|
HC ATHERECTOMY BRACH/CEPH BRANCH
|
Facility
OP
|
$25,169.00
|
|
| Hospital Charge Code |
909080031
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,340.48 |
| Max. Negotiated Rate |
$21,393.65 |
| Rate for Payer: Aetna of CA HMO/PPO |
$16,508.35
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$21,393.65
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13,842.95
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13,842.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,995.69
|
| Rate for Payer: BCBS Transplant Transplant |
$15,101.40
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$11,326.05
|
| Rate for Payer: Cash Price |
$11,326.05
|
| Rate for Payer: Cigna of CA PPO |
$18,625.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,393.65
|
| Rate for Payer: Dignity Health Media |
$21,393.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$21,393.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,067.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$10,067.60
|
| Rate for Payer: Galaxy Health WC |
$21,393.65
|
| Rate for Payer: Global Benefits Group Commercial |
$15,101.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$18,876.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,787.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,589.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,040.56
|
| Rate for Payer: Multiplan Commercial |
$20,135.20
|
| Rate for Payer: Networks By Design Commercial |
$16,359.85
|
| Rate for Payer: Prime Health Services Commercial |
$21,393.65
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$15,101.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15,101.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,584.50
|
| Rate for Payer: United Healthcare All Other HMO |
$12,584.50
|
| Rate for Payer: United Healthcare HMO Rider |
$12,584.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12,584.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,393.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21,393.65
|
| Rate for Payer: Vantage Medical Group Senior |
$21,393.65
|
|
|
HC ATHERECTOMY, EA ADD VISCERAL
|
Facility
IP
|
$1,258.00
|
|
|
Service Code
|
CPT 75996
|
| Hospital Charge Code |
909080035
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$301.92 |
| Max. Negotiated Rate |
$1,069.30 |
| Rate for Payer: Cash Price |
$566.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$503.20
|
| Rate for Payer: Galaxy Health WC |
$1,069.30
|
| Rate for Payer: Global Benefits Group Commercial |
$754.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$839.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$479.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$301.92
|
| Rate for Payer: Multiplan Commercial |
$1,006.40
|
| Rate for Payer: Networks By Design Commercial |
$817.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,069.30
|
|
|
HC ATHERECTOMY, EA ADD VISCERAL
|
Facility
OP
|
$1,258.00
|
|
|
Service Code
|
CPT 75996
|
| Hospital Charge Code |
909080035
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$301.92 |
| Max. Negotiated Rate |
$1,069.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$825.12
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,069.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$691.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$691.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$749.52
|
| Rate for Payer: BCBS Transplant Transplant |
$754.80
|
| Rate for Payer: Blue Shield of California Commercial |
$743.48
|
| Rate for Payer: Blue Shield of California EPN |
$590.00
|
| Rate for Payer: Cash Price |
$566.10
|
| Rate for Payer: Cigna of CA HMO |
$805.12
|
| Rate for Payer: Cigna of CA PPO |
$930.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,069.30
|
| Rate for Payer: Dignity Health Media |
$1,069.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,069.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$503.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$503.20
|
| Rate for Payer: Galaxy Health WC |
$1,069.30
|
| Rate for Payer: Global Benefits Group Commercial |
$754.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$943.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$839.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$479.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$301.92
|
| Rate for Payer: Multiplan Commercial |
$1,006.40
|
| Rate for Payer: Networks By Design Commercial |
$817.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,069.30
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$754.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$754.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$754.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$629.00
|
| Rate for Payer: United Healthcare All Other HMO |
$629.00
|
| Rate for Payer: United Healthcare HMO Rider |
$629.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$629.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,069.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,069.30
|
| Rate for Payer: Vantage Medical Group Senior |
$1,069.30
|
|
|
HC ATHERECTOMY ILIAC
|
Facility
IP
|
$25,169.00
|
|
| Hospital Charge Code |
909080049
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,040.56 |
| Max. Negotiated Rate |
$21,393.65 |
| Rate for Payer: Cash Price |
$11,326.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,067.60
|
| Rate for Payer: Galaxy Health WC |
$21,393.65
|
| Rate for Payer: Global Benefits Group Commercial |
