|
HC STNT ATRIUM ICAST
|
Facility
|
IP
|
$6,437.50
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
906812461
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,287.50 |
| Max. Negotiated Rate |
$5,793.75 |
| Rate for Payer: Adventist Health Commercial |
$1,287.50
|
| Rate for Payer: Blue Shield of California Commercial |
$4,976.19
|
| Rate for Payer: Blue Shield of California EPN |
$3,244.50
|
| Rate for Payer: Cash Price |
$3,540.63
|
| Rate for Payer: Central Health Plan Commercial |
$5,150.00
|
| Rate for Payer: Cigna of CA HMO |
$4,506.25
|
| Rate for Payer: Cigna of CA PPO |
$4,506.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,575.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,575.00
|
| Rate for Payer: Galaxy Health WC |
$5,471.88
|
| Rate for Payer: Global Benefits Group Commercial |
$3,862.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,793.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,293.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,452.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,984.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,287.50
|
| Rate for Payer: Multiplan Commercial |
$4,828.12
|
| Rate for Payer: Networks By Design Commercial |
$3,218.75
|
| Rate for Payer: Prime Health Services Commercial |
$5,471.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,415.99
|
| Rate for Payer: United Healthcare All Other HMO |
$2,351.62
|
| Rate for Payer: United Healthcare HMO Rider |
$2,300.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,108.28
|
|
|
HC STNT ATRIUM ICAST 22MM
|
Facility
|
IP
|
$5,973.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
906812673
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,194.60 |
| Max. Negotiated Rate |
$5,375.70 |
| Rate for Payer: Adventist Health Commercial |
$1,194.60
|
| Rate for Payer: Blue Shield of California Commercial |
$4,617.13
|
| Rate for Payer: Blue Shield of California EPN |
$3,010.39
|
| Rate for Payer: Cash Price |
$3,285.15
|
| Rate for Payer: Central Health Plan Commercial |
$4,778.40
|
| Rate for Payer: Cigna of CA HMO |
$4,181.10
|
| Rate for Payer: Cigna of CA PPO |
$4,181.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,389.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,389.20
|
| Rate for Payer: Galaxy Health WC |
$5,077.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,583.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,375.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,983.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,275.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,697.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,194.60
|
| Rate for Payer: Multiplan Commercial |
$4,479.75
|
| Rate for Payer: Networks By Design Commercial |
$2,986.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,077.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,241.67
|
| Rate for Payer: United Healthcare All Other HMO |
$2,181.94
|
| Rate for Payer: United Healthcare HMO Rider |
$2,134.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,956.16
|
|
|
HC STNT ATRIUM ICAST 22MM
|
Facility
|
OP
|
$5,973.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
906812673
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,194.60 |
| Max. Negotiated Rate |
$5,375.70 |
| Rate for Payer: Adventist Health Commercial |
$1,194.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,077.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,285.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,479.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,727.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,307.25
|
| Rate for Payer: Blue Shield of California Commercial |
$4,617.13
|
| Rate for Payer: Blue Shield of California EPN |
$3,010.39
|
| Rate for Payer: Cash Price |
$3,285.15
|
| Rate for Payer: Central Health Plan Commercial |
$4,778.40
|
| Rate for Payer: Cigna of CA HMO |
$4,181.10
|
| Rate for Payer: Cigna of CA PPO |
$4,181.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,077.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,077.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,077.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,389.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,389.20
|
| Rate for Payer: Galaxy Health WC |
$5,077.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,583.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,375.70
|
| Rate for Payer: InnovAge PACE Commercial |
$2,986.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,983.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,697.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,194.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,181.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,181.10
|
| Rate for Payer: Multiplan Commercial |
$4,479.75
|
| Rate for Payer: Networks By Design Commercial |
$2,986.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,077.05
|
| Rate for Payer: Riverside University Health System MISP |
$2,389.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,583.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,583.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,241.67
|
| Rate for Payer: United Healthcare All Other HMO |
$2,181.94
|
| Rate for Payer: United Healthcare HMO Rider |
$2,134.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,956.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,077.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,077.05
|
| Rate for Payer: Vantage Medical Group Senior |
$5,077.05
|
|
|
HC STNT ATRIUM ICAST 38MM
|
Facility
|
OP
|
$6,116.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
906812674
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,223.20 |
| Max. Negotiated Rate |
$5,504.40 |
| Rate for Payer: Adventist Health Commercial |
$1,223.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,198.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,363.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,792.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,386.43
|
| Rate for Payer: Blue Shield of California Commercial |
$4,727.67
|
| Rate for Payer: Blue Shield of California EPN |
$3,082.46
|
| Rate for Payer: Cash Price |
$3,363.80
|
| Rate for Payer: Central Health Plan Commercial |
$4,892.80
|
| Rate for Payer: Cigna of CA HMO |
$4,281.20
|
| Rate for Payer: Cigna of CA PPO |
$4,281.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,198.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,198.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,198.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,446.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,446.40
|
| Rate for Payer: Galaxy Health WC |
$5,198.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,669.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,504.40
