|
HC ATHERECTOMY W PTCA ADD'L VESSEL
|
Facility
|
OP
|
$10,164.00
|
|
|
Service Code
|
CPT 92925
|
| Hospital Charge Code |
906820238
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,032.80 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$2,032.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,639.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,590.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,623.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$3,968.41
|
| Rate for Payer: Cash Price |
$4,573.80
|
| Rate for Payer: Cash Price |
$4,573.80
|
| Rate for Payer: Cigna of CA HMO |
$6,606.60
|
| Rate for Payer: Cigna of CA PPO |
$7,521.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,639.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,639.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,639.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,065.60
|
| Rate for Payer: EPIC Health Plan Senior |
$4,065.60
|
| Rate for Payer: Galaxy Health WC |
$8,639.40
|
| Rate for Payer: Global Benefits Group Commercial |
$6,098.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,779.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,291.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,439.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,114.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,114.80
|
| Rate for Payer: Multiplan Commercial |
$8,131.20
|
| Rate for Payer: Networks By Design Commercial |
$6,606.60
|
| Rate for Payer: Prime Health Services Commercial |
$8,639.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,098.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,098.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$31,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,639.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,639.40
|
| Rate for Payer: Vantage Medical Group Senior |
$8,639.40
|
|
|
HC ATHERECTOMY W PTCA ADD'L VESSEL
|
Facility
|
IP
|
$10,164.00
|
|
|
Service Code
|
CPT 92925
|
| Hospital Charge Code |
906820238
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,032.80 |
| Max. Negotiated Rate |
$8,639.40 |
| Rate for Payer: Adventist Health Commercial |
$2,032.80
|
| Rate for Payer: Cash Price |
$4,573.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,065.60
|
| Rate for Payer: EPIC Health Plan Senior |
$4,065.60
|
| Rate for Payer: Galaxy Health WC |
$8,639.40
|
| Rate for Payer: Global Benefits Group Commercial |
$6,098.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,779.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,872.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,291.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,439.36
|
| Rate for Payer: Multiplan Commercial |
$8,131.20
|
| Rate for Payer: Networks By Design Commercial |
$6,606.60
|
| Rate for Payer: Prime Health Services Commercial |
$8,639.40
|
|
|
HC ATHERECTOMY W PTCA ADD'L VESSEL
|
Facility
|
OP
|
$10,458.00
|
|
|
Service Code
|
CPT 92925
|
| Hospital Charge Code |
906811435
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,091.60 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$2,091.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,889.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,751.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,843.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$3,968.41
|
| Rate for Payer: Cash Price |
$4,706.10
|
| Rate for Payer: Cash Price |
$4,706.10
|
| Rate for Payer: Cigna of CA HMO |
$6,797.70
|
| Rate for Payer: Cigna of CA PPO |
$7,738.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,889.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,889.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,889.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,183.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,183.20
|
| Rate for Payer: Galaxy Health WC |
$8,889.30
|
| Rate for Payer: Global Benefits Group Commercial |
$6,274.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,975.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,473.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,509.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,320.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,320.60
|
| Rate for Payer: Multiplan Commercial |
$8,366.40
|
| Rate for Payer: Networks By Design Commercial |
$6,797.70
|
| Rate for Payer: Prime Health Services Commercial |
$8,889.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,274.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,274.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$31,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,889.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,889.30
|
| Rate for Payer: Vantage Medical Group Senior |
$8,889.30
|
|
|
HC ATHERECTOMY W PTCA ADD'L VESSEL
|
Facility
|
IP
|
$10,458.00
|
|
|
Service Code
|
CPT 92925
|
| Hospital Charge Code |
906811435
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,091.60 |
| Max. Negotiated Rate |
$8,889.30 |
| Rate for Payer: Adventist Health Commercial |
$2,091.60
|
| Rate for Payer: Cash Price |
$4,706.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,183.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,183.20
|
| Rate for Payer: Galaxy Health WC |
$8,889.30
|
