|
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 |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,872.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,679.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,145.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,925.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| 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: Dignity Health Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,315.00
|
| Rate for Payer: Dignity Health Senior |
$3,315.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,496.00
|
| 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: 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: United Healthcare All Other HMO/non HMO |
$1,409.07
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,291.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,315.00
|
|
|
HC STNT BILIARY PALMAZ CORIN IQ
|
Facility
|
OP
|
$1,643.00
|
|
|
Service Code
|
CPT C1877
|
| Hospital Charge Code |
909081420
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$328.60 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$328.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$788.64
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,128.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,396.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$903.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,232.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$660.49
|
| Rate for Payer: Blue Shield of California EPN |
$660.49
|
| Rate for Payer: Cash Price |
$903.65
|
| Rate for Payer: Cash Price |
$903.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$755.78
|
| 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 Senior |
$1,396.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,051.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$760.71
|
| Rate for Payer: Heritage Provider Network Senior |
$760.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$821.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$821.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$821.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$410.75
|
| 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: United Healthcare All Other HMO/non HMO |
$593.62
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$544.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,396.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,396.55
|
| Rate for Payer: Vantage Medical Group Senior |
$1,396.55
|
|
|
HC STNT BILIARY PALMAZ CORIN IQ
|
Facility
|
IP
|
$1,643.00
|
|
|
Service Code
|
CPT C1877
|
| Hospital Charge Code |
909081420
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$328.60 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$328.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$788.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$660.49
|
| Rate for Payer: Blue Shield of California EPN |
$660.49
|
| Rate for Payer: Cash Price |
$903.65
|
| Rate for Payer: Cash Price |
$903.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$755.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$887.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$760.71
|
| Rate for Payer: Heritage Provider Network Senior |
$760.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$821.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$821.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$821.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$410.75
|
| Rate for Payer: Multiplan Commercial |
$1,232.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$593.62
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$544.00
|
|
|
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 |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$477.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,146.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$959.98
|
| Rate for Payer: Blue Shield of California EPN |
$959.98
|
| Rate for Payer: Cash Price |
$1,313.40
|
| Rate for Payer: Cash Price |
$1,313.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,098.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,289.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,105.64
|
| Rate for Payer: Heritage Provider Network Senior |
$1,105.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,194.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,194.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,194.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$597.00
|
| Rate for Payer: Multiplan Commercial |
$1,791.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$862.78
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$790.67
|
|
|
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 |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$477.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,146.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,640.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,029.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,313.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,791.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$959.98
|
| Rate for Payer: Blue Shield of California EPN |
$959.98
|
| Rate for Payer: Cash Price |
$1,313.40
|
| Rate for Payer: Cash Price |
$1,313.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,098.48
|
| 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 Senior |
$2,029.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,528.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,105.64
|
| Rate for Payer: Heritage Provider Network Senior |
$1,105.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,194.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,194.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,194.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$597.00
|
| 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: United Healthcare All Other HMO/non HMO |
$862.78
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$790.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,029.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,029.80
|
| Rate for Payer: Vantage Medical Group Senior |
$2,029.80
|
|
|
HC STNT BILIARY PALM CORIN IQ&DEL
|
Facility
|
IP
|
$3,900.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909081421
|
|
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
|
|
|
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 |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,872.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,679.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,145.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,925.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| 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: Dignity Health Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,315.00
|
| Rate for Payer: Dignity Health Senior |
$3,315.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,496.00
|
| 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: 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: United Healthcare All Other HMO/non HMO |
$1,409.07
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,291.29
|
| 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 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 |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$300.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$720.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,030.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,275.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$825.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,125.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$603.00
|
| Rate for Payer: Blue Shield of California EPN |
$603.00
|
| Rate for Payer: Cash Price |
$825.00
|
| Rate for Payer: Cash Price |
$825.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$690.00
|
| 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 Senior |
$1,275.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$960.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$694.50
|
| Rate for Payer: Heritage Provider Network Senior |
$694.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$750.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$750.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$750.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$375.00
|
| 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: United Healthcare All Other HMO/non HMO |
$541.95
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$496.65
|
| 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 |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$300.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$720.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$603.00
|
| Rate for Payer: Blue Shield of California EPN |
$603.00
|
| Rate for Payer: Cash Price |
$825.00
|
| Rate for Payer: Cash Price |
$825.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$690.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$810.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$694.50
|
| Rate for Payer: Heritage Provider Network Senior |
$694.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$750.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$750.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$750.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$375.00
|
| Rate for Payer: Multiplan Commercial |
