|
HC STENT TIBIOPERONEAL
|
Facility
|
OP
|
$22,445.00
|
|
|
Service Code
|
CPT 37230
|
| Hospital Charge Code |
909020071
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$43,350.04 |
| Rate for Payer: Adventist Health Commercial |
$4,489.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15,419.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22,815.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,785.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$12,344.75
|
| Rate for Payer: Cash Price |
$12,344.75
|
| Rate for Payer: Cash Price |
$12,344.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14,589.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,097.39
|
| Rate for Payer: Dignity Health Senior |
$22,815.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$22,815.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$13,893.45
|
| Rate for Payer: Heritage Provider Network Senior |
$28,063.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$963.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,815.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$43,350.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,062.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26,238.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,611.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28,747.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28,747.92
|
| Rate for Payer: Multiplan Commercial |
$16,833.75
|
| Rate for Payer: Multiplan WC |
$36,352.92
|
| Rate for Payer: TriValley Medical Group Commercial |
$25,097.39
|
| Rate for Payer: TriValley Medical Group Senior |
$25,097.39
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,861.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,025.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Vantage Medical Group Senior |
$22,815.81
|
|
|
HC STENT TIBIOPERONEAL
|
Facility
|
OP
|
$26,601.00
|
|
|
Service Code
|
CPT 37230
|
| Hospital Charge Code |
906820154
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$43,350.04 |
| Rate for Payer: Adventist Health Commercial |
$5,320.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18,274.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22,815.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,785.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$14,630.55
|
| Rate for Payer: Cash Price |
$14,630.55
|
| Rate for Payer: Cash Price |
$14,630.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$17,290.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,097.39
|
| Rate for Payer: Dignity Health Senior |
$22,815.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$22,815.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$16,466.02
|
| Rate for Payer: Heritage Provider Network Senior |
$28,063.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$963.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,815.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$43,350.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,814.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26,238.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,650.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28,747.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28,747.92
|
| Rate for Payer: Multiplan Commercial |
$19,950.75
|
| Rate for Payer: Multiplan WC |
$36,352.92
|
| Rate for Payer: TriValley Medical Group Commercial |
$25,097.39
|
| Rate for Payer: TriValley Medical Group Senior |
$25,097.39
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,861.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,025.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Vantage Medical Group Senior |
$22,815.81
|
|
|
HC STENT TIBIOPERONEAL EA ADDL
|
Facility
|
IP
|
$13,536.00
|
|
|
Service Code
|
CPT 37234
|
| Hospital Charge Code |
909020075
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,450.02 |
| Max. Negotiated Rate |
$10,152.00 |
| Rate for Payer: Adventist Health Commercial |
$2,707.20
|
| Rate for Payer: Cash Price |
$7,444.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,163.87
|
| Rate for Payer: Heritage Provider Network Senior |
$9,163.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,450.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,384.00
|
| Rate for Payer: Multiplan Commercial |
$10,152.00
|
|
|
HC STENT TIBIOPERONEAL EA ADDL
|
Facility
|
OP
|
$13,536.00
|
|
|
Service Code
|
CPT 37234
|
| Hospital Charge Code |
909020075
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$14,160.00 |
| Rate for Payer: Adventist Health Commercial |
$2,707.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,299.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,505.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,444.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,152.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$7,444.80
|
| Rate for Payer: Cash Price |
$7,444.80
|
| Rate for Payer: Cash Price |
$7,444.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8,798.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,505.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,505.60
|
| Rate for Payer: Dignity Health Senior |
$11,505.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,378.78
|
| Rate for Payer: Heritage Provider Network Senior |
$8,378.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$381.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6,456.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,450.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,384.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,475.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,475.20
|
| Rate for Payer: Multiplan Commercial |
$10,152.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14,160.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,956.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,505.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,505.60
|
| Rate for Payer: Vantage Medical Group Senior |
$11,505.60
|
|
|
HC STENT TIBIOPERONEAL EA ADDL
|
Facility
|
IP
|
$15,314.00
|
|
|
Service Code
|
CPT 37234
|
| Hospital Charge Code |
906820158
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,771.83 |
| Max. Negotiated Rate |
$11,485.50 |
| Rate for Payer: Adventist Health Commercial |
$3,062.80
|
| Rate for Payer: Cash Price |
$8,422.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$10,367.58
|
| Rate for Payer: Heritage Provider Network Senior |
$10,367.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,771.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,828.50
|
| Rate for Payer: Multiplan Commercial |
$11,485.50
|
|
|
HC STENT TIBIOPERONEAL EA ADDL
|
Facility