| Rate for Payer: Global Benefits Group Commercial |
$6,274.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,975.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,984.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,473.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,509.92
|
| Rate for Payer: Multiplan Commercial |
$8,366.40
|
| Rate for Payer: Networks By Design Commercial |
$6,797.70
|
| Rate for Payer: Prime Health Services Commercial |
$8,889.30
|
|
|
HC ATHRECTOMY AORTA
|
Facility
|
IP
|
$31,637.00
|
|
|
Service Code
|
CPT 0236T
|
| Hospital Charge Code |
909020080
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,327.40 |
| Max. Negotiated Rate |
$26,891.45 |
| Rate for Payer: Adventist Health Commercial |
$6,327.40
|
| Rate for Payer: Cash Price |
$14,236.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,654.80
|
| Rate for Payer: EPIC Health Plan Senior |
$12,654.80
|
| Rate for Payer: Galaxy Health WC |
$26,891.45
|
| Rate for Payer: Global Benefits Group Commercial |
$18,982.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21,101.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,053.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19,583.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,592.88
|
| Rate for Payer: Multiplan Commercial |
$25,309.60
|
| Rate for Payer: Networks By Design Commercial |
$20,564.05
|
| Rate for Payer: Prime Health Services Commercial |
$26,891.45
|
|
|
HC ATHRECTOMY AORTA
|
Facility
|
OP
|
$31,637.00
|
|
|
Service Code
|
CPT 0236T
|
| Hospital Charge Code |
909020080
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,510.17 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$6,327.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,409.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,712.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$5,510.17
|
| Rate for Payer: Cash Price |
$14,236.65
|
| Rate for Payer: Cash Price |
$14,236.65
|
| Rate for Payer: Cash Price |
$14,236.65
|
| Rate for Payer: Cigna of CA HMO |
$20,247.68
|
| Rate for Payer: Cigna of CA PPO |
$23,411.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,850.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,409.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,452.60
|
| Rate for Payer: EPIC Health Plan Senior |
$14,409.33
|
| Rate for Payer: Galaxy Health WC |
$26,891.45
|
| Rate for Payer: Global Benefits Group Commercial |
$18,982.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$23,631.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,409.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21,101.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,053.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,409.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,592.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,155.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,308.50
|
| Rate for Payer: Multiplan Commercial |
$25,309.60
|
| Rate for Payer: Multiplan WC |
$22,958.69
|
| Rate for Payer: Networks By Design Commercial |
$20,564.05
|
| Rate for Payer: Prime Health Services Commercial |
$26,891.45
|
| Rate for Payer: Prime Health Services WC |
$22,724.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18,982.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$31,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$14,409.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Vantage Medical Group Senior |
$14,409.33
|
|
|
HC ATHRECTOMY AORTA
|
Facility
|
IP
|
$37,221.00
|
|
|
Service Code
|
CPT 0236T
|
| Hospital Charge Code |
906820163
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,444.20 |
| Max. Negotiated Rate |
$31,637.85 |
| Rate for Payer: Adventist Health Commercial |
$7,444.20
|
| Rate for Payer: Cash Price |
$16,749.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,888.40
|
| Rate for Payer: EPIC Health Plan Senior |
$14,888.40
|
| Rate for Payer: Galaxy Health WC |
$31,637.85
|
| Rate for Payer: Global Benefits Group Commercial |
$22,332.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24,826.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,181.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23,039.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,933.04
|
| Rate for Payer: Multiplan Commercial |
$29,776.80
|
| Rate for Payer: Networks By Design Commercial |
$24,193.65
|
| Rate for Payer: Prime Health Services Commercial |
$31,637.85
|
|
|
HC ATHRECTOMY AORTA
|
Facility
|
OP
|
$37,221.00
|
|
|
Service Code
|
CPT 0236T
|
| Hospital Charge Code |
906820163
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,510.17 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$7,444.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,409.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,712.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$5,510.17
|
| Rate for Payer: Cash Price |
$16,749.45
|
| Rate for Payer: Cash Price |
$16,749.45
|
| Rate for Payer: Cash Price |
$16,749.45
|
| Rate for Payer: Cigna of CA HMO |
$23,821.44
|
| Rate for Payer: Cigna of CA PPO |
$27,543.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,850.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,409.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,452.60
|
| Rate for Payer: EPIC Health Plan Senior |
