|
HC ATHERECTOMY W CORONARY STENT
|
Facility
|
IP
|
$34,338.00
|
|
|
Service Code
|
CPT C9602
|
| Hospital Charge Code |
906811461
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$6,867.60 |
| Max. Negotiated Rate |
$29,187.30 |
| Rate for Payer: Adventist Health Commercial |
$6,867.60
|
| Rate for Payer: Cash Price |
$15,452.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$24,036.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,735.20
|
| Rate for Payer: EPIC Health Plan Senior |
$13,735.20
|
| Rate for Payer: Galaxy Health WC |
$29,187.30
|
| Rate for Payer: Global Benefits Group Commercial |
$20,602.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21,804.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20,259.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,241.12
|
| Rate for Payer: Multiplan Commercial |
$27,470.40
|
| Rate for Payer: Networks By Design Commercial |
$22,319.70
|
| Rate for Payer: Prime Health Services Commercial |
$29,187.30
|
|
|
HC ATHERECTOMY W CORONARY STENT
|
Facility
|
OP
|
$34,338.00
|
|
|
Service Code
|
CPT C9602
|
| Hospital Charge Code |
906811461
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$676.00 |
| Max. Negotiated Rate |
$38,902.96 |
| Rate for Payer: Adventist Health Commercial |
$6,867.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,492.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,935.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23,577.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16,261.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,262.29
|
| Rate for Payer: Blue Shield of California Commercial |
$4,136.63
|
| Rate for Payer: Cash Price |
$15,452.10
|
| Rate for Payer: Cash Price |
$15,452.10
|
| Rate for Payer: Cash Price |
$15,452.10
|
| Rate for Payer: Cash Price |
$15,452.10
|
| Rate for Payer: Cigna of CA HMO |
$21,976.32
|
| Rate for Payer: Cigna of CA PPO |
$25,410.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,935.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23,577.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$24,036.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$38,902.96
|
| Rate for Payer: EPIC Health Plan Senior |
$25,935.31
|
| Rate for Payer: Galaxy Health WC |
$29,187.30
|
| Rate for Payer: Global Benefits Group Commercial |
$20,602.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$38,667.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23,577.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21,804.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12,464.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33,008.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,241.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29,707.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$31,593.92
|
| Rate for Payer: Multiplan Commercial |
$27,470.40
|
| Rate for Payer: Networks By Design Commercial |
$22,319.70
|
| Rate for Payer: Prime Health Services Commercial |
$29,187.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20,602.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20,602.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$23,577.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,935.31
|
| Rate for Payer: Vantage Medical Group Senior |
$23,577.55
|
|
|
HC ATHERECTOMY W CORONARY STENT
|
Facility
|
OP
|
$52,060.00
|
|
|
Service Code
|
CPT 92933
|
| Hospital Charge Code |
906811438
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$907.45 |
| Max. Negotiated Rate |
$44,251.00 |
| Rate for Payer: Adventist Health Commercial |
$10,412.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,935.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23,577.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16,261.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,136.63
|
| Rate for Payer: Blue Shield of California Commercial |
$6,262.29
|
| Rate for Payer: Cash Price |
$23,427.00
|
| Rate for Payer: Cash Price |
$23,427.00
|
| Rate for Payer: Cash Price |
$23,427.00
|
| Rate for Payer: Cigna of CA HMO |
$33,839.00
|
| Rate for Payer: Cigna of CA PPO |
$38,524.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,935.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23,577.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$36,442.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$38,902.96
|
| Rate for Payer: EPIC Health Plan Senior |
$25,935.31
|
| Rate for Payer: Galaxy Health WC |
$44,251.00
|
| Rate for Payer: Global Benefits Group Commercial |
$31,236.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$38,667.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$907.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23,577.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$33,058.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,026.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33,008.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12,494.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29,707.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$31,593.92
|
| Rate for Payer: Multiplan Commercial |
$41,648.00
|
| Rate for Payer: Networks By Design Commercial |
$33,839.00
|
| Rate for Payer: Prime Health Services Commercial |
$44,251.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$31,236.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$31,236.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$26,030.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$23,577.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,935.31
|
| Rate for Payer: Vantage Medical Group Senior |
$23,577.55
|
|
|
HC ATHERECTOMY W CORO STENT ADD
|
Facility
|
OP
|
$30,119.00
|
|
|
Service Code
|
CPT C9603
|
| Hospital Charge Code |
906811462
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$676.00 |
| Max. Negotiated Rate |
$25,601.15 |
| Rate for Payer: Adventist Health Commercial |
$6,023.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$19,755.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25,601.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16,565.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22,589.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16,261.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,136.63
|
| Rate for Payer: Blue Shield of California Commercial |
$6,262.29
