|
HC STENT FEM/POP
|
Facility
|
OP
|
$16,959.00
|
|
|
Service Code
|
CPT 37226
|
| Hospital Charge Code |
909020067
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$27,377.73 |
| Rate for Payer: Adventist Health Commercial |
$3,391.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11,650.83
|
| 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 |
$9,327.45
|
| Rate for Payer: Cash Price |
$9,327.45
|
| Rate for Payer: Cash Price |
$9,327.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11,023.35
|
| 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 |
$10,497.62
|
| 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 |
$3,069.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,570.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,239.75
|
| 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 |
$12,719.25
|
| 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
|
|
|
HC STENT FEM/POP
|
Facility
|
IP
|
$19,952.00
|
|
|
Service Code
|
CPT 37226
|
| Hospital Charge Code |
906820150
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,611.31 |
| Max. Negotiated Rate |
$14,964.00 |
| Rate for Payer: Adventist Health Commercial |
$3,990.40
|
| Rate for Payer: Cash Price |
$10,973.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$13,507.50
|
| Rate for Payer: Heritage Provider Network Senior |
$13,507.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,611.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,988.00
|
| Rate for Payer: Multiplan Commercial |
$14,964.00
|
|
|
HC STENT FEM/POP
|
Facility
|
IP
|
$16,959.00
|
|
|
Service Code
|
CPT 37226
|
| Hospital Charge Code |
909020067
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,069.58 |
| Max. Negotiated Rate |
$12,719.25 |
| Rate for Payer: Adventist Health Commercial |
$3,391.80
|
| Rate for Payer: Cash Price |
$9,327.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,481.24
|
| Rate for Payer: Heritage Provider Network Senior |
$11,481.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,069.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,239.75
|
| Rate for Payer: Multiplan Commercial |
$12,719.25
|
|
|
HC STENT FLAIR
|
Facility
|
IP
|
$6,250.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020120
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,250.00 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$1,250.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,000.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,512.50
|
| Rate for Payer: Blue Shield of California EPN |
$2,512.50
|
| Rate for Payer: Cash Price |
$3,437.50
|
| Rate for Payer: Cash Price |
$3,437.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,875.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,375.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,893.75
|
| Rate for Payer: Heritage Provider Network Senior |
$2,893.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,125.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,125.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,125.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,562.50
|
| Rate for Payer: Multiplan Commercial |
$4,687.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,258.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,069.38
|
|
|
HC STENT FLAIR
|
Facility
|
OP
|
$6,250.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020120
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,250.00 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$1,250.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,000.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,293.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,312.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,437.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,687.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,512.50
|
| Rate for Payer: Blue Shield of California EPN |
$2,512.50
|
| Rate for Payer: Cash Price |
$3,437.50
|
| Rate for Payer: Cash Price |
$3,437.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,875.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,312.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,312.50
|
| Rate for Payer: Dignity Health Senior |
$5,312.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,000.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,893.75
|
| Rate for Payer: Heritage Provider Network Senior |
$2,893.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,125.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,125.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,125.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,562.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,375.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,375.00
|
| Rate for Payer: Multiplan Commercial |
$4,687.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,258.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,069.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,312.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,312.50
|
| Rate for Payer: Vantage Medical Group Senior |
$5,312.50
|
|
|
HC STENT GENESIS MOUNTED
|
Facility
|
OP
|
$3,900.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020089
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,872.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,679.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,145.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,925.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,567.80
|
| Rate for Payer: Blue Shield of California EPN |
$1,567.80
|
| Rate for Payer: Cash Price |
$2,145.00
|
| Rate for Payer: Cash Price |
$2,145.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,794.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,315.00
|
| Rate for Payer: Dignity Health Senior |
$3,315.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,496.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,805.70
|
| Rate for Payer: Heritage Provider Network Senior |
$1,805.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,950.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,950.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,950.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$975.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,730.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,730.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,409.07
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,291.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,315.00
|
|
|
HC STENT GENESIS MOUNTED
|
Facility
|
IP
|
$3,900.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020089
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,872.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,567.80
|
| Rate for Payer: Blue Shield of California EPN |
$1,567.80
|
| Rate for Payer: Cash Price |
$2,145.00
|
| Rate for Payer: Cash Price |
$2,145.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,794.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,106.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,805.70
|
| Rate for Payer: Heritage Provider Network Senior |
