|
HC STENT CCA W/O EPD
|
Facility
OP
|
$20,831.00
|
|
|
Service Code
|
CPT 37216
|
| Hospital Charge Code |
906820167
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$183.53 |
| Max. Negotiated Rate |
$17,706.35 |
| Rate for Payer: Adventist Health Commercial |
$4,166.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14,310.90
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$17,706.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$11,457.05
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$15,623.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$9,373.95
|
| Rate for Payer: Cash Price |
$9,373.95
|
| Rate for Payer: Cash Price |
$9,373.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13,540.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17,706.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$17,706.35
|
| Rate for Payer: Dignity Health Senior |
$17,706.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$12,894.39
|
| Rate for Payer: Heritage Provider Network Senior |
$12,894.39
|
| Rate for Payer: IEHP Medi-Cal |
$183.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$10,040.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,770.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,207.75
|
| Rate for Payer: Multiplan Commercial |
$15,623.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17,706.35
|
| Rate for Payer: Vantage Medical Group Senior |
$17,706.35
|
|
|
HC STENT COARCT INCLUDING LSCA
|
Facility
IP
|
$5,614.00
|
|
|
Service Code
|
CPT 33880
|
| Hospital Charge Code |
906820015
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,016.13 |
| Max. Negotiated Rate |
$4,210.50 |
| Rate for Payer: Adventist Health Commercial |
$1,122.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,856.82
|
| Rate for Payer: Cash Price |
$2,526.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,800.68
|
| Rate for Payer: Heritage Provider Network Senior |
$3,800.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,016.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,403.50
|
| Rate for Payer: Multiplan Commercial |
$4,210.50
|
|
|
HC STENT COARCT INCLUDING LSCA
|
Facility
OP
|
$5,614.00
|
|
|
Service Code
|
CPT 33880
|
| Hospital Charge Code |
906811485
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,016.13 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$1,122.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,856.82
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4,771.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3,087.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,210.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,742.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$2,526.30
|
| Rate for Payer: Cash Price |
$2,526.30
|
| Rate for Payer: Cash Price |
$2,526.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,649.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,771.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,771.90
|
| Rate for Payer: Dignity Health Senior |
$4,771.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,475.07
|
| Rate for Payer: Heritage Provider Network Senior |
$3,475.07
|
| Rate for Payer: IEHP Medi-Cal |
$2,331.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,705.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,016.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,403.50
|
| Rate for Payer: Multiplan Commercial |
$4,210.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,771.90
|
| Rate for Payer: Vantage Medical Group Senior |
$4,771.90
|
|
|
HC STENT COARCT INCLUDING LSCA
|
Facility
OP
|
$5,614.00
|
|
|
Service Code
|
CPT 33880
|
| Hospital Charge Code |
906820015
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,016.13 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$1,122.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,856.82
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4,771.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3,087.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,210.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,742.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$2,526.30
|
| Rate for Payer: Cash Price |
$2,526.30
|
| Rate for Payer: Cash Price |
$2,526.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,649.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,771.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,771.90
|
| Rate for Payer: Dignity Health Senior |
$4,771.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,475.07
|
| Rate for Payer: Heritage Provider Network Senior |
$3,475.07
|
| Rate for Payer: IEHP Medi-Cal |
$2,331.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,705.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,016.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,403.50
|
| Rate for Payer: Multiplan Commercial |
$4,210.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,771.90
|
| Rate for Payer: Vantage Medical Group Senior |
$4,771.90
|
|
|
HC STENT COARCT INCLUDING LSCA
|
Facility
IP
|
$5,614.00
|
|
|
Service Code
|
CPT 33880
|
| Hospital Charge Code |
906811485
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,016.13 |
| Max. Negotiated Rate |
$4,210.50 |
| Rate for Payer: Adventist Health Commercial |
$1,122.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,856.82
|
| Rate for Payer: Cash Price |
$2,526.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,800.68
|
| Rate for Payer: Heritage Provider Network Senior |
$3,800.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,016.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,403.50
|
| Rate for Payer: Multiplan Commercial |
$4,210.50
|
|
|
HC STENT COARCT NOT INCL LSCA
|
Facility
OP
|
$34,481.00
|
|
|
Service Code
|
CPT 33881
|
| Hospital Charge Code |
906820202
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$400.75 |
| Max. Negotiated Rate |
$29,308.85 |
| Rate for Payer: Adventist Health Commercial |
