|
HC STNT B/S VERIFLEX
|
Facility
|
IP
|
$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: 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: 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: 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: 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: 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
|
|
|
HC STNT COATED/COVERED W DELIVER
|
Facility
|
IP
|
$8,900.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
909081446
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,780.00 |
| Max. Negotiated Rate |
$8,010.00 |
| Rate for Payer: Adventist Health Commercial |
$1,780.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,879.70
|
| Rate for Payer: Blue Shield of California EPN |
$4,485.60
|
| Rate for Payer: Cash Price |
$4,895.00
|
| Rate for Payer: Central Health Plan Commercial |
$7,120.00
|
| Rate for Payer: Cigna of CA HMO |
$6,230.00
|
| Rate for Payer: Cigna of CA PPO |
$6,230.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,560.00
|
| Rate for Payer: Galaxy Health WC |
$7,565.00
|
| Rate for Payer: Global Benefits Group Commercial |
$5,340.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,010.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,936.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,390.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,509.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,780.00
|
| Rate for Payer: Multiplan Commercial |
$6,675.00
|
| Rate for Payer: Networks By Design Commercial |
$4,450.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,565.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,340.17
|
| Rate for Payer: United Healthcare All Other HMO |
$3,251.17
|
| Rate for Payer: United Healthcare HMO Rider |
$3,180.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,914.75
|
|
|
HC STNT COATED/COVERED W DELIVER
|
Facility
|
OP
|
$8,900.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
909081446
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,780.00 |
| Max. Negotiated Rate |
$8,010.00 |
| Rate for Payer: Adventist Health Commercial |
$1,780.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,565.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,895.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,675.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,063.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,927.93
|
| Rate for Payer: Blue Shield of California Commercial |
$6,879.70
|
| Rate for Payer: Blue Shield of California EPN |
$4,485.60
|
| Rate for Payer: Cash Price |
$4,895.00
|
| Rate for Payer: Central Health Plan Commercial |
$7,120.00
|
| Rate for Payer: Cigna of CA HMO |
$6,230.00
|
| Rate for Payer: Cigna of CA PPO |
$6,230.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,565.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,565.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,565.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,560.00
|
| Rate for Payer: Galaxy Health WC |
$7,565.00
|
| Rate for Payer: Global Benefits Group Commercial |
$5,340.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,010.00
|
| Rate for Payer: InnovAge PACE Commercial |
$4,450.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,936.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,509.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,780.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,230.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,230.00
|
| Rate for Payer: Multiplan Commercial |
$6,675.00
|
| Rate for Payer: Networks By Design Commercial |
$4,450.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,565.00
|
| Rate for Payer: Riverside University Health System MISP |
$3,560.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,340.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,340.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,340.17
|
| Rate for Payer: United Healthcare All Other HMO |
$3,251.17
|
| Rate for Payer: United Healthcare HMO Rider |
$3,180.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,914.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,565.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,565.00
|
| Rate for Payer: Vantage Medical Group Senior |
$7,565.00
|
|
|
HC STNT COOK ZILVER PTX 40MM
|
Facility
|
IP
|
$3,900.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
906812670
|
|
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 COOK ZILVER PTX 40MM
|
Facility
|
OP
|
$3,900.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
906812670
|
|
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 COOK ZILVER PTX 60MM
|
Facility
|
OP
|
$3,900.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
906812671
|
|
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 COOK ZILVER PTX 60MM
|
Facility
|
IP
|
$3,900.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
906812671
|
|
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 COOK ZILVER PTX 80-100MM
|
Facility
|
OP
|
$4,488.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
906812672
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$897.60 |
| Max. Negotiated Rate |
$4,039.20 |
| Rate for Payer: Adventist Health Commercial |