|
| Rate for Payer: InnovAge PACE Commercial |
$3,058.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,079.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,785.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,223.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,281.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,281.20
|
| Rate for Payer: Multiplan Commercial |
$4,587.00
|
| Rate for Payer: Networks By Design Commercial |
$3,058.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,198.60
|
| Rate for Payer: Riverside University Health System MISP |
$2,446.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,669.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,669.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,295.33
|
| Rate for Payer: United Healthcare All Other HMO |
$2,234.17
|
| Rate for Payer: United Healthcare HMO Rider |
$2,185.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,002.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,198.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,198.60
|
| Rate for Payer: Vantage Medical Group Senior |
$5,198.60
|
|
|
HC STNT ATRIUM ICAST 38MM
|
Facility
|
IP
|
$6,116.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
906812674
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,223.20 |
| Max. Negotiated Rate |
$5,504.40 |
| Rate for Payer: Adventist Health Commercial |
$1,223.20
|
| Rate for Payer: Blue Shield of California Commercial |
$4,727.67
|
| Rate for Payer: Blue Shield of California EPN |
$3,082.46
|
| Rate for Payer: Cash Price |
$3,363.80
|
| Rate for Payer: Central Health Plan Commercial |
$4,892.80
|
| Rate for Payer: Cigna of CA HMO |
$4,281.20
|
| Rate for Payer: Cigna of CA PPO |
$4,281.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,446.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,446.40
|
| Rate for Payer: Galaxy Health WC |
$5,198.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,669.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,504.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,079.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,330.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,785.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,223.20
|
| Rate for Payer: Multiplan Commercial |
$4,587.00
|
| Rate for Payer: Networks By Design Commercial |
$3,058.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,198.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,295.33
|
| Rate for Payer: United Healthcare All Other HMO |
$2,234.17
|
| Rate for Payer: United Healthcare HMO Rider |
$2,185.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,002.99
|
|
|
HC STNT ATRIUM ICAST 59MM
|
Facility
|
OP
|
$6,591.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
906812675
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,318.20 |
| Max. Negotiated Rate |
$5,931.90 |
| Rate for Payer: Adventist Health Commercial |
$1,318.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,602.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,625.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,943.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,009.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,649.44
|
| Rate for Payer: Blue Shield of California Commercial |
$5,094.84
|
| Rate for Payer: Blue Shield of California EPN |
$3,321.86
|
| Rate for Payer: Cash Price |
$3,625.05
|
| Rate for Payer: Central Health Plan Commercial |
$5,272.80
|
| Rate for Payer: Cigna of CA HMO |
$4,613.70
|
| Rate for Payer: Cigna of CA PPO |
$4,613.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,602.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,602.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,602.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,636.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,636.40
|
| Rate for Payer: Galaxy Health WC |
$5,602.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,954.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,931.90
|
| Rate for Payer: InnovAge PACE Commercial |
$3,295.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,396.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,079.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,318.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,613.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,613.70
|
| Rate for Payer: Multiplan Commercial |
$4,943.25
|
| Rate for Payer: Networks By Design Commercial |
$3,295.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,602.35
|
| Rate for Payer: Riverside University Health System MISP |
$2,636.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,954.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,954.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,473.60
|
| Rate for Payer: United Healthcare All Other HMO |
$2,407.69
|
| Rate for Payer: United Healthcare HMO Rider |
$2,355.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,158.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,602.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,602.35
|
| Rate for Payer: Vantage Medical Group Senior |
$5,602.35
|
|
|
HC STNT ATRIUM ICAST 59MM
|
Facility
|
IP
|
$6,591.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
906812675
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,318.20 |
| Max. Negotiated Rate |
$5,931.90 |
| Rate for Payer: Adventist Health Commercial |
$1,318.20
|
| Rate for Payer: Blue Shield of California Commercial |
$5,094.84
|
| Rate for Payer: Blue Shield of California EPN |
$3,321.86
|
| Rate for Payer: Cash Price |
$3,625.05
|
| Rate for Payer: Central Health Plan Commercial |
$5,272.80
|
| Rate for Payer: Cigna of CA HMO |
$4,613.70
|
| Rate for Payer: Cigna of CA PPO |
$4,613.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,636.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,636.40
|
| Rate for Payer: Galaxy Health WC |
$5,602.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,954.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,931.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,396.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,511.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,079.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,318.20
|
| Rate for Payer: Multiplan Commercial |
$4,943.25
|
| Rate for Payer: Networks By Design Commercial |
$3,295.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,602.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,473.60
|
| Rate for Payer: United Healthcare All Other HMO |
$2,407.69
|
| Rate for Payer: United Healthcare HMO Rider |
$2,355.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,158.55
|
|
|
HC STNT BARD VALEO BILIARY
|
Facility
|
OP
|
