|
HC STEREOTACTIC PROBE 8 GA
|
Facility
IP
|
$921.00
|
|
| Hospital Charge Code |
909001128
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$184.20 |
| Max. Negotiated Rate |
$828.90 |
| Rate for Payer: Cash Price |
$414.45
|
| Rate for Payer: Central Health Plan Commercial |
$736.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$368.40
|
| Rate for Payer: Galaxy Health WC |
$782.85
|
| Rate for Payer: Global Benefits Group Commercial |
$552.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$828.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$614.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$184.20
|
| Rate for Payer: Multiplan Commercial |
$690.75
|
| Rate for Payer: Networks By Design Commercial |
$598.65
|
| Rate for Payer: Prime Health Services Commercial |
$782.85
|
|
|
HC STERNOCLAVICLE REDUCTION
|
Facility
IP
|
$1,922.00
|
|
|
Service Code
|
CPT 23525
|
| Hospital Charge Code |
902890371
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$384.40 |
| Max. Negotiated Rate |
$1,729.80 |
| Rate for Payer: Cash Price |
$864.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,537.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$768.80
|
| Rate for Payer: Galaxy Health WC |
$1,633.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,153.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,729.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,281.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$384.40
|
| Rate for Payer: Multiplan Commercial |
$1,441.50
|
| Rate for Payer: Networks By Design Commercial |
$1,249.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,633.70
|
|
|
HC STERNOCLAVICLE REDUCTION
|
Facility
OP
|
$1,922.00
|
|
|
Service Code
|
CPT 23525
|
| Hospital Charge Code |
902890371
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$294.64 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$294.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$441.96
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$294.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: BCBS Transplant Transplant |
$1,153.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,208.94
|
| Rate for Payer: Blue Shield of California EPN |
$939.86
|
| Rate for Payer: Caremore Medicare Advantage |
$294.64
|
| Rate for Payer: Cash Price |
$864.90
|
| Rate for Payer: Cash Price |
$864.90
|
| Rate for Payer: Cash Price |
$864.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,537.60
|
| Rate for Payer: Cigna of CA HMO |
$1,230.08
|
| Rate for Payer: Cigna of CA PPO |
$1,422.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$441.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$397.76
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$294.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$294.64
|
| Rate for Payer: Galaxy Health WC |
$1,633.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,153.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,729.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,441.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$483.21
|
| Rate for Payer: IEHP medi-cal |
$486.16
|
| Rate for Payer: IEHP Medicare Advantage |
$294.64
|
| Rate for Payer: Innovage PACE Commercial |
$441.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,281.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$294.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$384.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$394.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$394.82
|
| Rate for Payer: Multiplan Commercial |
$1,441.50
|
| Rate for Payer: Networks By Design Commercial |
$1,249.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,633.70
|
| Rate for Payer: Prime Health Services Medicare |
$312.32
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,153.20
|
| Rate for Payer: Riverside University Health MISP |
$324.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,153.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,153.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$961.00
|
| Rate for Payer: United Healthcare All Other HMO |
$961.00
|
| Rate for Payer: United Healthcare HMO Rider |
$961.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$961.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$441.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: Vantage Medical Group Senior |
$294.64
|
|
|
HC STERNO CLAV JOINTS
|
Facility
OP
|
$895.00
|
|
|
Service Code
|
CPT 71130
|
| Hospital Charge Code |
909001428
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$113.54 |
| Max. Negotiated Rate |
$805.50 |
| Rate for Payer: Adventist Health Medi-Cal |
$113.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$149.96
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$113.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$145.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$177.37
|
| Rate for Payer: BCBS Transplant Transplant |
$537.00
|
| Rate for Payer: Blue Shield of California Commercial |
$553.11
|
| Rate for Payer: Blue Shield of California EPN |
$434.97
|
| Rate for Payer: Caremore Medicare Advantage |
$113.54
|
| Rate for Payer: Cash Price |
$402.75
|
| Rate for Payer: Cash Price |
$402.75
|
| Rate for Payer: Central Health Plan Commercial |
$716.00
|
| Rate for Payer: Cigna of CA HMO |
$572.80
|
| Rate for Payer: Cigna of CA PPO |
$662.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.28
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$113.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$113.54
|
| Rate for Payer: Galaxy Health WC |
$760.75
|
| Rate for Payer: Global Benefits Group Commercial |
$537.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$805.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$671.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$186.21
|
| Rate for Payer: IEHP medi-cal |
$187.34
|
| Rate for Payer: IEHP Medicare Advantage |
$113.54
|
| Rate for Payer: Innovage PACE Commercial |
$170.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$596.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$179.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$152.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$152.14
|
| Rate for Payer: Multiplan Commercial |
$671.25
|
| Rate for Payer: Networks By Design Commercial |
$581.75
|
| Rate for Payer: Prime Health Services Commercial |
$760.75
|
| Rate for Payer: Prime Health Services Medicare |
$120.35
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$537.00