|
OP
|
$15,314.00
|
|
|
Service Code
|
CPT 37234
|
| Hospital Charge Code |
906820158
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$14,160.00 |
| Rate for Payer: Adventist Health Commercial |
$3,062.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10,520.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,016.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,422.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11,485.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$8,422.70
|
| Rate for Payer: Cash Price |
$8,422.70
|
| Rate for Payer: Cash Price |
$8,422.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9,954.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,016.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$13,016.90
|
| Rate for Payer: Dignity Health Senior |
$13,016.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,479.37
|
| Rate for Payer: Heritage Provider Network Senior |
$9,479.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$381.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,304.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,771.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,828.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,719.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,719.80
|
| Rate for Payer: Multiplan Commercial |
$11,485.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14,160.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,956.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,016.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13,016.90
|
| Rate for Payer: Vantage Medical Group Senior |
$13,016.90
|
|
|
HC STENT ULTRAFLEX T-B COV W/DEL
|
Facility
|
IP
|
$3,053.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
900803704
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$610.60 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$610.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,465.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,227.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,227.31
|
| Rate for Payer: Cash Price |
$1,679.15
|
| Rate for Payer: Cash Price |
$1,679.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,404.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,648.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,413.54
|
| Rate for Payer: Heritage Provider Network Senior |
$1,413.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,526.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,526.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,526.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$763.25
|
| Rate for Payer: Multiplan Commercial |
$2,289.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,103.05
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,010.85
|
|
|
HC STENT ULTRAFLEX T-B COV W/DEL
|
Facility
|
OP
|
$3,053.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
900803704
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$610.60 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$610.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,465.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,097.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,595.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,679.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,289.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,227.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,227.31
|
| Rate for Payer: Cash Price |
$1,679.15
|
| Rate for Payer: Cash Price |
$1,679.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,404.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,595.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,595.05
|
| Rate for Payer: Dignity Health Senior |
$2,595.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,953.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,413.54
|
| Rate for Payer: Heritage Provider Network Senior |
$1,413.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,526.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,526.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,526.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$763.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,137.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,137.10
|
| Rate for Payer: Multiplan Commercial |
$2,289.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,103.05
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,010.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,595.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,595.05
|
| Rate for Payer: Vantage Medical Group Senior |
$2,595.05
|
|
|
HC STENT ULTRAFLEX T-B NON-COV W/
|
Facility
|
IP
|
$3,053.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
900803705
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$610.60 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$610.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,465.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,227.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,227.31
|
| Rate for Payer: Cash Price |
$1,679.15
|
| Rate for Payer: Cash Price |
$1,679.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,404.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,648.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,413.54
|
| Rate for Payer: Heritage Provider Network Senior |
$1,413.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,526.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,526.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,526.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$763.25
|
| Rate for Payer: Multiplan Commercial |
$2,289.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,103.05
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,010.85
|
|
|
HC STENT ULTRAFLEX T-B NON-COV W/
|
Facility
|
OP
|
$3,053.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
900803705
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$610.60 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$610.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,465.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,097.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,595.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,679.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,289.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,227.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,227.31
|
| Rate for Payer: Cash Price |
$1,679.15
|
| Rate for Payer: Cash Price |
$1,679.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,404.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,595.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,595.05
