|
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 Non-Gatekeeper |
$12,043.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16,564.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,718.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,616.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| 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: Dignity Health Commercial/Exchange |
$16,564.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$16,564.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$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 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: Molina Healthcare of CA Medi-Cal/Medicare |
$13,641.60
|
| Rate for Payer: Multiplan Commercial |
$14,616.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,041.01
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,452.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16,564.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16,564.80
|
| Rate for Payer: Vantage Medical Group Senior |
$16,564.80
|
|
|
HC STENT RUSCH Y
|
Facility
|
IP
|
$1,725.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
900803703
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$345.00 |
| Max. Negotiated Rate |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$345.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,110.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$693.45
|
| Rate for Payer: Blue Shield of California EPN |
$693.45
|
| Rate for Payer: Cash Price |
$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 |
$798.67
|
| Rate for Payer: Heritage Provider Network Senior |
$798.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$862.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$862.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$862.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$431.25
|
| Rate for Payer: Multiplan Commercial |
$1,293.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$623.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$571.15
|
|
|
HC STENT RUSCH Y
|
Facility
|
OP
|
$1,725.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
900803703
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$345.00 |
| Max. Negotiated Rate |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$345.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,066.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,466.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$948.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,293.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$693.45
|
| Rate for Payer: Blue Shield of California EPN |
$693.45
|
| Rate for Payer: Cash Price |
$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 Medicare Advantage |
$1,466.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,104.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$798.67
|
| Rate for Payer: Heritage Provider Network Senior |
$798.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$862.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$862.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$862.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$431.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,207.50
|
| Rate for Payer: Multiplan Commercial |
$1,293.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$623.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$571.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,466.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,466.25
|
| Rate for Payer: Vantage Medical Group Senior |
$1,466.25
|
|
|
HC STENT SCHNEIDER WALL
|
Facility
|
OP
|
$1,717.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
900803702
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$343.40 |
| Max. Negotiated Rate |
$13,770.00 |
| 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 SCHNEIDER WALL
|
Facility
|
IP
|
$1,717.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
900803702
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$343.40 |
| Max. Negotiated Rate |
$13,808.00 |
| 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 SUPERA
|
Facility
|
OP
|
$3,987.50
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020142
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$797.50 |
| Max. Negotiated Rate |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$797.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,464.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,389.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,193.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,990.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,602.97
|
| Rate for Payer: Blue Shield of California EPN |
$1,602.97
|
| Rate for Payer: Cash Price |
$1,794.38
|
| Rate for Payer: Cash Price |
$1,794.38
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,834.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,389.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,389.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,389.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,552.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,846.21
|
| Rate for Payer: Heritage Provider Network Senior |
$1,846.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,993.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,993.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,993.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$996.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,791.25
|
| Rate for Payer: Multiplan Commercial |
$2,990.62
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,440.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,320.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,389.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,389.38
|
| Rate for Payer: Vantage Medical Group Senior |
$3,389.38
|
|
|
HC STENT SUPERA
|
Facility
|
IP
|
$3,987.50
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020142
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$797.50 |
| Max. Negotiated Rate |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$797.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,567.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,602.97
|
| Rate for Payer: Blue Shield of California EPN |
$1,602.97
|
| Rate for Payer: Cash Price |
$1,794.38
|
| Rate for Payer: Cash Price |
$1,794.38
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,834.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,153.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,846.21
|
| Rate for Payer: Heritage Provider Network Senior |
$1,846.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,993.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,993.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,993.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$996.88
|
| Rate for Payer: Multiplan Commercial |
$2,990.62
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,440.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,320.26
|
|
|
HC STENT TIBIOPERONEAL
|
Facility
|
IP
|
$22,445.00
|
|
|
Service Code
|
CPT 37230
|
| Hospital Charge Code |
909020071
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,062.55 |
| Max. Negotiated Rate |
$16,833.75 |
| Rate for Payer: Adventist Health Commercial |
$4,489.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14,454.58
|
| Rate for Payer: Cash Price |
$10,100.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$15,195.26
|
| Rate for Payer: Heritage Provider Network Senior |
$15,195.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,062.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,611.25
|
| Rate for Payer: Multiplan Commercial |
$16,833.75
|
|
|
HC STENT TIBIOPERONEAL
|
Facility
|
OP
|
$22,445.00
|
|
|
Service Code