$897.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,814.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,468.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,366.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,049.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,485.01
|
| Rate for Payer: Blue Shield of California Commercial |
$3,469.22
|
| Rate for Payer: Blue Shield of California EPN |
$2,261.95
|
| Rate for Payer: Cash Price |
$2,468.40
|
| Rate for Payer: Central Health Plan Commercial |
$3,590.40
|
| Rate for Payer: Cigna of CA HMO |
$3,141.60
|
| Rate for Payer: Cigna of CA PPO |
$3,141.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,814.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,814.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,814.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,795.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,795.20
|
| Rate for Payer: Galaxy Health WC |
$3,814.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,692.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,039.20
|
| Rate for Payer: InnovAge PACE Commercial |
$2,244.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,993.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,778.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$897.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,141.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,141.60
|
| Rate for Payer: Multiplan Commercial |
$3,366.00
|
| Rate for Payer: Networks By Design Commercial |
$2,244.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,814.80
|
| Rate for Payer: Riverside University Health System MISP |
$1,795.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,692.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,692.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,684.35
|
| Rate for Payer: United Healthcare All Other HMO |
$1,639.47
|
| Rate for Payer: United Healthcare HMO Rider |
$1,604.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,469.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,814.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,814.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,814.80
|
|
|
HC STNT COOK ZILVER PTX 80-100MM
|
Facility
|
IP
|
$4,488.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
906812672
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$897.60 |
| Max. Negotiated Rate |
$4,039.20 |
| Rate for Payer: Adventist Health Commercial |
$897.60
|
| Rate for Payer: Blue Shield of California Commercial |
$3,469.22
|
| Rate for Payer: Blue Shield of California EPN |
$2,261.95
|
| Rate for Payer: Cash Price |
$2,468.40
|
| Rate for Payer: Central Health Plan Commercial |
$3,590.40
|
| Rate for Payer: Cigna of CA HMO |
$3,141.60
|
| Rate for Payer: Cigna of CA PPO |
$3,141.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,795.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,795.20
|
| Rate for Payer: Galaxy Health WC |
$3,814.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,692.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,039.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,993.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,709.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,778.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$897.60
|
| Rate for Payer: Multiplan Commercial |
$3,366.00
|
| Rate for Payer: Networks By Design Commercial |
$2,244.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,814.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,684.35
|
| Rate for Payer: United Healthcare All Other HMO |
$1,639.47
|
| Rate for Payer: United Healthcare HMO Rider |
$1,604.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,469.82
|
|
|
HC STNT CORDIS PALMAZ
|
Facility
|
OP
|
$3,901.50
|
|
|
Service Code
|
CPT C1877
|
| Hospital Charge Code |
906812435
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.30 |
| Max. Negotiated Rate |
$3,511.35 |
| Rate for Payer: Adventist Health Commercial |
$780.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,316.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,145.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,926.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,781.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,160.26
|
| Rate for Payer: Blue Shield of California Commercial |
$3,015.86
|
| Rate for Payer: Blue Shield of California EPN |
$1,966.36
|
| Rate for Payer: Cash Price |
$2,145.83
|
| Rate for Payer: Central Health Plan Commercial |
$3,121.20
|
| Rate for Payer: Cigna of CA HMO |
$2,731.05
|
| Rate for Payer: Cigna of CA PPO |
$2,731.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,316.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,316.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,316.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.60
|
| Rate for Payer: Galaxy Health WC |
$3,316.28
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,511.35
|
| Rate for Payer: InnovAge PACE Commercial |
$1,950.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,602.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,486.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,415.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$780.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,731.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,731.05
|
| Rate for Payer: Multiplan Commercial |
$2,926.12
|
