for Payer: Central Health Plan Commercial |
$3,350.00
|
| Rate for Payer: Cigna of CA HMO |
$2,931.25
|
| Rate for Payer: Cigna of CA PPO |
$2,931.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,559.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,559.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,559.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,675.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,675.00
|
| Rate for Payer: Galaxy Health WC |
$3,559.38
|
| Rate for Payer: Global Benefits Group Commercial |
$2,512.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,768.75
|
| Rate for Payer: InnovAge PACE Commercial |
$2,093.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,793.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,592.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$837.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,931.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,931.25
|
| Rate for Payer: Multiplan Commercial |
$3,140.62
|
| Rate for Payer: Networks By Design Commercial |
$2,093.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,559.38
|
| Rate for Payer: Riverside University Health System MISP |
$1,675.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,512.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,512.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,571.57
|
| Rate for Payer: United Healthcare All Other HMO |
$1,529.69
|
| Rate for Payer: United Healthcare HMO Rider |
$1,496.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,371.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,559.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,559.38
|
| Rate for Payer: Vantage Medical Group Senior |
$3,559.38
|
|
|
HC STNT B/S PROMUS DES
|
Facility
|
IP
|
$4,187.50
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
906812414
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$837.50 |
| Max. Negotiated Rate |
$3,768.75 |
| Rate for Payer: Adventist Health Commercial |
$837.50
|
| Rate for Payer: Blue Shield of California Commercial |
$3,236.94
|
| Rate for Payer: Blue Shield of California EPN |
$2,110.50
|
| Rate for Payer: Cash Price |
$2,303.12
|
| Rate for Payer: Central Health Plan Commercial |
$3,350.00
|
| Rate for Payer: Cigna of CA HMO |
$2,931.25
|
| Rate for Payer: Cigna of CA PPO |
$2,931.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,675.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,675.00
|
| Rate for Payer: Galaxy Health WC |
$3,559.38
|
| Rate for Payer: Global Benefits Group Commercial |
$2,512.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,768.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,793.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,595.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,592.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$837.50
|
| Rate for Payer: Multiplan Commercial |
$3,140.62
|
| Rate for Payer: Networks By Design Commercial |
$2,093.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,559.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,571.57
|
| Rate for Payer: United Healthcare All Other HMO |
$1,529.69
|
| Rate for Payer: United Healthcare HMO Rider |
$1,496.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,371.41
|
|
|
HC STNT B/S PROMUS DES
|
Facility
|
OP
|
$4,187.50
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
906812414
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$837.50 |
| Max. Negotiated Rate |
$3,768.75 |
| Rate for Payer: Adventist Health Commercial |
$837.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,559.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,303.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,140.62
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,912.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,318.62
|
| Rate for Payer: Blue Shield of California Commercial |
$3,236.94
|
| Rate for Payer: Blue Shield of California EPN |
$2,110.50
|
| Rate for Payer: Cash Price |
$2,303.12
|
| Rate for Payer: Central Health Plan Commercial |
$3,350.00
|
| Rate for Payer: Cigna of CA HMO |
$2,931.25
|
| Rate for Payer: Cigna of CA PPO |
$2,931.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,559.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,559.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,559.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,675.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,675.00
|
| Rate for Payer: Galaxy Health WC |
$3,559.38
|
| Rate for Payer: Global Benefits Group Commercial |
$2,512.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,768.75
|
| Rate for Payer: InnovAge PACE Commercial |
$2,093.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,793.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,592.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$837.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,931.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,931.25
|
| Rate for Payer: Multiplan Commercial |
$3,140.62
|
| Rate for Payer: Networks By Design Commercial |
$2,093.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,559.38
|
| Rate for Payer: Riverside University Health System MISP |
$1,675.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,512.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,512.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,571.57
|
| Rate for Payer: United Healthcare All Other HMO |
$1,529.69
|
| Rate for Payer: United Healthcare HMO Rider |
$1,496.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,371.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,559.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,559.38
|
| Rate for Payer: Vantage Medical Group Senior |
$3,559.38
|
|
|
HC STNT B/S PROMUS ELEMENT DES
|
Facility
|
OP
|
$3,937.50
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
906812447
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$787.50 |
| Max. Negotiated Rate |
$3,543.75 |
| Rate for Payer: Adventist Health Commercial |
$787.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,346.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,165.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,953.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,797.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,180.19
|
| Rate for Payer: Blue Shield of California Commercial |
$3,043.69
|
| Rate for Payer: Blue Shield of California EPN |
$1,984.50
|
| Rate for Payer: Cash Price |
$2,165.62
|
| Rate for Payer: Central Health Plan Commercial |
$3,150.00
|
| Rate for Payer: Cigna of CA HMO |
$2,756.25
|
| Rate for Payer: Cigna of CA PPO |
