|
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 Non-Gatekeeper |
$13,081.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,165.83
|
| Rate for Payer: Blue Shield of California EPN |
$8,165.83
|
| 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 |
$9,404.92
|
| Rate for Payer: Heritage Provider Network Senior |
$9,404.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$10,156.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10,156.50
|
| Rate for Payer: Kaiser Foundation Hospitals 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 |
$7,339.09
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,725.63
|
|
|
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 Non-Gatekeeper |
$12,553.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17,266.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11,172.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15,234.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,165.83
|
| Rate for Payer: Blue Shield of California EPN |
$8,165.83
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$10,156.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10,156.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,156.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,078.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$14,219.10
|
| Rate for Payer: Multiplan Commercial |
$15,234.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,339.09
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,725.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17,266.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17,266.05
|
| Rate for Payer: Vantage Medical Group Senior |
$17,266.05
|
|
|
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 |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,410.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,145.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,925.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,567.80
|
| Rate for Payer: Blue Shield of California EPN |
$1,567.80
|
| Rate for Payer: Cash Price |
$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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$1,950.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,950.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,950.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$975.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,730.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,409.07
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,291.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,315.00
|
|
|
HC STENT 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 |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,511.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,567.80
|
| Rate for Payer: Blue Shield of California EPN |
$1,567.80
|
| Rate for Payer: Cash Price |
$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 |
$1,805.70
|
| Rate for Payer: Heritage Provider Network Senior |
$1,805.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,950.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,950.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,950.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$975.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,409.07
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,291.29
|
|
|
HC STENT 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 |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,410.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,145.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,925.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,567.80
|
| Rate for Payer: Blue Shield of California EPN |
$1,567.80
|
| Rate for Payer: Cash Price |
$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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$1,950.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,950.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,950.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$975.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,730.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,409.07
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,291.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,315.00
|
|
|
HC STENT 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 |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,511.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,567.80
|
| Rate for Payer: Blue Shield of California EPN |
$1,567.80
|
| Rate for Payer: Cash Price |
$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 |
$1,805.70
|
| Rate for Payer: Heritage Provider Network Senior |
$1,805.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,950.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,950.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,950.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$975.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,409.07
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,291.29
|
|
|
HC STENT 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 |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,410.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,145.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,925.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,567.80
|
| Rate for Payer: Blue Shield of California EPN |
$1,567.80
|
| Rate for Payer: Cash Price |
$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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$1,950.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,950.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,950.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$975.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,730.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,409.07
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,291.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,315.00
|
|
|
HC STENT 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 |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,511.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,567.80
|
| Rate for Payer: Blue Shield of California EPN |
$1,567.80
|
| Rate for Payer: Cash Price |
$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 |
$1,805.70
|
| Rate for Payer: Heritage Provider Network Senior |
$1,805.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,950.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,950.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,950.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$975.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,409.07
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,291.29
|
|
|
HC STENT 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 |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,410.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,145.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,925.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,567.80
|
| Rate for Payer: Blue Shield of California EPN |
$1,567.80
|
| Rate for Payer: Cash Price |
$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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$1,950.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,950.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,950.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$975.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,730.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,409.07
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,291.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,315.00
|
|
|
HC STENT 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 |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,511.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,567.80
|
| Rate for Payer: Blue Shield of California EPN |
$1,567.80
|
| Rate for Payer: Cash Price |