|
| Rate for Payer: Cash Price |
$13,553.55
|
| Rate for Payer: Cash Price |
$13,553.55
|
| Rate for Payer: Cash Price |
$13,553.55
|
| Rate for Payer: Cigna of CA HMO |
$19,276.16
|
| Rate for Payer: Cigna of CA PPO |
$22,288.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25,601.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,601.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25,601.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21,083.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,047.60
|
| Rate for Payer: EPIC Health Plan Senior |
$12,047.60
|
| Rate for Payer: Galaxy Health WC |
$25,601.15
|
| Rate for Payer: Global Benefits Group Commercial |
$18,071.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19,125.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10,933.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17,770.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,228.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21,083.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21,083.30
|
| Rate for Payer: Multiplan Commercial |
$24,095.20
|
| Rate for Payer: Networks By Design Commercial |
$19,577.35
|
| Rate for Payer: Prime Health Services Commercial |
$25,601.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18,071.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18,071.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25,601.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,601.15
|
| Rate for Payer: Vantage Medical Group Senior |
$25,601.15
|
|
|
HC ATHERECTOMY W CORO STENT ADD
|
Facility
|
IP
|
$30,119.00
|
|
|
Service Code
|
CPT C9603
|
| Hospital Charge Code |
906811462
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$6,023.80 |
| Max. Negotiated Rate |
$25,601.15 |
| Rate for Payer: Adventist Health Commercial |
$6,023.80
|
| Rate for Payer: Cash Price |
$13,553.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21,083.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,047.60
|
| Rate for Payer: EPIC Health Plan Senior |
$12,047.60
|
| Rate for Payer: Galaxy Health WC |
$25,601.15
|
| Rate for Payer: Global Benefits Group Commercial |
$18,071.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19,125.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17,770.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,228.56
|
| Rate for Payer: Multiplan Commercial |
$24,095.20
|
| Rate for Payer: Networks By Design Commercial |
$19,577.35
|
| Rate for Payer: Prime Health Services Commercial |
$25,601.15
|
|
|
HC ATHERECTOMY W CORO STENT ADD'L
|
Facility
|
IP
|
$22,217.00
|
|
|
Service Code
|
CPT 92934
|
| Hospital Charge Code |
906811439
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,443.40 |
| Max. Negotiated Rate |
$18,884.45 |
| Rate for Payer: Adventist Health Commercial |
$4,443.40
|
| Rate for Payer: Cash Price |
$9,997.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15,551.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,886.80
|
| Rate for Payer: EPIC Health Plan Senior |
$8,886.80
|
| Rate for Payer: Galaxy Health WC |
$18,884.45
|
| Rate for Payer: Global Benefits Group Commercial |
$13,330.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14,107.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13,108.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,332.08
|
| Rate for Payer: Multiplan Commercial |
$17,773.60
|
| Rate for Payer: Networks By Design Commercial |
$14,441.05
|
| Rate for Payer: Prime Health Services Commercial |
$18,884.45
|
|
|
HC ATHERECTOMY W CORO STENT ADD'L
|
Facility
|
OP
|
$22,217.00
|
|
|
Service Code
|
CPT 92934
|
| Hospital Charge Code |
906811439
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,136.63 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$4,443.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18,884.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12,219.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16,662.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,136.63
|
| Rate for Payer: Blue Shield of California Commercial |
$6,262.29
|
| Rate for Payer: Cash Price |
$9,997.65
|
| Rate for Payer: Cash Price |
$9,997.65
|
| Rate for Payer: Cigna of CA HMO |
$14,441.05
|
| Rate for Payer: Cigna of CA PPO |
$16,440.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18,884.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$18,884.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18,884.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15,551.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,886.80
|
| Rate for Payer: EPIC Health Plan Senior |
$8,886.80
|
| Rate for Payer: Galaxy Health WC |
$18,884.45
|
| Rate for Payer: Global Benefits Group Commercial |
$13,330.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14,107.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8,064.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13,108.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,332.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15,551.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15,551.90
|
| Rate for Payer: Multiplan Commercial |
$17,773.60
|
| Rate for Payer: Networks By Design Commercial |
$14,441.05
|
| Rate for Payer: Prime Health Services Commercial |
$18,884.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13,330.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13,330.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,108.50
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18,884.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18,884.45
|
| Rate for Payer: Vantage Medical Group Senior |
$18,884.45
|
|
|
HC ATHERECTOMY W PTCA
|
Facility
|
IP
|
$26,142.00
|
|
|
Service Code
|
CPT 92924
|
| Hospital Charge Code |
906811434
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,228.40 |
| Max. Negotiated Rate |
$22,220.70 |
| Rate for Payer: Adventist Health Commercial |
$5,228.40
|
| Rate for Payer: Cash Price |
$11,763.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$18,299.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,456.80
|
| Rate for Payer: EPIC Health Plan Senior |
$10,456.80
|
| Rate for Payer: Galaxy Health WC |
$22,220.70
|
| Rate for Payer: Global Benefits Group Commercial |
