|
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 |
$12,173.00 |
| 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: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$2,025.00
|
| Rate for Payer: Cash Price |
$2,025.00
|
| 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 |
$3,046.50
|
| Rate for Payer: Heritage Provider Network Senior |
$3,046.50
|
| 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 |
$1,640.70
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,503.45
|
|
|
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 |
$12,139.00 |
| 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: AlphaCare Medical Group Commercial/Exchange |
$3,825.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,475.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,375.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,794.50
|
| Rate for Payer: Blue Shield of California EPN |
$2,641.50
|
| Rate for Payer: Cash Price |
$2,025.00
|
| Rate for Payer: Cash Price |
$2,025.00
|
| 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: Multiplan Commercial |
$3,375.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,640.70
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,503.45
|
| 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
OP
|
$26,298.00
|
|
|
Service Code
|
CPT 37221
|
| Hospital Charge Code |
909020062
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$134.69 |
| Max. Negotiated Rate |
$26,115.92 |
| Rate for Payer: Adventist Health Commercial |
$5,259.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18,066.73
|
| 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 |
$11,834.10
|
| Rate for Payer: Cash Price |
$11,834.10
|
| Rate for Payer: Cash Price |
$11,834.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$17,093.70
|
| 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 |
$16,278.46
|
| Rate for Payer: Heritage Provider Network Senior |
$16,906.62
|
| Rate for Payer: Humana Medicare |
$13,745.22
|
| Rate for Payer: IEHP Medi-Cal |
$134.69
|
| 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 |
$4,759.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,219.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,574.50
|
| 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 |
$19,723.50
|
| 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 ILIAC
|
Facility
OP
|
$25,474.00
|
|
|
Service Code
|
CPT 37221
|
| Hospital Charge Code |
906820145
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$134.69 |
| Max. Negotiated Rate |
$26,115.92 |
| Rate for Payer: Adventist Health Commercial |
$5,094.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17,500.64
|
| 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 |
$11,463.30
|
| Rate for Payer: Cash Price |
$11,463.30
|
| Rate for Payer: Cash Price |
$11,463.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16,558.10
|
| 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 |
$15,768.41
|
| Rate for Payer: Heritage Provider Network Senior |
$16,906.62
|
| Rate for Payer: Humana Medicare |
$13,745.22
|
| Rate for Payer: IEHP Medi-Cal |
$134.69
|
| 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 |
$4,610.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,219.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,368.50
|
| 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 |
$19,105.50
|
| 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 ILIAC
|
Facility
IP
|
$25,474.00
|
|
|
Service Code
|
CPT 37221
|
| Hospital Charge Code |
906820145
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,610.79 |
| Max. Negotiated Rate |
$19,105.50 |
| Rate for Payer: Adventist Health Commercial |
$5,094.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17,500.64
|
| Rate for Payer: Cash Price |
$11,463.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$17,245.90
|
| Rate for Payer: Heritage Provider Network Senior |
$17,245.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,610.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,368.50
|
| Rate for Payer: Multiplan Commercial |
$19,105.50
|
|
|
HC STENT ILIAC
|
Facility
IP
|
$26,298.00
|
|
|
Service Code
|
CPT 37221
|
| Hospital Charge Code |
909020062
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,759.94 |
| Max. Negotiated Rate |
$19,723.50 |
| Rate for Payer: Adventist Health Commercial |
$5,259.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18,066.73
|
| Rate for Payer: Cash Price |
$11,834.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$17,803.75
|
| Rate for Payer: Heritage Provider Network Senior |
$17,803.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,759.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,574.50
|
| Rate for Payer: Multiplan Commercial |
$19,723.50
|
|
|
HC STENT ILIAC EA ADDL
|
Facility
IP
|
$15,314.00
|
|
|
Service Code
|
CPT 37223
|
| Hospital Charge Code |
906820147
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,771.83 |
| Max. Negotiated Rate |
$11,485.50 |
| Rate for Payer: Adventist Health Commercial |
$3,062.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10,520.72
|
| Rate for Payer: Cash Price |
$6,891.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$10,367.58
|
| Rate for Payer: Heritage Provider Network Senior |
$10,367.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,771.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,828.50
|
| Rate for Payer: Multiplan Commercial |
$11,485.50
|
|
|
HC STENT ILIAC EA ADDL
|
Facility
OP
|
$17,684.00
|
|
|
Service Code
|
CPT 37223
|
| Hospital Charge Code |
909020064
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$56.88 |
| Max. Negotiated Rate |
$15,031.40 |
| Rate for Payer: Adventist Health Commercial |
$3,536.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12,148.91
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$15,031.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9,726.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13,263.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| 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 |
$7,957.80
|
| Rate for Payer: Cash Price |
$7,957.80
|
| Rate for Payer: Cash Price |
$7,957.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11,494.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15,031.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,031.40
|
| Rate for Payer: Dignity Health Senior |
$15,031.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$10,946.40
|
| Rate for Payer: Heritage Provider Network Senior |
