|
HC STERNO CLAV JOINTS
|
Facility
IP
|
$541.00
|
|
|
Service Code
|
CPT 71130
|
| Hospital Charge Code |
909001428
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$97.92 |
| Max. Negotiated Rate |
$405.75 |
| Rate for Payer: Adventist Health Commercial |
$108.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$371.67
|
| Rate for Payer: Cash Price |
$243.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$366.26
|
| Rate for Payer: Heritage Provider Network Senior |
$366.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$97.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.25
|
| Rate for Payer: Multiplan Commercial |
$405.75
|
|
|
HC STERNUM
|
Facility
IP
|
$512.00
|
|
|
Service Code
|
CPT 71120
|
| Hospital Charge Code |
909001427
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$92.67 |
| Max. Negotiated Rate |
$384.00 |
| Rate for Payer: Adventist Health Commercial |
$102.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$351.74
|
| Rate for Payer: Cash Price |
$230.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$346.62
|
| Rate for Payer: Heritage Provider Network Senior |
$346.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$128.00
|
| Rate for Payer: Multiplan Commercial |
$384.00
|
|
|
HC STERNUM
|
Facility
OP
|
$512.00
|
|
|
Service Code
|
CPT 71120
|
| Hospital Charge Code |
909001427
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$40.53 |
| Max. Negotiated Rate |
$384.00 |
| Rate for Payer: Adventist Health Commercial |
$102.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$49.59
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$351.74
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$113.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$155.70
|
| Rate for Payer: Blue Shield of California Commercial |
$133.09
|
| Rate for Payer: Blue Shield of California EPN |
$75.68
|
| Rate for Payer: Cash Price |
$230.40
|
| Rate for Payer: Cash Price |
$230.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$332.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.89
|
| Rate for Payer: Dignity Health Senior |
$113.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$332.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$113.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$316.93
|
| Rate for Payer: Heritage Provider Network Senior |
$316.93
|
| Rate for Payer: Humana Medicare |
$113.54
|
| Rate for Payer: IEHP Medi-Cal |
$40.53
|
| Rate for Payer: IEHP Medicare Advantage |
$113.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$215.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$133.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$128.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$143.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$143.06
|
| Rate for Payer: Multiplan Commercial |
$384.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$113.54
|
| Rate for Payer: TriValley Medical Group Senior |
$113.54
|
| 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 |
$170.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Vantage Medical Group Senior |
$113.54
|
|
|
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 |
$12,139.00 |
| 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: AlphaCare Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,145.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,925.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,421.90
|
| Rate for Payer: Blue Shield of California EPN |
$2,289.30
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Cash Price |
$1,755.00
|
| 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: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,421.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,302.99
|
| 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 |
$12,173.00 |
| 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: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Cash Price |
$1,755.00
|
| 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 |
$2,640.30
|
| Rate for Payer: Heritage Provider Network Senior |
$2,640.30
|
| 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 |
$1,421.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,302.99
|
|
|
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 |
$12,173.00 |
| 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: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$739.35
|
| Rate for Payer: Cash Price |
$739.35
|
| 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 |
$1,112.31
|
| Rate for Payer: Heritage Provider Network Senior |
$1,112.31
|
| 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 |
$599.04
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$548.93
|
|
|
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 |
$12,139.00 |
| 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: AlphaCare Medical Group Commercial/Exchange |
$1,396.55
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$903.65
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,232.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,020.30
|
| Rate for Payer: Blue Shield of California EPN |
$964.44
|
| Rate for Payer: Cash Price |
$739.35
|
| Rate for Payer: Cash Price |
$739.35
|
| 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: Multiplan Commercial |
$1,232.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$599.04
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$548.93
|
| 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
IP
|
$2,388.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909081223
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$477.60 |
| Max. Negotiated Rate |
$12,173.00 |
| 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: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$1,074.60
|
| Rate for Payer: Cash Price |
$1,074.60
|
| 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 |
$1,616.68
|
| Rate for Payer: Heritage Provider Network Senior |
$1,616.68
|
| 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 |
$870.66
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$797.83
|
|
|
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 |
$12,139.00 |
| 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: AlphaCare Medical Group Commercial/Exchange |
$2,029.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,313.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,791.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,482.95
|
| Rate for Payer: Blue Shield of California EPN |
$1,401.76
|
| Rate for Payer: Cash Price |
$1,074.60
|
| Rate for Payer: Cash Price |
$1,074.60
|
| 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: Multiplan Commercial |
$1,791.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$870.66
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$797.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,029.80
|
| Rate for Payer: Vantage Medical Group Senior |
$2,029.80
|
|
|
HC STNT BILIARY PALM CORIN IQ&DEL
|
Facility
OP
|
$3,900.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909081421
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$12,139.00 |
| 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: AlphaCare Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,145.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,925.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,421.90
|
| Rate for Payer: Blue Shield of California EPN |
$2,289.30
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Cash Price |
$1,755.00
|
| 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: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,421.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,302.99
|
| 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 |
$12,173.00 |
| 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: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Cash Price |
$1,755.00
|
| 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 |
$2,640.30
|
| Rate for Payer: Heritage Provider Network Senior |
$2,640.30
|
| 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 |
$1,421.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,302.99
|
|
|
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 |
$12,173.00 |
| 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: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cash Price |
$675.00
|
| 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 |
$1,015.50
|
| Rate for Payer: Heritage Provider Network Senior |
$1,015.50
|
| 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 |
$546.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$501.15
