|
HC STERNOCLAVICLE REDUCTION
|
Facility
|
IP
|
$2,542.00
|
|
|
Service Code
|
CPT 23525
|
| Hospital Charge Code |
902890371
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$508.40 |
| Max. Negotiated Rate |
$2,160.70 |
| Rate for Payer: EPIC Health Plan Commercial |
$1,016.80
|
| Rate for Payer: Adventist Health Commercial |
$508.40
|
| Rate for Payer: Cash Price |
$1,143.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,779.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,016.80
|
| Rate for Payer: Galaxy Health WC |
$2,160.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,525.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,614.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,499.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$610.08
|
| Rate for Payer: Multiplan Commercial |
$2,033.60
|
| Rate for Payer: Networks By Design Commercial |
$1,652.30
|
| Rate for Payer: Prime Health Services Commercial |
$2,160.70
|
|
|
HC STERNO CLAV JOINTS
|
Facility
|
OP
|
$699.00
|
|
|
Service Code
|
CPT 71130
|
| Hospital Charge Code |
909001428
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$43.65 |
| Max. Negotiated Rate |
$594.15 |
| Rate for Payer: Adventist Health Commercial |
$139.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$192.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$206.31
|
| Rate for Payer: Blue Shield of California Commercial |
$294.28
|
| Rate for Payer: Blue Shield of California Commercial |
$445.96
|
| Rate for Payer: Cash Price |
$314.55
|
| Rate for Payer: Cash Price |
$314.55
|
| Rate for Payer: Cigna of CA HMO |
$447.36
|
| Rate for Payer: Cigna of CA PPO |
$517.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$489.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.68
|
| Rate for Payer: EPIC Health Plan Senior |
$123.12
|
| Rate for Payer: Galaxy Health WC |
$594.15
|
| Rate for Payer: Global Benefits Group Commercial |
$419.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$43.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$443.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$49.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$167.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$141.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.99
|
| Rate for Payer: Multiplan Commercial |
$559.20
|
| Rate for Payer: Networks By Design Commercial |
$454.35
|
| Rate for Payer: Prime Health Services Commercial |
$594.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$419.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$419.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Vantage Medical Group Senior |
$111.93
|
|
|
HC STERNO CLAV JOINTS
|
Facility
|
IP
|
$699.00
|
|
|
Service Code
|
CPT 71130
|
| Hospital Charge Code |
909001428
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$139.80 |
| Max. Negotiated Rate |
$594.15 |
| Rate for Payer: Adventist Health Commercial |
$139.80
|
| Rate for Payer: Cash Price |
$314.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$489.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$279.60
|
| Rate for Payer: EPIC Health Plan Senior |
$279.60
|
| Rate for Payer: Galaxy Health WC |
$594.15
|
| Rate for Payer: Global Benefits Group Commercial |
$419.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$443.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$412.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$167.76
|
| Rate for Payer: Multiplan Commercial |
$559.20
|
| Rate for Payer: Networks By Design Commercial |
$454.35
|
| Rate for Payer: Prime Health Services Commercial |
$594.15
|
|
|
HC STERNUM
|
Facility
|
IP
|
$814.00
|
|
|
Service Code
|
CPT 71120
|
| Hospital Charge Code |
909001427
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$162.80 |
| Max. Negotiated Rate |
$691.90 |
| Rate for Payer: Adventist Health Commercial |
$162.80
|
| Rate for Payer: Cash Price |
$366.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$569.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$325.60
|
| Rate for Payer: EPIC Health Plan Senior |
$325.60
|
| Rate for Payer: Galaxy Health WC |
$691.90
|
| Rate for Payer: Global Benefits Group Commercial |
$488.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$516.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$480.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$195.36
|
| Rate for Payer: Multiplan Commercial |
$651.20
|
| Rate for Payer: Networks By Design Commercial |
$529.10
|
| Rate for Payer: Prime Health Services Commercial |
$691.90
|
|
|
HC STERNUM
|
Facility
|
OP
|
$814.00
|
|
|
Service Code
|
CPT 71120
|
| Hospital Charge Code |
909001427
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$43.65 |
| Max. Negotiated Rate |
$691.90 |
| Rate for Payer: Adventist Health Commercial |
$162.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$160.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$192.00
|
| Rate for Payer: Blue Shield of California Commercial |
$342.69
|
| Rate for Payer: Blue Shield of California Commercial |
$519.33
|
| Rate for Payer: Cash Price |
$366.30
|
| Rate for Payer: Cash Price |
$366.30
|
| Rate for Payer: Cigna of CA HMO |
$520.96
|
| Rate for Payer: Cigna of CA PPO |
$602.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$569.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.68
|
| Rate for Payer: EPIC Health Plan Senior |
$123.12
|
| Rate for Payer: Galaxy Health WC |
$691.90
|
| Rate for Payer: Global Benefits Group Commercial |
$488.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$43.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$516.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$49.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$195.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$141.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.99
|
| Rate for Payer: Multiplan Commercial |
$651.20
|
| Rate for Payer: Networks By Design Commercial |
$529.10
|
| Rate for Payer: Prime Health Services Commercial |
$691.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$488.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$488.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Vantage Medical Group Senior |
$111.93
|
|
|
HC STNT BILIARY MED PALMAZ & DELI
|
Facility
|
IP
|
