|
HC STENT METAL URETERAL
|
Facility
OP
|
$3,900.00
|
|
|
Service Code
|
CPT C2617
|
| Hospital Charge Code |
909020039
|
|
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 NEURO FORM 3
|
Facility
OP
|
$14,300.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909080045
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,860.00 |
| Max. Negotiated Rate |
$12,155.00 |
| Rate for Payer: Adventist Health Commercial |
$2,860.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6,864.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,824.10
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$12,155.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7,865.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$10,725.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,880.30
|
| Rate for Payer: Blue Shield of California EPN |
$8,394.10
|
| Rate for Payer: Cash Price |
$6,435.00
|
| Rate for Payer: Cash Price |
$6,435.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,578.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,155.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$12,155.00
|
| Rate for Payer: Dignity Health Senior |
$12,155.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,152.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,620.90
|
| Rate for Payer: Heritage Provider Network Senior |
$6,620.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,150.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,150.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,150.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,575.00
|
| Rate for Payer: Multiplan Commercial |
$10,725.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5,213.78
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4,777.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12,155.00
|
| Rate for Payer: Vantage Medical Group Senior |
$12,155.00
|
|
|
HC STENT NEURO FORM 3
|
Facility
IP
|
$14,300.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909080045
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,860.00 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$2,860.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6,864.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,824.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$6,435.00
|
| Rate for Payer: Cash Price |
$6,435.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,578.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,722.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,681.10
|
| Rate for Payer: Heritage Provider Network Senior |
$9,681.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,150.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,150.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,150.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,575.00
|
| Rate for Payer: Multiplan Commercial |
$10,725.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5,213.78
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4,777.63
|
|
|
HC STENT PALMAZ
|
Facility
OP
|
$1,963.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909081209
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$392.60 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$392.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$942.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,348.58
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,668.55
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,079.65
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,472.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,219.02
|
| Rate for Payer: Blue Shield of California EPN |
$1,152.28
|
| Rate for Payer: Cash Price |
$883.35
|
| Rate for Payer: Cash Price |
$883.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$902.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,668.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,668.55
|
| Rate for Payer: Dignity Health Senior |
$1,668.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,256.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$908.87
|
| Rate for Payer: Heritage Provider Network Senior |
$908.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$981.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$981.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$981.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$490.75
|
| Rate for Payer: Multiplan Commercial |
$1,472.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$715.71
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$655.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,668.55
|
| Rate for Payer: Vantage Medical Group Senior |
$1,668.55
|
|
|
HC STENT PALMAZ
|
Facility
IP
|
$1,963.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909081209
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$392.60 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$392.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$942.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,348.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$883.35
|
| Rate for Payer: Cash Price |
$883.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$902.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,060.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,328.95
|
| Rate for Payer: Heritage Provider Network Senior |
$1,328.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$981.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$981.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$981.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$490.75
|
| Rate for Payer: Multiplan Commercial |
$1,472.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$715.71
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$655.84
|
|
|
HC STENT PALMAZ BALLOON EXPAND
|
Facility
IP
|
$1,717.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
900803700
|
|
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 PALMAZ BALLOON EXPAND
|
Facility
OP
|
$1,717.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
900803700
|
|
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 PLACEMT RETRO CAROTID
|
Facility
OP
|
$17,500.00
|
|
|
Service Code
|
CPT 37217
|
| Hospital Charge Code |
909037217
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$933.56 |
| Max. Negotiated Rate |
$14,875.00 |
| Rate for Payer: Adventist Health Commercial |
$3,500.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12,022.50
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$14,875.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9,625.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13,125.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,086.22
|
| Rate for Payer: Blue Shield of California EPN |
$933.56
|
| Rate for Payer: Cash Price |
$7,875.00
|
| Rate for Payer: Cash Price |
