|
HC STENT CAROTID UNCVRD
|
Facility
|
IP
|
$6,825.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020141
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,365.00 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$1,365.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,276.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,743.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,743.65
|
| Rate for Payer: Cash Price |
$3,753.75
|
| Rate for Payer: Cash Price |
$3,753.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,139.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,685.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,159.97
|
| Rate for Payer: Heritage Provider Network Senior |
$3,159.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,412.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,412.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,412.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,706.25
|
| Rate for Payer: Multiplan Commercial |
$5,118.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,465.87
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,259.76
|
|
|
HC STENT CAROTID UNCVRD
|
Facility
|
OP
|
$6,825.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020141
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,365.00 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$1,365.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,276.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,688.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,801.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,753.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,118.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,743.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,743.65
|
| Rate for Payer: Cash Price |
$3,753.75
|
| Rate for Payer: Cash Price |
$3,753.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,139.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,801.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,801.25
|
| Rate for Payer: Dignity Health Senior |
$5,801.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,368.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,159.97
|
| Rate for Payer: Heritage Provider Network Senior |
$3,159.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,412.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,412.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,412.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,706.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,777.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,777.50
|
| Rate for Payer: Multiplan Commercial |
$5,118.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,465.87
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,259.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,801.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,801.25
|
| Rate for Payer: Vantage Medical Group Senior |
$5,801.25
|
|
|
HC STENT, CCA W EPD
|
Facility
|
OP
|
$23,575.00
|
|
|
Service Code
|
CPT 37215
|
| Hospital Charge Code |
909080026
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$20,038.75 |
| Rate for Payer: Adventist Health Commercial |
$4,715.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16,196.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20,038.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12,966.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17,681.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,785.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$12,966.25
|
| Rate for Payer: Cash Price |
$12,966.25
|
| Rate for Payer: Cash Price |
$12,966.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15,323.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20,038.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$20,038.75
|
| Rate for Payer: Dignity Health Senior |
$20,038.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$14,592.92
|
| Rate for Payer: Heritage Provider Network Senior |
$14,592.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$992.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$11,245.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,267.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,893.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16,502.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16,502.50
|
| Rate for Payer: Multiplan Commercial |
$17,681.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20,038.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20,038.75
|
| Rate for Payer: Vantage Medical Group Senior |
$20,038.75
|
|
|
HC STENT, CCA W EPD
|
Facility
|
IP
|
$20,500.00
|
|
|
Service Code
|
CPT 37215
|
| Hospital Charge Code |
906820166
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,710.50 |
| Max. Negotiated Rate |
$15,375.00 |
| Rate for Payer: Adventist Health Commercial |
$4,100.00
|
| Rate for Payer: Cash Price |
$11,275.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$13,878.50
|
| Rate for Payer: Heritage Provider Network Senior |
$13,878.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,710.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,125.00
|
| Rate for Payer: Multiplan Commercial |
$15,375.00
|
|
|
HC STENT, CCA W EPD
|
Facility
|
OP
|
$20,500.00
|
|
|
Service Code
|
CPT 37215
|
| Hospital Charge Code |
906820166
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$17,425.00 |
| Rate for Payer: Adventist Health Commercial |
$4,100.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14,083.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17,425.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11,275.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15,375.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,785.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$11,275.00
|
| Rate for Payer: Cash Price |
$11,275.00
|
| Rate for Payer: Cash Price |
$11,275.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13,325.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17,425.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$17,425.00
|
| Rate for Payer: Dignity Health Senior |
$17,425.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$12,689.50
|
| Rate for Payer: Heritage Provider Network Senior |
$12,689.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$992.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9,778.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,710.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,125.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14,350.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14,350.00
|
| Rate for Payer: Multiplan Commercial |
$15,375.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17,425.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17,425.00
|
| Rate for Payer: Vantage Medical Group Senior |
$17,425.00
|
|
|
HC STENT, CCA W EPD
|
Facility
|
IP
|
$23,575.00
|
|
|
Service Code
|
CPT 37215
|
| Hospital Charge Code |
909080026
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,267.07 |
| Max. Negotiated Rate |
$17,681.25 |
| Rate for Payer: Adventist Health Commercial |
$4,715.00
|
| Rate for Payer: Cash Price |
$12,966.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$15,960.27
|
| Rate for Payer: Heritage Provider Network Senior |
$15,960.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,267.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,893.75
|
| Rate for Payer: Multiplan Commercial |
$17,681.25
|
|
|
HC STENT CCA W/O EPD
|
Facility
|
IP
|
$27,549.00
|
|
|
Service Code
|
CPT 37216
|
| Hospital Charge Code |
909080027
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,986.37 |
| Max. Negotiated Rate |
$20,661.75 |
| Rate for Payer: Adventist Health Commercial |
$5,509.80
|
| Rate for Payer: Cash Price |
$15,151.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$18,650.67
|
| Rate for Payer: Heritage Provider Network Senior |
$18,650.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,986.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,887.25
|
| Rate for Payer: Multiplan Commercial |
$20,661.75
|
|
|
HC STENT CCA W/O EPD