$2,756.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,346.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,346.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,346.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,575.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,575.00
|
| Rate for Payer: Galaxy Health WC |
$3,346.88
|
| Rate for Payer: Global Benefits Group Commercial |
$2,362.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,543.75
|
| Rate for Payer: InnovAge PACE Commercial |
$1,968.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,626.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,437.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$787.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,756.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,756.25
|
| Rate for Payer: Multiplan Commercial |
$2,953.12
|
| Rate for Payer: Networks By Design Commercial |
$1,968.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,346.88
|
| Rate for Payer: Riverside University Health System MISP |
$1,575.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,362.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,362.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,477.74
|
| Rate for Payer: United Healthcare All Other HMO |
$1,438.37
|
| Rate for Payer: United Healthcare HMO Rider |
$1,407.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,289.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,346.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,346.88
|
| Rate for Payer: Vantage Medical Group Senior |
$3,346.88
|
|
|
HC STNT B/S PROMUS ELEMENT DES
|
Facility
|
IP
|
$3,937.50
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
906812447
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$787.50 |
| Max. Negotiated Rate |
$3,543.75 |
| Rate for Payer: Adventist Health Commercial |
$787.50
|
| Rate for Payer: Blue Shield of California Commercial |
$3,043.69
|
| Rate for Payer: Blue Shield of California EPN |
$1,984.50
|
| Rate for Payer: Cash Price |
$2,165.62
|
| Rate for Payer: Central Health Plan Commercial |
$3,150.00
|
| Rate for Payer: Cigna of CA HMO |
$2,756.25
|
| Rate for Payer: Cigna of CA PPO |
$2,756.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,575.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,575.00
|
| Rate for Payer: Galaxy Health WC |
$3,346.88
|
| Rate for Payer: Global Benefits Group Commercial |
$2,362.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,543.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,626.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,500.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,437.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$787.50
|
| Rate for Payer: Multiplan Commercial |
$2,953.12
|
| Rate for Payer: Networks By Design Commercial |
$1,968.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,346.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,477.74
|
| Rate for Payer: United Healthcare All Other HMO |
$1,438.37
|
| Rate for Payer: United Healthcare HMO Rider |
$1,407.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,289.53
|
|
|
HC STNT BS REBEL
|
Facility
|
OP
|
$2,340.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
906812542
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$468.00 |
| Max. Negotiated Rate |
$2,106.00 |
| Rate for Payer: Adventist Health Commercial |
$468.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,989.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,287.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,755.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,068.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,295.66
|
| Rate for Payer: Blue Shield of California Commercial |
$1,808.82
|
| Rate for Payer: Blue Shield of California EPN |
$1,179.36
|
| Rate for Payer: Cash Price |
$1,287.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,872.00
|
| Rate for Payer: Cigna of CA HMO |
$1,638.00
|
| Rate for Payer: Cigna of CA PPO |
$1,638.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,989.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,989.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,989.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$936.00
|
| Rate for Payer: EPIC Health Plan Senior |
$936.00
|
| Rate for Payer: Galaxy Health WC |
$1,989.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,404.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,106.00
|
| Rate for Payer: InnovAge PACE Commercial |
$1,170.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,560.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$891.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,448.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$468.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,638.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,638.00
|
| Rate for Payer: Multiplan Commercial |
$1,755.00
|
| Rate for Payer: Networks By Design Commercial |
$1,170.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,989.00
|
| Rate for Payer: Riverside University Health System MISP |
$936.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,404.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,404.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$878.20
|
| Rate for Payer: United Healthcare All Other HMO |
$854.80
|
| Rate for Payer: United Healthcare HMO Rider |
$836.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$766.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,989.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,989.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,989.00
|
|
|
HC STNT BS REBEL
|
Facility
|
IP
|
$2,340.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
906812542
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$468.00 |
| Max. Negotiated Rate |
$2,106.00 |
| Rate for Payer: Adventist Health Commercial |
$468.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,808.82
|
| Rate for Payer: Blue Shield of California EPN |
$1,179.36
|
| Rate for Payer: Cash Price |
$1,287.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,872.00
|
| Rate for Payer: Cigna of CA HMO |
$1,638.00
|
| Rate for Payer: Cigna of CA PPO |
$1,638.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$936.00
|
| Rate for Payer: EPIC Health Plan Senior |
$936.00
|
| Rate for Payer: Galaxy Health WC |
$1,989.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,404.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,106.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,560.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$891.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,448.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$468.00
|
| Rate for Payer: Multiplan Commercial |
$1,755.00
|
| Rate for Payer: Networks By Design Commercial |