|
| Rate for Payer: Riverside University Health MISP |
$124.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$537.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$537.00
|
| 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: Vantage Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Vantage Medical Group Senior |
$113.54
|
|
|
HC STERNO CLAV JOINTS
|
Facility
IP
|
$895.00
|
|
|
Service Code
|
CPT 71130
|
| Hospital Charge Code |
909001428
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$179.00 |
| Max. Negotiated Rate |
$805.50 |
| Rate for Payer: Cash Price |
$402.75
|
| Rate for Payer: Central Health Plan Commercial |
$716.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$358.00
|
| Rate for Payer: Galaxy Health WC |
$760.75
|
| Rate for Payer: Global Benefits Group Commercial |
$537.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$805.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$596.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$179.00
|
| Rate for Payer: Multiplan Commercial |
$671.25
|
| Rate for Payer: Networks By Design Commercial |
$581.75
|
| Rate for Payer: Prime Health Services Commercial |
$760.75
|
|
|
HC STERNUM
|
Facility
OP
|
$1,043.00
|
|
|
Service Code
|
CPT 71120
|
| Hospital Charge Code |
909001427
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$113.54 |
| Max. Negotiated Rate |
$938.70 |
| Rate for Payer: Adventist Health Medi-Cal |
$113.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$125.11
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$113.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$135.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$165.06
|
| Rate for Payer: BCBS Transplant Transplant |
$625.80
|
| Rate for Payer: Blue Shield of California Commercial |
$644.57
|
| Rate for Payer: Blue Shield of California EPN |
$506.90
|
| Rate for Payer: Caremore Medicare Advantage |
$113.54
|
| Rate for Payer: Cash Price |
$469.35
|
| Rate for Payer: Cash Price |
$469.35
|
| Rate for Payer: Central Health Plan Commercial |
$834.40
|
| Rate for Payer: Cigna of CA HMO |
$667.52
|
| Rate for Payer: Cigna of CA PPO |
$771.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.28
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$113.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$113.54
|
| Rate for Payer: Galaxy Health WC |
$886.55
|
| Rate for Payer: Global Benefits Group Commercial |
$625.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$938.70
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$782.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$186.21
|
| Rate for Payer: IEHP medi-cal |
$187.34
|
| Rate for Payer: IEHP Medicare Advantage |
$113.54
|
| Rate for Payer: Innovage PACE Commercial |
$170.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$695.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$208.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$152.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$152.14
|
| Rate for Payer: Multiplan Commercial |
$782.25
|
| Rate for Payer: Networks By Design Commercial |
$677.95
|
| Rate for Payer: Prime Health Services Commercial |
$886.55
|
| Rate for Payer: Prime Health Services Medicare |
$120.35
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$625.80
|
| Rate for Payer: Riverside University Health MISP |
$124.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$625.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$625.80
|
| 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: Vantage Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Vantage Medical Group Senior |
$113.54
|
|
|
HC STERNUM
|
Facility
IP
|
$1,043.00
|
|
|
Service Code
|
CPT 71120
|
| Hospital Charge Code |
909001427
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$208.60 |
| Max. Negotiated Rate |
$938.70 |
| Rate for Payer: Cash Price |
$469.35
|
| Rate for Payer: Central Health Plan Commercial |
$834.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$417.20
|
| Rate for Payer: Galaxy Health WC |
$886.55
|
| Rate for Payer: Global Benefits Group Commercial |
$625.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$938.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$695.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$208.60
|
| Rate for Payer: Multiplan Commercial |
$782.25
|
| Rate for Payer: Networks By Design Commercial |
$677.95
|
| Rate for Payer: Prime Health Services Commercial |
$886.55
|
|
|
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 |
$3,510.00 |
| Rate for Payer: Blue Shield of California EPN |
$2,082.60
|
| Rate for Payer: Cash Price |
$1,755.00
|
| 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 Transplant |
$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: LLUH Dept of Risk Management WC |
$780.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
|
|
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 |
$8,941.56 |
| Rate for Payer: Aetna of CA HMO/PPO |
$8,941.56
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,145.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,145.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,780.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,172.30
|
| Rate for Payer: BCBS Transplant Transplant |
$2,340.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,925.00
|
| Rate for Payer: Blue Shield of California EPN |
$2,121.60
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Cash Price |
$1,755.00
|
| 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: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$2,925.00
|
| Rate for Payer: IEHP medi-cal |
$1,365.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| 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: Riverside University Health 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 |
$1,950.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,950.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,950.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,950.00
|
| 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 |
$1,478.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,086.63
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,396.55
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$903.65
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$903.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$750.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$915.15
|
| Rate for Payer: BCBS Transplant Transplant |