|
Facility
|
OP
|
$27,549.00
|
|
|
Service Code
|
CPT 37216
|
| Hospital Charge Code |
909080027
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$23,416.65 |
| Rate for Payer: Adventist Health Commercial |
$5,509.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18,926.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23,416.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,151.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20,661.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,111.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$15,151.95
|
| Rate for Payer: Cash Price |
$15,151.95
|
| Rate for Payer: Cash Price |
$15,151.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$17,906.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23,416.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$23,416.65
|
| Rate for Payer: Dignity Health Senior |
$23,416.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$17,052.83
|
| Rate for Payer: Heritage Provider Network Senior |
$17,052.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$190.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13,140.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,986.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,887.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19,284.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,284.30
|
| Rate for Payer: Multiplan Commercial |
$20,661.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23,416.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23,416.65
|
| Rate for Payer: Vantage Medical Group Senior |
$23,416.65
|
|
|
HC STENT CCA W/O EPD
|
Facility
|
IP
|
$23,956.00
|
|
|
Service Code
|
CPT 37216
|
| Hospital Charge Code |
906820167
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,336.04 |
| Max. Negotiated Rate |
$17,967.00 |
| Rate for Payer: Adventist Health Commercial |
$4,791.20
|
| Rate for Payer: Cash Price |
$13,175.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$16,218.21
|
| Rate for Payer: Heritage Provider Network Senior |
$16,218.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,336.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,989.00
|
| Rate for Payer: Multiplan Commercial |
$17,967.00
|
|
|
HC STENT CCA W/O EPD
|
Facility
|
OP
|
$23,956.00
|
|
|
Service Code
|
CPT 37216
|
| Hospital Charge Code |
906820167
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$20,362.60 |
| Rate for Payer: Adventist Health Commercial |
$4,791.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16,457.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20,362.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13,175.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17,967.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,111.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$13,175.80
|
| Rate for Payer: Cash Price |
$13,175.80
|
| Rate for Payer: Cash Price |
$13,175.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15,571.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20,362.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$20,362.60
|
| Rate for Payer: Dignity Health Senior |
$20,362.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$14,828.76
|
| Rate for Payer: Heritage Provider Network Senior |
$14,828.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$190.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$11,427.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,336.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,989.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16,769.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16,769.20
|
| Rate for Payer: Multiplan Commercial |
$17,967.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20,362.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20,362.60
|
| Rate for Payer: Vantage Medical Group Senior |
$20,362.60
|
|
|
HC STENT COARCT INCLUDING LSCA
|
Facility
|
OP
|
$5,333.00
|
|
|
Service Code
|
CPT 33880
|
| Hospital Charge Code |
906820015
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$965.27 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$1,066.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,663.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,533.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,933.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,717.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$2,933.15
|
| Rate for Payer: Cash Price |
$2,933.15
|
| Rate for Payer: Cash Price |
$2,933.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,466.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,533.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,533.05
|
| Rate for Payer: Dignity Health Senior |
$4,533.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,301.13
|
| Rate for Payer: Heritage Provider Network Senior |
$3,301.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,420.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,543.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$965.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,333.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,733.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,733.10
|
| Rate for Payer: Multiplan Commercial |
$3,999.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,533.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,533.05
|
| Rate for Payer: Vantage Medical Group Senior |
$4,533.05
|
|
|
HC STENT COARCT INCLUDING LSCA
|
Facility
|
IP
|
$5,333.00
|
|
|
Service Code
|
CPT 33880
|
| Hospital Charge Code |
906820015
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$965.27 |
| Max. Negotiated Rate |
$3,999.75 |
| Rate for Payer: Adventist Health Commercial |
$1,066.60
|
| Rate for Payer: Cash Price |
$2,933.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,610.44
|
| Rate for Payer: Heritage Provider Network Senior |
$3,610.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$965.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,333.25
|
| Rate for Payer: Multiplan Commercial |
$3,999.75
|
|
|
HC STENT COARCT INCLUDING LSCA
|
Facility
|
IP
|
$4,791.00
|
|
|
Service Code
|
CPT 33880
|
| Hospital Charge Code |
906811485
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$867.17 |
| Max. Negotiated Rate |
$3,593.25 |
| Rate for Payer: Adventist Health Commercial |
$958.20
|
| Rate for Payer: Cash Price |
$2,635.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,243.51
|
| Rate for Payer: Heritage Provider Network Senior |
$3,243.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$867.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,197.75
|
| Rate for Payer: Multiplan Commercial |
$3,593.25
|
|
|
HC STENT COARCT INCLUDING LSCA
|
Facility
|
OP
|
$4,791.00
|
|
|
Service Code
|
CPT 33880
|
| Hospital Charge Code |
906811485
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$867.17 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$958.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,291.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,072.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,635.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,593.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,717.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$2,635.05
|
| Rate for Payer: Cash Price |
$2,635.05
|
| Rate for Payer: Cash Price |
$2,635.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,114.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,072.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,072.35
|
| Rate for Payer: Dignity Health Senior |
$4,072.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,965.63
|
| Rate for Payer: Heritage Provider Network Senior |
$2,965.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,420.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,285.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$867.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,197.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,353.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,353.70
|
| Rate for Payer: Multiplan Commercial |