|
| Rate for Payer: Dignity Health Senior |
$2,595.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,953.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,413.54
|
| Rate for Payer: Heritage Provider Network Senior |
$1,413.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,526.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,526.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,526.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$763.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,137.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,137.10
|
| Rate for Payer: Multiplan Commercial |
$2,289.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,103.05
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,010.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,595.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,595.05
|
| Rate for Payer: Vantage Medical Group Senior |
$2,595.05
|
|
|
HC STENT VIABAHN
|
Facility
|
OP
|
$7,625.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
909020094
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,525.00 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$1,525.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,660.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,238.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,481.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,193.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,718.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,065.25
|
| Rate for Payer: Blue Shield of California EPN |
$3,065.25
|
| Rate for Payer: Cash Price |
$4,193.75
|
| Rate for Payer: Cash Price |
$4,193.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,507.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,481.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,481.25
|
| Rate for Payer: Dignity Health Senior |
$6,481.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,880.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,530.38
|
| Rate for Payer: Heritage Provider Network Senior |
$3,530.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,812.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,812.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,812.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,906.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,337.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,337.50
|
| Rate for Payer: Multiplan Commercial |
$5,718.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,754.91
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,524.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,481.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,481.25
|
| Rate for Payer: Vantage Medical Group Senior |
$6,481.25
|
|
|
HC STENT VIABAHN
|
Facility
|
IP
|
$7,625.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
909020094
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,525.00 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$1,525.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,660.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,065.25
|
| Rate for Payer: Blue Shield of California EPN |
$3,065.25
|
| Rate for Payer: Cash Price |
$4,193.75
|
| Rate for Payer: Cash Price |
$4,193.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,507.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,117.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,530.38
|
| Rate for Payer: Heritage Provider Network Senior |
$3,530.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,812.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,812.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,812.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,906.25
|
| Rate for Payer: Multiplan Commercial |
$5,718.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,754.91
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,524.64
|
|
|
HC STENT VIATORR/COVERED
|
Facility
|
OP
|
$9,412.50
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
909081419
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,882.50 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$1,882.50
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,518.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,466.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,000.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,176.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,059.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,783.82
|
| Rate for Payer: Blue Shield of California EPN |
$3,783.82
|
| Rate for Payer: Cash Price |
$5,176.88
|
| Rate for Payer: Cash Price |
$5,176.88
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,329.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,000.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,000.62
|
| Rate for Payer: Dignity Health Senior |
$8,000.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,024.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,357.99
|
| Rate for Payer: Heritage Provider Network Senior |
$4,357.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,706.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,706.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,706.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,353.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,588.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,588.75
|
| Rate for Payer: Multiplan Commercial |
$7,059.38
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,400.74
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,116.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,000.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,000.62
|
| Rate for Payer: Vantage Medical Group Senior |
$8,000.62
|
|
|
HC STENT VIATORR/COVERED
|
Facility
|
IP
|
$9,412.50
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
909081419
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,882.50 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$1,882.50
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,518.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,783.82
|
| Rate for Payer: Blue Shield of California EPN |
$3,783.82
|
| Rate for Payer: Cash Price |
$5,176.88
|
| Rate for Payer: Cash Price |
$5,176.88
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,329.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,082.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,357.99
|
| Rate for Payer: Heritage Provider Network Senior |
$4,357.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,706.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,706.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,706.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,353.12