$985.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,232.25
|
| Rate for Payer: Blue Shield of California EPN |
$893.79
|
| Rate for Payer: Cash Price |
$739.35
|
| Rate for Payer: Cash Price |
$739.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,314.40
|
| 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: EPIC Health Plan Commercial |
$657.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$657.20
|
| Rate for Payer: Galaxy Health WC |
$1,396.55
|
| Rate for Payer: Global Benefits Group Commercial |
$985.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,478.70
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,232.25
|
| Rate for Payer: IEHP medi-cal |
$575.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,095.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$328.60
|
| Rate for Payer: Multiplan Commercial |
$1,232.25
|
| Rate for Payer: Networks By Design Commercial |
$821.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,396.55
|
| Rate for Payer: Riverside University Health MISP |
$657.20
|
| 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 |
$821.50
|
| Rate for Payer: United Healthcare All Other HMO |
$821.50
|
| Rate for Payer: United Healthcare HMO Rider |
$821.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$821.50
|
| 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 |
$1,478.70 |
| Rate for Payer: Blue Shield of California EPN |
$877.36
|
| Rate for Payer: Cash Price |
$739.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,314.40
|
| Rate for Payer: Cigna of CA HMO |
$1,150.10
|
| Rate for Payer: Cigna of CA PPO |
$1,150.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$657.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$657.20
|
| Rate for Payer: Galaxy Health WC |
$1,396.55
|
| Rate for Payer: Global Benefits Group Commercial |
$985.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,478.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,095.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$328.60
|
| Rate for Payer: Multiplan Commercial |
$1,232.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,396.55
|
|
|
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 |
$2,149.20 |
| Rate for Payer: Blue Shield of California EPN |
$1,275.19
|
| Rate for Payer: Cash Price |
$1,074.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,910.40
|
| Rate for Payer: Cigna of CA HMO |
$1,671.60
|
| Rate for Payer: Cigna of CA PPO |
$1,671.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$955.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$955.20
|
| Rate for Payer: Galaxy Health WC |
$2,029.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,432.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,149.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,592.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$477.60
|
| Rate for Payer: Multiplan Commercial |
$1,791.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,029.80
|
|
|
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 |
$8,941.56 |
| Rate for Payer: Aetna of CA HMO/PPO |
$8,941.56
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,029.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,313.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,313.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,090.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,330.12
|
| Rate for Payer: BCBS Transplant Transplant |
$1,432.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,791.00
|
| Rate for Payer: Blue Shield of California EPN |
$1,299.07
|
| Rate for Payer: Cash Price |
$1,074.60
|
| Rate for Payer: Cash Price |
$1,074.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,910.40
|
| 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: EPIC Health Plan Commercial |
$955.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$955.20
|
| Rate for Payer: Galaxy Health WC |
$2,029.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,432.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,149.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,791.00
|
| Rate for Payer: IEHP medi-cal |
$835.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,592.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$477.60
|
| Rate for Payer: Multiplan Commercial |
$1,791.00
|
| Rate for Payer: Networks By Design Commercial |
$1,194.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,029.80
|
| Rate for Payer: Riverside University Health MISP |
$955.20
|
| 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 |
$1,194.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,194.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,194.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,194.00
|
| 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 |
$8,941.56 |
| Rate for Payer: Aetna of CA HMO/PPO |
$8,941.56
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,145.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,145.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,780.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,172.30
|
| Rate for Payer: BCBS Transplant Transplant |
$2,340.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,925.00
|
| Rate for Payer: Blue Shield of California EPN |
$2,121.60
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Cash Price |
$1,755.00
|
| 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: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$2,925.00
|
| Rate for Payer: IEHP medi-cal |
$1,365.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| 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: Riverside University Health 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 |
$1,950.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,950.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,950.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,950.00
|
| 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 |
$3,510.00 |
| Rate for Payer: Blue Shield of California EPN |
$2,082.60
|
| Rate for Payer: Cash Price |
$1,755.00
|
| 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 Transplant |
$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: LLUH Dept of Risk Management WC |
$780.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
|
|
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 |
$1,350.00 |
| Rate for Payer: Blue Shield of California EPN |
$801.00
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,200.00
