|
HC STENT PROMUS PREMIER 3.0X28MM
|
Facility
|
IP
|
$4,487.50
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
900102000
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$897.50 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$897.50
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,154.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,803.97
|
| Rate for Payer: Blue Shield of California EPN |
$1,803.97
|
| Rate for Payer: Cash Price |
$2,468.12
|
| Rate for Payer: Cash Price |
$2,468.12
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,064.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,423.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,077.71
|
| Rate for Payer: Heritage Provider Network Senior |
$2,077.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,243.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,243.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,243.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,121.88
|
| Rate for Payer: Multiplan Commercial |
$3,365.62
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,621.33
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,485.81
|
|
|
HC STENT PROMUS PREMIER 3.0X8MM
|
Facility
|
OP
|
$4,487.50
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
900102001
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$897.50 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$897.50
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,154.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,082.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,814.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,468.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,365.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,803.97
|
| Rate for Payer: Blue Shield of California EPN |
$1,803.97
|
| Rate for Payer: Cash Price |
$2,468.12
|
| Rate for Payer: Cash Price |
$2,468.12
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,064.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,814.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,814.38
|
| Rate for Payer: Dignity Health Senior |
$3,814.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,872.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,077.71
|
| Rate for Payer: Heritage Provider Network Senior |
$2,077.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,243.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,243.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,243.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,121.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,141.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,141.25
|
| Rate for Payer: Multiplan Commercial |
$3,365.62
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,621.33
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,485.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,814.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,814.38
|
| Rate for Payer: Vantage Medical Group Senior |
$3,814.38
|
|
|
HC STENT PROMUS PREMIER 3.0X8MM
|
Facility
|
IP
|
$4,487.50
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
900102001
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$897.50 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$897.50
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,154.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,803.97
|
| Rate for Payer: Blue Shield of California EPN |
$1,803.97
|
| Rate for Payer: Cash Price |
$2,468.12
|
| Rate for Payer: Cash Price |
$2,468.12
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,064.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,423.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,077.71
|
| Rate for Payer: Heritage Provider Network Senior |
$2,077.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,243.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,243.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,243.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,121.88
|
| Rate for Payer: Multiplan Commercial |
$3,365.62
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,621.33
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,485.81
|
|
|
HC STENT PROMUS PREMIER 3.5X20MM
|
Facility
|
IP
|
$4,487.50
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
900102002
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$897.50 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$897.50
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,154.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,803.97
|
| Rate for Payer: Blue Shield of California EPN |
$1,803.97
|
| Rate for Payer: Cash Price |
$2,468.12
|
| Rate for Payer: Cash Price |
$2,468.12
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,064.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,423.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,077.71
|
| Rate for Payer: Heritage Provider Network Senior |
$2,077.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,243.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,243.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,243.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,121.88
|
| Rate for Payer: Multiplan Commercial |
$3,365.62
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,621.33
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,485.81
|
|
|
HC STENT PROMUS PREMIER 3.5X20MM
|
Facility
|
OP
|
$4,487.50
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
900102002
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$897.50 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$897.50
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,154.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,082.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,814.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,468.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,365.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,803.97
|
| Rate for Payer: Blue Shield of California EPN |
$1,803.97
|
| Rate for Payer: Cash Price |
$2,468.12
|
| Rate for Payer: Cash Price |
$2,468.12
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,064.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,814.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,814.38
|
| Rate for Payer: Dignity Health Senior |
$3,814.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,872.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,077.71
|
| Rate for Payer: Heritage Provider Network Senior |
$2,077.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,243.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,243.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,243.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,121.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,141.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,141.25
|
| Rate for Payer: Multiplan Commercial |
$3,365.62
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,621.33
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,485.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,814.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,814.38
|
| Rate for Payer: Vantage Medical Group Senior |
$3,814.38
|
|
|
HC STENT PROMUS PREMIER 3.5X24MM
|
Facility
|
OP
|
$4,487.50
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
900102003
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$897.50 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$897.50
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,154.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,082.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,814.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,468.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,365.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,803.97
|
| Rate for Payer: Blue Shield of California EPN |
$1,803.97
|
| Rate for Payer: Cash Price |
$2,468.12
|
| Rate for Payer: Cash Price |
$2,468.12
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,064.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,814.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,814.38
|
| Rate for Payer: Dignity Health Senior |