| Rate for Payer: Networks By Design Commercial |
$1,950.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,316.28
|
| Rate for Payer: Riverside University Health System MISP |
$1,560.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,340.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,340.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,464.23
|
| Rate for Payer: United Healthcare All Other HMO |
$1,425.22
|
| Rate for Payer: United Healthcare HMO Rider |
$1,394.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,277.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,316.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,316.28
|
| Rate for Payer: Vantage Medical Group Senior |
$3,316.28
|
|
|
HC STNT CORDIS PALMAZ
|
Facility
|
IP
|
$3,901.50
|
|
|
Service Code
|
CPT C1877
|
| Hospital Charge Code |
906812435
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.30 |
| Max. Negotiated Rate |
$3,511.35 |
| Rate for Payer: Adventist Health Commercial |
$780.30
|
| Rate for Payer: Blue Shield of California Commercial |
$3,015.86
|
| Rate for Payer: Blue Shield of California EPN |
$1,966.36
|
| Rate for Payer: Cash Price |
$2,145.83
|
| Rate for Payer: Central Health Plan Commercial |
$3,121.20
|
| Rate for Payer: Cigna of CA HMO |
$2,731.05
|
| Rate for Payer: Cigna of CA PPO |
$2,731.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.60
|
| Rate for Payer: Galaxy Health WC |
$3,316.28
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,511.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,602.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,486.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,415.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$780.30
|
| Rate for Payer: Multiplan Commercial |
$2,926.12
|
| Rate for Payer: Networks By Design Commercial |
$1,950.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,316.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,464.23
|
| Rate for Payer: United Healthcare All Other HMO |
$1,425.22
|
| Rate for Payer: United Healthcare HMO Rider |
$1,394.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,277.74
|
|
|
HC STNT CORDIS PALMAZ BLUE MTND
|
Facility
|
IP
|
$797.04
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
906812463
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$159.41 |
| Max. Negotiated Rate |
$717.34 |
| Rate for Payer: Adventist Health Commercial |
$159.41
|
| Rate for Payer: Blue Shield of California Commercial |
$616.11
|
| Rate for Payer: Blue Shield of California EPN |
$401.71
|
| Rate for Payer: Cash Price |
$438.37
|
| Rate for Payer: Central Health Plan Commercial |
$637.63
|
| Rate for Payer: Cigna of CA HMO |
$557.93
|
| Rate for Payer: Cigna of CA PPO |
$557.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$318.82
|
| Rate for Payer: EPIC Health Plan Senior |
$318.82
|
| Rate for Payer: Galaxy Health WC |
$677.48
|
| Rate for Payer: Global Benefits Group Commercial |
$478.22
|
| Rate for Payer: Health Management Network EPO/PPO |
$717.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$531.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$303.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$493.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$159.41
|
| Rate for Payer: Multiplan Commercial |
$597.78
|
| Rate for Payer: Networks By Design Commercial |
$398.52
|
| Rate for Payer: Prime Health Services Commercial |
$677.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$299.13
|
| Rate for Payer: United Healthcare All Other HMO |
$291.16
|
| Rate for Payer: United Healthcare HMO Rider |
$284.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$261.03
|
|
|
HC STNT CORDIS PALMAZ BLUE MTND
|
Facility
|
OP
|
$797.04
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
906812463
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$159.41 |
| Max. Negotiated Rate |
$717.34 |
| Rate for Payer: Adventist Health Commercial |
$159.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$677.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$438.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$597.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$363.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$441.32
|
| Rate for Payer: Blue Shield of California Commercial |
$616.11
|
| Rate for Payer: Blue Shield of California EPN |
$401.71
|
| Rate for Payer: Cash Price |
$438.37
|
| Rate for Payer: Central Health Plan Commercial |
$637.63
|
| Rate for Payer: Cigna of CA HMO |
$557.93
|
| Rate for Payer: Cigna of CA PPO |
$557.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$677.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$677.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$677.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$318.82
|
| Rate for Payer: EPIC Health Plan Senior |
$318.82
|
| Rate for Payer: Galaxy Health WC |
$677.48
|
| Rate for Payer: Global Benefits Group Commercial |
$478.22
|
| Rate for Payer: Health Management Network EPO/PPO |
$717.34
|
| Rate for Payer: InnovAge PACE Commercial |
$398.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$531.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$303.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$493.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$159.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$557.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$557.93