|
CPT 37230
|
| Hospital Charge Code |
909020071
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,062.55 |
| Max. Negotiated Rate |
$36,352.92 |
| Rate for Payer: Adventist Health Commercial |
$4,489.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13,871.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19,078.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12,344.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16,833.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,136.00
|
| 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 |
$10,100.25
|
| Rate for Payer: Cash Price |
$10,100.25
|
| Rate for Payer: Cash Price |
$10,100.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14,589.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19,078.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$19,078.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19,078.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$13,893.45
|
| Rate for Payer: Heritage Provider Network Senior |
$13,893.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$10,706.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,062.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,611.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15,711.50
|
| Rate for Payer: Multiplan Commercial |
$16,833.75
|
| Rate for Payer: Multiplan WC |
$36,352.92
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,861.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,025.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19,078.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19,078.25
|
| Rate for Payer: Vantage Medical Group Senior |
$19,078.25
|
|
|
HC STENT TIBIOPERONEAL EA ADDL
|
Facility
|
IP
|
$13,536.00
|
|
|
Service Code
|
CPT 37234
|
| Hospital Charge Code |
909020075
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,450.02 |
| Max. Negotiated Rate |
$10,152.00 |
| Rate for Payer: Adventist Health Commercial |
$2,707.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,717.18
|
| Rate for Payer: Cash Price |
$6,091.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,163.87
|
| Rate for Payer: Heritage Provider Network Senior |
$9,163.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,450.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,384.00
|
| Rate for Payer: Multiplan Commercial |
$10,152.00
|
|
|
HC STENT TIBIOPERONEAL EA ADDL
|
Facility
|
OP
|
$13,536.00
|
|
|
Service Code
|
CPT 37234
|
| Hospital Charge Code |
909020075
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,450.02 |
| Max. Negotiated Rate |
$14,160.00 |
| Rate for Payer: Adventist Health Commercial |
$2,707.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,365.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,505.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,444.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,152.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| 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 |
$6,091.20
|
| Rate for Payer: Cash Price |
$6,091.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8,798.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,505.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,505.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11,505.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,378.78
|
| Rate for Payer: Heritage Provider Network Senior |
$8,378.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$6,456.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,450.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,384.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9,475.20
|
| Rate for Payer: Multiplan Commercial |
$10,152.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14,160.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,956.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,505.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,505.60
|
| Rate for Payer: Vantage Medical Group Senior |
$11,505.60
|
|
|
HC STENT ULTRAFLEX T-B COV W/DEL
|
Facility
|
OP
|
$3,053.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
900803704
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$610.60 |
| Max. Negotiated Rate |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$610.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,886.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,595.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,679.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,289.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,227.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,227.31
|
| Rate for Payer: Cash Price |
$1,373.85
|
| Rate for Payer: Cash Price |
$1,373.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,404.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,595.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,595.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,595.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,953.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,413.54
|
| Rate for Payer: Heritage Provider Network Senior |
$1,413.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,526.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,526.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,526.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$763.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,137.10
|
| Rate for Payer: Multiplan Commercial |
$2,289.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,103.05
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,010.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,595.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,595.05
|
| Rate for Payer: Vantage Medical Group Senior |
$2,595.05
|
|
|
HC STENT ULTRAFLEX T-B COV W/DEL
|
Facility
|
IP
|
$3,053.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
900803704
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$610.60 |
| Max. Negotiated Rate |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$610.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,966.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,227.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,227.31
|
| Rate for Payer: Cash Price |
$1,373.85
|
| Rate for Payer: Cash Price |
$1,373.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,404.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,648.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,413.54
|
| Rate for Payer: Heritage Provider Network Senior |
$1,413.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,526.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,526.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,526.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$763.25
|
| Rate for Payer: Multiplan Commercial |
$2,289.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,103.05
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,010.85
|
|
|
HC STENT ULTRAFLEX T-B NON-COV W/
|
Facility
|
OP
|
$3,053.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
900803705
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$610.60 |
| Max. Negotiated Rate |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$610.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,886.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,595.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,679.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,289.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,227.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,227.31
|
| Rate for Payer: Cash Price |
$1,373.85
|
| Rate for Payer: Cash Price |