$1,805.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,950.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,950.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,950.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$975.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,409.07
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,291.29
|
|
|
HC STENT GENESIS UNMOUNTED
|
Facility
|
IP
|
$3,900.00
|
|
|
Service Code
|
CPT C1877
|
| Hospital Charge Code |
909020090
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,872.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,567.80
|
| Rate for Payer: Blue Shield of California EPN |
$1,567.80
|
| Rate for Payer: Cash Price |
$2,145.00
|
| Rate for Payer: Cash Price |
$2,145.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,794.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,106.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,805.70
|
| Rate for Payer: Heritage Provider Network Senior |
$1,805.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,950.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,950.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,950.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$975.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,409.07
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,291.29
|
|
|
HC STENT GENESIS UNMOUNTED
|
Facility
|
OP
|
$3,900.00
|
|
|
Service Code
|
CPT C1877
|
| Hospital Charge Code |
909020090
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,872.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,679.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,145.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,925.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,567.80
|
| Rate for Payer: Blue Shield of California EPN |
$1,567.80
|
| Rate for Payer: Cash Price |
$2,145.00
|
| Rate for Payer: Cash Price |
$2,145.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,794.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,315.00
|
| Rate for Payer: Dignity Health Senior |
$3,315.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,496.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,805.70
|
| Rate for Payer: Heritage Provider Network Senior |
$1,805.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,950.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,950.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,950.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$975.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,730.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,730.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,409.07
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,291.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,315.00
|
|
|
HC STENT GENESIS XLG
|
Facility
|
IP
|
$4,500.00
|
|
|
Service Code
|
CPT C1877
|
| Hospital Charge Code |
909020091
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$900.00 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$900.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,160.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,809.00
|
| Rate for Payer: Blue Shield of California EPN |
$1,809.00
|
| Rate for Payer: Cash Price |
$2,475.00
|
| Rate for Payer: Cash Price |
$2,475.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,070.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,430.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,083.50
|
| Rate for Payer: Heritage Provider Network Senior |
$2,083.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,250.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,250.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,250.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,125.00
|
| Rate for Payer: Multiplan Commercial |
$3,375.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,625.85
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,489.95
|
|
|
HC STENT GENESIS XLG
|
Facility
|
OP
|
$4,500.00
|
|
|
Service Code
|
CPT C1877
|
| Hospital Charge Code |
909020091
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$900.00 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$900.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,160.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,091.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,825.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,475.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,375.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,809.00
|
| Rate for Payer: Blue Shield of California EPN |
$1,809.00
|
| Rate for Payer: Cash Price |
$2,475.00
|
| Rate for Payer: Cash Price |
$2,475.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,070.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,825.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,825.00
|
| Rate for Payer: Dignity Health Senior |
$3,825.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,880.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,083.50
|
| Rate for Payer: Heritage Provider Network Senior |
$2,083.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,250.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,250.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,250.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,125.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,150.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,150.00
|
| Rate for Payer: Multiplan Commercial |
$3,375.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,625.85
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,489.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,825.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,825.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,825.00
|
|
|
HC STENT ILIAC
|
Facility
|
IP
|
$24,200.00
|
|
|
Service Code
|
CPT 37221
|
| Hospital Charge Code |
906820145
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,380.20 |
| Max. Negotiated Rate |
$18,150.00 |
| Rate for Payer: Adventist Health Commercial |
$4,840.00
|
| Rate for Payer: Cash Price |
$13,310.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$16,383.40
|
| Rate for Payer: Heritage Provider Network Senior |
$16,383.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,380.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,050.00
|
| Rate for Payer: Multiplan Commercial |
$18,150.00
|
|
|
HC STENT ILIAC
|
Facility
|
OP
|
$20,570.00
|
|
|
Service Code
|
CPT 37221
|
| Hospital Charge Code |
909020062
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$27,377.73 |
| Rate for Payer: Adventist Health Commercial |
$4,114.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14,131.59
|
| 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 |
$11,313.50
|
| Rate for Payer: Cash Price |
$11,313.50
|
| Rate for Payer: Cash Price |
$11,313.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13,370.50
|
| 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 |
$12,732.83
|
| Rate for Payer: Heritage Provider Network Senior |
$17,723.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$139.92
|
| 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 |