|
| Rate for Payer: Multiplan Commercial |
$597.78
|
| Rate for Payer: Networks By Design Commercial |
$398.52
|
| Rate for Payer: Prime Health Services Commercial |
$677.48
|
| Rate for Payer: Riverside University Health System MISP |
$318.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$478.22
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$478.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$299.13
|
| Rate for Payer: United Healthcare All Other HMO |
$291.16
|
| Rate for Payer: United Healthcare HMO Rider |
$284.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$261.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$677.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$677.48
|
| Rate for Payer: Vantage Medical Group Senior |
$677.48
|
|
|
HC STNT EV3 INTRASTENT
|
Facility
|
IP
|
$3,900.00
|
|
|
Service Code
|
CPT C1877
|
| Hospital Charge Code |
906812434
|
|
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 EV3 INTRASTENT
|
Facility
|
OP
|
$3,900.00
|
|
|
Service Code
|
CPT C1877
|
| Hospital Charge Code |
906812434
|
|
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 EV3 VISI-PRO
|
Facility
|
IP
|
$3,705.00
|
|
|
Service Code
|
CPT C1877
|
| Hospital Charge Code |
906812417
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$741.00 |
| Max. Negotiated Rate |
$3,334.50 |
| Rate for Payer: Adventist Health Commercial |
$741.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,863.97
|
| Rate for Payer: Blue Shield of California EPN |
$1,867.32
|
| Rate for Payer: Cash Price |
$2,037.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,964.00
|
| Rate for Payer: Cigna of CA HMO |
$2,593.50
|
| Rate for Payer: Cigna of CA PPO |
$2,593.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,482.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,482.00
|
| Rate for Payer: Galaxy Health WC |
$3,149.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,223.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,334.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,471.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,411.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,293.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$741.00
|
| Rate for Payer: Multiplan Commercial |
$2,778.75
|
| Rate for Payer: Networks By Design Commercial |
$1,852.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,149.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,390.49
|
| Rate for Payer: United Healthcare All Other HMO |
$1,353.44
|
| Rate for Payer: United Healthcare HMO Rider |
$1,324.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,213.39
|
|
|
HC STNT EV3 VISI-PRO
|
Facility
|
OP
|
$3,705.00
|
|
|
Service Code
|
CPT C1877
|
| Hospital Charge Code |
906812417
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$741.00 |
| Max. Negotiated Rate |
$3,334.50 |
| Rate for Payer: Adventist Health Commercial |
$741.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,149.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,037.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,778.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,691.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,051.46
|
| Rate for Payer: Blue Shield of California Commercial |
$2,863.97
|
| Rate for Payer: Blue Shield of California EPN |
$1,867.32
|
| Rate for Payer: Cash Price |
$2,037.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,964.00
|
| Rate for Payer: Cigna of CA HMO |
$2,593.50
|
| Rate for Payer: Cigna of CA PPO |
$2,593.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,149.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,149.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,149.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,482.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,482.00
|
| Rate for Payer: Galaxy Health WC |
$3,149.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,223.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,334.50
|
| Rate for Payer: InnovAge PACE Commercial |
$1,852.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,471.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,411.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,293.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$741.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,593.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,593.50
|
| Rate for Payer: Multiplan Commercial |
$2,778.75
|
| Rate for Payer: Networks By Design Commercial |
$1,852.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,149.25
|
| Rate for Payer: Riverside University Health System MISP |
$1,482.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,223.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,223.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,390.49
|
| Rate for Payer: United Healthcare All Other HMO |
$1,353.44
|
| Rate for Payer: United Healthcare HMO Rider |
$1,324.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,213.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,149.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,149.25
|
| Rate for Payer: Vantage Medical Group Senior |
$3,149.25
|
|
|
HC STNT GORE VIABA 5MMX10CMX120CM
|
Facility
|
OP
|
$8,393.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