$3,900.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
906812460
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,510.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,145.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,925.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,780.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,159.43
|
| Rate for Payer: Blue Shield of California Commercial |
$3,014.70
|
| Rate for Payer: Blue Shield of California EPN |
$1,965.60
|
| Rate for Payer: Cash Price |
$2,145.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.00
|
| Rate for Payer: Cigna of CA HMO |
$2,730.00
|
| Rate for Payer: Cigna of CA PPO |
$2,730.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,315.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,315.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,510.00
|
| Rate for Payer: InnovAge PACE Commercial |
$1,950.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$780.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,730.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,730.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: Networks By Design Commercial |
$1,950.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| Rate for Payer: Riverside University Health System MISP |
$1,560.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,340.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,340.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,463.67
|
| Rate for Payer: United Healthcare All Other HMO |
$1,424.67
|
| Rate for Payer: United Healthcare HMO Rider |
$1,393.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,277.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,315.00
|
|
|
HC STNT BARD VALEO BILIARY
|
Facility
|
IP
|
$3,900.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
906812460
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,510.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,014.70
|
| Rate for Payer: Blue Shield of California EPN |
$1,965.60
|
| Rate for Payer: Cash Price |
$2,145.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.00
|
| Rate for Payer: Cigna of CA HMO |
$2,730.00
|
| Rate for Payer: Cigna of CA PPO |
$2,730.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,510.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$780.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: Networks By Design Commercial |
$1,950.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,463.67
|
| Rate for Payer: United Healthcare All Other HMO |
$1,424.67
|
| Rate for Payer: United Healthcare HMO Rider |
$1,393.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,277.25
|
|
|
HC STNT 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 |
$3,510.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,145.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,925.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,780.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,159.43
|
| Rate for Payer: Blue Shield of California Commercial |
$3,014.70
|
| Rate for Payer: Blue Shield of California EPN |
$1,965.60
|
| Rate for Payer: Cash Price |
$2,145.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.00
|
| Rate for Payer: Cigna of CA HMO |
$2,730.00
|
| Rate for Payer: Cigna of CA PPO |
$2,730.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,315.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,315.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,510.00
|
| Rate for Payer: InnovAge PACE Commercial |
$1,950.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$780.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,730.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,730.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: Networks By Design Commercial |
$1,950.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| Rate for Payer: Riverside University Health System MISP |
$1,560.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,340.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,340.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,463.67
|
| Rate for Payer: United Healthcare All Other HMO |
$1,424.67
|
| Rate for Payer: United Healthcare HMO Rider |
$1,393.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,277.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,315.00
|
|
|
HC STNT 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: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,014.70
|
| Rate for Payer: Blue Shield of California EPN |
$1,965.60
|
| Rate for Payer: Cash Price |
$2,145.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.00
|
| Rate for Payer: Cigna of CA HMO |
$2,730.00
|
| Rate for Payer: Cigna of CA PPO |
$2,730.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,510.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$780.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: Networks By Design Commercial |
$1,950.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,463.67
|
| Rate for Payer: United Healthcare All Other HMO |
$1,424.67
|
| Rate for Payer: United Healthcare HMO Rider |
$1,393.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,277.25
|
|
|
HC STNT 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: Adventist Health Commercial |
$328.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,270.04
|
| Rate for Payer: Blue Shield of California EPN |
$828.07
|
| Rate for Payer: Cash Price |
$903.65
|
| 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 Senior |
$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: Kaiser Permanente of CA Medi-Cal |
$625.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,017.02
|
| 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: 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 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: 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 Exchange |
$750.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$909.73
|
| Rate for Payer: Blue Shield of California Commercial |
$1,270.04
|
| Rate for Payer: Blue Shield of California EPN |
$828.07
|
| Rate for Payer: Cash Price |
$903.65
|
| 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: Dignity Health Medi-Cal |
$1,396.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,396.55
|
| 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: Health Management Network EPO/PPO |
$1,478.70
|
| Rate for Payer: InnovAge PACE Commercial |
$821.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,095.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$625.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,017.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$328.60
|
| 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 |
$1,232.25
|
| 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 System 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 |
