|
HC STNT GORE VIABA 6MMX5CMX120CM
|
Facility
|
OP
|
$7,650.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
906812688
|
|
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 6MMX5CMX120CM
|
Facility
|
IP
|
$7,650.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
906812688
|
|
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 7MMX10CMX120CM
|
Facility
|
OP
|
$8,393.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
906812691
|
|
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 7MMX10CMX120CM
|
Facility
|
IP
|
$8,393.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
906812691
|
|
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 7MMX5CMX120CM
|
Facility
|
IP
|
$7,650.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
906812690
|
|
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 7MMX5CMX120CM
|
Facility
|
OP
|
$7,650.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
906812690
|
|
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 VIABAHN
|
Facility
|
OP
|
$7,097.50
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
906812513
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,419.50 |
| Max. Negotiated Rate |
$6,387.75 |
| Rate for Payer: Adventist Health Commercial |
$1,419.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,032.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,903.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,323.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,240.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,929.89
|
| Rate for Payer: Blue Shield of California Commercial |
$5,486.37
|
| Rate for Payer: Blue Shield of California EPN |
$3,577.14
|
| Rate for Payer: Cash Price |
$3,903.63
|
| Rate for Payer: Central Health Plan Commercial |
$5,678.00
|
| Rate for Payer: Cigna of CA HMO |
$4,968.25
|
| Rate for Payer: Cigna of CA PPO |
$4,968.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,032.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,032.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,032.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,839.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,839.00
|
| Rate for Payer: Galaxy Health WC |
$6,032.88
|
| Rate for Payer: Global Benefits Group Commercial |
$4,258.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,387.75
|
| Rate for Payer: InnovAge PACE Commercial |
$3,548.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,734.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,393.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,419.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,968.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,968.25
|
| Rate for Payer: Multiplan Commercial |
$5,323.12
|
| Rate for Payer: Networks By Design Commercial |
$3,548.75
|
| Rate for Payer: Prime Health Services Commercial |
$6,032.88
|
| Rate for Payer: Riverside University Health System MISP |
$2,839.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,258.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,258.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,663.69
|
| Rate for Payer: United Healthcare All Other HMO |
$2,592.72
|
| Rate for Payer: United Healthcare HMO Rider |
$2,536.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,324.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,032.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,032.88
|
| Rate for Payer: Vantage Medical Group Senior |
$6,032.88
|
|
|
HC STNT GORE VIABAHN
|
Facility
|
IP
|
$7,097.50
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
906812513
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,419.50 |
| Max. Negotiated Rate |
$6,387.75 |
| Rate for Payer: Adventist Health Commercial |
$1,419.50
|
| Rate for Payer: Blue Shield of California Commercial |
$5,486.37
|
| Rate for Payer: Blue Shield of California EPN |
$3,577.14
|
| Rate for Payer: Cash Price |
$3,903.63
|
| Rate for Payer: Central Health Plan Commercial |
$5,678.00
|
| Rate for Payer: Cigna of CA HMO |
$4,968.25
|
| Rate for Payer: Cigna of CA PPO |
$4,968.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,839.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,839.00
|
| Rate for Payer: Galaxy Health WC |
$6,032.88
|
| Rate for Payer: Global Benefits Group Commercial |
$4,258.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,387.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,734.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,704.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,393.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,419.50
|
| Rate for Payer: Multiplan Commercial |
$5,323.12
|
| Rate for Payer: Networks By Design Commercial |
$3,548.75
|
| Rate for Payer: Prime Health Services Commercial |
$6,032.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,663.69
|
| Rate for Payer: United Healthcare All Other HMO |
$2,592.72
|
| Rate for Payer: United Healthcare HMO Rider |
$2,536.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,324.43
|
|
|
HC STNT MED ENDEAVOR DES
|
Facility
|
IP
|
$5,438.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
906812361
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,087.60 |
| Max. Negotiated Rate |
$4,894.20 |
| Rate for Payer: Adventist Health Commercial |
$1,087.60
|
| Rate for Payer: Blue Shield of California Commercial |
$4,203.57
|
| Rate for Payer: Blue Shield of California EPN |
$2,740.75
|
| Rate for Payer: Cash Price |
$2,990.90
|
| Rate for Payer: Central Health Plan Commercial |
$4,350.40
|
| Rate for Payer: Cigna of CA HMO |
$3,806.60
|
| Rate for Payer: Cigna of CA PPO |
$3,806.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,175.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,175.20