906812687
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,678.60 |
| Max. Negotiated Rate |
$7,553.70 |
| Rate for Payer: Adventist Health Commercial |
$1,678.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,134.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,616.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,294.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,832.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,647.20
|
| Rate for Payer: Blue Shield of California Commercial |
$6,487.79
|
| Rate for Payer: Blue Shield of California EPN |
$4,230.07
|
| Rate for Payer: Cash Price |
$4,616.15
|
| Rate for Payer: Central Health Plan Commercial |
$6,714.40
|
| Rate for Payer: Cigna of CA HMO |
$5,875.10
|
| Rate for Payer: Cigna of CA PPO |
$5,875.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,134.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,134.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,134.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,357.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,357.20
|
| Rate for Payer: Galaxy Health WC |
$7,134.05
|
| Rate for Payer: Global Benefits Group Commercial |
$5,035.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,553.70
|
| Rate for Payer: InnovAge PACE Commercial |
$4,196.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,598.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,195.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,678.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,875.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,875.10
|
| Rate for Payer: Multiplan Commercial |
$6,294.75
|
| Rate for Payer: Networks By Design Commercial |
$4,196.50
|
| Rate for Payer: Prime Health Services Commercial |
$7,134.05
|
| Rate for Payer: Riverside University Health System MISP |
$3,357.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,035.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,035.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,149.89
|
| Rate for Payer: United Healthcare All Other HMO |
$3,065.96
|
| Rate for Payer: United Healthcare HMO Rider |
$2,999.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,748.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,134.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,134.05
|
| Rate for Payer: Vantage Medical Group Senior |
$7,134.05
|
|
|
HC STNT GORE VIABA 5MMX10CMX120CM
|
Facility
|
IP
|
$8,393.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
906812687
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,678.60 |
| Max. Negotiated Rate |
$7,553.70 |
| Rate for Payer: Adventist Health Commercial |
$1,678.60
|
| Rate for Payer: Blue Shield of California Commercial |
$6,487.79
|
| Rate for Payer: Blue Shield of California EPN |
$4,230.07
|
| Rate for Payer: Cash Price |
$4,616.15
|
| Rate for Payer: Central Health Plan Commercial |
$6,714.40
|
| Rate for Payer: Cigna of CA HMO |
$5,875.10
|
| Rate for Payer: Cigna of CA PPO |
$5,875.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,357.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,357.20
|
| Rate for Payer: Galaxy Health WC |
$7,134.05
|
| Rate for Payer: Global Benefits Group Commercial |
$5,035.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,553.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,598.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,197.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,195.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,678.60
|
| Rate for Payer: Multiplan Commercial |
$6,294.75
|
| Rate for Payer: Networks By Design Commercial |
$4,196.50
|
| Rate for Payer: Prime Health Services Commercial |
$7,134.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,149.89
|
| Rate for Payer: United Healthcare All Other HMO |
$3,065.96
|
| Rate for Payer: United Healthcare HMO Rider |
$2,999.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,748.71
|
|
|
HC STNT GORE VIABA 5MMX5CMX120CM
|
Facility
|
IP
|
$7,650.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
906812666
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,530.00 |
| Max. Negotiated Rate |
$6,885.00 |
| Rate for Payer: Adventist Health Commercial |
$1,530.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,913.45
|
| Rate for Payer: Blue Shield of California EPN |
$3,855.60
|
| Rate for Payer: Cash Price |
$4,207.50
|
| Rate for Payer: Central Health Plan Commercial |
$6,120.00
|
| Rate for Payer: Cigna of CA HMO |
$5,355.00
|
| Rate for Payer: Cigna of CA PPO |
$5,355.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,060.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,060.00
|
| Rate for Payer: Galaxy Health WC |
$6,502.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,590.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,885.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,102.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,914.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,735.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,530.00
|
| Rate for Payer: Multiplan Commercial |
$5,737.50
|
| Rate for Payer: Networks By Design Commercial |
$3,825.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,502.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,871.05
|
| Rate for Payer: United Healthcare All Other HMO |