$6,896.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$23,688.45
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$29,308.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$18,964.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$25,860.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,742.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$15,516.45
|
| Rate for Payer: Cash Price |
$15,516.45
|
| Rate for Payer: Cash Price |
$15,516.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$22,412.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29,308.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$29,308.85
|
| Rate for Payer: Dignity Health Senior |
$29,308.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$21,343.74
|
| Rate for Payer: Heritage Provider Network Senior |
$21,343.74
|
| Rate for Payer: IEHP Medi-Cal |
$400.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$16,619.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,241.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,620.25
|
| Rate for Payer: Multiplan Commercial |
$25,860.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29,308.85
|
| Rate for Payer: Vantage Medical Group Senior |
$29,308.85
|
|
|
HC STENT COARCT NOT INCL LSCA
|
Facility
IP
|
$34,481.00
|
|
|
Service Code
|
CPT 33881
|
| Hospital Charge Code |
906820202
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,241.06 |
| Max. Negotiated Rate |
$25,860.75 |
| Rate for Payer: Adventist Health Commercial |
$6,896.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$23,688.45
|
| Rate for Payer: Cash Price |
$15,516.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$23,343.64
|
| Rate for Payer: Heritage Provider Network Senior |
$23,343.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,241.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,620.25
|
| Rate for Payer: Multiplan Commercial |
$25,860.75
|
|
|
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 |
$12,139.00 |
| 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: AlphaCare Medical Group Commercial/Exchange |
$5,471.88
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3,540.62
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,828.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,997.69
|
| Rate for Payer: Blue Shield of California EPN |
$3,778.81
|
| Rate for Payer: Cash Price |
$2,896.88
|
| Rate for Payer: Cash Price |
$2,896.88
|
| 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: Multiplan Commercial |
$4,828.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,347.11
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,150.77
|
| 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 |
$12,173.00 |
| 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: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$2,896.88
|
| Rate for Payer: Cash Price |
$2,896.88
|
| 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 |
$4,358.19
|
| Rate for Payer: Heritage Provider Network Senior |
$4,358.19
|
| 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 |
$2,347.11
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,150.77
|
|
|
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 |
$12,139.00 |
| 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: AlphaCare Medical Group Commercial/Exchange |
$1,459.45
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$944.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,287.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,066.26
|
| Rate for Payer: Blue Shield of California EPN |
$1,007.88
|
| Rate for Payer: Cash Price |
$772.65
|
| Rate for Payer: Cash Price |
$772.65
|
| 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: Multiplan Commercial |
$1,287.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$626.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$573.65
|
| 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 |
$12,173.00 |
| 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: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$772.65
|
| Rate for Payer: Cash Price |
$772.65
|
| 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 |
$1,162.41
|
| Rate for Payer: Heritage Provider Network Senior |
$1,162.41
|
| 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 |
$626.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$573.65
|
|
|
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 |
$12,139.00 |
| 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: AlphaCare Medical Group Commercial/Exchange |
$11,050.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7,150.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9,750.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,073.00
|
| Rate for Payer: Blue Shield of California EPN |
$7,631.00
|
| Rate for Payer: Cash Price |
$5,850.00
|
| Rate for Payer: Cash Price |
$5,850.00
|
| 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: Multiplan Commercial |
$9,750.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4,739.80
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4,343.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,050.00
|
| Rate for Payer: Vantage Medical Group Senior |
$11,050.00
|
|
|
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 |
$12,173.00 |
| 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: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$5,850.00
|
| Rate for Payer: Cash Price |
$5,850.00
|
| 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 |
$8,801.00
|
| Rate for Payer: Heritage Provider Network Senior |
$8,801.00
|
| 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 |
$4,739.80
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4,343.30
|
|
|
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 |
$12,173.00 |
| 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: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$1,667.25
|
| Rate for Payer: Cash Price |
$1,667.25
|