|
| Rate for Payer: Galaxy Health WC |
$4,622.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,262.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,894.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,627.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,071.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,366.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,087.60
|
| Rate for Payer: Multiplan Commercial |
$4,078.50
|
| Rate for Payer: Networks By Design Commercial |
$2,719.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,622.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,040.88
|
| Rate for Payer: United Healthcare All Other HMO |
$1,986.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,943.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,780.94
|
|
|
HC STNT MED ENDEAVOR DES
|
Facility
|
OP
|
$5,438.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
906812361
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,087.60 |
| Max. Negotiated Rate |
$4,894.20 |
| Rate for Payer: Adventist Health Commercial |
$1,087.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,622.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,990.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,078.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,482.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,011.02
|
| Rate for Payer: Blue Shield of California Commercial |
$4,203.57
|
| Rate for Payer: Blue Shield of California EPN |
$2,740.75
|
| Rate for Payer: Cash Price |
$2,990.90
|
| Rate for Payer: Central Health Plan Commercial |
$4,350.40
|
| Rate for Payer: Cigna of CA HMO |
$3,806.60
|
| Rate for Payer: Cigna of CA PPO |
$3,806.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,622.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,622.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,622.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,175.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,175.20
|
| Rate for Payer: Galaxy Health WC |
$4,622.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,262.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,894.20
|
| Rate for Payer: InnovAge PACE Commercial |
$2,719.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,627.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,366.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,087.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,806.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,806.60
|
| Rate for Payer: Multiplan Commercial |
$4,078.50
|
| Rate for Payer: Networks By Design Commercial |
$2,719.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,622.30
|
| Rate for Payer: Riverside University Health System MISP |
$2,175.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,262.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,262.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,040.88
|
| Rate for Payer: United Healthcare All Other HMO |
$1,986.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,943.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,780.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,622.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,622.30
|
| Rate for Payer: Vantage Medical Group Senior |
$4,622.30
|
|
|
HC STNT MED RESOLUTE ONYX DES
|
Facility
|
IP
|
$3,238.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
906812742
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$647.60 |
| Max. Negotiated Rate |
$2,914.20 |
| Rate for Payer: Adventist Health Commercial |
$647.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,502.97
|
| Rate for Payer: Blue Shield of California EPN |
$1,631.95
|
| Rate for Payer: Cash Price |
$1,780.90
|
| Rate for Payer: Central Health Plan Commercial |
$2,590.40
|
| Rate for Payer: Cigna of CA HMO |
$2,266.60
|
| Rate for Payer: Cigna of CA PPO |
$2,266.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,295.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,295.20
|
| Rate for Payer: Galaxy Health WC |
$2,752.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,942.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,914.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,159.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,233.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,004.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$647.60
|
| Rate for Payer: Multiplan Commercial |
$2,428.50
|
| Rate for Payer: Networks By Design Commercial |
$1,619.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,752.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,215.22
|
| Rate for Payer: United Healthcare All Other HMO |
$1,182.84
|
| Rate for Payer: United Healthcare HMO Rider |
$1,157.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,060.44
|
|
|
HC STNT MED RESOLUTE ONYX DES
|
Facility
|
OP
|
$3,238.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
906812742
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$647.60 |
| Max. Negotiated Rate |
$2,914.20 |
| Rate for Payer: Adventist Health Commercial |
$647.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,752.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,780.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,428.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,478.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,792.88
|
| Rate for Payer: Blue Shield of California Commercial |
$2,502.97
|
| Rate for Payer: Blue Shield of California EPN |
$1,631.95
|
| Rate for Payer: Cash Price |
$1,780.90
|
| Rate for Payer: Central Health Plan Commercial |
$2,590.40
|
| Rate for Payer: Cigna of CA HMO |
$2,266.60
|
| Rate for Payer: Cigna of CA PPO |