$1,373.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,404.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,595.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,595.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,595.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,953.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,413.54
|
| Rate for Payer: Heritage Provider Network Senior |
$1,413.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,526.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,526.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,526.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$763.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,137.10
|
| Rate for Payer: Multiplan Commercial |
$2,289.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,103.05
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,010.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,595.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,595.05
|
| Rate for Payer: Vantage Medical Group Senior |
$2,595.05
|
|
|
HC STENT ULTRAFLEX T-B NON-COV W/
|
Facility
|
IP
|
$3,053.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
900803705
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$610.60 |
| Max. Negotiated Rate |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$610.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,966.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,227.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,227.31
|
| Rate for Payer: Cash Price |
$1,373.85
|
| Rate for Payer: Cash Price |
$1,373.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,404.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,648.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,413.54
|
| Rate for Payer: Heritage Provider Network Senior |
$1,413.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,526.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,526.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,526.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$763.25
|
| Rate for Payer: Multiplan Commercial |
$2,289.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,103.05
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,010.85
|
|
|
HC STENT VIABAHN
|
Facility
|
IP
|
$7,625.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
909020094
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,525.00 |
| Max. Negotiated Rate |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$1,525.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,910.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,065.25
|
| Rate for Payer: Blue Shield of California EPN |
$3,065.25
|
| Rate for Payer: Cash Price |
$3,431.25
|
| Rate for Payer: Cash Price |
$3,431.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,507.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,117.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,530.38
|
| Rate for Payer: Heritage Provider Network Senior |
$3,530.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3,812.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,812.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,812.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,906.25
|
| Rate for Payer: Multiplan Commercial |
$5,718.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,754.91
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,524.64
|
|
|
HC STENT VIABAHN
|
Facility
|
OP
|
$7,625.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
909020094
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,525.00 |
| Max. Negotiated Rate |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$1,525.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,712.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,481.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,193.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,718.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,065.25
|
| Rate for Payer: Blue Shield of California EPN |
$3,065.25
|
| Rate for Payer: Cash Price |
$3,431.25
|
| Rate for Payer: Cash Price |
$3,431.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,507.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,481.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,481.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,481.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,880.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,530.38
|
| Rate for Payer: Heritage Provider Network Senior |
$3,530.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3,812.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,812.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,812.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,906.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,337.50
|
| Rate for Payer: Multiplan Commercial |
$5,718.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,754.91
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,524.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,481.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,481.25
|
| Rate for Payer: Vantage Medical Group Senior |
$6,481.25
|
|
|
HC STENT VIATORR/COVERED
|
Facility
|
OP
|
$9,412.50
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
909081419
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,882.50 |
| Max. Negotiated Rate |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$1,882.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,816.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,000.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,176.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,059.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,783.82
|
| Rate for Payer: Blue Shield of California EPN |
$3,783.82
|
| Rate for Payer: Cash Price |
$4,235.62
|
| Rate for Payer: Cash Price |
$4,235.62
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,329.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,000.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,000.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,000.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,024.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,357.99
|
| Rate for Payer: Heritage Provider Network Senior |
$4,357.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4,706.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,706.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,706.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,353.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,588.75
|
| Rate for Payer: Multiplan Commercial |
$7,059.38
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,400.74
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,116.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,000.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,000.62
|
| Rate for Payer: Vantage Medical Group Senior |
$8,000.62
|
|
|
HC STENT VIATORR/COVERED
|
Facility
|
IP
|
$9,412.50
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
909081419
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,882.50 |
| Max. Negotiated Rate |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$1,882.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,061.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,783.82
|
| Rate for Payer: Blue Shield of California EPN |
$3,783.82
|
| Rate for Payer: Cash Price |
$4,235.62
|
| Rate for Payer: Cash Price |
$4,235.62
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,329.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,082.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,357.99
|
| Rate for Payer: Heritage Provider Network Senior |
$4,357.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4,706.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,706.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,706.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,353.12
|