|
| Rate for Payer: Multiplan Commercial |
$7,059.38
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,400.74
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,116.48
|
|
|
HC STENT WINGSPAN
|
Facility
|
IP
|
$15,287.50
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020055
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,057.50 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$3,057.50
|
| Rate for Payer: Aetna of CA Gatekeeper |
$7,338.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,145.57
|
| Rate for Payer: Blue Shield of California EPN |
$6,145.57
|
| Rate for Payer: Cash Price |
$8,408.12
|
| Rate for Payer: Cash Price |
$8,408.12
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,032.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,255.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,078.11
|
| Rate for Payer: Heritage Provider Network Senior |
$7,078.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,643.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,643.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,643.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,821.88
|
| Rate for Payer: Multiplan Commercial |
$11,465.62
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5,523.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,061.69
|
|
|
HC STENT WINGSPAN
|
Facility
|
OP
|
$15,287.50
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020055
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,057.50 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$3,057.50
|
| Rate for Payer: Aetna of CA Gatekeeper |
$7,338.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10,502.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,994.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,408.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11,465.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,145.57
|
| Rate for Payer: Blue Shield of California EPN |
$6,145.57
|
| Rate for Payer: Cash Price |
$8,408.12
|
| Rate for Payer: Cash Price |
$8,408.12
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,032.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,994.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$12,994.38
|
| Rate for Payer: Dignity Health Senior |
$12,994.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,784.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,078.11
|
| Rate for Payer: Heritage Provider Network Senior |
$7,078.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,643.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,643.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,643.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,821.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,701.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,701.25
|
| Rate for Payer: Multiplan Commercial |
$11,465.62
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5,523.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,061.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,994.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12,994.38
|
| Rate for Payer: Vantage Medical Group Senior |
$12,994.38
|
|
|
HC STEREOTACTIC PROBE 11 GA
|
Facility
|
IP
|
$774.00
|
|
| Hospital Charge Code |
909001127
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$140.09 |
| Max. Negotiated Rate |
$580.50 |
| Rate for Payer: Adventist Health Commercial |
$154.80
|
| Rate for Payer: Cash Price |
$425.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$524.00
|
| Rate for Payer: Heritage Provider Network Senior |
$524.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$140.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$193.50
|
| Rate for Payer: Multiplan Commercial |
$580.50
|
|
|
HC STEREOTACTIC PROBE 11 GA
|
Facility
|
OP
|
$774.00
|
|
| Hospital Charge Code |
909001127
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$140.09 |
| Max. Negotiated Rate |
$657.90 |
| Rate for Payer: Adventist Health Commercial |
$154.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$413.70
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$531.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$657.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$425.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$580.50
|
| Rate for Payer: Blue Shield of California Commercial |
$472.14
|
| Rate for Payer: Blue Shield of California EPN |
$377.71
|
| Rate for Payer: Cash Price |
$425.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$503.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$657.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$657.90
|
| Rate for Payer: Dignity Health Senior |
$657.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$503.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$479.11
|
| Rate for Payer: Heritage Provider Network Senior |
$479.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$369.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$140.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$193.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$541.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$541.80
|
| Rate for Payer: Multiplan Commercial |
$580.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$387.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$387.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$657.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$657.90
|
| Rate for Payer: Vantage Medical Group Senior |
$657.90
|
|
|
HC STEREOTACTIC PROBE 8 GA
|
Facility
|
IP
|
$921.00
|
|
| Hospital Charge Code |
909001128
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$166.70 |
| Max. Negotiated Rate |
$690.75 |
| Rate for Payer: Adventist Health Commercial |
$184.20
|
| Rate for Payer: Cash Price |
$506.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$623.52
|
| Rate for Payer: Heritage Provider Network Senior |
$623.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$166.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$230.25
|
| Rate for Payer: Multiplan Commercial |
$690.75
|
|
|
HC STEREOTACTIC PROBE 8 GA
|
Facility
|
OP
|
$921.00
|
|
| Hospital Charge Code |
909001128
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$166.70 |
| Max. Negotiated Rate |
$782.85 |
| Rate for Payer: Adventist Health Commercial |
$184.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$492.27
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$632.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$782.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$506.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$690.75