$15,101.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,787.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,589.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,040.56
|
| Rate for Payer: Multiplan Commercial |
$20,135.20
|
| Rate for Payer: Networks By Design Commercial |
$16,359.85
|
| Rate for Payer: Prime Health Services Commercial |
$21,393.65
|
|
|
HC ATHERECTOMY ILIAC
|
Facility
OP
|
$25,169.00
|
|
| Hospital Charge Code |
909080049
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,340.48 |
| Max. Negotiated Rate |
$21,393.65 |
| Rate for Payer: Aetna of CA HMO/PPO |
$16,508.35
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$21,393.65
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13,842.95
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13,842.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,995.69
|
| Rate for Payer: BCBS Transplant Transplant |
$15,101.40
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$11,326.05
|
| Rate for Payer: Cash Price |
$11,326.05
|
| Rate for Payer: Cigna of CA PPO |
$18,625.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,393.65
|
| Rate for Payer: Dignity Health Media |
$21,393.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$21,393.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,067.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$10,067.60
|
| Rate for Payer: Galaxy Health WC |
$21,393.65
|
| Rate for Payer: Global Benefits Group Commercial |
$15,101.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$18,876.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,787.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,589.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,040.56
|
| Rate for Payer: Multiplan Commercial |
$20,135.20
|
| Rate for Payer: Networks By Design Commercial |
$16,359.85
|
| Rate for Payer: Prime Health Services Commercial |
$21,393.65
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$15,101.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15,101.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,584.50
|
| Rate for Payer: United Healthcare All Other HMO |
$12,584.50
|
| Rate for Payer: United Healthcare HMO Rider |
$12,584.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12,584.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,393.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21,393.65
|
| Rate for Payer: Vantage Medical Group Senior |
$21,393.65
|
|
|
HC ATHERECTOMY, RENAL
|
Facility
IP
|
$2,515.00
|
|
|
Service Code
|
CPT 75994
|
| Hospital Charge Code |
909080033
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$603.60 |
| Max. Negotiated Rate |
$2,137.75 |
| Rate for Payer: Cash Price |
$1,131.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,006.00
|
| Rate for Payer: Galaxy Health WC |
$2,137.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,509.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,677.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$958.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$603.60
|
| Rate for Payer: Multiplan Commercial |
$2,012.00
|
| Rate for Payer: Networks By Design Commercial |
$1,634.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,137.75
|
|
|
HC ATHERECTOMY, RENAL
|
Facility
OP
|
$2,515.00
|
|
|
Service Code
|
CPT 75994
|
| Hospital Charge Code |
909080033
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$603.60 |
| Max. Negotiated Rate |
$2,137.75 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,649.59
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,137.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,383.25
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,383.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,498.44
|
| Rate for Payer: BCBS Transplant Transplant |
$1,509.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,486.36
|
| Rate for Payer: Blue Shield of California EPN |
$1,179.54
|
| Rate for Payer: Cash Price |
$1,131.75
|
| Rate for Payer: Cigna of CA HMO |
$1,609.60
|
| Rate for Payer: Cigna of CA PPO |
$1,861.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,137.75
|
| Rate for Payer: Dignity Health Media |
$2,137.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,137.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,006.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,006.00
|
| Rate for Payer: Galaxy Health WC |
$2,137.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,509.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,886.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,677.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$958.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$603.60
|
| Rate for Payer: Multiplan Commercial |
$2,012.00
|
| Rate for Payer: Networks By Design Commercial |
$1,634.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,137.75
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,509.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,509.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,509.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,257.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,257.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,257.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,257.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,137.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,137.75
|
| Rate for Payer: Vantage Medical Group Senior |
$2,137.75
|
|
|
HC ATHERECTOMY RENAL OR VISCERAL
|
Facility
OP
|
$25,169.00
|
|
| Hospital Charge Code |
909080028
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,340.48 |