$1,125.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$541.95
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$496.65
|
|
|
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 |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$360.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$864.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$723.60
|
| Rate for Payer: Blue Shield of California EPN |
$723.60
|
| Rate for Payer: Cash Price |
$990.00
|
| Rate for Payer: Cash Price |
$990.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$828.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$972.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$833.40
|
| Rate for Payer: Heritage Provider Network Senior |
$833.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$900.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$900.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$900.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$450.00
|
| Rate for Payer: Multiplan Commercial |
$1,350.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$650.34
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$595.98
|
|
|
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 |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$360.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$864.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,236.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,530.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$990.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,350.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$723.60
|
| Rate for Payer: Blue Shield of California EPN |
$723.60
|
| Rate for Payer: Cash Price |
$990.00
|
| Rate for Payer: Cash Price |
$990.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$828.00
|
| 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 Senior |
$1,530.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,152.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$833.40
|
| Rate for Payer: Heritage Provider Network Senior |
$833.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$900.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$900.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$900.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$450.00
|
| 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: United Healthcare All Other HMO/non HMO |
$650.34
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$595.98
|
| 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
|
IP
|
$4,020.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909081693
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$804.00 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$804.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,929.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,616.04
|
| Rate for Payer: Blue Shield of California EPN |
$1,616.04
|
| Rate for Payer: Cash Price |
$2,211.00
|
| Rate for Payer: Cash Price |
$2,211.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,849.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,170.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,861.26
|
| Rate for Payer: Heritage Provider Network Senior |
$1,861.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,010.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,010.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,010.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,005.00
|
| Rate for Payer: Multiplan Commercial |
$3,015.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,452.43
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,331.02
|
|
|
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 |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$804.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,929.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,761.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,417.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,211.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,015.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,616.04
|
| Rate for Payer: Blue Shield of California EPN |
$1,616.04
|
| Rate for Payer: Cash Price |
$2,211.00
|
| Rate for Payer: Cash Price |
$2,211.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,849.20
|
| 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 Senior |
$3,417.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,572.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,861.26
|
| Rate for Payer: Heritage Provider Network Senior |
$1,861.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,010.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,010.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,010.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,005.00
|
| 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: United Healthcare All Other HMO/non HMO |
$1,452.43
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,331.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,417.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,417.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,417.00
|
|
|
HC STNT BILRY LG PALM BLLN W/DELI
|
Facility
|
OP
|
$1,718.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909081445
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$343.60 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$343.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$824.64
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,180.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,460.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$944.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,288.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$690.64
|
| Rate for Payer: Blue Shield of California EPN |
$690.64
|
| Rate for Payer: Cash Price |
$944.90
|
| Rate for Payer: Cash Price |
$944.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$790.28
|
| 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 Senior |
$1,460.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,099.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$795.43
|
| Rate for Payer: Heritage Provider Network Senior |
$795.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$859.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$859.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$859.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$429.50
|
| 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: United Healthcare All Other HMO/non HMO |
$620.71
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$568.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,460.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,460.30
|
| Rate for Payer: Vantage Medical Group Senior |
$1,460.30
|
|
|
HC STNT BILRY LG PALM BLLN W/DELI
|
Facility
|
IP
|
$1,718.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909081445
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$343.60 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$343.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$824.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$690.64
|
| Rate for Payer: Blue Shield of California EPN |
$690.64
|
| Rate for Payer: Cash Price |
$944.90
|
| Rate for Payer: Cash Price |
$944.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$790.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$927.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$795.43
|
| Rate for Payer: Heritage Provider Network Senior |
$795.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$859.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$859.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$859.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$429.50
|
| Rate for Payer: Multiplan Commercial |
$1,288.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$620.71
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$568.83
|
|
|
HC STNT BILRY SMART CORDIS NIT 20
|
Facility
|
OP
|
$1,800.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909081428
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$360.00 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$360.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$864.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,236.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,530.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$990.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,350.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$723.60
|
| Rate for Payer: Blue Shield of California EPN |
$723.60
|
| Rate for Payer: Cash Price |
$990.00
|
| Rate for Payer: Cash Price |
$990.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$828.00
|
| 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 Senior |
$1,530.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,152.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$833.40
|
| Rate for Payer: Heritage Provider Network Senior |
$833.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$900.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$900.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$900.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$450.00
|
| 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: United Healthcare All Other HMO/non HMO |
$650.34
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$595.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,530.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,530.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,530.00