$7,875.00
|
| Rate for Payer: Cash Price |
$7,875.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11,375.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14,875.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$14,875.00
|
| Rate for Payer: Dignity Health Senior |
$14,875.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$10,832.50
|
| Rate for Payer: Heritage Provider Network Senior |
$10,832.50
|
| Rate for Payer: IEHP Medi-Cal |
$1,479.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8,435.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,167.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,375.00
|
| Rate for Payer: Multiplan Commercial |
$13,125.00
|
| 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 |
$14,875.00
|
| Rate for Payer: Vantage Medical Group Senior |
$14,875.00
|
|
|
HC STENT PLACEMT RETRO CAROTID
|
Facility
IP
|
$17,500.00
|
|
|
Service Code
|
CPT 37217
|
| Hospital Charge Code |
909037217
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,167.50 |
| Max. Negotiated Rate |
$13,125.00 |
| Rate for Payer: Adventist Health Commercial |
$3,500.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12,022.50
|
| Rate for Payer: Cash Price |
$7,875.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,847.50
|
| Rate for Payer: Heritage Provider Network Senior |
$11,847.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,167.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,375.00
|
| Rate for Payer: Multiplan Commercial |
$13,125.00
|
|
|
HC STENT PLACEMT RETRO CAROTID
|
Facility
OP
|
$17,500.00
|
|
|
Service Code
|
CPT 37217
|
| Hospital Charge Code |
906820026
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$933.56 |
| Max. Negotiated Rate |
$14,875.00 |
| Rate for Payer: Adventist Health Commercial |
$3,500.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12,022.50
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$14,875.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9,625.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13,125.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,086.22
|
| Rate for Payer: Blue Shield of California EPN |
$933.56
|
| Rate for Payer: Cash Price |
$7,875.00
|
| Rate for Payer: Cash Price |
$7,875.00
|
| Rate for Payer: Cash Price |
$7,875.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11,375.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14,875.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$14,875.00
|
| Rate for Payer: Dignity Health Senior |
$14,875.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$10,832.50
|
| Rate for Payer: Heritage Provider Network Senior |
$10,832.50
|
| Rate for Payer: IEHP Medi-Cal |
$1,479.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8,435.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,167.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,375.00
|
| Rate for Payer: Multiplan Commercial |
$13,125.00
|
| 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 |
$14,875.00
|
| Rate for Payer: Vantage Medical Group Senior |
$14,875.00
|
|
|
HC STENT PLACEMT RETRO CAROTID
|
Facility
IP
|
$17,500.00
|
|
|
Service Code
|
CPT 37217
|
| Hospital Charge Code |
906820026
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,167.50 |
| Max. Negotiated Rate |
$13,125.00 |
| Rate for Payer: Adventist Health Commercial |
$3,500.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12,022.50
|
| Rate for Payer: Cash Price |
$7,875.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,847.50
|
| Rate for Payer: Heritage Provider Network Senior |
$11,847.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,167.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,375.00
|
| Rate for Payer: Multiplan Commercial |
$13,125.00
|
|
|
HC STENT PLACMNT ANTE CAROTID
|
Facility
IP
|
$17,500.00
|
|
|
Service Code
|
CPT 37218
|
| Hospital Charge Code |
906820018
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,167.50 |
| Max. Negotiated Rate |
$13,125.00 |
| Rate for Payer: Adventist Health Commercial |
$3,500.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12,022.50
|
| Rate for Payer: Cash Price |
$7,875.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,847.50
|
| Rate for Payer: Heritage Provider Network Senior |
$11,847.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,167.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,375.00
|
| Rate for Payer: Multiplan Commercial |
$13,125.00
|
|
|
HC STENT PLACMNT ANTE CAROTID
|
Facility
OP
|
$17,500.00
|
|
|
Service Code
|
CPT 37218
|
| Hospital Charge Code |
906820018
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$220.69 |
| Max. Negotiated Rate |
$14,875.00 |
| Rate for Payer: Adventist Health Commercial |
$3,500.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12,022.50
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$14,875.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9,625.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13,125.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,086.22
|
| Rate for Payer: Blue Shield of California EPN |
$933.56
|
| Rate for Payer: Cash Price |
$7,875.00
|
| Rate for Payer: Cash Price |
$7,875.00
|
| Rate for Payer: Cash Price |
$7,875.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11,375.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14,875.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$14,875.00
|
| Rate for Payer: Dignity Health Senior |
$14,875.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$10,832.50
|
| Rate for Payer: Heritage Provider Network Senior |
$10,832.50
|
| Rate for Payer: IEHP Medi-Cal |
$220.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8,435.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,167.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,375.00
|
| Rate for Payer: Multiplan Commercial |
$13,125.00
|
| 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 |
$14,875.00
|
| Rate for Payer: Vantage Medical Group Senior |
$14,875.00
|
|
|
HC STENT PLACMNT ANTE CAROTID
|
Facility
OP
|
$17,500.00
|
|
|
Service Code
|
CPT 37218
|
| Hospital Charge Code |
909037218
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$220.69 |
| Max. Negotiated Rate |
$14,875.00 |
| Rate for Payer: Adventist Health Commercial |
$3,500.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12,022.50
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$14,875.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9,625.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13,125.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,086.22
|
| Rate for Payer: Blue Shield of California EPN |
$933.56
|
| Rate for Payer: Cash Price |
$7,875.00
|
| Rate for Payer: Cash Price |
$7,875.00
|
| Rate for Payer: Cash Price |