$3,593.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,072.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,072.35
|
| Rate for Payer: Vantage Medical Group Senior |
$4,072.35
|
|
|
HC STENT COARCT NOT INCL LSCA
|
Facility
|
OP
|
$32,757.00
|
|
|
Service Code
|
CPT 33881
|
| Hospital Charge Code |
906820202
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$416.16 |
| Max. Negotiated Rate |
$27,843.45 |
| Rate for Payer: Adventist Health Commercial |
$6,551.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$22,504.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27,843.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18,016.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24,567.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,717.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$18,016.35
|
| Rate for Payer: Cash Price |
$18,016.35
|
| Rate for Payer: Cash Price |
$18,016.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$21,292.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27,843.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$27,843.45
|
| Rate for Payer: Dignity Health Senior |
$27,843.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$20,276.58
|
| Rate for Payer: Heritage Provider Network Senior |
$20,276.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$416.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$15,625.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,929.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,189.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22,929.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22,929.90
|
| Rate for Payer: Multiplan Commercial |
$24,567.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27,843.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27,843.45
|
| Rate for Payer: Vantage Medical Group Senior |
$27,843.45
|
|
|
HC STENT COARCT NOT INCL LSCA
|
Facility
|
IP
|
$32,757.00
|
|
|
Service Code
|
CPT 33881
|
| Hospital Charge Code |
906820202
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,929.02 |
| Max. Negotiated Rate |
$24,567.75 |
| Rate for Payer: Adventist Health Commercial |
$6,551.40
|
| Rate for Payer: Cash Price |
$18,016.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$22,176.49
|
| Rate for Payer: Heritage Provider Network Senior |
$22,176.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,929.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,189.25
|
| Rate for Payer: Multiplan Commercial |
$24,567.75
|
|
|
HC STENT COVERED I CAST
|
Facility
|
OP
|
$6,437.50
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
909020087
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,287.50 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$1,287.50
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,090.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,422.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,471.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,540.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,828.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,587.88
|
| Rate for Payer: Blue Shield of California EPN |
$2,587.88
|
| Rate for Payer: Cash Price |
$3,540.63
|
| Rate for Payer: Cash Price |
$3,540.63
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,961.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,471.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,471.88
|
| Rate for Payer: Dignity Health Senior |
$5,471.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,120.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,980.56
|
| Rate for Payer: Heritage Provider Network Senior |
$2,980.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,218.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,218.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,218.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,609.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,506.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,506.25
|
| Rate for Payer: Multiplan Commercial |
$4,828.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,325.87
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,131.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,471.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,471.88
|
| Rate for Payer: Vantage Medical Group Senior |
$5,471.88
|
|
|
HC STENT COVERED I CAST
|
Facility
|
IP
|
$6,437.50
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
909020087
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,287.50 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$1,287.50
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,090.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,587.88
|
| Rate for Payer: Blue Shield of California EPN |
$2,587.88
|
| Rate for Payer: Cash Price |
$3,540.63
|
| Rate for Payer: Cash Price |
$3,540.63
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,961.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,476.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,980.56
|
| Rate for Payer: Heritage Provider Network Senior |
$2,980.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,218.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,218.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,218.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,609.38
|
| Rate for Payer: Multiplan Commercial |
$4,828.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,325.87
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,131.46
|
|
|
HC STENT DUMONT TRACHEOBRONCHIAL
|
Facility
|
OP
|
$1,717.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
900803701
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$343.40 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$343.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$824.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,179.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,459.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$944.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,287.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$690.23
|
| Rate for Payer: Blue Shield of California EPN |
$690.23
|
| Rate for Payer: Cash Price |
$944.35
|
| Rate for Payer: Cash Price |
$944.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$789.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,459.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,459.45
|
| Rate for Payer: Dignity Health Senior |
$1,459.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,098.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$794.97
|
| Rate for Payer: Heritage Provider Network Senior |
$794.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$858.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$858.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$858.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$429.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,201.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,201.90
|
| Rate for Payer: Multiplan Commercial |
$1,287.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$620.35
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$568.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,459.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,459.45
|
| Rate for Payer: Vantage Medical Group Senior |
$1,459.45
|
|
|
HC STENT DUMONT TRACHEOBRONCHIAL
|
Facility
|
IP
|
$1,717.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
900803701
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$343.40 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$343.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$824.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$690.23
|
| Rate for Payer: Blue Shield of California EPN |
$690.23
|
| Rate for Payer: Cash Price |
$944.35
|
| Rate for Payer: Cash Price |
$944.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$789.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$927.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$794.97
|
| Rate for Payer: Heritage Provider Network Senior |