$3,723.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,570.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,142.50
|
| 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 |
$15,427.50
|
| 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
|
|
|
HC STENT ILIAC
|
Facility
|
IP
|
$20,570.00
|
|
|
Service Code
|
CPT 37221
|
| Hospital Charge Code |
909020062
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,723.17 |
| Max. Negotiated Rate |
$15,427.50 |
| Rate for Payer: Adventist Health Commercial |
$4,114.00
|
| Rate for Payer: Cash Price |
$11,313.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$13,925.89
|
| Rate for Payer: Heritage Provider Network Senior |
$13,925.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,723.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,142.50
|
| Rate for Payer: Multiplan Commercial |
$15,427.50
|
|
|
HC STENT ILIAC
|
Facility
|
OP
|
$24,200.00
|
|
|
Service Code
|
CPT 37221
|
| Hospital Charge Code |
906820145
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$27,377.73 |
| Rate for Payer: Adventist Health Commercial |
$4,840.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16,625.40
|
| 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 |
$13,310.00
|
| Rate for Payer: Cash Price |
$13,310.00
|
| Rate for Payer: Cash Price |
$13,310.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15,730.00
|
| 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 |
$14,979.80
|
| Rate for Payer: Heritage Provider Network Senior |
$17,723.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$139.92
|
| 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 |
$4,380.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,570.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,050.00
|
| 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 |
$18,150.00
|
| 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
|
|
|
HC STENT ILIAC EA ADDL
|
Facility
|
IP
|
$14,548.00
|
|
|
Service Code
|
CPT 37223
|
| Hospital Charge Code |
906820147
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,633.19 |
| Max. Negotiated Rate |
$10,911.00 |
| Rate for Payer: Adventist Health Commercial |
$2,909.60
|
| Rate for Payer: Cash Price |
$8,001.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,849.00
|
| Rate for Payer: Heritage Provider Network Senior |
$9,849.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,633.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,637.00
|
| Rate for Payer: Multiplan Commercial |
$10,911.00
|
|
|
HC STENT ILIAC EA ADDL
|
Facility
|
OP
|
$14,548.00
|
|
|
Service Code
|
CPT 37223
|
| Hospital Charge Code |
906820147
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$14,160.00 |
| Rate for Payer: Adventist Health Commercial |
$2,909.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,994.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,365.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,001.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,911.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$8,001.40
|
| Rate for Payer: Cash Price |
$8,001.40
|
| Rate for Payer: Cash Price |
$8,001.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9,456.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,365.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$12,365.80
|
| Rate for Payer: Dignity Health Senior |
$12,365.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,005.21
|
| Rate for Payer: Heritage Provider Network Senior |
$9,005.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$59.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6,939.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,633.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,637.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,183.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,183.60
|
| Rate for Payer: Multiplan Commercial |
$10,911.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14,160.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,956.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,365.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12,365.80
|
| Rate for Payer: Vantage Medical Group Senior |
$12,365.80
|
|
|
HC STENT ILIAC EA ADDL
|
Facility
|
OP
|
$12,366.00
|
|
|
Service Code
|
CPT 37223
|
| Hospital Charge Code |
909020064
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$14,160.00 |
| Rate for Payer: Adventist Health Commercial |
$2,473.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,495.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,511.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,801.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,274.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$6,801.30
|
| Rate for Payer: Cash Price |
$6,801.30
|
| Rate for Payer: Cash Price |
$6,801.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8,037.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,511.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,511.10
|
| Rate for Payer: Dignity Health Senior |
$10,511.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,654.55
|
| Rate for Payer: Heritage Provider Network Senior |
$7,654.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$59.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5,898.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,238.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,091.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,656.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,656.20
|
| Rate for Payer: Multiplan Commercial |
$9,274.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14,160.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,956.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,511.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,511.10
|
| Rate for Payer: Vantage Medical Group Senior |
$10,511.10
|
|
|
HC STENT ILIAC EA ADDL
|
Facility
|
IP
|
$12,366.00
|
|
|
Service Code
|
CPT 37223
|
| Hospital Charge Code |
909020064
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,238.25 |
| Max. Negotiated Rate |
$9,274.50 |
| Rate for Payer: Adventist Health Commercial |
$2,473.20
|
| Rate for Payer: Cash Price |
$6,801.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,371.78
|
| Rate for Payer: Heritage Provider Network Senior |
$8,371.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,238.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,091.50
|
| Rate for Payer: Multiplan Commercial |
$9,274.50
|
|
|
HC STENT INSERTION INDWELLING DBL
|
Facility
|
OP
|
$13,034.00
|
|
|
Service Code
|
CPT 52332
|
| Hospital Charge Code |
909020042
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,775.50 |
| Rate for Payer: Adventist Health Commercial |
$2,606.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,954.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,573.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,820.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,382.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$7,168.70
|
| Rate for Payer: Cash Price |
$7,168.70
|
| Rate for Payer: Cash Price |