$3,814.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,872.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,077.71
|
| Rate for Payer: Heritage Provider Network Senior |
$2,077.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,243.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,243.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,243.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,121.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,141.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,141.25
|
| Rate for Payer: Multiplan Commercial |
$3,365.62
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,621.33
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,485.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,814.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,814.38
|
| Rate for Payer: Vantage Medical Group Senior |
$3,814.38
|
|
|
HC STENT PROMUS PREMIER 3.5X24MM
|
Facility
|
IP
|
$4,487.50
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
900102003
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$897.50 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$897.50
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,154.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,803.97
|
| Rate for Payer: Blue Shield of California EPN |
$1,803.97
|
| Rate for Payer: Cash Price |
$2,468.12
|
| Rate for Payer: Cash Price |
$2,468.12
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,064.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,423.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,077.71
|
| Rate for Payer: Heritage Provider Network Senior |
$2,077.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,243.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,243.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,243.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,121.88
|
| Rate for Payer: Multiplan Commercial |
$3,365.62
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,621.33
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,485.81
|
|
|
HC STENT PROMUS PREMIER 4.0X12MM
|
Facility
|
OP
|
$4,487.50
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
900102004
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$897.50 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$897.50
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,154.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,082.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,814.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,468.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,365.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,803.97
|
| Rate for Payer: Blue Shield of California EPN |
$1,803.97
|
| Rate for Payer: Cash Price |
$2,468.12
|
| Rate for Payer: Cash Price |
$2,468.12
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,064.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,814.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,814.38
|
| Rate for Payer: Dignity Health Senior |
$3,814.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,872.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,077.71
|
| Rate for Payer: Heritage Provider Network Senior |
$2,077.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,243.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,243.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,243.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,121.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,141.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,141.25
|
| Rate for Payer: Multiplan Commercial |
$3,365.62
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,621.33
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,485.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,814.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,814.38
|
| Rate for Payer: Vantage Medical Group Senior |
$3,814.38
|
|
|
HC STENT PROMUS PREMIER 4.0X12MM
|
Facility
|
IP
|
$4,487.50
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
900102004
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$897.50 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$897.50
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,154.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,803.97
|
| Rate for Payer: Blue Shield of California EPN |
$1,803.97
|
| Rate for Payer: Cash Price |
$2,468.12
|
| Rate for Payer: Cash Price |
$2,468.12
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,064.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,423.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,077.71
|
| Rate for Payer: Heritage Provider Network Senior |
$2,077.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,243.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,243.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,243.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,121.88
|
| Rate for Payer: Multiplan Commercial |
$3,365.62
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,621.33
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,485.81
|
|
|
HC STENT PROMUS PREMIER CORONARY 3X38MMX144CM 2.7FR REX
|
Facility
|
OP
|
$4,487.50
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
900102005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$897.50 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$897.50
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,154.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,082.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,814.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,468.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,365.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,803.97
|
| Rate for Payer: Blue Shield of California EPN |
$1,803.97
|
| Rate for Payer: Cash Price |
$2,468.12
|
| Rate for Payer: Cash Price |
$2,468.12
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,064.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,814.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,814.38
|
| Rate for Payer: Dignity Health Senior |
$3,814.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,872.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,077.71
|
| Rate for Payer: Heritage Provider Network Senior |
$2,077.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,243.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,243.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,243.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,121.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,141.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,141.25
|
| Rate for Payer: Multiplan Commercial |
$3,365.62
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,621.33
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,485.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,814.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,814.38
|
| Rate for Payer: Vantage Medical Group Senior |
$3,814.38
|
|
|
HC STENT PROMUS PREMIER CORONARY 3X38MMX144CM 2.7FR REX
|
Facility
|
IP
|
$4,487.50
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
900102005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$897.50 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$897.50
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,154.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,803.97
|
| Rate for Payer: Blue Shield of California EPN |
$1,803.97
|
| Rate for Payer: Cash Price |
$2,468.12
|
| Rate for Payer: Cash Price |
$2,468.12
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,064.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,423.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,077.71
|
| Rate for Payer: Heritage Provider Network Senior |
$2,077.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,243.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,243.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,243.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,121.88
|
| Rate for Payer: Multiplan Commercial |
$3,365.62
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,621.33
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,485.81
|
|
|
HC STENT PROTEGE
|
Facility
|
OP
|
$6,050.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020030