$15,685.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16,600.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15,423.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,274.08
|
| Rate for Payer: Multiplan Commercial |
$20,913.60
|
| Rate for Payer: Networks By Design Commercial |
$16,992.30
|
| Rate for Payer: Prime Health Services Commercial |
$22,220.70
|
|
|
HC ATHERECTOMY W PTCA
|
Facility
|
OP
|
$26,142.00
|
|
|
Service Code
|
CPT 92924
|
| Hospital Charge Code |
906811434
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$869.00 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$5,228.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16,332.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,847.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16,261.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,136.63
|
| Rate for Payer: Blue Shield of California Commercial |
$6,262.29
|
| Rate for Payer: Cash Price |
$11,763.90
|
| Rate for Payer: Cash Price |
$11,763.90
|
| Rate for Payer: Cash Price |
$11,763.90
|
| Rate for Payer: Cigna of CA HMO |
$16,992.30
|
| Rate for Payer: Cigna of CA PPO |
$19,345.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$16,332.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,847.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$18,299.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$24,498.80
|
| Rate for Payer: EPIC Health Plan Senior |
$16,332.54
|
| Rate for Payer: Galaxy Health WC |
$22,220.70
|
| Rate for Payer: Global Benefits Group Commercial |
$15,685.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$24,350.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$869.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,847.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16,600.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$982.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20,786.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,274.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,708.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,896.00
|
| Rate for Payer: Multiplan Commercial |
$20,913.60
|
| Rate for Payer: Networks By Design Commercial |
$16,992.30
|
| Rate for Payer: Prime Health Services Commercial |
$22,220.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15,685.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15,685.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,071.00
|
| 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 |
$14,847.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16,332.54
|
| Rate for Payer: Vantage Medical Group Senior |
$14,847.76
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,320.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$6,640.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,170.22
|
| 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 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 |
$32,312.00
|
| 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 |
$8,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,136.63
|
| Rate for Payer: Blue Shield of California Commercial |
$6,262.29
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,320.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$6,640.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,796.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,170.22
|
| 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 |
$5,229.00
|
| 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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$22,145.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$20,089.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18,665.83
|
| 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 |
$5,743.74 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$6,327.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16,332.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,847.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,104.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,743.74
|
| Rate for Payer: Blue Shield of California Commercial |
$8,695.24
|
| 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 |
$22,271.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$16,332.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,847.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$22,145.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$24,498.80
|
| Rate for Payer: EPIC Health Plan Senior |
$16,332.54
|
| 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/Senior |
$24,350.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,847.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$20,089.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11,484.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20,786.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,592.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,708.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,896.00
|
| 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 |
$15,818.50
|
| 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 |
$14,847.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16,332.54
|
| Rate for Payer: Vantage Medical Group Senior |
$14,847.76
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$22,145.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$20,089.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18,665.83
|
| 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
|
$31,637.00
|
|
|
Service Code
|
CPT 0237T
|
| Hospital Charge Code |
909020079
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,743.74 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$6,327.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16,332.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,847.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,104.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,743.74
|
| Rate for Payer: Blue Shield of California Commercial |
$8,695.24
|
| 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 |
$22,271.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$16,332.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,847.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$22,145.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$24,498.80
|
| Rate for Payer: EPIC Health Plan Senior |
$16,332.54
|
| 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/Senior |