$3,900.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909081422
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Cigna of CA HMO |
$2,730.00
|
| Rate for Payer: Cigna of CA PPO |
$2,730.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,476.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,301.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$936.00
|
| Rate for Payer: Multiplan Commercial |
$3,120.00
|
| 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 BILIARY MED PALMAZ & DELI
|
Facility
|
OP
|
$3,900.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909081422
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,315.00 |
| 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 HMO/PPO |
$2,360.67
|
| Rate for Payer: Blue Shield of California Commercial |
$1,977.30
|
| Rate for Payer: Blue Shield of California Commercial |
$2,999.10
|
| Rate for Payer: Cash Price |
$1,755.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,476.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,415.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,301.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$936.00
|
| 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 |
$3,120.00
|
| Rate for Payer: Networks By Design Commercial |
$1,950.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| 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 BILIARY PALMAZ CORIN IQ
|
Facility
|
OP
|
$1,643.00
|
|
|
Service Code
|
CPT C1877
|
| Hospital Charge Code |
909081420
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$328.60 |
| Max. Negotiated Rate |
$1,396.55 |
| Rate for Payer: Adventist Health Commercial |
$328.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,396.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$903.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,232.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$994.51
|
| Rate for Payer: Blue Shield of California Commercial |
$1,263.47
|
| Rate for Payer: Blue Shield of California Commercial |
$833.00
|
| Rate for Payer: Cash Price |
$739.35
|
| Rate for Payer: Cigna of CA HMO |
$1,150.10
|
| Rate for Payer: Cigna of CA PPO |
$1,150.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,396.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,396.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,396.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,150.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$657.20
|
| Rate for Payer: EPIC Health Plan Senior |
$657.20
|
| Rate for Payer: Galaxy Health WC |
$1,396.55
|
| Rate for Payer: Global Benefits Group Commercial |
$985.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,043.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$596.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$969.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$394.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,150.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,150.10
|
| Rate for Payer: Multiplan Commercial |
$1,314.40
|
| Rate for Payer: Networks By Design Commercial |
$821.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,396.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$985.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$985.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$616.62
|
| Rate for Payer: United Healthcare All Other HMO |
$600.19
|
| Rate for Payer: United Healthcare HMO Rider |
$587.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$538.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,396.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,396.55
|
| Rate for Payer: Vantage Medical Group Senior |
$1,396.55
|
|
|
HC STNT BILIARY PALMAZ CORIN IQ
|
Facility
|
IP
|
$1,643.00
|
|
|
Service Code
|
CPT C1877
|
| Hospital Charge Code |
909081420
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$328.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$328.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$739.35
|
| Rate for Payer: Cash Price |
$739.35
|
| Rate for Payer: Cigna of CA HMO |
$1,150.10
|
| Rate for Payer: Cigna of CA PPO |
$1,150.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,150.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$657.20
|
| Rate for Payer: EPIC Health Plan Senior |
$657.20
|
| Rate for Payer: Galaxy Health WC |
$1,396.55
|
| Rate for Payer: Global Benefits Group Commercial |
$985.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,043.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$969.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$394.32
|
| Rate for Payer: Multiplan Commercial |
$1,314.40
|
| Rate for Payer: Networks By Design Commercial |
$821.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,396.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$616.62
|
| Rate for Payer: United Healthcare All Other HMO |
$600.19
|
| Rate for Payer: United Healthcare HMO Rider |
$587.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$538.08
|
|
|
HC STNT BILIARY PALMAZ CORINTHIA
|
Facility
|
IP
|
$2,388.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909081223
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$477.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$477.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$1,074.60
|
| Rate for Payer: Cash Price |
$1,074.60
|
| Rate for Payer: Cigna of CA HMO |
$1,671.60
|
| Rate for Payer: Cigna of CA PPO |
$1,671.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,671.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$955.20
|
| Rate for Payer: EPIC Health Plan Senior |
$955.20
|
| Rate for Payer: Galaxy Health WC |
$2,029.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,432.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,516.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,408.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$573.12
|
| Rate for Payer: Multiplan Commercial |
$1,910.40
|
| Rate for Payer: Networks By Design Commercial |
$1,194.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,029.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$896.22
|
| Rate for Payer: United Healthcare All Other HMO |
$872.34
|
| Rate for Payer: United Healthcare HMO Rider |
$853.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$782.07
|
|
|
HC STNT BILIARY PALMAZ CORINTHIA
|