$2,794.55
|
| Rate for Payer: United Healthcare HMO Rider |
$2,734.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,505.38
|
|
|
HC STNT GORE VIABA 5MMX5CMX120CM
|
Facility
|
OP
|
$7,650.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
906812666
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,530.00 |
| Max. Negotiated Rate |
$6,885.00 |
| Rate for Payer: Adventist Health Commercial |
$1,530.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,502.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,207.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,737.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,492.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,235.81
|
| Rate for Payer: Blue Shield of California Commercial |
$5,913.45
|
| Rate for Payer: Blue Shield of California EPN |
$3,855.60
|
| Rate for Payer: Cash Price |
$4,207.50
|
| Rate for Payer: Central Health Plan Commercial |
$6,120.00
|
| Rate for Payer: Cigna of CA HMO |
$5,355.00
|
| Rate for Payer: Cigna of CA PPO |
$5,355.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,502.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,502.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,502.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,060.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,060.00
|
| Rate for Payer: Galaxy Health WC |
$6,502.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,590.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,885.00
|
| Rate for Payer: InnovAge PACE Commercial |
$3,825.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,102.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,735.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,530.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,355.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,355.00
|
| Rate for Payer: Multiplan Commercial |
$5,737.50
|
| Rate for Payer: Networks By Design Commercial |
$3,825.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,502.50
|
| Rate for Payer: Riverside University Health System MISP |
$3,060.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,590.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,590.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,871.05
|
| Rate for Payer: United Healthcare All Other HMO |
$2,794.55
|
| Rate for Payer: United Healthcare HMO Rider |
$2,734.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,505.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,502.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,502.50
|
| Rate for Payer: Vantage Medical Group Senior |
$6,502.50
|
|
|
HC STNT GORE VIABA 5MMX5CMX120CM
|
Facility
|
OP
|
$7,650.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
906812694
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,530.00 |
| Max. Negotiated Rate |
$6,885.00 |
| Rate for Payer: Adventist Health Commercial |
$1,530.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,502.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,207.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,737.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,492.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,235.81
|
| Rate for Payer: Blue Shield of California Commercial |
$5,913.45
|
| Rate for Payer: Blue Shield of California EPN |
$3,855.60
|
| Rate for Payer: Cash Price |
$4,207.50
|
| Rate for Payer: Central Health Plan Commercial |
$6,120.00
|
| Rate for Payer: Cigna of CA HMO |
$5,355.00
|
| Rate for Payer: Cigna of CA PPO |
$5,355.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,502.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,502.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,502.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,060.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,060.00
|
| Rate for Payer: Galaxy Health WC |
$6,502.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,590.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,885.00
|
| Rate for Payer: InnovAge PACE Commercial |
$3,825.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,102.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,735.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,530.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,355.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,355.00
|
| Rate for Payer: Multiplan Commercial |
$5,737.50
|
| Rate for Payer: Networks By Design Commercial |
$3,825.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,502.50
|
| Rate for Payer: Riverside University Health System MISP |
$3,060.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,590.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,590.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,871.05
|
| Rate for Payer: United Healthcare All Other HMO |
$2,794.55
|
| Rate for Payer: United Healthcare HMO Rider |
$2,734.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,505.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,502.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,502.50
|
| Rate for Payer: Vantage Medical Group Senior |
$6,502.50
|
|
|
HC STNT GORE VIABA 5MMX5CMX120CM
|
Facility
|
IP
|
$7,650.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
906812694
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,530.00 |
| Max. Negotiated Rate |
$6,885.00 |