$24,350.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,847.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$20,089.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11,484.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20,786.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,592.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,708.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,896.00
|
| 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 |
$15,818.50
|
| 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 |
$14,847.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16,332.54
|
| Rate for Payer: Vantage Medical Group Senior |
$14,847.76
|
|
|
HC ATHRECTOMY FEM/POP
|
Facility
|
OP
|
$27,371.00
|
|
|
Service Code
|
CPT 37225
|
| Hospital Charge Code |
909020066
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,638.65 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$5,474.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23,265.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,054.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20,528.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,104.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,508.41
|
| Rate for Payer: Blue Shield of California Commercial |
$3,638.65
|
| 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 |
$23,265.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$23,265.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23,265.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$19,159.70
|
| 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 Foundation Hospitals Commercial/Self Funded |
$17,380.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9,935.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16,148.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,569.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19,159.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,159.70
|
| 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 |
$13,685.50
|
| 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 |
$23,265.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23,265.35
|
| Rate for Payer: Vantage Medical Group Senior |
$23,265.35
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$19,159.70
|
| 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 Foundation Hospitals Commercial/Self Funded |
$17,380.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16,148.89
|
| 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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$22,145.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$20,089.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18,665.83
|
| 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
|
OP
|
$31,637.00
|
|
|
Service Code
|
CPT 0238T
|
| Hospital Charge Code |
909020081
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,743.74 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$6,327.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,935.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23,577.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,104.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,743.74
|
| Rate for Payer: Blue Shield of California Commercial |
$8,695.24
|
| 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 |
$35,366.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,935.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23,577.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$22,145.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$38,902.96
|
| Rate for Payer: EPIC Health Plan Senior |
$25,935.31
|
| 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/Senior |
$38,667.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23,577.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$20,089.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11,484.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33,008.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,592.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29,707.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$31,593.92
|
| 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 |
$15,818.50
|
| 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 |
$23,577.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,935.31
|
| Rate for Payer: Vantage Medical Group Senior |
$23,577.55
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$22,145.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$20,089.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18,665.83
|
| 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 |
$5,743.74 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$6,327.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16,332.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,847.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,104.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,743.74
|
| Rate for Payer: Blue Shield of California Commercial |
$8,695.24
|
| 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 |
$22,271.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$16,332.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,847.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$22,145.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$24,498.80
|
| Rate for Payer: EPIC Health Plan Senior |
$16,332.54
|
| 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/Senior |
$24,350.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,847.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$20,089.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11,484.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20,786.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,592.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,708.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,896.00
|
| 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 |
$15,818.50
|
| 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 |
$14,847.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16,332.54
|
| Rate for Payer: Vantage Medical Group Senior |
$14,847.76
|
|
|
HC ATHRECTOMY & STENT FEM/POP
|
Facility
|
OP
|
$48,422.00
|
|
|
Service Code
|
CPT 37227
|
| Hospital Charge Code |
909020068
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,638.65 |