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,210.00 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$1,210.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,904.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,156.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,142.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,327.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,537.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,432.10
|
| Rate for Payer: Blue Shield of California EPN |
$2,432.10
|
| Rate for Payer: Cash Price |
$3,327.50
|
| Rate for Payer: Cash Price |
$3,327.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,783.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,142.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,142.50
|
| Rate for Payer: Dignity Health Senior |
$5,142.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,872.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,801.15
|
| Rate for Payer: Heritage Provider Network Senior |
$2,801.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,025.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,025.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,025.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,512.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,235.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,235.00
|
| Rate for Payer: Multiplan Commercial |
$4,537.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,185.86
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,003.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,142.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,142.50
|
| Rate for Payer: Vantage Medical Group Senior |
$5,142.50
|
|
|
HC STENT PROTEGE
|
Facility
|
IP
|
$6,050.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020030
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,210.00 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$1,210.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,904.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,432.10
|
| Rate for Payer: Blue Shield of California EPN |
$2,432.10
|
| Rate for Payer: Cash Price |
$3,327.50
|
| Rate for Payer: Cash Price |
$3,327.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,783.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,267.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,801.15
|
| Rate for Payer: Heritage Provider Network Senior |
$2,801.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,025.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,025.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,025.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,512.50
|
| Rate for Payer: Multiplan Commercial |
$4,537.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,185.86
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,003.15
|
|
|
HC STENT PROTEGE EVERFLEX
|
Facility
|
IP
|
$3,510.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020093
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$702.00 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$702.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,684.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,411.02
|
| Rate for Payer: Blue Shield of California EPN |
$1,411.02
|
| Rate for Payer: Cash Price |
$1,930.50
|
| Rate for Payer: Cash Price |
$1,930.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,614.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,895.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,625.13
|
| Rate for Payer: Heritage Provider Network Senior |
$1,625.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,755.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,755.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,755.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$877.50
|
| Rate for Payer: Multiplan Commercial |
$2,632.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,268.16
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,162.16
|
|
|
HC STENT PROTEGE EVERFLEX
|
Facility
|
OP
|
$3,510.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020093
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$702.00 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$702.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,684.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,411.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,983.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,930.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,632.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,411.02
|
| Rate for Payer: Blue Shield of California EPN |
$1,411.02
|
| Rate for Payer: Cash Price |
$1,930.50
|
| Rate for Payer: Cash Price |
$1,930.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,614.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,983.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,983.50
|
| Rate for Payer: Dignity Health Senior |
$2,983.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,246.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,625.13
|
| Rate for Payer: Heritage Provider Network Senior |
$1,625.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,755.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,755.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,755.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$877.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,457.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,457.00
|
| Rate for Payer: Multiplan Commercial |
$2,632.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,268.16
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,162.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,983.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,983.50
|
| Rate for Payer: Vantage Medical Group Senior |
$2,983.50
|
|
|
HC STENT RETRIEVER TREVO
|
Facility
|
IP
|
$19,488.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909000006
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,897.60 |
| Max. Negotiated Rate |
$14,616.00 |
| Rate for Payer: Adventist Health Commercial |
$3,897.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$9,354.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,834.18
|
| Rate for Payer: Blue Shield of California EPN |
$7,834.18
|
| Rate for Payer: Cash Price |
$10,718.40
|
| Rate for Payer: Cash Price |
$10,718.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8,964.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,523.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,022.94
|
| Rate for Payer: Heritage Provider Network Senior |
$9,022.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9,744.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,744.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,744.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,872.00
|
| Rate for Payer: Multiplan Commercial |
$14,616.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,041.01
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,452.48
|
|
|
HC STENT RETRIEVER TREVO
|
Facility
|
OP
|
$19,488.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909000006
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,897.60 |
| Max. Negotiated Rate |
$16,564.80 |
| Rate for Payer: Adventist Health Commercial |
$3,897.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$9,354.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13,388.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16,564.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,718.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,616.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,834.18
|
| Rate for Payer: Blue Shield of California EPN |
$7,834.18
|
| Rate for Payer: Cash Price |
$10,718.40
|
| Rate for Payer: Cash Price |
$10,718.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8,964.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16,564.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$16,564.80
|
| Rate for Payer: Dignity Health Senior |
$16,564.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,472.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,022.94
|
| Rate for Payer: Heritage Provider Network Senior |