$2,266.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,752.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,752.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,752.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,295.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,295.20
|
| Rate for Payer: Galaxy Health WC |
$2,752.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,942.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,914.20
|
| Rate for Payer: InnovAge PACE Commercial |
$1,619.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,159.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,004.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$647.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,266.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,266.60
|
| Rate for Payer: Multiplan Commercial |
$2,428.50
|
| Rate for Payer: Networks By Design Commercial |
$1,619.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,752.30
|
| Rate for Payer: Riverside University Health System MISP |
$1,295.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,942.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,942.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,215.22
|
| Rate for Payer: United Healthcare All Other HMO |
$1,182.84
|
| Rate for Payer: United Healthcare HMO Rider |
$1,157.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,060.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,752.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,752.30
|
| Rate for Payer: Vantage Medical Group Senior |
$2,752.30
|
|
|
HC STNT NO COAT/COVER W DEL SYS
|
Facility
|
IP
|
$3,900.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909081403
|
|
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 NO COAT/COVER W DEL SYS
|
Facility
|
OP
|
$3,900.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909081403
|
|
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 NUMED CMCP 3.4 SMALLER
|
Facility
|
IP
|
$16,375.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
906812481
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,275.00 |
| Max. Negotiated Rate |
$14,737.50 |
| Rate for Payer: Adventist Health Commercial |
$3,275.00
|
| Rate for Payer: Blue Shield of California Commercial |
$12,657.88
|
| Rate for Payer: Blue Shield of California EPN |
$8,253.00
|
| Rate for Payer: Cash Price |
$9,006.25
|
| Rate for Payer: Central Health Plan Commercial |
$13,100.00
|
| Rate for Payer: Cigna of CA HMO |
$11,462.50
|
| Rate for Payer: Cigna of CA PPO |
$11,462.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,550.00
|
| Rate for Payer: EPIC Health Plan Senior |
$6,550.00
|
| Rate for Payer: Galaxy Health WC |
$13,918.75
|
| Rate for Payer: Global Benefits Group Commercial |
$9,825.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,737.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,922.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,238.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,136.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,275.00
|
| Rate for Payer: Multiplan Commercial |
$12,281.25
|
| Rate for Payer: Networks By Design Commercial |
$8,187.50
|
| Rate for Payer: Prime Health Services Commercial |
$13,918.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,145.54
|
| Rate for Payer: United Healthcare All Other HMO |
$5,981.79
|
| Rate for Payer: United Healthcare HMO Rider |
$5,852.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,362.81
|
|
|
HC STNT NUMED CMCP 3.4 SMALLER
|
Facility
|
OP
|
$16,375.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
906812481
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,275.00 |
| Max. Negotiated Rate |
$14,737.50 |
| Rate for Payer: Adventist Health Commercial |
$3,275.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,918.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,006.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12,281.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7,476.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,066.84
|
| Rate for Payer: Blue Shield of California Commercial |
$12,657.88
|
| Rate for Payer: Blue Shield of California EPN |
$8,253.00
|
| Rate for Payer: Cash Price |
$9,006.25
|
| Rate for Payer: Central Health Plan Commercial |
$13,100.00
|
| Rate for Payer: Cigna of CA HMO |
$11,462.50
|
| Rate for Payer: Cigna of CA PPO |
$11,462.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,918.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$13,918.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13,918.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,550.00
|
| Rate for Payer: EPIC Health Plan Senior |
$6,550.00
|
| Rate for Payer: Galaxy Health WC |
$13,918.75
|
| Rate for Payer: Global Benefits Group Commercial |
$9,825.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,737.50
|
| Rate for Payer: InnovAge PACE Commercial |
$8,187.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,922.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,136.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,275.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,462.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,462.50
|
| Rate for Payer: Multiplan Commercial |
$12,281.25
|
| Rate for Payer: Networks By Design Commercial |
$8,187.50
|
| Rate for Payer: Prime Health Services Commercial |
$13,918.75
|
| Rate for Payer: Riverside University Health System MISP |
$6,550.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,825.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,825.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,145.54
|
| Rate for Payer: United Healthcare All Other HMO |
$5,981.79
|