$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 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 |
$2,149.20 |
| 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 Exchange |
$1,090.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,322.24
|
| Rate for Payer: Blue Shield of California Commercial |
$1,845.92
|
| Rate for Payer: Blue Shield of California EPN |
$1,203.55
|
| Rate for Payer: Cash Price |
$1,313.40
|
| 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: Dignity Health Medi-Cal |
$2,029.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,029.80
|
| 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: Health Management Network EPO/PPO |
$2,149.20
|
| Rate for Payer: InnovAge PACE Commercial |
$1,194.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,592.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$909.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,478.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$477.60
|
| 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 |
$1,791.00
|
| 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 System 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 |
$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 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: Adventist Health Commercial |
$477.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,845.92
|
| Rate for Payer: Blue Shield of California EPN |
$1,203.55
|
| Rate for Payer: Cash Price |
$1,313.40
|
| 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 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: Health Management Network EPO/PPO |
$2,149.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,592.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$909.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,478.17
|
| 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: 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 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 |
$3,510.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,145.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,925.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,780.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,159.43
|
| Rate for Payer: Blue Shield of California Commercial |
$3,014.70
|
| Rate for Payer: Blue Shield of California EPN |
$1,965.60
|
| Rate for Payer: Cash Price |
$2,145.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.00
|
| Rate for Payer: Cigna of CA HMO |
$2,730.00
|
| Rate for Payer: Cigna of CA PPO |
$2,730.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,315.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,315.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,510.00
|
| Rate for Payer: InnovAge PACE Commercial |
$1,950.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$780.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,730.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,730.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: Networks By Design Commercial |
$1,950.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| Rate for Payer: Riverside University Health System MISP |
$1,560.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,340.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,340.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,463.67
|
| Rate for Payer: United Healthcare All Other HMO |
$1,424.67
|
| Rate for Payer: United Healthcare HMO Rider |
$1,393.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,277.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,315.00
|
|
|
HC STNT 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: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,014.70
|
| Rate for Payer: Blue Shield of California EPN |
$1,965.60
|
| Rate for Payer: Cash Price |
$2,145.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.00
|
| Rate for Payer: Cigna of CA HMO |
$2,730.00
|
| Rate for Payer: Cigna of CA PPO |
$2,730.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,510.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$780.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: Networks By Design Commercial |
$1,950.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,463.67
|
| Rate for Payer: United Healthcare All Other HMO |
$1,424.67
|
| Rate for Payer: United Healthcare HMO Rider |
$1,393.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,277.25
|
|
|
HC STNT 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: 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 Exchange |
$684.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$830.55
|
| Rate for Payer: Blue Shield of California Commercial |
$1,159.50
|
| Rate for Payer: Blue Shield of California EPN |
$756.00
|
| Rate for Payer: Cash Price |
$825.00
|
| 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: Dignity Health Medi-Cal |
$1,275.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,275.00
|
| 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: Health Management Network EPO/PPO |
$1,350.00
|
| Rate for Payer: InnovAge PACE Commercial |
$750.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,000.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$571.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$928.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$300.00
|
| 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 |
$1,125.00
|
| 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 System 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 |
$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 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: Adventist Health Commercial |
$300.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,159.50
|
| Rate for Payer: Blue Shield of California EPN |
$756.00
|
| Rate for Payer: Cash Price |
$825.00
|
| 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 Senior |
$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: Kaiser Permanente of CA Medi-Cal |
$571.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$928.50
|
| 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: 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 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: Adventist Health Commercial |
$360.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,391.40
|
| Rate for Payer: Blue Shield of California EPN |
$907.20
|
| Rate for Payer: Cash Price |
$990.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,440.00
|
| Rate for Payer: Cigna of CA HMO |
$1,260.00
|
| Rate for Payer: Cigna of CA PPO |
$1,260.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$720.00
|
| Rate for Payer: EPIC Health Plan Senior |
$720.00
|
| Rate for Payer: Galaxy Health WC |