| 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 |
$2,508.28
|
| Rate for Payer: Heritage Provider Network Senior |
$2,508.28
|
| 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 |
$1,350.84
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,237.84
|
|
|
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 |
$12,139.00 |
| 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: AlphaCare Medical Group Commercial/Exchange |
$3,149.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,037.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,778.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,300.80
|
| Rate for Payer: Blue Shield of California EPN |
$2,174.84
|
| Rate for Payer: Cash Price |
$1,667.25
|
| Rate for Payer: Cash Price |
$1,667.25
|
| 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 |
$1,715.42
|
| Rate for Payer: Heritage Provider Network Senior |
$1,715.42
|
| 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 |
$1,350.84
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,237.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,149.25
|
| Rate for Payer: Vantage Medical Group Senior |
$3,149.25
|
|
|
HC STENT FEM/POP
|
Facility
IP
|
$21,002.00
|
|
|
Service Code
|
CPT 37226
|
| Hospital Charge Code |
906820150
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,801.36 |
| Max. Negotiated Rate |
$15,751.50 |
| Rate for Payer: Adventist Health Commercial |
$4,200.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14,428.37
|
| Rate for Payer: Cash Price |
$9,450.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$14,218.35
|
| Rate for Payer: Heritage Provider Network Senior |
$14,218.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,801.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,250.50
|
| Rate for Payer: Multiplan Commercial |
$15,751.50
|
|
|
HC STENT FEM/POP
|
Facility
OP
|
$21,002.00
|
|
|
Service Code
|
CPT 37226
|
| Hospital Charge Code |
906820150
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$688.08 |
| Max. Negotiated Rate |
$26,115.92 |
| Rate for Payer: Adventist Health Commercial |
$4,200.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14,428.37
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$20,617.83
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$15,119.74
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13,745.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,651.80
|
| Rate for Payer: Blue Shield of California EPN |
$5,716.91
|
| Rate for Payer: Cash Price |
$9,450.90
|
| Rate for Payer: Cash Price |
$9,450.90
|
| Rate for Payer: Cash Price |
$9,450.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13,651.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,119.74
|
| Rate for Payer: Dignity Health Senior |
$13,745.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$13,745.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$13,000.24
|
| Rate for Payer: Heritage Provider Network Senior |
$16,906.62
|
| Rate for Payer: Humana Medicare |
$13,745.22
|
| Rate for Payer: IEHP Medi-Cal |
$688.08
|
| Rate for Payer: IEHP Medicare Advantage |
$13,745.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$26,115.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,801.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,219.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,250.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,318.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17,318.98
|
| Rate for Payer: Multiplan Commercial |
$15,751.50
|
| Rate for Payer: Multiplan WC |
$18,791.68
|
| Rate for Payer: TriValley Medical Group Commercial |
$15,119.74
|
| Rate for Payer: TriValley Medical Group Senior |
$15,119.74
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,002.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14,303.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,119.74
|
| Rate for Payer: Vantage Medical Group Senior |
$13,745.22
|
|
|
HC STENT FEM/POP
|
Facility
OP
|
$28,637.00
|
|
|
Service Code
|
CPT 37226
|
| Hospital Charge Code |
909020067
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$688.08 |
| Max. Negotiated Rate |
$26,115.92 |
| Rate for Payer: Adventist Health Commercial |
$5,727.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19,673.62
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$20,617.83
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$15,119.74
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13,745.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,651.80
|
| Rate for Payer: Blue Shield of California EPN |
$5,716.91
|
| Rate for Payer: Cash Price |
$12,886.65
|
| Rate for Payer: Cash Price |
$12,886.65
|
| Rate for Payer: Cash Price |
$12,886.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$18,614.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,119.74
|
| Rate for Payer: Dignity Health Senior |
$13,745.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$13,745.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$17,726.30
|
| Rate for Payer: Heritage Provider Network Senior |
$16,906.62
|
| Rate for Payer: Humana Medicare |
$13,745.22
|
| Rate for Payer: IEHP Medi-Cal |
$688.08
|
| Rate for Payer: IEHP Medicare Advantage |
$13,745.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$26,115.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,183.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,219.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,159.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,318.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17,318.98
|
| Rate for Payer: Multiplan Commercial |
$21,477.75
|
| Rate for Payer: Multiplan WC |
$18,791.68
|
| Rate for Payer: TriValley Medical Group Commercial |
$15,119.74
|
| Rate for Payer: TriValley Medical Group Senior |
$15,119.74
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,002.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14,303.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,119.74