| Rate for Payer: United Healthcare HMO Rider |
$5,852.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,362.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,918.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13,918.75
|
| Rate for Payer: Vantage Medical Group Senior |
$13,918.75
|
|
|
HC STNT NUMED CMCP 3.9 LARGER
|
Facility
|
OP
|
$16,875.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
906812482
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,375.00 |
| Max. Negotiated Rate |
$15,187.50 |
| Rate for Payer: Adventist Health Commercial |
$3,375.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14,343.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,281.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12,656.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7,705.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,343.69
|
| Rate for Payer: Blue Shield of California Commercial |
$13,044.38
|
| Rate for Payer: Blue Shield of California EPN |
$8,505.00
|
| Rate for Payer: Cash Price |
$9,281.25
|
| Rate for Payer: Central Health Plan Commercial |
$13,500.00
|
| Rate for Payer: Cigna of CA HMO |
$11,812.50
|
| Rate for Payer: Cigna of CA PPO |
$11,812.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14,343.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$14,343.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,343.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,750.00
|
| Rate for Payer: EPIC Health Plan Senior |
$6,750.00
|
| Rate for Payer: Galaxy Health WC |
$14,343.75
|
| Rate for Payer: Global Benefits Group Commercial |
$10,125.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,187.50
|
| Rate for Payer: InnovAge PACE Commercial |
$8,437.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,255.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,445.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,375.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,812.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,812.50
|
| Rate for Payer: Multiplan Commercial |
$12,656.25
|
| Rate for Payer: Networks By Design Commercial |
$8,437.50
|
| Rate for Payer: Prime Health Services Commercial |
$14,343.75
|
| Rate for Payer: Riverside University Health System MISP |
$6,750.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,125.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10,125.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,333.19
|
| Rate for Payer: United Healthcare All Other HMO |
$6,164.44
|
| Rate for Payer: United Healthcare HMO Rider |
$6,031.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,526.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14,343.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14,343.75
|
| Rate for Payer: Vantage Medical Group Senior |
$14,343.75
|
|
|
HC STNT NUMED CMCP 3.9 LARGER
|
Facility
|
IP
|
$16,875.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
906812482
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,375.00 |
| Max. Negotiated Rate |
$15,187.50 |
| Rate for Payer: Adventist Health Commercial |
$3,375.00
|
| Rate for Payer: Blue Shield of California Commercial |
$13,044.38
|
| Rate for Payer: Blue Shield of California EPN |
$8,505.00
|
| Rate for Payer: Cash Price |
$9,281.25
|
| Rate for Payer: Central Health Plan Commercial |
$13,500.00
|
| Rate for Payer: Cigna of CA HMO |
$11,812.50
|
| Rate for Payer: Cigna of CA PPO |
$11,812.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,750.00
|
| Rate for Payer: EPIC Health Plan Senior |
$6,750.00
|
| Rate for Payer: Galaxy Health WC |
$14,343.75
|
| Rate for Payer: Global Benefits Group Commercial |
$10,125.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,187.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,255.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,429.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,445.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,375.00
|
| Rate for Payer: Multiplan Commercial |
$12,656.25
|
| Rate for Payer: Networks By Design Commercial |
$8,437.50
|
| Rate for Payer: Prime Health Services Commercial |
$14,343.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,333.19
|
| Rate for Payer: United Healthcare All Other HMO |
$6,164.44
|
| Rate for Payer: United Healthcare HMO Rider |
$6,031.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,526.56
|
|
|
HC STNT NUMED CP 3.4 COVERED UNM
|
Facility
|
IP
|
$13,375.00
|
|
|
Service Code
|
CPT C1877
|
| Hospital Charge Code |
906812620
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,675.00 |
| Max. Negotiated Rate |
$12,037.50 |
| Rate for Payer: Adventist Health Commercial |
$2,675.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,338.88
|
| Rate for Payer: Blue Shield of California EPN |
$6,741.00
|
| Rate for Payer: Cash Price |
$7,356.25
|
| Rate for Payer: Central Health Plan Commercial |
$10,700.00
|
| Rate for Payer: Cigna of CA HMO |
$9,362.50
|
| Rate for Payer: Cigna of CA PPO |
$9,362.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,350.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,350.00
|
| Rate for Payer: Galaxy Health WC |
$11,368.75
|
| Rate for Payer: Global Benefits Group Commercial |
$8,025.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,037.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,921.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,095.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,279.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,675.00
|
| Rate for Payer: Multiplan Commercial |
$10,031.25
|
| Rate for Payer: Networks By Design Commercial |
$6,687.50
|
| Rate for Payer: Prime Health Services Commercial |
$11,368.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,019.64