Facility
|
OP
|
$2,388.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909081223
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$477.60 |
| Max. Negotiated Rate |
$2,029.80 |
| Rate for Payer: Adventist Health Commercial |
$477.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,029.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,313.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,791.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,445.46
|
| Rate for Payer: Blue Shield of California Commercial |
$1,210.72
|
| Rate for Payer: Blue Shield of California Commercial |
$1,836.37
|
| Rate for Payer: Cash Price |
$1,074.60
|
| Rate for Payer: Cigna of CA HMO |
$1,671.60
|
| Rate for Payer: Cigna of CA PPO |
$1,671.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,029.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,029.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,029.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,671.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$955.20
|
| Rate for Payer: EPIC Health Plan Senior |
$955.20
|
| Rate for Payer: Galaxy Health WC |
$2,029.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,432.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,516.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$866.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,408.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$573.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,671.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,671.60
|
| Rate for Payer: Multiplan Commercial |
$1,910.40
|
| Rate for Payer: Networks By Design Commercial |
$1,194.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,029.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,432.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,432.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$896.22
|
| Rate for Payer: United Healthcare All Other HMO |
$872.34
|
| Rate for Payer: United Healthcare HMO Rider |
$853.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$782.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,029.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,029.80
|
| Rate for Payer: Vantage Medical Group Senior |
$2,029.80
|
|
|
HC STNT BILIARY PALM CORIN IQ&DEL
|
Facility
|
OP
|
$3,900.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909081421
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,315.00 |
| 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 HMO/PPO |
$2,360.67
|
| Rate for Payer: Blue Shield of California Commercial |
$1,977.30
|
| Rate for Payer: Blue Shield of California Commercial |
$2,999.10
|
| Rate for Payer: Cash Price |
$1,755.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,476.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,415.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,301.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$936.00
|
| 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 |
$3,120.00
|
| Rate for Payer: Networks By Design Commercial |
$1,950.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| 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 BILIARY PALM CORIN IQ&DEL
|
Facility
|
IP
|
$3,900.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909081421
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Cigna of CA HMO |
$2,730.00
|
| Rate for Payer: Cigna of CA PPO |
$2,730.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,476.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,301.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$936.00
|
| Rate for Payer: Multiplan Commercial |
$3,120.00
|
| 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 BILIARY PALM XL TRANS 40
|
Facility
|
IP
|
$1,500.00
|
|
|
Service Code
|
CPT C1877
|
| Hospital Charge Code |
909081423
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$300.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$300.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cigna of CA HMO |
$1,050.00
|
| Rate for Payer: Cigna of CA PPO |
$1,050.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,050.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$600.00
|
| Rate for Payer: EPIC Health Plan Senior |
$600.00
|
| Rate for Payer: Galaxy Health WC |
$1,275.00
|
| Rate for Payer: Global Benefits Group Commercial |
$900.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$952.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$885.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$360.00
|
| Rate for Payer: Multiplan Commercial |
$1,200.00
|
| Rate for Payer: Networks By Design Commercial |
$750.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,275.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$562.95
|
| Rate for Payer: United Healthcare All Other HMO |
$547.95
|
| Rate for Payer: United Healthcare HMO Rider |
$536.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$491.25
|
|
|
HC STNT BILIARY PALM XL TRANS 40
|
Facility
|
OP
|
$1,500.00
|
|
|
Service Code
|
CPT C1877
|
| Hospital Charge Code |
909081423
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$300.00 |
| Max. Negotiated Rate |
$1,275.00 |
| Rate for Payer: Adventist Health Commercial |
$300.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,275.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$825.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,125.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$907.95
|
| Rate for Payer: Blue Shield of California Commercial |
$1,153.50
|
| Rate for Payer: Blue Shield of California Commercial |
$760.50
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cigna of CA HMO |
$1,050.00
|
| Rate for Payer: Cigna of CA PPO |
$1,050.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,275.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,275.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,275.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,050.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$600.00
|
| Rate for Payer: EPIC Health Plan Senior |
$600.00
|
| Rate for Payer: Galaxy Health WC |
$1,275.00
|
| Rate for Payer: Global Benefits Group Commercial |