|
| Rate for Payer: Cigna of CA HMO |
$1,050.00
|
| Rate for Payer: Cigna of CA PPO |
$1,050.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$600.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$600.00
|
| Rate for Payer: Galaxy Health WC |
$1,275.00
|
| Rate for Payer: Global Benefits Group Commercial |
$900.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,350.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,000.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$300.00
|
| Rate for Payer: Multiplan Commercial |
$1,125.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,275.00
|
|
|
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 |
$1,350.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,086.63
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,275.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$825.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$825.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$684.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$835.50
|
| Rate for Payer: BCBS Transplant Transplant |
$900.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,125.00
|
| Rate for Payer: Blue Shield of California EPN |
$816.00
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,200.00
|
| 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: EPIC Health Plan Commercial |
$600.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$600.00
|
| Rate for Payer: Galaxy Health WC |
$1,275.00
|
| Rate for Payer: Global Benefits Group Commercial |
$900.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,350.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,125.00
|
| Rate for Payer: IEHP medi-cal |
$525.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,000.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$300.00
|
| Rate for Payer: Multiplan Commercial |
$1,125.00
|
| Rate for Payer: Networks By Design Commercial |
$750.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,275.00
|
| Rate for Payer: Riverside University Health MISP |
$600.00
|
| 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 |
$750.00
|
| Rate for Payer: United Healthcare All Other HMO |
$750.00
|
| Rate for Payer: United Healthcare HMO Rider |
$750.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$750.00
|
| 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 |
$1,620.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,086.63
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,530.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$990.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$990.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$821.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,002.60
|
| Rate for Payer: BCBS Transplant Transplant |
$1,080.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,350.00
|
| Rate for Payer: Blue Shield of California EPN |
$979.20
|
| Rate for Payer: Cash Price |
$810.00
|
| Rate for Payer: Cash Price |
$810.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,440.00
|
| Rate for Payer: Cigna of CA HMO |
$1,260.00
|
| Rate for Payer: Cigna of CA PPO |
$1,260.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,530.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$720.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$720.00
|
| Rate for Payer: Galaxy Health WC |
$1,530.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,080.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,620.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,350.00
|
| Rate for Payer: IEHP medi-cal |
$630.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,200.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$360.00
|
| Rate for Payer: Multiplan Commercial |
$1,350.00
|
| Rate for Payer: Networks By Design Commercial |
$900.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,530.00
|
| Rate for Payer: Riverside University Health MISP |
$720.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,080.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,080.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$900.00
|
| Rate for Payer: United Healthcare All Other HMO |
$900.00
|
| Rate for Payer: United Healthcare HMO Rider |
$900.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$900.00
|
| 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 |
$1,620.00 |
| Rate for Payer: Blue Shield of California EPN |
$961.20
|
| Rate for Payer: Cash Price |
$810.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,440.00
|
| Rate for Payer: Cigna of CA HMO |
$1,260.00
|
| Rate for Payer: Cigna of CA PPO |
$1,260.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$720.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$720.00
|
| Rate for Payer: Galaxy Health WC |
$1,530.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,080.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,620.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,200.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$360.00
|
| Rate for Payer: Multiplan Commercial |
$1,350.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,530.00
|
|
|
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 |
$8,941.56 |
| Rate for Payer: Aetna of CA HMO/PPO |
$8,941.56
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,417.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,211.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,211.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,835.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,239.14
|
| Rate for Payer: BCBS Transplant Transplant |
$2,412.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,015.00
|
| Rate for Payer: Blue Shield of California EPN |
$2,186.88
|
| Rate for Payer: Cash Price |
$1,809.00
|
| Rate for Payer: Cash Price |
$1,809.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,216.00
|
| 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: EPIC Health Plan Commercial |
$1,608.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Management Network EPO/PPO |
$3,618.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3,015.00
|
| Rate for Payer: IEHP medi-cal |
$1,407.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,681.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$804.00
|
| Rate for Payer: Multiplan Commercial |
$3,015.00
|
| Rate for Payer: Networks By Design Commercial |
$2,010.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,417.00
|
| Rate for Payer: Riverside University Health MISP |