$14,409.33
|
| Rate for Payer: Galaxy Health WC |
$31,637.85
|
| Rate for Payer: Global Benefits Group Commercial |
$22,332.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$23,631.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,409.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24,826.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,181.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,409.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,933.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,155.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,308.50
|
| Rate for Payer: Multiplan Commercial |
$29,776.80
|
| Rate for Payer: Multiplan WC |
$22,958.69
|
| Rate for Payer: Networks By Design Commercial |
$24,193.65
|
| Rate for Payer: Prime Health Services Commercial |
$31,637.85
|
| Rate for Payer: Prime Health Services WC |
$22,724.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22,332.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$31,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$14,409.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Vantage Medical Group Senior |
$14,409.33
|
|
|
HC ATHRECTOMY BRACHIOCEPHALIC
|
Facility
|
IP
|
$31,637.00
|
|
|
Service Code
|
CPT 0237T
|
| Hospital Charge Code |
909020079
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,327.40 |
| Max. Negotiated Rate |
$26,891.45 |
| Rate for Payer: Adventist Health Commercial |
$6,327.40
|
| Rate for Payer: Cash Price |
$14,236.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,654.80
|
| Rate for Payer: EPIC Health Plan Senior |
$12,654.80
|
| Rate for Payer: Galaxy Health WC |
$26,891.45
|
| Rate for Payer: Global Benefits Group Commercial |
$18,982.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21,101.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,053.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19,583.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,592.88
|
| Rate for Payer: Multiplan Commercial |
$25,309.60
|
| Rate for Payer: Networks By Design Commercial |
$20,564.05
|
| Rate for Payer: Prime Health Services Commercial |
$26,891.45
|
|
|
HC ATHRECTOMY BRACHIOCEPHALIC
|
Facility
|
OP
|
$37,221.00
|
|
|
Service Code
|
CPT 0237T
|
| Hospital Charge Code |
906820162
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,510.17 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$7,444.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,409.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,712.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$5,510.17
|
| Rate for Payer: Cash Price |
$16,749.45
|
| Rate for Payer: Cash Price |
$16,749.45
|
| Rate for Payer: Cash Price |
$16,749.45
|
| Rate for Payer: Cigna of CA HMO |
$23,821.44
|
| Rate for Payer: Cigna of CA PPO |
$27,543.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,850.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,409.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,452.60
|
| Rate for Payer: EPIC Health Plan Senior |
$14,409.33
|
| Rate for Payer: Galaxy Health WC |
$31,637.85
|
| Rate for Payer: Global Benefits Group Commercial |
$22,332.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$23,631.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,409.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24,826.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,181.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,409.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,933.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,155.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,308.50
|
| Rate for Payer: Multiplan Commercial |
$29,776.80
|
| Rate for Payer: Multiplan WC |
$22,958.69
|
| Rate for Payer: Networks By Design Commercial |
$24,193.65
|
| Rate for Payer: Prime Health Services Commercial |
$31,637.85
|
| Rate for Payer: Prime Health Services WC |
$22,724.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22,332.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$31,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$14,409.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Vantage Medical Group Senior |
$14,409.33
|
|
|
HC ATHRECTOMY BRACHIOCEPHALIC
|
Facility
|
IP
|
$37,221.00
|
|
|
Service Code
|
CPT 0237T
|
| Hospital Charge Code |
906820162
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,444.20 |
| Max. Negotiated Rate |
$31,637.85 |
| Rate for Payer: Adventist Health Commercial |
$7,444.20
|
| Rate for Payer: Cash Price |
$16,749.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,888.40
|
| Rate for Payer: EPIC Health Plan Senior |
$14,888.40
|
| Rate for Payer: Galaxy Health WC |
$31,637.85
|
| Rate for Payer: Global Benefits Group Commercial |
$22,332.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24,826.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,181.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23,039.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,933.04
|
| Rate for Payer: Multiplan Commercial |
$29,776.80
|
| Rate for Payer: Networks By Design Commercial |
$24,193.65
|
| Rate for Payer: Prime Health Services Commercial |
$31,637.85
|
|
|
HC ATHRECTOMY BRACHIOCEPHALIC
|
Facility
|
OP
|
$31,637.00
|
|
|
Service Code
|
CPT 0237T
|
| Hospital Charge Code |