$900.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$952.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$544.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$885.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$360.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,050.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,050.00
|
| Rate for Payer: Multiplan Commercial |
$1,200.00
|
| Rate for Payer: Networks By Design Commercial |
$750.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,275.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$900.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$900.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$562.95
|
| Rate for Payer: United Healthcare All Other HMO |
$547.95
|
| Rate for Payer: United Healthcare HMO Rider |
$536.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$491.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,275.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,275.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,275.00
|
|
|
HC STNT BILIARY PALM XL TRANS 50
|
Facility
|
OP
|
$1,800.00
|
|
|
Service Code
|
CPT C1877
|
| Hospital Charge Code |
909081424
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$360.00 |
| Max. Negotiated Rate |
$1,530.00 |
| Rate for Payer: Adventist Health Commercial |
$360.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,530.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$990.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,350.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,089.54
|
| Rate for Payer: Blue Shield of California Commercial |
$1,384.20
|
| Rate for Payer: Blue Shield of California Commercial |
$912.60
|
| Rate for Payer: Cash Price |
$810.00
|
| Rate for Payer: Cigna of CA HMO |
$1,260.00
|
| Rate for Payer: Cigna of CA PPO |
$1,260.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,530.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,530.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,530.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,260.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$720.00
|
| Rate for Payer: EPIC Health Plan Senior |
$720.00
|
| Rate for Payer: Galaxy Health WC |
$1,530.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,080.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,143.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$653.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,062.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$432.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,260.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,260.00
|
| Rate for Payer: Multiplan Commercial |
$1,440.00
|
| Rate for Payer: Networks By Design Commercial |
$900.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,530.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,080.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,080.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$675.54
|
| Rate for Payer: United Healthcare All Other HMO |
$657.54
|
| Rate for Payer: United Healthcare HMO Rider |
$643.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$589.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,530.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,530.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,530.00
|
|
|
HC STNT BILIARY PALM XL TRANS 50
|
Facility
|
IP
|
$1,800.00
|
|
|
Service Code
|
CPT C1877
|
| Hospital Charge Code |
909081424
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$360.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$360.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$810.00
|
| Rate for Payer: Cash Price |
$810.00
|
| Rate for Payer: Cigna of CA HMO |
$1,260.00
|
| Rate for Payer: Cigna of CA PPO |
$1,260.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,260.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$720.00
|
| Rate for Payer: EPIC Health Plan Senior |
$720.00
|
| Rate for Payer: Galaxy Health WC |
$1,530.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,080.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,143.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,062.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$432.00
|
| Rate for Payer: Multiplan Commercial |
$1,440.00
|
| Rate for Payer: Networks By Design Commercial |
$900.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,530.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$675.54
|
| Rate for Payer: United Healthcare All Other HMO |
$657.54
|
| Rate for Payer: United Healthcare HMO Rider |
$643.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$589.50
|
|
|
HC STNT BILIARY SMART CORDIS 7-14
|
Facility
|
IP
|
$4,020.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909081693
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$804.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$804.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$1,809.00
|
| Rate for Payer: Cash Price |
$1,809.00
|
| Rate for Payer: Cigna of CA HMO |
$2,814.00
|
| Rate for Payer: Cigna of CA PPO |
$2,814.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,814.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,608.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,608.00
|
| Rate for Payer: Galaxy Health WC |
$3,417.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,412.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,552.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,371.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$964.80
|
| Rate for Payer: Multiplan Commercial |
$3,216.00
|
| Rate for Payer: Networks By Design Commercial |
$2,010.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,417.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,508.71
|
| Rate for Payer: United Healthcare All Other HMO |
$1,468.51
|
| Rate for Payer: United Healthcare HMO Rider |
$1,436.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,316.55
|
|
|
HC STNT BILIARY SMART CORDIS 7-14
|
Facility
|
OP
|
$4,020.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909081693
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$804.00 |
| Max. Negotiated Rate |
$3,417.00 |
| Rate for Payer: Adventist Health Commercial |
$804.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,417.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,211.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,015.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,433.31