$1,170.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,989.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$878.20
|
| Rate for Payer: United Healthcare All Other HMO |
$854.80
|
| Rate for Payer: United Healthcare HMO Rider |
$836.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$766.35
|
|
|
HC STNT B/S SYNERGY DES
|
Facility
|
IP
|
$3,900.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
906812569
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,510.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,014.70
|
| Rate for Payer: Blue Shield of California EPN |
$1,965.60
|
| Rate for Payer: Cash Price |
$2,145.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.00
|
| Rate for Payer: Cigna of CA HMO |
$2,730.00
|
| Rate for Payer: Cigna of CA PPO |
$2,730.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,510.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$780.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: Networks By Design Commercial |
$1,950.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,463.67
|
| Rate for Payer: United Healthcare All Other HMO |
$1,424.67
|
| Rate for Payer: United Healthcare HMO Rider |
$1,393.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,277.25
|
|
|
HC STNT B/S SYNERGY DES
|
Facility
|
OP
|
$3,900.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
906812569
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,510.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,145.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,925.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,780.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,159.43
|
| Rate for Payer: Blue Shield of California Commercial |
$3,014.70
|
| Rate for Payer: Blue Shield of California EPN |
$1,965.60
|
| Rate for Payer: Cash Price |
$2,145.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.00
|
| Rate for Payer: Cigna of CA HMO |
$2,730.00
|
| Rate for Payer: Cigna of CA PPO |
$2,730.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,315.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,315.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,510.00
|
| Rate for Payer: InnovAge PACE Commercial |
$1,950.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$780.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,730.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,730.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: Networks By Design Commercial |
$1,950.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| Rate for Payer: Riverside University Health System MISP |
$1,560.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,340.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,340.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,463.67
|
| Rate for Payer: United Healthcare All Other HMO |
$1,424.67
|
| Rate for Payer: United Healthcare HMO Rider |
$1,393.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,277.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,315.00
|
|
|
HC STNT B/S TAXUS LIB. ATOM DES
|
Facility
|
IP
|
$5,250.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
906812395
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,050.00 |
| Max. Negotiated Rate |
$4,725.00 |
| Rate for Payer: Adventist Health Commercial |
$1,050.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,058.25
|
| Rate for Payer: Blue Shield of California EPN |
$2,646.00
|
| Rate for Payer: Cash Price |
$2,887.50
|
| Rate for Payer: Central Health Plan Commercial |
$4,200.00
|
| Rate for Payer: Cigna of CA HMO |
$3,675.00
|
| Rate for Payer: Cigna of CA PPO |
$3,675.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,100.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,100.00
|
| Rate for Payer: Galaxy Health WC |
$4,462.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,150.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,725.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,501.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,000.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,249.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,050.00
|
| Rate for Payer: Multiplan Commercial |
$3,937.50
|
| Rate for Payer: Networks By Design Commercial |
$2,625.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,462.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,970.33
|
| Rate for Payer: United Healthcare All Other HMO |
$1,917.83
|
| Rate for Payer: United Healthcare HMO Rider |
$1,876.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,719.38
|
|
|
HC STNT B/S TAXUS LIB. ATOM DES
|
Facility
|
OP
|
$5,250.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
906812395
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,050.00 |
| Max. Negotiated Rate |
$4,725.00 |
| Rate for Payer: Adventist Health Commercial |
$1,050.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,462.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,887.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,937.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,397.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,906.93
|
| Rate for Payer: Blue Shield of California Commercial |
$4,058.25
|
| Rate for Payer: Blue Shield of California EPN |
$2,646.00
|
| Rate for Payer: Cash Price |
$2,887.50
|
| Rate for Payer: Central Health Plan Commercial |
$4,200.00
|
| Rate for Payer: Cigna of CA HMO |
$3,675.00
|
| Rate for Payer: Cigna of CA PPO |
$3,675.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,462.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,462.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,462.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,100.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,100.00
|
| Rate for Payer: Galaxy Health WC |
$4,462.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,150.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,725.00
|
| Rate for Payer: InnovAge PACE Commercial |
$2,625.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,501.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,249.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,050.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,675.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,675.00
|
| Rate for Payer: Multiplan Commercial |
$3,937.50
|
| Rate for Payer: Networks By Design Commercial |
$2,625.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,462.50
|
| Rate for Payer: Riverside University Health System MISP |
$2,100.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,150.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,150.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,970.33
|
| Rate for Payer: United Healthcare All Other HMO |
$1,917.83
|
| Rate for Payer: United Healthcare HMO Rider |