$1,530.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,080.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,620.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,200.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$685.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,114.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$360.00
|
| Rate for Payer: Multiplan Commercial |
$1,350.00
|
| Rate for Payer: Networks By Design Commercial |
$900.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,530.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$675.54
|
| Rate for Payer: United Healthcare All Other HMO |
$657.54
|
| Rate for Payer: United Healthcare HMO Rider |
$643.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$589.50
|
|
|
HC STNT 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: Adventist Health Commercial |
$360.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,530.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$990.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,350.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$821.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$996.66
|
| Rate for Payer: Blue Shield of California Commercial |
$1,391.40
|
| Rate for Payer: Blue Shield of California EPN |
$907.20
|
| Rate for Payer: Cash Price |
$990.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,440.00
|
| Rate for Payer: Cigna of CA HMO |
$1,260.00
|
| Rate for Payer: Cigna of CA PPO |
$1,260.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,530.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,530.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,530.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$720.00
|
| Rate for Payer: EPIC Health Plan Senior |
$720.00
|
| Rate for Payer: Galaxy Health WC |
$1,530.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,080.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,620.00
|
| Rate for Payer: InnovAge PACE Commercial |
$900.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,200.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$685.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,114.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$360.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,260.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,260.00
|
| Rate for Payer: Multiplan Commercial |
$1,350.00
|
| Rate for Payer: Networks By Design Commercial |
$900.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,530.00
|
| Rate for Payer: Riverside University Health System MISP |
$720.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,080.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,080.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$675.54
|
| Rate for Payer: United Healthcare All Other HMO |
$657.54
|
| Rate for Payer: United Healthcare HMO Rider |
$643.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$589.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,530.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,530.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,530.00
|
|
|
HC STNT 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 |
$3,618.00 |
| 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 Exchange |
$1,835.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,225.87
|
| Rate for Payer: Blue Shield of California Commercial |
$3,107.46
|
| Rate for Payer: Blue Shield of California EPN |
$2,026.08
|
| Rate for Payer: Cash Price |
$2,211.00
|
| 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: Dignity Health Medi-Cal |
$3,417.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,417.00
|
| 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: Health Management Network EPO/PPO |
$3,618.00
|
| Rate for Payer: InnovAge PACE Commercial |
$2,010.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,681.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,531.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,488.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$804.00
|
| 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 |
$3,015.00
|
| 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 System 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 |
$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 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: Adventist Health Commercial |
$804.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,107.46
|
| Rate for Payer: Blue Shield of California EPN |
$2,026.08
|
| Rate for Payer: Cash Price |
$2,211.00
|
| 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 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: Health Management Network EPO/PPO |
$3,618.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,681.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,531.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,488.38
|
| 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: 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 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: Adventist Health Commercial |
$343.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,328.01
|
| Rate for Payer: Blue Shield of California EPN |
$865.87
|
| Rate for Payer: Cash Price |
$944.90
|
| 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 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: Health Management Network EPO/PPO |
$1,546.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,145.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$654.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,063.44
|
| 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: 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 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 |
$1,546.20 |
| 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 Exchange |
$784.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$951.26
|
| Rate for Payer: Blue Shield of California Commercial |
$1,328.01
|
| Rate for Payer: Blue Shield of California EPN |
$865.87
|
| Rate for Payer: Cash Price |
$944.90
|
| 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: Dignity Health Medi-Cal |
$1,460.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,460.30
|
| 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: Health Management Network EPO/PPO |
$1,546.20
|
| Rate for Payer: InnovAge PACE Commercial |
$859.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,145.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$654.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,063.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$343.60
|
| 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 |
$1,288.50
|
| 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 System 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 |
$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
|
|