|
| Rate for Payer: Blue Shield of California Commercial |
$2,038.14
|
| Rate for Payer: Blue Shield of California Commercial |
$3,091.38
|
| Rate for Payer: Cash Price |
$1,809.00
|
| Rate for Payer: Cigna of CA HMO |
$2,814.00
|
| Rate for Payer: Cigna of CA PPO |
$2,814.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,417.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,417.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,417.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,814.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,608.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,608.00
|
| Rate for Payer: Galaxy Health WC |
$3,417.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,412.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,552.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,459.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,371.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$964.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,814.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,814.00
|
| Rate for Payer: Multiplan Commercial |
$3,216.00
|
| Rate for Payer: Networks By Design Commercial |
$2,010.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,417.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,412.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,412.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,508.71
|
| Rate for Payer: United Healthcare All Other HMO |
$1,468.51
|
| Rate for Payer: United Healthcare HMO Rider |
$1,436.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,316.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,417.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,417.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,417.00
|
|
|
HC STNT BILRY LG PALM BLLN W/DELI
|
Facility
|
OP
|
$1,718.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909081445
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$343.60 |
| Max. Negotiated Rate |
$1,460.30 |
| Rate for Payer: Networks By Design Commercial |
$859.00
|
| Rate for Payer: Adventist Health Commercial |
$343.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,460.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$944.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,288.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,039.91
|
| Rate for Payer: Blue Shield of California Commercial |
$1,321.14
|
| Rate for Payer: Blue Shield of California Commercial |
$871.03
|
| Rate for Payer: Cash Price |
$773.10
|
| Rate for Payer: Cigna of CA HMO |
$1,202.60
|
| Rate for Payer: Cigna of CA PPO |
$1,202.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,460.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,460.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,460.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,202.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$687.20
|
| Rate for Payer: EPIC Health Plan Senior |
$687.20
|
| Rate for Payer: Galaxy Health WC |
$1,460.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,030.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,090.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$623.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,013.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$412.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,202.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,202.60
|
| Rate for Payer: Multiplan Commercial |
$1,374.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,460.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,030.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,030.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$644.77
|
| Rate for Payer: United Healthcare All Other HMO |
$627.59
|
| Rate for Payer: United Healthcare HMO Rider |
$614.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$562.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,460.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,460.30
|
| Rate for Payer: Vantage Medical Group Senior |
$1,460.30
|
|
|
HC STNT BILRY LG PALM BLLN W/DELI
|
Facility
|
IP
|
$1,718.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909081445
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$343.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$343.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$773.10
|
| Rate for Payer: Cash Price |
$773.10
|
| Rate for Payer: Cigna of CA HMO |
$1,202.60
|
| Rate for Payer: Cigna of CA PPO |
$1,202.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,202.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$687.20
|
| Rate for Payer: EPIC Health Plan Senior |
$687.20
|
| Rate for Payer: Galaxy Health WC |
$1,460.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,030.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,090.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,013.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$412.32
|
| Rate for Payer: Multiplan Commercial |
$1,374.40
|
| Rate for Payer: Networks By Design Commercial |
$859.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,460.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$644.77
|
| Rate for Payer: United Healthcare All Other HMO |
$627.59
|
| Rate for Payer: United Healthcare HMO Rider |
$614.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$562.64
|
|
|
HC STNT BILRY SMART CORDIS NIT 20
|
Facility
|
OP
|
$1,800.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909081428
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$360.00 |
| Max. Negotiated Rate |
$1,530.00 |
| Rate for Payer: Adventist Health Commercial |
$360.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,530.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$990.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,350.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,089.54
|
| Rate for Payer: Blue Shield of California Commercial |
$1,384.20
|
| Rate for Payer: Blue Shield of California Commercial |
$912.60
|
| Rate for Payer: Cash Price |
$810.00
|
| Rate for Payer: Cigna of CA HMO |
$1,260.00
|
| Rate for Payer: Cigna of CA PPO |