$7,875.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11,375.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14,875.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$14,875.00
|
| Rate for Payer: Dignity Health Senior |
$14,875.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$10,832.50
|
| Rate for Payer: Heritage Provider Network Senior |
$10,832.50
|
| Rate for Payer: IEHP Medi-Cal |
$220.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8,435.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,167.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,375.00
|
| Rate for Payer: Multiplan Commercial |
$13,125.00
|
| 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 |
$14,875.00
|
| Rate for Payer: Vantage Medical Group Senior |
$14,875.00
|
|
|
HC STENT PLACMNT ANTE CAROTID
|
Facility
IP
|
$17,500.00
|
|
|
Service Code
|
CPT 37218
|
| Hospital Charge Code |
909037218
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,167.50 |
| Max. Negotiated Rate |
$13,125.00 |
| Rate for Payer: Adventist Health Commercial |
$3,500.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12,022.50
|
| Rate for Payer: Cash Price |
$7,875.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,847.50
|
| Rate for Payer: Heritage Provider Network Senior |
$11,847.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,167.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,375.00
|
| Rate for Payer: Multiplan Commercial |
$13,125.00
|
|
|
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 |
$12,173.00 |
| 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: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$2,722.50
|
| Rate for Payer: Cash Price |
$2,722.50
|
| 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 |
$4,095.85
|
| Rate for Payer: Heritage Provider Network Senior |
$4,095.85
|
| 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 |
$2,205.83
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,021.30
|
|
|
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 |
$12,139.00 |
| 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: AlphaCare Medical Group Commercial/Exchange |
$5,142.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3,327.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,537.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,757.05
|
| Rate for Payer: Blue Shield of California EPN |
$3,551.35
|
| Rate for Payer: Cash Price |
$2,722.50
|
| Rate for Payer: Cash Price |
$2,722.50
|
| 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: Multiplan Commercial |
$4,537.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,205.83
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,021.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,142.50
|
| Rate for Payer: Vantage Medical Group Senior |
$5,142.50
|
|
|
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 |
$12,139.00 |
| 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: AlphaCare Medical Group Commercial/Exchange |
$2,983.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,930.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,632.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,179.71
|
| Rate for Payer: Blue Shield of California EPN |
$2,060.37
|
| Rate for Payer: Cash Price |
$1,579.50
|
| Rate for Payer: Cash Price |
$1,579.50
|
| 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: Multiplan Commercial |
$2,632.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,279.75
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,172.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,983.50
|
| Rate for Payer: Vantage Medical Group Senior |
$2,983.50
|
|
|
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 |
$12,173.00 |
| 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: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$1,579.50
|
| Rate for Payer: Cash Price |
$1,579.50
|
| 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 |
$2,376.27
|
| Rate for Payer: Heritage Provider Network Senior |
$2,376.27
|
| 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 |
$1,279.75
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,172.69
|
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$16,564.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$10,718.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$14,616.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$12,102.05
|
| Rate for Payer: Blue Shield of California EPN |
$11,439.46
|
| Rate for Payer: Cash Price |
$8,769.60
|
| Rate for Payer: Cash Price |
$8,769.60
|
| 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: Multiplan Commercial |
$14,616.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,105.32
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,510.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16,564.80
|
| Rate for Payer: Vantage Medical Group Senior |
$16,564.80
|
|
|
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: Aetna of CA Non-Gatekeeper |
$13,388.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$8,769.60
|
| Rate for Payer: Cash Price |
$8,769.60
|
| 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 |
$13,193.38
|
| Rate for Payer: Heritage Provider Network Senior |
$13,193.38
|
| 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 |
$7,105.32
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,510.94
|
|
|
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 |
$12,139.00 |
| 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: AlphaCare Medical Group Commercial/Exchange |
$1,466.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$948.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,293.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,071.22
|
| Rate for Payer: Blue Shield of California EPN |
$1,012.58
|
| Rate for Payer: Cash Price |
$776.25
|
| Rate for Payer: Cash Price |
$776.25
|
| 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 |
$798.68
|
| Rate for Payer: Heritage Provider Network Senior |
$798.68
|
| 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 |
$628.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$576.32
|
| 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 |
$12,173.00 |
| 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: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$776.25
|
| Rate for Payer: Cash Price |
$776.25
|
| 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 |
$1,167.82
|
| Rate for Payer: Heritage Provider Network Senior |
$1,167.82
|
| 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 |
$628.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$576.32
|
|
|
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 |
$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 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 |
$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
|
|