$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 |
$1,805.70
|
| Rate for Payer: Heritage Provider Network Senior |
$1,805.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,950.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,950.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,950.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$975.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,409.07
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,291.29
|
|
|
HC STENT 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 |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$2,860.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,837.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,155.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,865.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,725.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,748.60
|
| Rate for Payer: Blue Shield of California EPN |
$5,748.60
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$7,150.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7,150.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,150.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,575.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10,010.00
|
| Rate for Payer: Multiplan Commercial |
$10,725.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5,166.59
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4,734.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,155.00
|
| 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 |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$2,860.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,209.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,748.60
|
| Rate for Payer: Blue Shield of California EPN |
$5,748.60
|
| 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 |
$6,620.90
|
| Rate for Payer: Heritage Provider Network Senior |
$6,620.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7,150.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7,150.00
|
| Rate for Payer: Kaiser Foundation Hospitals 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 |
$5,166.59
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4,734.73
|
|
|
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 |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$392.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,213.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,668.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,079.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,472.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$789.13
|
| Rate for Payer: Blue Shield of California EPN |
$789.13
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$981.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$981.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$981.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$490.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,374.10
|
| Rate for Payer: Multiplan Commercial |
$1,472.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$709.23
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$649.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,668.55
|
| 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 |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$392.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,264.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$789.13
|
| Rate for Payer: Blue Shield of California EPN |
$789.13
|
| 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 |
$908.87
|
| Rate for Payer: Heritage Provider Network Senior |
$908.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$981.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$981.50
|
| Rate for Payer: Kaiser Foundation Hospitals 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 |
$709.23
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$649.95
|
|
|
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 |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$343.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,061.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,459.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$944.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,287.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$690.23
|
| Rate for Payer: Blue Shield of California EPN |
$690.23
|
| Rate for Payer: Cash Price |
$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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$858.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$858.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$858.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$429.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,201.90
|
| Rate for Payer: Multiplan Commercial |
$1,287.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$620.35
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$568.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,459.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,459.45
|
| Rate for Payer: Vantage Medical Group Senior |
$1,459.45
|
|
|
HC STENT 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 |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$343.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,105.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$690.23
|
| Rate for Payer: Blue Shield of California EPN |
$690.23
|
| Rate for Payer: Cash Price |
$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 |
$794.97
|
| Rate for Payer: Heritage Provider Network Senior |
$794.97
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$858.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$858.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$858.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$429.25
|
| Rate for Payer: Multiplan Commercial |
$1,287.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$620.35
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$568.50
|
|
|
HC STENT PLACEMT RETRO CAROTID
|
Facility
|
IP
|
$14,936.00
|
|
|
Service Code
|
CPT 37217
|
| Hospital Charge Code |
909037217
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,703.42 |
| Max. Negotiated Rate |
$11,202.00 |
| Rate for Payer: Adventist Health Commercial |
$2,987.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,618.78
|
| Rate for Payer: Cash Price |
$6,721.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$10,111.67
|
| Rate for Payer: Heritage Provider Network Senior |
$10,111.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,703.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,734.00
|
| Rate for Payer: Multiplan Commercial |
$11,202.00
|
|
|
HC STENT PLACEMT RETRO CAROTID
|
Facility
|
OP
|
$14,936.00
|
|
|
Service Code
|
CPT 37217
|
| Hospital Charge Code |
909037217
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,703.42 |
| Max. Negotiated Rate |
$12,695.60 |
| Rate for Payer: Adventist Health Commercial |
$2,987.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,230.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,695.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,214.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11,202.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,435.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$6,721.20
|
| Rate for Payer: Cash Price |
$6,721.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9,708.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,695.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$12,695.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12,695.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,245.38
|
| Rate for Payer: Heritage Provider Network Senior |
$9,245.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7,124.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,703.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,734.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10,455.20