| Max. Negotiated Rate |
$21,393.65 |
| Rate for Payer: Aetna of CA HMO/PPO |
$16,508.35
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$21,393.65
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13,842.95
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13,842.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,995.69
|
| Rate for Payer: BCBS Transplant Transplant |
$15,101.40
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$11,326.05
|
| Rate for Payer: Cash Price |
$11,326.05
|
| Rate for Payer: Cigna of CA PPO |
$18,625.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,393.65
|
| Rate for Payer: Dignity Health Media |
$21,393.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$21,393.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,067.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$10,067.60
|
| Rate for Payer: Galaxy Health WC |
$21,393.65
|
| Rate for Payer: Global Benefits Group Commercial |
$15,101.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$18,876.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,787.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,589.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,040.56
|
| Rate for Payer: Multiplan Commercial |
$20,135.20
|
| Rate for Payer: Networks By Design Commercial |
$16,359.85
|
| Rate for Payer: Prime Health Services Commercial |
$21,393.65
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$15,101.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15,101.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,584.50
|
| Rate for Payer: United Healthcare All Other HMO |
$12,584.50
|
| Rate for Payer: United Healthcare HMO Rider |
$12,584.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12,584.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,393.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21,393.65
|
| Rate for Payer: Vantage Medical Group Senior |
$21,393.65
|
|
|
HC ATHERECTOMY RENAL OR VISCERAL
|
Facility
IP
|
$25,169.00
|
|
| Hospital Charge Code |
909080028
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,040.56 |
| Max. Negotiated Rate |
$21,393.65 |
| Rate for Payer: Cash Price |
$11,326.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,067.60
|
| Rate for Payer: Galaxy Health WC |
$21,393.65
|
| Rate for Payer: Global Benefits Group Commercial |
$15,101.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,787.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,589.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,040.56
|
| Rate for Payer: Multiplan Commercial |
$20,135.20
|
| Rate for Payer: Networks By Design Commercial |
$16,359.85
|
| Rate for Payer: Prime Health Services Commercial |
$21,393.65
|
|
|
HC ATHERECTOMY, VISCERAL
|
Facility
IP
|
$2,515.00
|
|
|
Service Code
|
CPT 75995
|
| Hospital Charge Code |
909080034
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$603.60 |
| Max. Negotiated Rate |
$2,137.75 |
| Rate for Payer: Cash Price |
$1,131.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,006.00
|
| Rate for Payer: Galaxy Health WC |
$2,137.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,509.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,677.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$958.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$603.60
|
| Rate for Payer: Multiplan Commercial |
$2,012.00
|
| Rate for Payer: Networks By Design Commercial |
$1,634.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,137.75
|
|
|
HC ATHERECTOMY, VISCERAL
|
Facility
OP
|
$2,515.00
|
|
|
Service Code
|
CPT 75995
|
| Hospital Charge Code |
909080034
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$603.60 |
| Max. Negotiated Rate |
$2,137.75 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,649.59
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,137.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,383.25
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,383.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,498.44
|
| Rate for Payer: BCBS Transplant Transplant |
$1,509.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,486.36
|
| Rate for Payer: Blue Shield of California EPN |
$1,179.54
|
| Rate for Payer: Cash Price |
$1,131.75
|
| Rate for Payer: Cigna of CA HMO |
$1,609.60
|
| Rate for Payer: Cigna of CA PPO |
$1,861.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,137.75
|
| Rate for Payer: Dignity Health Media |
$2,137.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,137.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,006.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,006.00
|
| Rate for Payer: Galaxy Health WC |
$2,137.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,509.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,886.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,677.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$958.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$603.60
|
| Rate for Payer: Multiplan Commercial |
$2,012.00
|
| Rate for Payer: Networks By Design Commercial |
$1,634.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,137.75
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,509.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,509.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,509.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,257.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,257.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,257.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,257.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,137.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,137.75