$1,608.00
|
| 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 |
$2,010.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,010.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,010.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,010.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,417.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,417.00
|
|
|
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 |
$3,618.00 |
| Rate for Payer: Blue Shield of California EPN |
$2,146.68
|
| Rate for Payer: Cash Price |
$1,809.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,216.00
|
| Rate for Payer: Cigna of CA HMO |
$2,814.00
|
| Rate for Payer: Cigna of CA PPO |
$2,814.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,608.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Management Network EPO/PPO |
$3,618.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,681.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$804.00
|
| Rate for Payer: Multiplan Commercial |
$3,015.00
|
| Rate for Payer: Prime Health Services Commercial |
$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 |
$8,941.56 |
| Rate for Payer: Aetna of CA HMO/PPO |
$8,941.56
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,460.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$944.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$944.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$784.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$956.93
|
| Rate for Payer: BCBS Transplant Transplant |
$1,030.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,288.50
|
| Rate for Payer: Blue Shield of California EPN |
$934.59
|
| Rate for Payer: Cash Price |
$773.10
|
| Rate for Payer: Cash Price |
$773.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,374.40
|
| 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: EPIC Health Plan Commercial |
$687.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$687.20
|
| Rate for Payer: Galaxy Health WC |
$1,460.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,030.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,546.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,288.50
|
| Rate for Payer: IEHP medi-cal |
$601.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,145.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$343.60
|
| Rate for Payer: Multiplan Commercial |
$1,288.50
|
| Rate for Payer: Networks By Design Commercial |
$859.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,460.30
|
| Rate for Payer: Riverside University Health MISP |
$687.20
|
| 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 |
$859.00
|
| Rate for Payer: United Healthcare All Other HMO |
$859.00
|
| Rate for Payer: United Healthcare HMO Rider |
$859.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$859.00
|
| 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 |
$1,546.20 |
| Rate for Payer: Blue Shield of California EPN |
$917.41
|
| Rate for Payer: Cash Price |
$773.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,374.40
|
| Rate for Payer: Cigna of CA HMO |
$1,202.60
|
| Rate for Payer: Cigna of CA PPO |
$1,202.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$687.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$687.20
|
| Rate for Payer: Galaxy Health WC |
$1,460.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,030.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,546.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,145.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$343.60
|
| Rate for Payer: Multiplan Commercial |
$1,288.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,460.30
|
|
|
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 |
$8,941.56 |
| Rate for Payer: Aetna of CA HMO/PPO |
$8,941.56
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,530.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$990.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$990.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$821.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,002.60
|
| Rate for Payer: BCBS Transplant Transplant |
$1,080.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,350.00
|
| Rate for Payer: Blue Shield of California EPN |
$979.20
|
| Rate for Payer: Cash Price |
$810.00
|
| Rate for Payer: Cash Price |
$810.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,440.00
|
| Rate for Payer: Cigna of CA HMO |
$1,260.00
|
| Rate for Payer: Cigna of CA PPO |
$1,260.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,530.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$720.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$720.00
|
| Rate for Payer: Galaxy Health WC |
$1,530.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,080.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,620.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,350.00
|
| Rate for Payer: IEHP medi-cal |
$630.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,200.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$360.00
|
| Rate for Payer: Multiplan Commercial |
$1,350.00
|
| Rate for Payer: Networks By Design Commercial |
$900.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,530.00
|
| Rate for Payer: Riverside University Health MISP |
$720.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,080.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,080.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$900.00
|
| Rate for Payer: United Healthcare All Other HMO |
$900.00
|
| Rate for Payer: United Healthcare HMO Rider |
$900.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$900.00
|
| 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 |
$1,620.00 |
| Rate for Payer: Blue Shield of California EPN |
$961.20
|
| Rate for Payer: Cash Price |
$810.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,440.00
|
| Rate for Payer: Cigna of CA HMO |
$1,260.00
|
| Rate for Payer: Cigna of CA PPO |
$1,260.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$720.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$720.00
|
| Rate for Payer: Galaxy Health WC |
$1,530.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,080.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,620.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,200.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$360.00
|
| Rate for Payer: Multiplan Commercial |
$1,350.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,530.00
|
|