$1,876.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,719.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,462.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,462.50
|
| Rate for Payer: Vantage Medical Group Senior |
$4,462.50
|
|
|
HC STNT B/S TAXUS LIB LONG DES
|
Facility
|
OP
|
$4,187.50
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
906812415
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$837.50 |
| Max. Negotiated Rate |
$3,768.75 |
| Rate for Payer: Adventist Health Commercial |
$837.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,559.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,303.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,140.62
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,912.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,318.62
|
| Rate for Payer: Blue Shield of California Commercial |
$3,236.94
|
| Rate for Payer: Blue Shield of California EPN |
$2,110.50
|
| Rate for Payer: Cash Price |
$2,303.12
|
| Rate for Payer: Central Health Plan Commercial |
$3,350.00
|
| Rate for Payer: Cigna of CA HMO |
$2,931.25
|
| Rate for Payer: Cigna of CA PPO |
$2,931.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,559.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,559.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,559.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,675.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,675.00
|
| Rate for Payer: Galaxy Health WC |
$3,559.38
|
| Rate for Payer: Global Benefits Group Commercial |
$2,512.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,768.75
|
| Rate for Payer: InnovAge PACE Commercial |
$2,093.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,793.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,592.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$837.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,931.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,931.25
|
| Rate for Payer: Multiplan Commercial |
$3,140.62
|
| Rate for Payer: Networks By Design Commercial |
$2,093.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,559.38
|
| Rate for Payer: Riverside University Health System MISP |
$1,675.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,512.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,512.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,571.57
|
| Rate for Payer: United Healthcare All Other HMO |
$1,529.69
|
| Rate for Payer: United Healthcare HMO Rider |
$1,496.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,371.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,559.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,559.38
|
| Rate for Payer: Vantage Medical Group Senior |
$3,559.38
|
|
|
HC STNT B/S TAXUS LIB LONG DES
|
Facility
|
IP
|
$4,187.50
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
906812415
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$837.50 |
| Max. Negotiated Rate |
$3,768.75 |
| Rate for Payer: Adventist Health Commercial |
$837.50
|
| Rate for Payer: Blue Shield of California Commercial |
$3,236.94
|
| Rate for Payer: Blue Shield of California EPN |
$2,110.50
|
| Rate for Payer: Cash Price |
$2,303.12
|
| Rate for Payer: Central Health Plan Commercial |
$3,350.00
|
| Rate for Payer: Cigna of CA HMO |
$2,931.25
|
| Rate for Payer: Cigna of CA PPO |
$2,931.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,675.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,675.00
|
| Rate for Payer: Galaxy Health WC |
$3,559.38
|
| Rate for Payer: Global Benefits Group Commercial |
$2,512.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,768.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,793.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,595.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,592.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$837.50
|
| Rate for Payer: Multiplan Commercial |
$3,140.62
|
| Rate for Payer: Networks By Design Commercial |
$2,093.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,559.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,571.57
|
| Rate for Payer: United Healthcare All Other HMO |
$1,529.69
|
| Rate for Payer: United Healthcare HMO Rider |
$1,496.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,371.41
|
|
|
HC STNT B/S VERIFLEX
|
Facility
|
OP
|
$2,535.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
906812408
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$507.00 |
| Max. Negotiated Rate |
$2,281.50 |
| Rate for Payer: Adventist Health Commercial |
$507.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,154.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,394.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,901.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,157.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,403.63
|
| Rate for Payer: Blue Shield of California Commercial |
$1,959.56
|
| Rate for Payer: Blue Shield of California EPN |
$1,277.64
|
| Rate for Payer: Cash Price |
$1,394.25
|
| Rate for Payer: Central Health Plan Commercial |
$2,028.00
|
| Rate for Payer: Cigna of CA HMO |
$1,774.50
|
| Rate for Payer: Cigna of CA PPO |
$1,774.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,154.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,154.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,154.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,014.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,014.00
|
| Rate for Payer: Galaxy Health WC |
$2,154.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,521.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,281.50
|
| Rate for Payer: InnovAge PACE Commercial |
$1,267.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,690.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$965.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,569.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$507.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,774.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,774.50
|
| Rate for Payer: Multiplan Commercial |
$1,901.25
|
| Rate for Payer: Networks By Design Commercial |
$1,267.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,154.75
|
| Rate for Payer: Riverside University Health System MISP |
$1,014.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,521.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,521.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$951.39
|
| Rate for Payer: United Healthcare All Other HMO |
$926.04
|
| Rate for Payer: United Healthcare HMO Rider |
$906.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$830.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,154.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,154.75
|
| Rate for Payer: Vantage Medical Group Senior |
$2,154.75
|
|