909020079
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,510.17 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$6,327.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,409.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,712.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$5,510.17
|
| Rate for Payer: Cash Price |
$14,236.65
|
| Rate for Payer: Cash Price |
$14,236.65
|
| Rate for Payer: Cash Price |
$14,236.65
|
| Rate for Payer: Cigna of CA HMO |
$20,247.68
|
| Rate for Payer: Cigna of CA PPO |
$23,411.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,850.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,409.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,452.60
|
| Rate for Payer: EPIC Health Plan Senior |
$14,409.33
|
| Rate for Payer: Galaxy Health WC |
$26,891.45
|
| Rate for Payer: Global Benefits Group Commercial |
$18,982.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$23,631.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,409.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21,101.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,053.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,409.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,592.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,155.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,308.50
|
| Rate for Payer: Multiplan Commercial |
$25,309.60
|
| Rate for Payer: Multiplan WC |
$22,958.69
|
| Rate for Payer: Networks By Design Commercial |
$20,564.05
|
| Rate for Payer: Prime Health Services Commercial |
$26,891.45
|
| Rate for Payer: Prime Health Services WC |
$22,724.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18,982.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$31,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$14,409.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Vantage Medical Group Senior |
$14,409.33
|
|
|
HC ATHRECTOMY FEM/POP
|
Facility
|
OP
|
$26,601.00
|
|
|
Service Code
|
CPT 37225
|
| Hospital Charge Code |
906820149
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$175.76 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$5,320.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22,815.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,712.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$3,490.94
|
| Rate for Payer: Cash Price |
$11,970.45
|
| Rate for Payer: Cash Price |
$11,970.45
|
| Rate for Payer: Cash Price |
$11,970.45
|
| Rate for Payer: Cigna of CA HMO |
$17,024.64
|
| Rate for Payer: Cigna of CA PPO |
$19,684.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,097.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22,815.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$30,801.34
|
| Rate for Payer: EPIC Health Plan Senior |
$22,815.81
|
| Rate for Payer: Galaxy Health WC |
$22,610.85
|
| Rate for Payer: Global Benefits Group Commercial |
$15,960.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$37,417.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$175.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,815.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17,742.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$198.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,815.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,384.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28,747.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30,573.19
|
| Rate for Payer: Multiplan Commercial |
$21,280.80
|
| Rate for Payer: Multiplan WC |
$36,352.92
|
| Rate for Payer: Networks By Design Commercial |
$17,290.65
|
| Rate for Payer: Prime Health Services Commercial |
$22,610.85
|
| Rate for Payer: Prime Health Services WC |
$35,981.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15,960.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$31,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$22,815.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Vantage Medical Group Senior |
$22,815.81
|
|
|
HC ATHRECTOMY FEM/POP
|
Facility
|
IP
|
$26,601.00
|
|
|
Service Code
|
CPT 37225
|
| Hospital Charge Code |
906820149
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,320.20 |
| Max. Negotiated Rate |
$22,610.85 |
| Rate for Payer: Adventist Health Commercial |
$5,320.20
|
| Rate for Payer: Cash Price |
$11,970.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,640.40
|
| Rate for Payer: EPIC Health Plan Senior |
$10,640.40
|
| Rate for Payer: Galaxy Health WC |
$22,610.85
|
| Rate for Payer: Global Benefits Group Commercial |
$15,960.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17,742.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,134.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,466.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,384.24
|
| Rate for Payer: Multiplan Commercial |
$21,280.80
|
| Rate for Payer: Networks By Design Commercial |
$17,290.65
|
| Rate for Payer: Prime Health Services Commercial |
$22,610.85
|
|
|
HC ATHRECTOMY FEM/POP
|
Facility
|
IP
|
$27,371.00
|
|
|
Service Code
|
CPT 37225
|
| Hospital Charge Code |
909020066
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,474.20 |
| Max. Negotiated Rate |
$23,265.35 |
| Rate for Payer: Adventist Health Commercial |
$5,474.20
|
| Rate for Payer: Cash Price |