|
| Rate for Payer: Blue Shield of California Commercial |
$561.81
|
| Rate for Payer: Blue Shield of California EPN |
$449.45
|
| Rate for Payer: Cash Price |
$506.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$598.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$782.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$782.85
|
| Rate for Payer: Dignity Health Senior |
$782.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$598.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$570.10
|
| Rate for Payer: Heritage Provider Network Senior |
$570.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$439.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$166.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$230.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$644.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$644.70
|
| Rate for Payer: Multiplan Commercial |
$690.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$460.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$460.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$782.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$782.85
|
| Rate for Payer: Vantage Medical Group Senior |
$782.85
|
|
|
HC STERNO CLAV JOINTS
|
Facility
|
OP
|
$617.00
|
|
|
Service Code
|
CPT 71130
|
| Hospital Charge Code |
909001428
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$42.09 |
| Max. Negotiated Rate |
$462.75 |
| Rate for Payer: Adventist Health Commercial |
$123.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$329.79
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$423.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$182.48
|
| Rate for Payer: Blue Shield of California Commercial |
$149.18
|
| Rate for Payer: Blue Shield of California EPN |
$119.97
|
| Rate for Payer: Cash Price |
$339.35
|
| Rate for Payer: Cash Price |
$339.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$401.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Senior |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$401.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$111.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$381.92
|
| Rate for Payer: Heritage Provider Network Senior |
$381.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$42.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$294.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$111.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$128.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$154.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$140.97
|
| Rate for Payer: Multiplan Commercial |
$462.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$111.88
|
| Rate for Payer: TriValley Medical Group Senior |
$111.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$71.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$71.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC STERNO CLAV JOINTS
|
Facility
|
IP
|
$617.00
|
|
|
Service Code
|
CPT 71130
|
| Hospital Charge Code |
909001428
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$111.68 |
| Max. Negotiated Rate |
$462.75 |
| Rate for Payer: Adventist Health Commercial |
$123.40
|
| Rate for Payer: Cash Price |
$339.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$417.71
|
| Rate for Payer: Heritage Provider Network Senior |
$417.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$111.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$154.25
|
| Rate for Payer: Multiplan Commercial |
$462.75
|
|
|
HC STERNUM
|
Facility
|
IP
|
$584.00
|
|
|
Service Code
|
CPT 71120
|
| Hospital Charge Code |
909001427
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$105.70 |
| Max. Negotiated Rate |
$438.00 |
| Rate for Payer: Adventist Health Commercial |
$116.80
|
| Rate for Payer: Cash Price |
$321.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$395.37
|
| Rate for Payer: Heritage Provider Network Senior |
$395.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$105.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$146.00
|
| Rate for Payer: Multiplan Commercial |
$438.00
|
|
|
HC STERNUM
|
Facility
|
OP
|
$584.00
|
|
|
Service Code
|
CPT 71120
|
| Hospital Charge Code |
909001427
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$42.09 |
| Max. Negotiated Rate |
$438.00 |
| Rate for Payer: Adventist Health Commercial |
$116.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$312.15
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$401.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$169.82
|
| Rate for Payer: Blue Shield of California Commercial |
$137.09
|
| Rate for Payer: Blue Shield of California EPN |
$110.24
|
| Rate for Payer: Cash Price |
$321.20
|
| Rate for Payer: Cash Price |
$321.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$379.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Senior |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$379.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$111.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$361.50
|
| Rate for Payer: Heritage Provider Network Senior |
$361.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$42.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$278.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$105.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$128.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$146.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$140.97
|
| Rate for Payer: Multiplan Commercial |
$438.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$111.88
|
| Rate for Payer: TriValley Medical Group Senior |
$111.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$71.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$71.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
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 |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,872.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,567.80
|
| Rate for Payer: Blue Shield of California EPN |
$1,567.80
|
| Rate for Payer: Cash Price |
$2,145.00
|
| Rate for Payer: Cash Price |
$2,145.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,794.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,106.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,805.70
|
| Rate for Payer: Heritage Provider Network Senior |
$1,805.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,950.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,950.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,950.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$975.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,409.07
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,291.29
|
|