|
| Rate for Payer: Multiplan Commercial |
$11,202.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,695.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12,695.60
|
| Rate for Payer: Vantage Medical Group Senior |
$12,695.60
|
|
|
HC STENT PLACMNT ANTE CAROTID
|
Facility
|
IP
|
$14,131.00
|
|
|
Service Code
|
CPT 37218
|
| Hospital Charge Code |
909037218
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,557.71 |
| Max. Negotiated Rate |
$10,598.25 |
| Rate for Payer: Adventist Health Commercial |
$2,826.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,100.36
|
| Rate for Payer: Cash Price |
$6,358.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,566.69
|
| Rate for Payer: Heritage Provider Network Senior |
$9,566.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,557.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,532.75
|
| Rate for Payer: Multiplan Commercial |
$10,598.25
|
|
|
HC STENT PLACMNT ANTE CAROTID
|
Facility
|
OP
|
$14,131.00
|
|
|
Service Code
|
CPT 37218
|
| Hospital Charge Code |
909037218
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,557.71 |
| Max. Negotiated Rate |
$12,011.35 |
| Rate for Payer: Adventist Health Commercial |
$2,826.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,732.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,011.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,772.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,598.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,435.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$6,358.95
|
| Rate for Payer: Cash Price |
$6,358.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9,185.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,011.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$12,011.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12,011.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,747.09
|
| Rate for Payer: Heritage Provider Network Senior |
$8,747.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$6,740.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,557.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,532.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9,891.70
|
| Rate for Payer: Multiplan Commercial |
$10,598.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,011.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12,011.35
|
| Rate for Payer: Vantage Medical Group Senior |
$12,011.35
|
|
|
HC STENT PROTEGE
|
Facility
|
OP
|
$6,050.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020030
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,210.00 |
| Max. Negotiated Rate |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$1,210.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,738.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,142.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,327.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,537.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,432.10
|
| Rate for Payer: Blue Shield of California EPN |
$2,432.10
|
| Rate for Payer: Cash Price |
$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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$3,025.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,025.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,025.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,512.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,235.00
|
| Rate for Payer: Multiplan Commercial |
$4,537.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,185.86
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,003.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,142.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,142.50
|
| Rate for Payer: Vantage Medical Group Senior |
$5,142.50
|
|
|
HC STENT PROTEGE
|
Facility
|
IP
|
$6,050.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020030
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,210.00 |
| Max. Negotiated Rate |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$1,210.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,896.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,432.10
|
| Rate for Payer: Blue Shield of California EPN |
$2,432.10
|
| Rate for Payer: Cash Price |
$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 |
$2,801.15
|
| Rate for Payer: Heritage Provider Network Senior |
$2,801.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3,025.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,025.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,025.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,512.50
|
| Rate for Payer: Multiplan Commercial |
$4,537.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,185.86
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,003.15
|
|
|
HC STENT PROTEGE EVERFLEX
|
Facility
|
OP
|
$3,510.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020093
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$702.00 |
| Max. Negotiated Rate |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$702.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,169.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,983.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,930.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,632.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,411.02
|
| Rate for Payer: Blue Shield of California EPN |
$1,411.02
|
| Rate for Payer: Cash Price |
$1,579.50
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$1,755.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,755.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,755.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$877.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,457.00
|
| Rate for Payer: Multiplan Commercial |
$2,632.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,268.16
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,162.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,983.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,983.50
|
| Rate for Payer: Vantage Medical Group Senior |
$2,983.50
|
|
|
HC STENT PROTEGE EVERFLEX
|
Facility
|
IP
|
$3,510.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020093
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$702.00 |
| Max. Negotiated Rate |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$702.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,260.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,411.02
|
| Rate for Payer: Blue Shield of California EPN |
$1,411.02
|
| Rate for Payer: Cash Price |
$1,579.50
|
| 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 |
$1,625.13
|
| Rate for Payer: Heritage Provider Network Senior |
$1,625.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,755.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,755.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,755.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$877.50
|
| Rate for Payer: Multiplan Commercial |
$2,632.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,268.16
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,162.16
|
|
|
HC STENT 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 Non-Gatekeeper |
$12,550.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,834.18
|
| Rate for Payer: Blue Shield of California EPN |
$7,834.18
|
| Rate for Payer: Cash Price |
$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 |
$9,022.94
|
| Rate for Payer: Heritage Provider Network Senior |
$9,022.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$9,744.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9,744.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9,744.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,872.00
|
| Rate for Payer: Multiplan Commercial |
$14,616.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,041.01
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,452.48
|
|