$10,946.40
|
| Rate for Payer: IEHP Medi-Cal |
$56.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8,523.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,200.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,421.00
|
| Rate for Payer: Multiplan Commercial |
$13,263.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13,479.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,381.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,031.40
|
| Rate for Payer: Vantage Medical Group Senior |
$15,031.40
|
|
|
HC STENT ILIAC EA ADDL
|
Facility
OP
|
$15,314.00
|
|
|
Service Code
|
CPT 37223
|
| Hospital Charge Code |
906820147
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$56.88 |
| Max. Negotiated Rate |
$13,479.00 |
| Rate for Payer: Adventist Health Commercial |
$3,062.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10,520.72
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$13,016.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8,422.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$11,485.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| 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 |
$6,891.30
|
| Rate for Payer: Cash Price |
$6,891.30
|
| Rate for Payer: Cash Price |
$6,891.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9,954.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,016.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$13,016.90
|
| Rate for Payer: Dignity Health Senior |
$13,016.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,479.37
|
| Rate for Payer: Heritage Provider Network Senior |
$9,479.37
|
| Rate for Payer: IEHP Medi-Cal |
$56.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,381.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,771.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,828.50
|
| Rate for Payer: Multiplan Commercial |
$11,485.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13,479.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,381.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13,016.90
|
| Rate for Payer: Vantage Medical Group Senior |
$13,016.90
|
|
|
HC STENT ILIAC EA ADDL
|
Facility
IP
|
$17,684.00
|
|
|
Service Code
|
CPT 37223
|
| Hospital Charge Code |
909020064
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,200.80 |
| Max. Negotiated Rate |
$13,263.00 |
| Rate for Payer: Adventist Health Commercial |
$3,536.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12,148.91
|
| Rate for Payer: Cash Price |
$7,957.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,972.07
|
| Rate for Payer: Heritage Provider Network Senior |
$11,972.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,200.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,421.00
|
| Rate for Payer: Multiplan Commercial |
$13,263.00
|
|
|
HC STENT INSERTION INDWELLING DBL
|
Facility
OP
|
$11,930.00
|
|
|
Service Code
|
CPT 52332
|
| Hospital Charge Code |
909020042
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$858.98 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$2,386.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,195.91
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,533.58
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,791.29
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,355.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,706.95
|
| Rate for Payer: Blue Shield of California EPN |
$4,045.41
|
| Rate for Payer: Cash Price |
$5,368.50
|
| Rate for Payer: Cash Price |
$5,368.50
|
| Rate for Payer: Cash Price |
$5,368.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,754.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,533.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,791.29
|
| Rate for Payer: Dignity Health Senior |
$4,355.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,355.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,384.67
|
| Rate for Payer: Heritage Provider Network Senior |
$5,357.54
|
| Rate for Payer: Humana Medicare |
$4,355.72
|
| Rate for Payer: IEHP Medi-Cal |
$858.98
|
| Rate for Payer: IEHP Medicare Advantage |
$4,355.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8,275.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,159.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,139.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,982.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,488.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,488.21
|
| Rate for Payer: Multiplan Commercial |
$8,947.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,791.29
|
| Rate for Payer: TriValley Medical Group Senior |
$4,791.29
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,096.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,971.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,533.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,791.29
|
| Rate for Payer: Vantage Medical Group Senior |
$4,355.72
|
|
|
HC STENT INSERTION INDWELLING DBL
|
Facility
IP
|
$11,930.00
|
|
|
Service Code
|
CPT 52332
|
| Hospital Charge Code |
909020042
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,159.33 |
| Max. Negotiated Rate |
$8,947.50 |
| Rate for Payer: Adventist Health Commercial |
$2,386.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,195.91
|
| Rate for Payer: Cash Price |
$5,368.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,076.61
|
| Rate for Payer: Heritage Provider Network Senior |
$8,076.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,159.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,982.50
|
| Rate for Payer: Multiplan Commercial |
$8,947.50
|
|
|
HC STENT INTRACRAN ATHERO STENOSI
|
Facility
IP
|
$11,256.00
|
|
|
Service Code
|
CPT 61635
|
| Hospital Charge Code |
909081014
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,037.34 |
| Max. Negotiated Rate |
$8,442.00 |
| Rate for Payer: Adventist Health Commercial |
$2,251.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,732.87
|
| Rate for Payer: Cash Price |
$5,065.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,620.31
|
| Rate for Payer: Heritage Provider Network Senior |
$7,620.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,037.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,814.00
|
| Rate for Payer: Multiplan Commercial |
$8,442.00
|
|
|
HC STENT INTRACRAN ATHERO STENOSI
|
Facility
OP
|
$11,256.00
|
|
|
Service Code
|
CPT 61635
|
| Hospital Charge Code |
909081014