$7,168.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8,472.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,573.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,820.49
|
| Rate for Payer: Dignity Health Senior |
$4,382.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,382.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,068.05
|
| Rate for Payer: Heritage Provider Network Senior |
$5,390.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$892.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,382.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8,326.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,359.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,039.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,258.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,521.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,521.65
|
| Rate for Payer: Multiplan Commercial |
$9,775.50
|
| Rate for Payer: Multiplan WC |
$6,982.34
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,820.49
|
| Rate for Payer: TriValley Medical Group Senior |
$4,820.49
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,454.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,273.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,573.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,820.49
|
| Rate for Payer: Vantage Medical Group Senior |
$4,382.26
|
|
|
HC STENT INSERTION INDWELLING DBL
|
Facility
|
IP
|
$13,034.00
|
|
|
Service Code
|
CPT 52332
|
| Hospital Charge Code |
909020042
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,359.15 |
| Max. Negotiated Rate |
$9,775.50 |
| Rate for Payer: Adventist Health Commercial |
$2,606.80
|
| Rate for Payer: Cash Price |
$7,168.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,824.02
|
| Rate for Payer: Heritage Provider Network Senior |
$8,824.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,359.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,258.50
|
| Rate for Payer: Multiplan Commercial |
$9,775.50
|
|
|
HC STENT INTRACRAN ATHERO STENOSI
|
Facility
|
IP
|
$11,708.00
|
|
|
Service Code
|
CPT 61635
|
| Hospital Charge Code |
909081014
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,119.15 |
| Max. Negotiated Rate |
$8,781.00 |
| Rate for Payer: Adventist Health Commercial |
$2,341.60
|
| Rate for Payer: Cash Price |
$6,439.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,926.32
|
| Rate for Payer: Heritage Provider Network Senior |
$7,926.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,119.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,927.00
|
| Rate for Payer: Multiplan Commercial |
$8,781.00
|
|
|
HC STENT INTRACRAN ATHERO STENOSI
|
Facility
|
OP
|
$11,708.00
|
|
|
Service Code
|
CPT 61635
|
| Hospital Charge Code |
909081014
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,119.15 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$2,341.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,043.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,951.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,439.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,781.00
|
| 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 |
$6,439.40
|
| Rate for Payer: Cash Price |
$6,439.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,610.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,951.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,951.80
|
| Rate for Payer: Dignity Health Senior |
$9,951.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,024.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,247.25
|
| Rate for Payer: Heritage Provider Network Senior |
$7,247.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5,584.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,119.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,927.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,195.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,195.60
|
| Rate for Payer: Multiplan Commercial |
$8,781.00
|
| 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 |
$9,951.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,951.80
|
| Rate for Payer: Vantage Medical Group Senior |
$9,951.80
|
|
|
HC STENT LIFE
|
Facility
|
IP
|
$2,828.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909000008
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$565.60 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$565.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,357.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,136.86
|
| Rate for Payer: Blue Shield of California EPN |
$1,136.86
|
| Rate for Payer: Cash Price |
$1,555.40
|
| Rate for Payer: Cash Price |
$1,555.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,300.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,527.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,309.36
|
| Rate for Payer: Heritage Provider Network Senior |
$1,309.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,414.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,414.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,414.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$707.00
|
| Rate for Payer: Multiplan Commercial |
$2,121.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,021.76
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$936.35
|
|
|
HC STENT LIFE
|
Facility
|
OP
|
$2,828.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909000008
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$565.60 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$565.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,357.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,942.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,403.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,555.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,121.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,136.86
|
| Rate for Payer: Blue Shield of California EPN |
$1,136.86
|
| Rate for Payer: Cash Price |
$1,555.40
|
| Rate for Payer: Cash Price |
$1,555.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,300.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,403.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,403.80
|
| Rate for Payer: Dignity Health Senior |
$2,403.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,809.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,309.36
|
| Rate for Payer: Heritage Provider Network Senior |
$1,309.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,414.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,414.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,414.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$707.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,979.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,979.60
|
| Rate for Payer: Multiplan Commercial |
$2,121.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,021.76
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$936.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,403.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,403.80
|
| Rate for Payer: Vantage Medical Group Senior |
$2,403.80
|
|