$1,260.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,530.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,530.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,530.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,260.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$720.00
|
| Rate for Payer: EPIC Health Plan Senior |
$720.00
|
| Rate for Payer: Galaxy Health WC |
$1,530.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,080.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,143.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$653.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,062.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$432.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,260.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,260.00
|
| Rate for Payer: Multiplan Commercial |
$1,440.00
|
| Rate for Payer: Networks By Design Commercial |
$900.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,530.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,080.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,080.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$675.54
|
| Rate for Payer: United Healthcare All Other HMO |
$657.54
|
| Rate for Payer: United Healthcare HMO Rider |
$643.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$589.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,530.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,530.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,530.00
|
|
|
HC STNT BILRY SMART CORDIS NIT 20
|
Facility
|
IP
|
$1,800.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909081428
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$360.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$360.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$810.00
|
| Rate for Payer: Cash Price |
$810.00
|
| Rate for Payer: Cigna of CA HMO |
$1,260.00
|
| Rate for Payer: Cigna of CA PPO |
$1,260.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,260.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$720.00
|
| Rate for Payer: EPIC Health Plan Senior |
$720.00
|
| Rate for Payer: Galaxy Health WC |
$1,530.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,080.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,143.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,062.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$432.00
|
| Rate for Payer: Multiplan Commercial |
$1,440.00
|
| Rate for Payer: Networks By Design Commercial |
$900.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,530.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$675.54
|
| Rate for Payer: United Healthcare All Other HMO |
$657.54
|
| Rate for Payer: United Healthcare HMO Rider |
$643.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$589.50
|
|
|
HC STNT BILRY SMRT CORD NIT 40/60
|
Facility
|
OP
|
$4,350.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909081429
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$870.00 |
| Max. Negotiated Rate |
$3,697.50 |
| Rate for Payer: Adventist Health Commercial |
$870.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,697.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,392.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,262.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,633.05
|
| Rate for Payer: Blue Shield of California Commercial |
$2,205.45
|
| Rate for Payer: Blue Shield of California Commercial |
$3,345.15
|
| Rate for Payer: Cash Price |
$1,957.50
|
| Rate for Payer: Cigna of CA HMO |
$3,045.00
|
| Rate for Payer: Cigna of CA PPO |
$3,045.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,697.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,697.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,697.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,045.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,740.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,740.00
|
| Rate for Payer: Galaxy Health WC |
$3,697.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,610.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,762.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,579.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,566.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,044.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,045.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,045.00
|
| Rate for Payer: Multiplan Commercial |
$3,480.00
|
| Rate for Payer: Networks By Design Commercial |
$2,175.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,697.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,610.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,610.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,632.56
|
| Rate for Payer: United Healthcare All Other HMO |
$1,589.06
|
| Rate for Payer: United Healthcare HMO Rider |
$1,554.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,424.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,697.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,697.50
|
| Rate for Payer: Vantage Medical Group Senior |
$3,697.50
|
|
|
HC STNT BILRY SMRT CORD NIT 40/60
|
Facility
|
IP
|
$4,350.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909081429
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$870.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$870.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$1,957.50
|
| Rate for Payer: Cash Price |
$1,957.50
|
| Rate for Payer: Cigna of CA HMO |
$3,045.00
|
| Rate for Payer: Cigna of CA PPO |
$3,045.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,045.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,740.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,740.00
|
| Rate for Payer: Galaxy Health WC |
$3,697.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,610.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,762.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,566.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,044.00
|
| Rate for Payer: Multiplan Commercial |
$3,480.00
|
| Rate for Payer: Networks By Design Commercial |
$2,175.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,697.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,632.56
|
| Rate for Payer: United Healthcare All Other HMO |
$1,589.06
|
| Rate for Payer: United Healthcare HMO Rider |
$1,554.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,424.62
|
|