$12,316.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,948.40
|
| Rate for Payer: EPIC Health Plan Senior |
$10,948.40
|
| Rate for Payer: Galaxy Health WC |
$23,265.35
|
| Rate for Payer: Global Benefits Group Commercial |
$16,422.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18,256.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,428.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,942.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,569.04
|
| Rate for Payer: Multiplan Commercial |
$21,896.80
|
| Rate for Payer: Networks By Design Commercial |
$17,791.15
|
| Rate for Payer: Prime Health Services Commercial |
$23,265.35
|
|
|
HC ATHRECTOMY FEM/POP
|
Facility
|
OP
|
$27,371.00
|
|
|
Service Code
|
CPT 37225
|
| Hospital Charge Code |
909020066
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$175.76 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$5,474.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22,815.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,712.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$3,490.94
|
| Rate for Payer: Cash Price |
$12,316.95
|
| Rate for Payer: Cash Price |
$12,316.95
|
| Rate for Payer: Cash Price |
$12,316.95
|
| Rate for Payer: Cigna of CA HMO |
$17,517.44
|
| Rate for Payer: Cigna of CA PPO |
$20,254.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,097.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22,815.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$30,801.34
|
| Rate for Payer: EPIC Health Plan Senior |
$22,815.81
|
| Rate for Payer: Galaxy Health WC |
$23,265.35
|
| Rate for Payer: Global Benefits Group Commercial |
$16,422.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$37,417.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$175.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,815.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18,256.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$198.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,815.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,569.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28,747.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30,573.19
|
| Rate for Payer: Multiplan Commercial |
$21,896.80
|
| Rate for Payer: Multiplan WC |
$36,352.92
|
| Rate for Payer: Networks By Design Commercial |
$17,791.15
|
| Rate for Payer: Prime Health Services Commercial |
$23,265.35
|
| Rate for Payer: Prime Health Services WC |
$35,981.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16,422.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$31,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$22,815.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Vantage Medical Group Senior |
$22,815.81
|
|
|
HC ATHRECTOMY ILIAC
|
Facility
|
OP
|
$31,637.00
|
|
|
Service Code
|
CPT 0238T
|
| Hospital Charge Code |
909020081
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,510.17 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$6,327.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,370.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22,815.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,712.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$5,510.17
|
| Rate for Payer: Cash Price |
$14,236.65
|
| Rate for Payer: Cash Price |
$14,236.65
|
| Rate for Payer: Cash Price |
$14,236.65
|
| Rate for Payer: Cigna of CA HMO |
$20,247.68
|
| Rate for Payer: Cigna of CA PPO |
$23,411.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,097.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22,815.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$30,801.34
|
| Rate for Payer: EPIC Health Plan Senior |
$22,815.81
|
| Rate for Payer: Galaxy Health WC |
$26,891.45
|
| Rate for Payer: Global Benefits Group Commercial |
$18,982.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$37,417.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,815.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21,101.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,053.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,815.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,592.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28,747.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30,573.19
|
| Rate for Payer: Multiplan Commercial |
$25,309.60
|
| Rate for Payer: Multiplan WC |
$36,352.92
|
| Rate for Payer: Networks By Design Commercial |
$20,564.05
|
| Rate for Payer: Prime Health Services Commercial |
$26,891.45
|
| Rate for Payer: Prime Health Services WC |
$35,981.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18,982.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$31,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$22,815.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Vantage Medical Group Senior |
$22,815.81
|
|
|
HC ATHRECTOMY ILIAC
|
Facility
|
IP
|
$31,637.00
|
|
|
Service Code
|
CPT 0238T
|
| Hospital Charge Code |
909020081
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,327.40 |
| Max. Negotiated Rate |
$26,891.45 |
| Rate for Payer: Adventist Health Commercial |
$6,327.40
|
| Rate for Payer: Cash Price |
$14,236.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,654.80
|
| Rate for Payer: EPIC Health Plan Senior |
$12,654.80
|
