|
HC STERNO CLAV JOINTS
|
Facility
|
OP
|
$617.00
|
|
|
Service Code
|
CPT 71130
|
| Hospital Charge Code |
909001428
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$71.68 |
| Max. Negotiated Rate |
$462.75 |
| Rate for Payer: Adventist Health Commercial |
$123.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$381.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$189.78
|
| 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 |
$277.65
|
| Rate for Payer: Cash Price |
$277.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$401.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$364.03
|
| Rate for Payer: EPIC Health Plan Medicare |
$111.93
|
| 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) Medicare Advantage |
$111.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$294.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$111.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$128.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$154.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$149.99
|
| Rate for Payer: Multiplan Commercial |
$462.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$111.93
|
| Rate for Payer: TriValley Medical Group Senior |
$111.93
|
| 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 |
$167.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Vantage Medical Group Senior |
$111.93
|
|
|
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: Aetna of CA Non-Gatekeeper |
$397.35
|
| Rate for Payer: Cash Price |
$277.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$417.71
|
| Rate for Payer: Heritage Provider Network Senior |
$417.71
|
| Rate for Payer: Kaiser Foundation Hospitals 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: Aetna of CA Non-Gatekeeper |
$376.10
|
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$395.37
|
| Rate for Payer: Heritage Provider Network Senior |
$395.37
|
| Rate for Payer: Kaiser Foundation Hospitals 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 |
$71.68 |
| Max. Negotiated Rate |
$438.00 |
| Rate for Payer: Adventist Health Commercial |
$116.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$360.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$176.62
|
| 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 |
$262.80
|
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$379.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$344.56
|
| Rate for Payer: EPIC Health Plan Medicare |
$111.93
|
| 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) Medicare Advantage |
$111.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$278.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$105.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$128.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$146.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$149.99
|
| Rate for Payer: Multiplan Commercial |
$438.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$111.93
|
| Rate for Payer: TriValley Medical Group Senior |
$111.93
|
| 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 |
$167.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Vantage Medical Group Senior |
$111.93
|
|
|
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 |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,410.20
|
| 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 |
$13,770.00
|
| 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 |
$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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$1,950.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,950.00
|
| Rate for Payer: Kaiser Foundation Hospitals 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/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 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 |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,511.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| 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 |
$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 |
$1,805.70
|
| Rate for Payer: Heritage Provider Network Senior |
$1,805.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,950.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,950.00
|
| Rate for Payer: Kaiser Foundation Hospitals 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 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 |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$328.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,015.37
|
| 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 |
$13,770.00
|
| 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 |
$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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$821.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$821.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$821.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$410.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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 |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$328.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,058.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| 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 |
$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 |
$760.71
|
| Rate for Payer: Heritage Provider Network Senior |
$760.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$821.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$821.50
|
| Rate for Payer: Kaiser Foundation Hospitals 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 |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$477.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,537.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| 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 |
$1,074.60
|
| 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 |
$1,105.64
|
| Rate for Payer: Heritage Provider Network Senior |
$1,105.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,194.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,194.00
|
| Rate for Payer: Kaiser Foundation Hospitals 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 |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$477.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,475.78
|
| 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 |
$13,770.00
|
| 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 |
$1,074.60
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$1,194.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,194.00
|
| Rate for Payer: Kaiser Foundation Hospitals 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/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 |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,511.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| 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 |
$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 |
$1,805.70
|
| Rate for Payer: Heritage Provider Network Senior |
$1,805.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,950.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,950.00
|
| Rate for Payer: Kaiser Foundation Hospitals 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 |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,410.20
|
| 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 |
$13,770.00
|
| 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 |
$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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$1,950.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,950.00
|
| Rate for Payer: Kaiser Foundation Hospitals 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/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 |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$300.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$927.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,275.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$825.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,125.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| 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 |
$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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$750.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$750.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$750.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$375.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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 |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$300.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$966.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| 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 |
$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 |
$694.50
|
| Rate for Payer: Heritage Provider Network Senior |
$694.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$750.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$750.00
|
| Rate for Payer: Kaiser Foundation Hospitals 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
|
OP
|
$1,800.00
|
|
|
Service Code
|
CPT C1877
|
| Hospital Charge Code |
909081424
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$360.00 |
| Max. Negotiated Rate |
$13,770.00 |
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,112.40
|
| Rate for Payer: Adventist Health Commercial |
$360.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,530.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$990.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,350.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| 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 |
$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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$900.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$900.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$900.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$450.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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 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 |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$360.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,159.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| 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 |
$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 |
$833.40
|
| Rate for Payer: Heritage Provider Network Senior |
$833.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$900.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$900.00
|
| Rate for Payer: Kaiser Foundation Hospitals 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 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 |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$804.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,484.36
|
| 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 |
$13,770.00
|
| 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 |
$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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$2,010.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,010.00
|
| Rate for Payer: Kaiser Foundation Hospitals 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/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 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 |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$804.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,588.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| 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 |
$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 |
$1,861.26
|
| Rate for Payer: Heritage Provider Network Senior |
$1,861.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,010.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,010.00
|
| Rate for Payer: Kaiser Foundation Hospitals 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 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 |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$343.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,061.72
|
| 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 |
$13,770.00
|
| 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 |
$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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$859.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$859.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$859.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$429.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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 |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$343.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,106.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| 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 |
$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 |
$795.43
|
| Rate for Payer: Heritage Provider Network Senior |
$795.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$859.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$859.00
|
| Rate for Payer: Kaiser Foundation Hospitals 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 |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$360.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,112.40
|
| 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 |
$13,770.00
|
| 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 |
$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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$900.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$900.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$900.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$450.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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 |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$360.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,159.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| 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 |
$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 |
$833.40
|
| Rate for Payer: Heritage Provider Network Senior |
$833.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$900.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$900.00
|
| Rate for Payer: Kaiser Foundation Hospitals 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
|
OP
|
$4,350.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909081429
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$870.00 |
| Max. Negotiated Rate |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$870.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,688.30
|
| 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 |
$13,770.00
|
| 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 |
$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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$2,175.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,175.00
|
| Rate for Payer: Kaiser Foundation Hospitals 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/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 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 |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$870.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,801.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| 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 |
$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 |
$2,014.05
|
| Rate for Payer: Heritage Provider Network Senior |
$2,014.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,175.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,175.00
|
| Rate for Payer: Kaiser Foundation Hospitals 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 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 |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,511.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| 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 |
$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 |
$1,805.70
|
| Rate for Payer: Heritage Provider Network Senior |
$1,805.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,950.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,950.00
|
| Rate for Payer: Kaiser Foundation Hospitals 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
|
|