|
|
|
HC STNT BILRY SMART CORDIS NIT 20
|
Facility
|
IP
|
$1,800.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909081428
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$360.00 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$360.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$864.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$723.60
|
| Rate for Payer: Blue Shield of California EPN |
$723.60
|
| Rate for Payer: Cash Price |
$990.00
|
| Rate for Payer: Cash Price |
$990.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$828.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$972.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$833.40
|
| Rate for Payer: Heritage Provider Network Senior |
$833.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$900.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$900.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$900.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$450.00
|
| Rate for Payer: Multiplan Commercial |
$1,350.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$650.34
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$595.98
|
|
|
HC STNT BILRY SMRT CORD NIT 40/60
|
Facility
|
IP
|
$4,350.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909081429
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$870.00 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$870.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,088.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,748.70
|
| Rate for Payer: Blue Shield of California EPN |
$1,748.70
|
| Rate for Payer: Cash Price |
$2,392.50
|
| Rate for Payer: Cash Price |
$2,392.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,001.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,349.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,014.05
|
| Rate for Payer: Heritage Provider Network Senior |
$2,014.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,175.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,175.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,175.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,087.50
|
| Rate for Payer: Multiplan Commercial |
$3,262.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,571.65
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,440.29
|
|
|
HC STNT BILRY SMRT CORD NIT 40/60
|
Facility
|
OP
|
$4,350.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909081429
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$870.00 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$870.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,088.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,988.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,697.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,392.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,262.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,748.70
|
| Rate for Payer: Blue Shield of California EPN |
$1,748.70
|
| Rate for Payer: Cash Price |
$2,392.50
|
| Rate for Payer: Cash Price |
$2,392.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,001.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,697.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,697.50
|
| Rate for Payer: Dignity Health Senior |
$3,697.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,784.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,014.05
|
| Rate for Payer: Heritage Provider Network Senior |
$2,014.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,175.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,175.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,175.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,087.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,045.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,045.00
|
| Rate for Payer: Multiplan Commercial |
$3,262.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,571.65
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,440.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,697.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,697.50
|
| Rate for Payer: Vantage Medical Group Senior |
$3,697.50
|
|
|
HC STNT BILRY SMRT CORD NITINL 80
|
Facility
|
OP
|
$3,900.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909081430
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,872.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,679.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,145.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,925.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| 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: Dignity Health Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,315.00
|
| Rate for Payer: Dignity Health Senior |
$3,315.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,496.00
|
| 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: 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: United Healthcare All Other HMO/non HMO |
$1,409.07
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,291.29
|
| 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 BILRY SMRT CORD NITINL 80
|
Facility
|
IP
|
$3,900.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909081430
|
|
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
|
|
|
HC STNT COATED/COVERED W DELIVER
|
Facility
|
IP
|
$8,900.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
909081446
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,780.00 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$1,780.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,272.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,577.80
|
| Rate for Payer: Blue Shield of California EPN |
$3,577.80
|
| Rate for Payer: Cash Price |
$4,895.00
|
| Rate for Payer: Cash Price |
$4,895.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,094.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,806.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,120.70
|
| Rate for Payer: Heritage Provider Network Senior |
$4,120.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,450.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,450.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,450.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,225.00
|
| Rate for Payer: Multiplan Commercial |
$6,675.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,215.57
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,946.79
|
|
|
HC STNT COATED/COVERED W DELIVER
|
Facility
|
OP
|
$8,900.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
909081446
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,780.00 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$1,780.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,272.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,114.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,565.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,895.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,675.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,577.80
|
| Rate for Payer: Blue Shield of California EPN |
$3,577.80
|
| Rate for Payer: Cash Price |
$4,895.00
|
| Rate for Payer: Cash Price |
$4,895.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,094.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,565.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,565.00
|
| Rate for Payer: Dignity Health Senior |
$7,565.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,696.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,120.70
|
| Rate for Payer: Heritage Provider Network Senior |
$4,120.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,450.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,450.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,450.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,225.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,230.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,230.00
|
| Rate for Payer: Multiplan Commercial |
$6,675.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,215.57
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,946.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,565.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,565.00
|
| Rate for Payer: Vantage Medical Group Senior |
$7,565.00
|
|
|
HC STNT NO COAT/COVER W DEL SYS
|
Facility
|
IP
|
$3,900.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909081403
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$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
|
|
|
HC STNT NO COAT/COVER W DEL SYS
|
Facility
|
OP
|
$3,900.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909081403
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,872.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,679.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,145.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,925.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| 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: Dignity Health Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,315.00
|
| Rate for Payer: Dignity Health Senior |
$3,315.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,496.00
|
| 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: 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: United Healthcare All Other HMO/non HMO |
$1,409.07
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,291.29
|
| 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
|
|