| Rate for Payer: Galaxy Health WC |
$26,891.45
|
| Rate for Payer: Global Benefits Group Commercial |
$18,982.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21,101.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,053.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19,583.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,592.88
|
| Rate for Payer: Multiplan Commercial |
$25,309.60
|
| Rate for Payer: Networks By Design Commercial |
$20,564.05
|
| Rate for Payer: Prime Health Services Commercial |
$26,891.45
|
|
|
HC ATHRECTOMY ILIAC
|
Facility
|
IP
|
$37,221.00
|
|
|
Service Code
|
CPT 0238T
|
| Hospital Charge Code |
906820164
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,444.20 |
| Max. Negotiated Rate |
$31,637.85 |
| Rate for Payer: Adventist Health Commercial |
$7,444.20
|
| Rate for Payer: Cash Price |
$16,749.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,888.40
|
| Rate for Payer: EPIC Health Plan Senior |
$14,888.40
|
| Rate for Payer: Galaxy Health WC |
$31,637.85
|
| Rate for Payer: Global Benefits Group Commercial |
$22,332.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24,826.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,181.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23,039.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,933.04
|
| Rate for Payer: Multiplan Commercial |
$29,776.80
|
| Rate for Payer: Networks By Design Commercial |
$24,193.65
|
| Rate for Payer: Prime Health Services Commercial |
$31,637.85
|
|
|
HC ATHRECTOMY ILIAC
|
Facility
|
OP
|
$37,221.00
|
|
|
Service Code
|
CPT 0238T
|
| Hospital Charge Code |
906820164
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,510.17 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$7,444.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,370.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22,815.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,712.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$5,510.17
|
| Rate for Payer: Cash Price |
$16,749.45
|
| Rate for Payer: Cash Price |
$16,749.45
|
| Rate for Payer: Cash Price |
$16,749.45
|
| Rate for Payer: Cigna of CA HMO |
$23,821.44
|
| Rate for Payer: Cigna of CA PPO |
$27,543.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,097.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22,815.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$30,801.34
|
| Rate for Payer: EPIC Health Plan Senior |
$22,815.81
|
| Rate for Payer: Galaxy Health WC |
$31,637.85
|
| Rate for Payer: Global Benefits Group Commercial |
$22,332.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$37,417.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,815.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24,826.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,181.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,815.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,933.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28,747.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30,573.19
|
| Rate for Payer: Multiplan Commercial |
$29,776.80
|
| Rate for Payer: Multiplan WC |
$36,352.92
|
| Rate for Payer: Networks By Design Commercial |
$24,193.65
|
| Rate for Payer: Prime Health Services Commercial |
$31,637.85
|
| Rate for Payer: Prime Health Services WC |
$35,981.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22,332.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$31,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$22,815.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Vantage Medical Group Senior |
$22,815.81
|
|
|
HC ATHRECTOMY RENAL
|
Facility
|
IP
|
$31,637.00
|
|
|
Service Code
|
CPT 0234T
|
| Hospital Charge Code |
909020077
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,327.40 |
| Max. Negotiated Rate |
$26,891.45 |
| Rate for Payer: Adventist Health Commercial |
$6,327.40
|
| Rate for Payer: Cash Price |
$14,236.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,654.80
|
| Rate for Payer: EPIC Health Plan Senior |
$12,654.80
|
| Rate for Payer: Galaxy Health WC |
$26,891.45
|
| Rate for Payer: Global Benefits Group Commercial |
$18,982.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21,101.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,053.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19,583.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,592.88
|
| Rate for Payer: Multiplan Commercial |
$25,309.60
|
| Rate for Payer: Networks By Design Commercial |
$20,564.05
|
| Rate for Payer: Prime Health Services Commercial |
$26,891.45
|
|
|
HC ATHRECTOMY RENAL
|
Facility
|
OP
|
$31,637.00
|
|
|
Service Code
|
CPT 0234T
|
| Hospital Charge Code |
909020077
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,510.17 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$6,327.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,409.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,712.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$5,510.17
|
| Rate for Payer: Cash Price |
$14,236.65
|
| Rate for Payer: Cash Price |
$14,236.65
|
| Rate for Payer: Cash Price |
$14,236.65
|
| Rate for Payer: Cigna of CA HMO |
$20,247.68
|
| Rate for Payer: Cigna of CA PPO |