|
| Rate for Payer: Vantage Medical Group Senior |
$13,745.22
|
|
|
HC STENT FEM/POP
|
Facility
IP
|
$28,637.00
|
|
|
Service Code
|
CPT 37226
|
| Hospital Charge Code |
909020067
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,183.30 |
| Max. Negotiated Rate |
$21,477.75 |
| Rate for Payer: Adventist Health Commercial |
$5,727.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19,673.62
|
| Rate for Payer: Cash Price |
$12,886.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$19,387.25
|
| Rate for Payer: Heritage Provider Network Senior |
$19,387.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,183.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,159.25
|
| Rate for Payer: Multiplan Commercial |
$21,477.75
|
|
|
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 |
$12,173.00 |
| 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: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$2,812.50
|
| Rate for Payer: Cash Price |
$2,812.50
|
| 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 |
$4,231.25
|
| Rate for Payer: Heritage Provider Network Senior |
$4,231.25
|
| 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 |
$2,278.75
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,088.12
|
|
|
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 |
$12,139.00 |
| 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: AlphaCare Medical Group Commercial/Exchange |
$5,312.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3,437.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,687.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,881.25
|
| Rate for Payer: Blue Shield of California EPN |
$3,668.75
|
| Rate for Payer: Cash Price |
$2,812.50
|
| Rate for Payer: Cash Price |
$2,812.50
|
| 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: Multiplan Commercial |
$4,687.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,278.75
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,088.12
|
| 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
IP
|
$3,900.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020089
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,872.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,679.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,794.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,106.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,640.30
|
| Rate for Payer: Heritage Provider Network Senior |
$2,640.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,950.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,950.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,950.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$975.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,421.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,302.99
|
|
|
HC 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 |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,872.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,679.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,145.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,925.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,421.90
|
| Rate for Payer: Blue Shield of California EPN |
$2,289.30
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,794.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,315.00
|
| Rate for Payer: Dignity Health Senior |
$3,315.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,496.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,805.70
|
| Rate for Payer: Heritage Provider Network Senior |
$1,805.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,950.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,950.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,950.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$975.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,421.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,302.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,315.00
|
|
|
HC 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 |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,872.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,679.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,145.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,925.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,421.90
|
| Rate for Payer: Blue Shield of California EPN |
$2,289.30
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,794.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,315.00
|
| Rate for Payer: Dignity Health Senior |
$3,315.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,496.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,805.70
|
| Rate for Payer: Heritage Provider Network Senior |
$1,805.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,950.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,950.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,950.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$975.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,421.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,302.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,315.00
|
|
|
HC 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 |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,872.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,679.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,794.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,106.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,640.30
|
| Rate for Payer: Heritage Provider Network Senior |
$2,640.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,950.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,950.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,950.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$975.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,421.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,302.99
|
|