|
|
|
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 |
$12,139.00 |
| 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: AlphaCare Medical Group Commercial/Exchange |
$1,275.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$825.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,125.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$931.50
|
| Rate for Payer: Blue Shield of California EPN |
$880.50
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cash Price |
$675.00
|
| 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: Multiplan Commercial |
$1,125.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$546.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$501.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,275.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,275.00
|
|
|
HC STNT BILIARY PALM XL TRANS 50
|
Facility
IP
|
$1,800.00
|
|
|
Service Code
|
CPT C1877
|
| Hospital Charge Code |
909081424
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$360.00 |
| Max. Negotiated Rate |
$12,173.00 |
| 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: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$810.00
|
| Rate for Payer: Cash Price |
$810.00
|
| 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 |
$1,218.60
|
| Rate for Payer: Heritage Provider Network Senior |
$1,218.60
|
| 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 |
$656.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$601.38
|
|
|
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 |
$12,139.00 |
| 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: AlphaCare Medical Group Commercial/Exchange |
$1,530.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$990.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,350.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,117.80
|
| Rate for Payer: Blue Shield of California EPN |
$1,056.60
|
| Rate for Payer: Cash Price |
$810.00
|
| Rate for Payer: Cash Price |
$810.00
|
| 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: Multiplan Commercial |
$1,350.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$656.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$601.38
|
| 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 |
$12,139.00 |
| 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: AlphaCare Medical Group Commercial/Exchange |
$3,417.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,211.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,015.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,496.42
|
| Rate for Payer: Blue Shield of California EPN |
$2,359.74
|
| Rate for Payer: Cash Price |
$1,809.00
|
| Rate for Payer: Cash Price |
$1,809.00
|
| 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: Multiplan Commercial |
$3,015.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,465.69
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,343.08
|
| 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 |
$12,173.00 |
| 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: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$1,809.00
|
| Rate for Payer: Cash Price |
$1,809.00
|
| 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 |
$2,721.54
|
| Rate for Payer: Heritage Provider Network Senior |
$2,721.54
|
| 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 |
$1,465.69
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,343.08
|
|
|
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 |
$12,173.00 |
| 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: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$773.10
|
| Rate for Payer: Cash Price |
$773.10
|
| 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 |
$1,163.09
|
| Rate for Payer: Heritage Provider Network Senior |
$1,163.09
|
| 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 |
$626.38
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$573.98
|
|
|
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 |
$12,139.00 |
| 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: AlphaCare Medical Group Commercial/Exchange |
$1,460.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$944.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,288.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,066.88
|
| Rate for Payer: Blue Shield of California EPN |
$1,008.47
|
| Rate for Payer: Cash Price |
$773.10
|
| Rate for Payer: Cash Price |
$773.10
|
| 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: Multiplan Commercial |
$1,288.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$626.38
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$573.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,460.30
|
| Rate for Payer: Vantage Medical Group Senior |
$1,460.30
|
|
|
HC STNT BILRY SMART CORDIS NIT 20
|
Facility
OP
|
$1,800.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909081428
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$360.00 |
| Max. Negotiated Rate |
$12,139.00 |
| 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: AlphaCare Medical Group Commercial/Exchange |
$1,530.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$990.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,350.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,117.80
|
| Rate for Payer: Blue Shield of California EPN |
$1,056.60
|
| Rate for Payer: Cash Price |
$810.00
|
| Rate for Payer: Cash Price |
$810.00
|
| 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: Multiplan Commercial |
$1,350.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$656.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$601.38
|
| 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 |
$12,173.00 |
| 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: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$810.00
|
| Rate for Payer: Cash Price |
$810.00
|
| 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 |
$1,218.60
|
| Rate for Payer: Heritage Provider Network Senior |
$1,218.60
|
| 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 |
$656.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$601.38
|
|
|
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 |
$12,173.00 |
| 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: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$1,957.50
|
| Rate for Payer: Cash Price |
$1,957.50
|
| 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 |
$2,944.95
|
| Rate for Payer: Heritage Provider Network Senior |
$2,944.95
|
| 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 |
$1,586.01
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,453.34
|
|
|
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 |
$12,139.00 |
| 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: AlphaCare Medical Group Commercial/Exchange |
$3,697.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,392.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,262.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,701.35
|
| Rate for Payer: Blue Shield of California EPN |
$2,553.45
|
| Rate for Payer: Cash Price |
$1,957.50
|
| Rate for Payer: Cash Price |
$1,957.50
|
| 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: Multiplan Commercial |
$3,262.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,586.01
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,453.34
|
| 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
IP
|
$3,900.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909081430
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$12,173.00 |
| 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: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Cash Price |
$1,755.00
|
| 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 |
$2,640.30
|
| Rate for Payer: Heritage Provider Network Senior |
$2,640.30
|
| 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 |
$1,421.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,302.99
|
|
|
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 |
$12,139.00 |
| 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: AlphaCare Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,145.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,925.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,421.90
|
| Rate for Payer: Blue Shield of California EPN |
$2,289.30
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Cash Price |
$1,755.00
|
| 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: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,421.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,302.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,315.00
|
|