|
| Rate for Payer: United Healthcare All Other HMO |
$4,885.89
|
| Rate for Payer: United Healthcare HMO Rider |
$4,780.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,380.31
|
|
|
HC STNT NUMED CP 3.4 COVERED UNM
|
Facility
|
OP
|
$13,375.00
|
|
|
Service Code
|
CPT C1877
|
| Hospital Charge Code |
906812620
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,675.00 |
| Max. Negotiated Rate |
$12,037.50 |
| Rate for Payer: Adventist Health Commercial |
$2,675.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,368.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,356.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,031.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,107.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,405.74
|
| Rate for Payer: Blue Shield of California Commercial |
$10,338.88
|
| Rate for Payer: Blue Shield of California EPN |
$6,741.00
|
| Rate for Payer: Cash Price |
$7,356.25
|
| Rate for Payer: Central Health Plan Commercial |
$10,700.00
|
| Rate for Payer: Cigna of CA HMO |
$9,362.50
|
| Rate for Payer: Cigna of CA PPO |
$9,362.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,368.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,368.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11,368.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,350.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,350.00
|
| Rate for Payer: Galaxy Health WC |
$11,368.75
|
| Rate for Payer: Global Benefits Group Commercial |
$8,025.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,037.50
|
| Rate for Payer: InnovAge PACE Commercial |
$6,687.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,921.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,095.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,279.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,675.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,362.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,362.50
|
| Rate for Payer: Multiplan Commercial |
$10,031.25
|
| Rate for Payer: Networks By Design Commercial |
$6,687.50
|
| Rate for Payer: Prime Health Services Commercial |
$11,368.75
|
| Rate for Payer: Riverside University Health System MISP |
$5,350.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,025.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8,025.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,019.64
|
| Rate for Payer: United Healthcare All Other HMO |
$4,885.89
|
| Rate for Payer: United Healthcare HMO Rider |
$4,780.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,380.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,368.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,368.75
|
| Rate for Payer: Vantage Medical Group Senior |
$11,368.75
|
|
|
HC STNT NUMED CP 3.9 COVERED UNM
|
Facility
|
OP
|
$13,375.00
|
|
|
Service Code
|
CPT C1877
|
| Hospital Charge Code |
906812621
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,675.00 |
| Max. Negotiated Rate |
$12,037.50 |
| Rate for Payer: Adventist Health Commercial |
$2,675.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,368.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,356.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,031.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,107.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,405.74
|
| Rate for Payer: Blue Shield of California Commercial |
$10,338.88
|
| Rate for Payer: Blue Shield of California EPN |
$6,741.00
|
| Rate for Payer: Cash Price |
$7,356.25
|
| Rate for Payer: Central Health Plan Commercial |
$10,700.00
|
| Rate for Payer: Cigna of CA HMO |
$9,362.50
|
| Rate for Payer: Cigna of CA PPO |
$9,362.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,368.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,368.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11,368.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,350.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,350.00
|
| Rate for Payer: Galaxy Health WC |
$11,368.75
|
| Rate for Payer: Global Benefits Group Commercial |
$8,025.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,037.50
|
| Rate for Payer: InnovAge PACE Commercial |
$6,687.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,921.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,095.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,279.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,675.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,362.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,362.50
|
| Rate for Payer: Multiplan Commercial |
$10,031.25
|
| Rate for Payer: Networks By Design Commercial |
$6,687.50
|
| Rate for Payer: Prime Health Services Commercial |
$11,368.75
|
| Rate for Payer: Riverside University Health System MISP |
$5,350.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,025.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8,025.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,019.64
|
| Rate for Payer: United Healthcare All Other HMO |
$4,885.89
|
| Rate for Payer: United Healthcare HMO Rider |
$4,780.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,380.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,368.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,368.75
|
| Rate for Payer: Vantage Medical Group Senior |
$11,368.75
|
|
|
HC STNT NUMED CP 3.9 COVERED UNM
|
Facility
|
IP
|
$13,375.00
|
|
|
Service Code
|
CPT C1877
|
| Hospital Charge Code |
906812621
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,675.00 |
| Max. Negotiated Rate |
$12,037.50 |
| Rate for Payer: Adventist Health Commercial |
$2,675.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,338.88
|