$794.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$858.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$858.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$858.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$429.25
|
| Rate for Payer: Multiplan Commercial |
$1,287.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$620.35
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$568.50
|
|
|
HC STENT ENTERPRISE
|
Facility
|
IP
|
$13,000.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020034
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,600.00 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$2,600.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6,240.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,226.00
|
| Rate for Payer: Blue Shield of California EPN |
$5,226.00
|
| Rate for Payer: Cash Price |
$7,150.00
|
| Rate for Payer: Cash Price |
$7,150.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,980.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,020.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,019.00
|
| Rate for Payer: Heritage Provider Network Senior |
$6,019.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6,500.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,500.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,500.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,250.00
|
| Rate for Payer: Multiplan Commercial |
$9,750.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4,696.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4,304.30
|
|
|
HC STENT ENTERPRISE
|
Facility
|
OP
|
$13,000.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020034
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,600.00 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$2,600.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6,240.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,931.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,050.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,150.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,750.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,226.00
|
| Rate for Payer: Blue Shield of California EPN |
$5,226.00
|
| Rate for Payer: Cash Price |
$7,150.00
|
| Rate for Payer: Cash Price |
$7,150.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,980.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,050.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,050.00
|
| Rate for Payer: Dignity Health Senior |
$11,050.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,320.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,019.00
|
| Rate for Payer: Heritage Provider Network Senior |
$6,019.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6,500.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,500.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,500.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,250.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,100.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,100.00
|
| Rate for Payer: Multiplan Commercial |
$9,750.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4,696.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4,304.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,050.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,050.00
|
| Rate for Payer: Vantage Medical Group Senior |
$11,050.00
|
|
|
HC STENT EV3 VISI PRO
|
Facility
|
OP
|
$3,705.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020092
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$741.00 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$741.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,778.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,545.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,149.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,037.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,778.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,489.41
|
| Rate for Payer: Blue Shield of California EPN |
$1,489.41
|
| Rate for Payer: Cash Price |
$2,037.75
|
| Rate for Payer: Cash Price |
$2,037.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,704.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,149.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,149.25
|
| Rate for Payer: Dignity Health Senior |
$3,149.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,371.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,715.41
|
| Rate for Payer: Heritage Provider Network Senior |
$1,715.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,852.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,852.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,852.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$926.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,593.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,593.50
|
| Rate for Payer: Multiplan Commercial |
$2,778.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,338.62
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,226.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,149.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,149.25
|
| Rate for Payer: Vantage Medical Group Senior |
$3,149.25
|
|
|
HC STENT EV3 VISI PRO
|
Facility
|
IP
|
$3,705.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020092
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$741.00 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$741.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,778.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,489.41
|
| Rate for Payer: Blue Shield of California EPN |
$1,489.41
|
| Rate for Payer: Cash Price |
$2,037.75
|
| Rate for Payer: Cash Price |
$2,037.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,704.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,000.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,715.41
|
| Rate for Payer: Heritage Provider Network Senior |
$1,715.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,852.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,852.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,852.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$926.25
|
| Rate for Payer: Multiplan Commercial |
$2,778.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,338.62
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,226.73
|
|
|
HC STENT FEM/POP
|
Facility
|
OP
|
$19,952.00
|
|
|
Service Code
|
CPT 37226
|
| Hospital Charge Code |
906820150
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$27,377.73 |
| Rate for Payer: Adventist Health Commercial |
$3,990.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13,707.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,409.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,111.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$10,973.60
|
| Rate for Payer: Cash Price |
$10,973.60
|
| Rate for Payer: Cash Price |
$10,973.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12,968.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,850.26
|
| Rate for Payer: Dignity Health Senior |
$14,409.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$14,409.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$12,350.29
|
| Rate for Payer: Heritage Provider Network Senior |
$17,723.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$714.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,409.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$27,377.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,611.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,570.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,988.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,155.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18,155.76
|
| Rate for Payer: Multiplan Commercial |
$14,964.00
|
| Rate for Payer: Multiplan WC |
$22,958.69
|
| Rate for Payer: TriValley Medical Group Commercial |
$15,850.26
|
| Rate for Payer: TriValley Medical Group Senior |
$15,850.26
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,861.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,025.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Vantage Medical Group Senior |
$14,409.33
|
|