| Rate for Payer: Multiplan Commercial |
$7,059.38
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,400.74
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,116.48
|
|
|
HC STENT WINGSPAN
|
Facility
|
OP
|
$15,287.50
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020055
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,057.50 |
| Max. Negotiated Rate |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$3,057.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,447.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,994.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,408.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11,465.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,145.57
|
| Rate for Payer: Blue Shield of California EPN |
$6,145.57
|
| Rate for Payer: Cash Price |
$6,879.38
|
| Rate for Payer: Cash Price |
$6,879.38
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,032.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,994.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$12,994.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12,994.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,784.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,078.11
|
| Rate for Payer: Heritage Provider Network Senior |
$7,078.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7,643.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7,643.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,643.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,821.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10,701.25
|
| Rate for Payer: Multiplan Commercial |
$11,465.62
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5,523.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,061.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,994.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12,994.38
|
| Rate for Payer: Vantage Medical Group Senior |
$12,994.38
|
|
|
HC STENT WINGSPAN
|
Facility
|
IP
|
$15,287.50
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020055
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,057.50 |
| Max. Negotiated Rate |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$3,057.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,845.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,145.57
|
| Rate for Payer: Blue Shield of California EPN |
$6,145.57
|
| Rate for Payer: Cash Price |
$6,879.38
|
| Rate for Payer: Cash Price |
$6,879.38
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,032.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,255.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,078.11
|
| Rate for Payer: Heritage Provider Network Senior |
$7,078.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7,643.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7,643.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,643.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,821.88
|
| Rate for Payer: Multiplan Commercial |
$11,465.62
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5,523.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,061.69
|
|
|
HC STEREOTACTIC PROBE 11 GA
|
Facility
|
OP
|
$774.00
|
|
| Hospital Charge Code |
909001127
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$140.09 |
| Max. Negotiated Rate |
$657.90 |
| Rate for Payer: Adventist Health Commercial |
$154.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$478.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$657.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$425.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$580.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$387.15
|
| Rate for Payer: Blue Shield of California Commercial |
$472.14
|
| Rate for Payer: Blue Shield of California EPN |
$377.71
|
| Rate for Payer: Cash Price |
$348.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$503.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$657.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$657.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$657.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$456.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$479.11
|
| Rate for Payer: Heritage Provider Network Senior |
$479.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$369.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$140.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$193.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$541.80
|
| Rate for Payer: Multiplan Commercial |
$580.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$387.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$387.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$657.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$657.90
|
| Rate for Payer: Vantage Medical Group Senior |
$657.90
|
|
|
HC STEREOTACTIC PROBE 11 GA
|
Facility
|
IP
|
$774.00
|
|
| Hospital Charge Code |
909001127
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$140.09 |
| Max. Negotiated Rate |
$580.50 |
| Rate for Payer: Adventist Health Commercial |
$154.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$498.46
|
| Rate for Payer: Cash Price |
$348.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$524.00
|
| Rate for Payer: Heritage Provider Network Senior |
$524.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$140.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$193.50
|
| Rate for Payer: Multiplan Commercial |
$580.50
|
|
|
HC STEREOTACTIC PROBE 8 GA
|
Facility
|
OP
|
$921.00
|
|
| Hospital Charge Code |
909001128
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$166.70 |
| Max. Negotiated Rate |
$782.85 |
| Rate for Payer: Adventist Health Commercial |
$184.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$569.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$782.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$506.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$690.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$460.68
|
| Rate for Payer: Blue Shield of California Commercial |
$561.81
|
| Rate for Payer: Blue Shield of California EPN |
$449.45
|
| Rate for Payer: Cash Price |
$414.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$598.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$782.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$782.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$782.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$543.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$570.10
|
| Rate for Payer: Heritage Provider Network Senior |
$570.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$439.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$166.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$230.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$644.70
|
| Rate for Payer: Multiplan Commercial |
$690.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$460.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$460.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$782.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$782.85
|
| Rate for Payer: Vantage Medical Group Senior |
$782.85
|
|
|
HC STEREOTACTIC PROBE 8 GA
|
Facility
|
IP
|
$921.00
|
|
| Hospital Charge Code |
909001128
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$166.70 |
| Max. Negotiated Rate |
$690.75 |
| Rate for Payer: Adventist Health Commercial |
$184.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$593.12
|
| Rate for Payer: Cash Price |
$414.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$623.52
|
| Rate for Payer: Heritage Provider Network Senior |
$623.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$166.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$230.25
|
| Rate for Payer: Multiplan Commercial |
$690.75
|
|