| Rate for Payer: Adventist Health Commercial |
$1,530.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,913.45
|
| Rate for Payer: Blue Shield of California EPN |
$3,855.60
|
| Rate for Payer: Cash Price |
$4,207.50
|
| Rate for Payer: Central Health Plan Commercial |
$6,120.00
|
| Rate for Payer: Cigna of CA HMO |
$5,355.00
|
| Rate for Payer: Cigna of CA PPO |
$5,355.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,060.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,060.00
|
| Rate for Payer: Galaxy Health WC |
$6,502.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,590.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,885.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,102.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,914.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,735.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,530.00
|
| Rate for Payer: Multiplan Commercial |
$5,737.50
|
| Rate for Payer: Networks By Design Commercial |
$3,825.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,502.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,871.05
|
| Rate for Payer: United Healthcare All Other HMO |
$2,794.55
|
| Rate for Payer: United Healthcare HMO Rider |
$2,734.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,505.38
|
|
|
HC STNT GORE VIABA 6MMX10CMX120CM
|
Facility
|
OP
|
$8,393.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
906812689
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,678.60 |
| Max. Negotiated Rate |
$7,553.70 |
| Rate for Payer: Adventist Health Commercial |
$1,678.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,134.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,616.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,294.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,832.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,647.20
|
| Rate for Payer: Blue Shield of California Commercial |
$6,487.79
|
| Rate for Payer: Blue Shield of California EPN |
$4,230.07
|
| Rate for Payer: Cash Price |
$4,616.15
|
| Rate for Payer: Central Health Plan Commercial |
$6,714.40
|
| Rate for Payer: Cigna of CA HMO |
$5,875.10
|
| Rate for Payer: Cigna of CA PPO |
$5,875.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,134.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,134.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,134.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,357.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,357.20
|
| Rate for Payer: Galaxy Health WC |
$7,134.05
|
| Rate for Payer: Global Benefits Group Commercial |
$5,035.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,553.70
|
| Rate for Payer: InnovAge PACE Commercial |
$4,196.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,598.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,195.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,678.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,875.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,875.10
|
| Rate for Payer: Multiplan Commercial |
$6,294.75
|
| Rate for Payer: Networks By Design Commercial |
$4,196.50
|
| Rate for Payer: Prime Health Services Commercial |
$7,134.05
|
| Rate for Payer: Riverside University Health System MISP |
$3,357.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,035.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,035.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,149.89
|
| Rate for Payer: United Healthcare All Other HMO |
$3,065.96
|
| Rate for Payer: United Healthcare HMO Rider |
$2,999.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,748.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,134.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,134.05
|
| Rate for Payer: Vantage Medical Group Senior |
$7,134.05
|
|
|
HC STNT GORE VIABA 6MMX10CMX120CM
|
Facility
|
IP
|
$8,393.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
906812689
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,678.60 |
| Max. Negotiated Rate |
$7,553.70 |
| Rate for Payer: Adventist Health Commercial |
$1,678.60
|
| Rate for Payer: Blue Shield of California Commercial |
$6,487.79
|
| Rate for Payer: Blue Shield of California EPN |
$4,230.07
|
| Rate for Payer: Cash Price |
$4,616.15
|
| Rate for Payer: Central Health Plan Commercial |
$6,714.40
|
| Rate for Payer: Cigna of CA HMO |
$5,875.10
|
| Rate for Payer: Cigna of CA PPO |
$5,875.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,357.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,357.20
|
| Rate for Payer: Galaxy Health WC |
$7,134.05
|
| Rate for Payer: Global Benefits Group Commercial |
$5,035.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,553.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,598.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,197.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,195.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,678.60
|
| Rate for Payer: Multiplan Commercial |
$6,294.75
|
| Rate for Payer: Networks By Design Commercial |
$4,196.50
|
| Rate for Payer: Prime Health Services Commercial |
$7,134.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,149.89
|
| Rate for Payer: United Healthcare All Other HMO |
$3,065.96
|
| Rate for Payer: United Healthcare HMO Rider |
$2,999.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,748.71
|
|