| Max. Negotiated Rate |
$71,375.00 |
| Rate for Payer: Adventist Health Commercial |
$9,684.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$41,158.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26,632.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$36,316.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,323.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,508.41
|
| Rate for Payer: Blue Shield of California Commercial |
$3,638.65
|
| Rate for Payer: Cash Price |
$21,789.90
|
| Rate for Payer: Cash Price |
$21,789.90
|
| Rate for Payer: Cash Price |
$21,789.90
|
| Rate for Payer: Cigna of CA HMO |
$30,990.08
|
| Rate for Payer: Cigna of CA PPO |
$35,832.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$41,158.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$41,158.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$41,158.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$33,895.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,368.80
|
| Rate for Payer: EPIC Health Plan Senior |
$19,368.80
|
| Rate for Payer: Galaxy Health WC |
$41,158.70
|
| Rate for Payer: Global Benefits Group Commercial |
$29,053.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$30,747.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17,577.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28,568.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,621.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33,895.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33,895.40
|
| Rate for Payer: Multiplan Commercial |
$38,737.60
|
| Rate for Payer: Multiplan WC |
$36,352.92
|
| Rate for Payer: Networks By Design Commercial |
$31,474.30
|
| Rate for Payer: Prime Health Services Commercial |
$41,158.70
|
| Rate for Payer: Prime Health Services WC |
$35,981.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29,053.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$24,211.00
|
| Rate for Payer: United Healthcare All Other HMO |
$71,375.00
|
| Rate for Payer: United Healthcare HMO Rider |
$57,385.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$52,575.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$41,158.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41,158.70
|
| Rate for Payer: Vantage Medical Group Senior |
$41,158.70
|
|
|
HC ATHRECTOMY & STENT FEM/POP
|
Facility
|
IP
|
$48,422.00
|
|
|
Service Code
|
CPT 37227
|
| Hospital Charge Code |
909020068
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$9,684.40 |
| Max. Negotiated Rate |
$41,158.70 |
| Rate for Payer: Adventist Health Commercial |
$9,684.40
|
| Rate for Payer: Cash Price |
$21,789.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$33,895.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,368.80
|
| Rate for Payer: EPIC Health Plan Senior |
$19,368.80
|
| Rate for Payer: Galaxy Health WC |
$41,158.70
|
| Rate for Payer: Global Benefits Group Commercial |
$29,053.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$30,747.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28,568.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,621.28
|
| Rate for Payer: Multiplan Commercial |
$38,737.60
|
| Rate for Payer: Networks By Design Commercial |
$31,474.30
|
| Rate for Payer: Prime Health Services Commercial |
$41,158.70
|
|
|
HC ATHRECTOMY & STENT TIBIOPER EA
|
Facility
|
IP
|
$15,757.00
|
|
|
Service Code
|
CPT 37235
|
| Hospital Charge Code |
909020076
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,151.40 |
| Max. Negotiated Rate |
$13,393.45 |
| Rate for Payer: Adventist Health Commercial |
$3,151.40
|
| Rate for Payer: Cash Price |
$7,090.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11,029.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,302.80
|
| Rate for Payer: EPIC Health Plan Senior |
$6,302.80
|
| Rate for Payer: Galaxy Health WC |
$13,393.45
|
| Rate for Payer: Global Benefits Group Commercial |
$9,454.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10,005.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9,296.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,781.68
|
| Rate for Payer: Multiplan Commercial |
$12,605.60
|
| Rate for Payer: Networks By Design Commercial |
$10,242.05
|
| Rate for Payer: Prime Health Services Commercial |
$13,393.45
|
|
|
HC ATHRECTOMY & STENT TIBIOPER EA
|
Facility
|
OP
|
$15,757.00
|
|
|
Service Code
|
CPT 37235
|
| Hospital Charge Code |
909020076
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,151.40 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$3,151.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,393.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,666.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11,817.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,638.65
|
| Rate for Payer: Blue Shield of California Commercial |
$5,508.41
|
| Rate for Payer: Cash Price |
$7,090.65
|
| Rate for Payer: Cash Price |
$7,090.65
|
| Rate for Payer: Cigna of CA HMO |
$10,084.48
|
| Rate for Payer: Cigna of CA PPO |
$11,660.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,393.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$13,393.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13,393.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11,029.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,302.80
|
| Rate for Payer: EPIC Health Plan Senior |
$6,302.80
|
| Rate for Payer: Galaxy Health WC |
$13,393.45
|
| Rate for Payer: Global Benefits Group Commercial |
$9,454.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10,005.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5,719.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9,296.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,781.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,029.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,029.90
|
| Rate for Payer: Multiplan Commercial |
$12,605.60
|
| Rate for Payer: Networks By Design Commercial |
$10,242.05
|
| Rate for Payer: Prime Health Services Commercial |
$13,393.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,454.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,878.50
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,393.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13,393.45
|
| Rate for Payer: Vantage Medical Group Senior |
$13,393.45
|
|