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,037.34 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$2,251.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,732.87
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9,567.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6,190.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8,442.00
|
| 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 |
$5,065.20
|
| Rate for Payer: Cash Price |
$5,065.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,316.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,567.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,567.60
|
| Rate for Payer: Dignity Health Senior |
$9,567.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,753.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,967.46
|
| Rate for Payer: Heritage Provider Network Senior |
$6,967.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5,425.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,037.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,814.00
|
| Rate for Payer: Multiplan Commercial |
$8,442.00
|
| 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 |
$9,567.60
|
| Rate for Payer: Vantage Medical Group Senior |
$9,567.60
|
|
|
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 |
$12,139.00 |
| 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: AlphaCare Medical Group Commercial/Exchange |
$2,403.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,555.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,121.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,756.19
|
| Rate for Payer: Blue Shield of California EPN |
$1,660.04
|
| Rate for Payer: Cash Price |
$1,272.60
|
| Rate for Payer: Cash Price |
$1,272.60
|
| 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: Multiplan Commercial |
$2,121.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,031.09
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$944.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,403.80
|
| Rate for Payer: Vantage Medical Group Senior |
$2,403.80
|
|
|
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 |
$12,173.00 |
| 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: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$1,272.60
|
| Rate for Payer: Cash Price |
$1,272.60
|
| 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 |
$1,914.56
|
| Rate for Payer: Heritage Provider Network Senior |
$1,914.56
|
| 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 |
$1,031.09
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$944.83
|
|
|
HC STENT LVIS
|
Facility
OP
|
$20,313.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909001876
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,062.60 |
| Max. Negotiated Rate |
$17,266.05 |
| Rate for Payer: Adventist Health Commercial |
$4,062.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$9,750.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13,955.03
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$17,266.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$11,172.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$15,234.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$12,614.37
|
| Rate for Payer: Blue Shield of California EPN |
$11,923.73
|
| Rate for Payer: Cash Price |
$9,140.85
|
| Rate for Payer: Cash Price |
$9,140.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9,343.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17,266.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$17,266.05
|
| Rate for Payer: Dignity Health Senior |
$17,266.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,000.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,404.92
|
| Rate for Payer: Heritage Provider Network Senior |
$9,404.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$10,156.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,156.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,156.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,078.25
|
| Rate for Payer: Multiplan Commercial |
$15,234.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,406.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,786.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17,266.05
|
| Rate for Payer: Vantage Medical Group Senior |
$17,266.05
|
|
|
HC STENT LVIS
|
Facility
IP
|
$20,313.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909001876
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,062.60 |
| Max. Negotiated Rate |
$15,234.75 |
| Rate for Payer: Adventist Health Commercial |
$4,062.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$9,750.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13,955.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$9,140.85
|
| Rate for Payer: Cash Price |
$9,140.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9,343.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,969.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$13,751.90
|
| Rate for Payer: Heritage Provider Network Senior |
$13,751.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$10,156.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,156.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,156.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,078.25
|
| Rate for Payer: Multiplan Commercial |
$15,234.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,406.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,786.57
|
|
|
HC STENT MEDTRONIC BALN EXPAND
|
Facility
OP
|
$3,900.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020115
|
|
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 MEDTRONIC BALN EXPAND
|
Facility
IP
|
$3,900.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020115
|
|
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 MEDTRONIC SE 12-150
|
Facility
IP
|
$3,900.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020114
|
|
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 MEDTRONIC SE 12-150
|
Facility
OP
|
$3,900.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020114
|
|
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 MEDTRONIC SE 40-100
|
Facility
OP
|
$3,900.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020113
|
|
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 MEDTRONIC SE 40-100
|
Facility
IP
|
$3,900.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020113
|
|
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 METAL URETERAL
|
Facility
IP
|
$3,900.00
|
|
|
Service Code
|
CPT C2617
|
| Hospital Charge Code |
909020039
|
|
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
|
|