$23,411.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,850.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,409.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,452.60
|
| Rate for Payer: EPIC Health Plan Senior |
$14,409.33
|
| Rate for Payer: Galaxy Health WC |
$26,891.45
|
| Rate for Payer: Global Benefits Group Commercial |
$18,982.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$23,631.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,409.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21,101.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,053.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,409.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,592.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,155.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,308.50
|
| Rate for Payer: Multiplan Commercial |
$25,309.60
|
| Rate for Payer: Multiplan WC |
$22,958.69
|
| Rate for Payer: Networks By Design Commercial |
$20,564.05
|
| Rate for Payer: Prime Health Services Commercial |
$26,891.45
|
| Rate for Payer: Prime Health Services WC |
$22,724.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18,982.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$31,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$14,409.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Vantage Medical Group Senior |
$14,409.33
|
|
|
HC ATHRECTOMY RENAL
|
Facility
|
IP
|
$37,221.00
|
|
|
Service Code
|
CPT 0234T
|
| Hospital Charge Code |
906820160
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,444.20 |
| Max. Negotiated Rate |
$31,637.85 |
| Rate for Payer: Adventist Health Commercial |
$7,444.20
|
| Rate for Payer: Cash Price |
$16,749.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,888.40
|
| Rate for Payer: EPIC Health Plan Senior |
$14,888.40
|
| Rate for Payer: Galaxy Health WC |
$31,637.85
|
| Rate for Payer: Global Benefits Group Commercial |
$22,332.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24,826.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,181.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23,039.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,933.04
|
| Rate for Payer: Multiplan Commercial |
$29,776.80
|
| Rate for Payer: Networks By Design Commercial |
$24,193.65
|
| Rate for Payer: Prime Health Services Commercial |
$31,637.85
|
|
|
HC ATHRECTOMY RENAL
|
Facility
|
OP
|
$37,221.00
|
|
|
Service Code
|
CPT 0234T
|
| Hospital Charge Code |
906820160
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,510.17 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$7,444.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,409.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,712.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$5,510.17
|
| Rate for Payer: Cash Price |
$16,749.45
|
| Rate for Payer: Cash Price |
$16,749.45
|
| Rate for Payer: Cash Price |
$16,749.45
|
| Rate for Payer: Cigna of CA HMO |
$23,821.44
|
| Rate for Payer: Cigna of CA PPO |
$27,543.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,850.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,409.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,452.60
|
| Rate for Payer: EPIC Health Plan Senior |
$14,409.33
|
| Rate for Payer: Galaxy Health WC |
$31,637.85
|
| Rate for Payer: Global Benefits Group Commercial |
$22,332.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$23,631.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,409.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24,826.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,181.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,409.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,933.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,155.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,308.50
|
| Rate for Payer: Multiplan Commercial |
$29,776.80
|
| Rate for Payer: Multiplan WC |
$22,958.69
|
| Rate for Payer: Networks By Design Commercial |
$24,193.65
|
| Rate for Payer: Prime Health Services Commercial |
$31,637.85
|
| Rate for Payer: Prime Health Services WC |
$22,724.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22,332.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$31,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$14,409.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Vantage Medical Group Senior |
$14,409.33
|
|
|
HC ATHRECTOMY & STENT FEM/POP
|
Facility
|
IP
|
$47,060.00
|
|
|
Service Code
|
CPT 37227
|
| Hospital Charge Code |
906820151
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$9,412.00 |
| Max. Negotiated Rate |
$40,001.00 |
| Rate for Payer: Adventist Health Commercial |
$9,412.00
|
| Rate for Payer: Cash Price |
$21,177.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,824.00
|
| Rate for Payer: EPIC Health Plan Senior |
$18,824.00
|
| Rate for Payer: Galaxy Health WC |
$40,001.00
|
| Rate for Payer: Global Benefits Group Commercial |
$28,236.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31,389.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17,929.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29,130.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,294.40
|
| Rate for Payer: Multiplan Commercial |
$37,648.00
|
| Rate for Payer: Networks By Design Commercial |
$30,589.00
|
| Rate for Payer: Prime Health Services Commercial |
$40,001.00
|
|