| Rate for Payer: Blue Shield of California EPN |
$6,741.00
|
| Rate for Payer: Cash Price |
$7,356.25
|
| Rate for Payer: Central Health Plan Commercial |
$10,700.00
|
| Rate for Payer: Cigna of CA HMO |
$9,362.50
|
| Rate for Payer: Cigna of CA PPO |
$9,362.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,350.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,350.00
|
| Rate for Payer: Galaxy Health WC |
$11,368.75
|
| Rate for Payer: Global Benefits Group Commercial |
$8,025.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,037.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,921.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,095.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,279.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,675.00
|
| Rate for Payer: Multiplan Commercial |
$10,031.25
|
| Rate for Payer: Networks By Design Commercial |
$6,687.50
|
| Rate for Payer: Prime Health Services Commercial |
$11,368.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,019.64
|
| Rate for Payer: United Healthcare All Other HMO |
$4,885.89
|
| Rate for Payer: United Healthcare HMO Rider |
$4,780.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,380.31
|
|
|
HC STNT PLCMT CNTRL DIALYSIS SEG
|
Facility
|
OP
|
$6,886.00
|
|
|
Service Code
|
CPT 36908
|
| Hospital Charge Code |
909036908
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,000.00 |
| Max. Negotiated Rate |
$8,581.00 |
| Rate for Payer: Adventist Health Commercial |
$1,377.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,853.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,787.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,164.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,581.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,999.40
|
| Rate for Payer: Blue Shield of California EPN |
$3,914.40
|
| Rate for Payer: Cash Price |
$3,787.30
|
| Rate for Payer: Cash Price |
$3,787.30
|
| Rate for Payer: Cash Price |
$3,787.30
|
| Rate for Payer: Central Health Plan Commercial |
$5,508.80
|
| Rate for Payer: Cigna of CA HMO |
$4,407.04
|
| Rate for Payer: Cigna of CA PPO |
$5,095.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,853.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,853.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,853.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,754.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,754.40
|
| Rate for Payer: Galaxy Health WC |
$5,853.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,131.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,197.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4,269.25
|
| Rate for Payer: InnovAge PACE Commercial |
$3,443.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,592.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,716.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,262.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,377.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,820.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,820.20
|
| Rate for Payer: Multiplan Commercial |
$5,164.50
|
| Rate for Payer: Networks By Design Commercial |
$4,475.90
|
| Rate for Payer: Prime Health Services Commercial |
$5,853.10
|
| Rate for Payer: Riverside University Health System MISP |
$2,754.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,131.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,853.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,853.10
|
| Rate for Payer: Vantage Medical Group Senior |
$5,853.10
|
|
|
HC STNT PLCMT CNTRL DIALYSIS SEG
|
Facility
|
IP
|
$8,101.00
|
|
|
Service Code
|
CPT 36908
|
| Hospital Charge Code |
906820283
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,620.20 |
| Max. Negotiated Rate |
$7,290.90 |
| Rate for Payer: Adventist Health Commercial |
$1,620.20
|
| Rate for Payer: Cash Price |
$4,455.55
|
| Rate for Payer: Central Health Plan Commercial |
$6,480.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,240.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,240.40
|
| Rate for Payer: Galaxy Health WC |
$6,885.85
|
| Rate for Payer: Global Benefits Group Commercial |
$4,860.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,290.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,403.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,086.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,014.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,620.20
|
| Rate for Payer: Multiplan Commercial |
$6,075.75
|
| Rate for Payer: Networks By Design Commercial |
$5,265.65
|
| Rate for Payer: Prime Health Services Commercial |
$6,885.85
|
|
|
HC STNT PLCMT CNTRL DIALYSIS SEG
|
Facility
|
IP
|
$6,886.00
|
|
|
Service Code
|
CPT 36908
|
| Hospital Charge Code |
909036908
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,377.20 |
| Max. Negotiated Rate |
$6,197.40 |
| Rate for Payer: Adventist Health Commercial |
$1,377.20
|
| Rate for Payer: Cash Price |
$3,787.30
|
| Rate for Payer: Central Health Plan Commercial |
$5,508.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,754.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,754.40
|
| Rate for Payer: Galaxy Health WC |
$5,853.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,131.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,197.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,592.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,623.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,262.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,377.20
|
| Rate for Payer: Multiplan Commercial |
$5,164.50
|
| Rate for Payer: Networks By Design Commercial |
$4,475.90
|
| Rate for Payer: Prime Health Services Commercial |
$5,853.10
|
|