$9,022.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9,744.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,744.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,744.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,872.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13,641.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13,641.60
|
| Rate for Payer: Multiplan Commercial |
$14,616.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,041.01
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,452.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16,564.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16,564.80
|
| Rate for Payer: Vantage Medical Group Senior |
$16,564.80
|
|
|
HC STENT RUSCH Y
|
Facility
|
OP
|
$1,725.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
900803703
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$345.00 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$345.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$828.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,185.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,466.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$948.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,293.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$693.45
|
| Rate for Payer: Blue Shield of California EPN |
$693.45
|
| Rate for Payer: Cash Price |
$948.75
|
| Rate for Payer: Cash Price |
$948.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$793.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,466.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,466.25
|
| Rate for Payer: Dignity Health Senior |
$1,466.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,104.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$798.67
|
| Rate for Payer: Heritage Provider Network Senior |
$798.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$862.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$862.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$862.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$431.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,207.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,207.50
|
| Rate for Payer: Multiplan Commercial |
$1,293.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$623.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$571.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,466.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,466.25
|
| Rate for Payer: Vantage Medical Group Senior |
$1,466.25
|
|
|
HC STENT RUSCH Y
|
Facility
|
IP
|
$1,725.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
900803703
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$345.00 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$345.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$828.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$693.45
|
| Rate for Payer: Blue Shield of California EPN |
$693.45
|
| Rate for Payer: Cash Price |
$948.75
|
| Rate for Payer: Cash Price |
$948.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$793.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$931.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$798.67
|
| Rate for Payer: Heritage Provider Network Senior |
$798.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$862.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$862.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$862.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$431.25
|
| Rate for Payer: Multiplan Commercial |
$1,293.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$623.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$571.15
|
|
|
HC STENT SCHNEIDER WALL
|
Facility
|
IP
|
$1,717.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
900803702
|
|
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 SCHNEIDER WALL
|
Facility
|
OP
|
$1,717.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
900803702
|
|
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 SUPERA
|
Facility
|
OP
|
$3,987.50
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020142
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$797.50 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$797.50
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,914.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,739.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,389.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,193.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,990.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,602.97
|
| Rate for Payer: Blue Shield of California EPN |
$1,602.97
|
| Rate for Payer: Cash Price |
$2,193.12
|
| Rate for Payer: Cash Price |
$2,193.12
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,834.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,389.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,389.38
|
| Rate for Payer: Dignity Health Senior |
$3,389.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,552.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,846.21
|
| Rate for Payer: Heritage Provider Network Senior |
$1,846.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,993.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,993.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,993.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$996.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,791.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,791.25
|
| Rate for Payer: Multiplan Commercial |
$2,990.62
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,440.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,320.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,389.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,389.38
|
| Rate for Payer: Vantage Medical Group Senior |
$3,389.38
|
|
|
HC STENT SUPERA
|
Facility
|
IP
|
$3,987.50
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020142
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$797.50 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$797.50
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,914.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,602.97
|
| Rate for Payer: Blue Shield of California EPN |
$1,602.97
|
| Rate for Payer: Cash Price |
$2,193.12
|
| Rate for Payer: Cash Price |
$2,193.12
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,834.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,153.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,846.21
|
| Rate for Payer: Heritage Provider Network Senior |
$1,846.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,993.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,993.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,993.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$996.88
|
| Rate for Payer: Multiplan Commercial |
$2,990.62
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,440.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,320.26
|
|
|
HC STENT TIBIOPERONEAL
|
Facility
|
IP
|
$26,601.00
|
|
|
Service Code
|
CPT 37230
|
| Hospital Charge Code |
906820154
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,814.78 |
| Max. Negotiated Rate |
$19,950.75 |
| Rate for Payer: Adventist Health Commercial |
$5,320.20
|
| Rate for Payer: Cash Price |
$14,630.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$18,008.88
|
| Rate for Payer: Heritage Provider Network Senior |
$18,008.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,814.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,650.25
|
| Rate for Payer: Multiplan Commercial |
$19,950.75
|
|
|
HC STENT TIBIOPERONEAL
|
Facility
|
IP
|
$22,445.00
|
|
|
Service Code
|
CPT 37230
|
| Hospital Charge Code |
909020071
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,062.55 |
| Max. Negotiated Rate |
$16,833.75 |
| Rate for Payer: Adventist Health Commercial |
$4,489.00
|
| Rate for Payer: Cash Price |
$12,344.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$15,195.26
|
| Rate for Payer: Heritage Provider Network Senior |
$15,195.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,062.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,611.25
|
| Rate for Payer: Multiplan Commercial |
$16,833.75
|
|