|
| Rate for Payer: Vantage Medical Group Senior |
$2,137.75
|
|
|
HC ATHERECTOMY W CORONARY STENT
|
Facility
OP
|
$35,129.00
|
|
|
Service Code
|
CPT C9602
|
| Hospital Charge Code |
906811461
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$643.00 |
| Max. Negotiated Rate |
$35,930.69 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6,492.38
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$32,863.44
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$24,099.86
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$21,908.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,375.00
|
| Rate for Payer: BCBS Transplant Transplant |
$21,077.40
|
| Rate for Payer: Blue Shield of California Commercial |
$5,803.51
|
| Rate for Payer: Blue Shield of California EPN |
$3,777.25
|
| Rate for Payer: Cash Price |
$15,808.05
|
| Rate for Payer: Cash Price |
$15,808.05
|
| Rate for Payer: Cash Price |
$15,808.05
|
| Rate for Payer: Cigna of CA HMO |
$22,482.56
|
| Rate for Payer: Cigna of CA PPO |
$25,995.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Dignity Health Media |
$21,908.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$24,099.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$29,577.10
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$21,908.96
|
| Rate for Payer: EPIC Health Plan Transplant |
$21,908.96
|
| Rate for Payer: Galaxy Health WC |
$29,859.65
|
| Rate for Payer: Global Benefits Group Commercial |
$21,077.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$26,346.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$35,930.69
|
| Rate for Payer: Heritage Provider Network Transplant |
$35,930.69
|
| Rate for Payer: IEHP Medi-Cal |
$35,492.52
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$35,492.52
|
| Rate for Payer: IEHP Medicare Advantage |
$21,908.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23,431.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,384.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21,908.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,430.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27,605.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29,358.01
|
| Rate for Payer: Multiplan Commercial |
$28,103.20
|
| Rate for Payer: Networks By Design Commercial |
$22,833.85
|
| Rate for Payer: Prime Health Services Commercial |
$29,859.65
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$21,077.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21,077.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21,077.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,078.00
|
| Rate for Payer: United Healthcare All Other HMO |
$827.00
|
| Rate for Payer: United Healthcare HMO Rider |
$702.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$643.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24,099.86
|
| Rate for Payer: Vantage Medical Group Senior |
$21,908.96
|
|
|
HC ATHERECTOMY W CORONARY STENT
|
Facility
OP
|
$53,259.00
|
|
|
Service Code
|
CPT 92933
|
| Hospital Charge Code |
906811438
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,026.28 |
| Max. Negotiated Rate |
$45,270.15 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4,201.84
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$32,863.44
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$24,099.86
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$21,908.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,375.00
|
| Rate for Payer: BCBS Transplant Transplant |
$31,955.40
|
| Rate for Payer: Blue Shield of California Commercial |
$5,803.51
|
| Rate for Payer: Blue Shield of California EPN |
$3,777.25
|
| Rate for Payer: Cash Price |
$23,966.55
|
| Rate for Payer: Cash Price |
$23,966.55
|
| Rate for Payer: Cigna of CA PPO |
$39,411.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Dignity Health Media |
$21,908.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$24,099.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$29,577.10
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$21,908.96
|
| Rate for Payer: EPIC Health Plan Transplant |
$21,908.96
|
| Rate for Payer: Galaxy Health WC |
$45,270.15
|
| Rate for Payer: Global Benefits Group Commercial |
$31,955.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$39,944.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$35,930.69
|
| Rate for Payer: Heritage Provider Network Transplant |
$35,930.69
|
| Rate for Payer: IEHP Medi-Cal |
$35,492.52
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$35,492.52
|
| Rate for Payer: IEHP Medicare Advantage |
$21,908.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35,523.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,026.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21,908.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12,782.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27,605.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29,358.01
|
| Rate for Payer: Multiplan Commercial |
$42,607.20
|
| Rate for Payer: Networks By Design Commercial |
$34,618.35
|
| Rate for Payer: Prime Health Services Commercial |
$45,270.15
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$31,955.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$31,955.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$31,955.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$16,813.00
|
| Rate for Payer: United Healthcare All Other HMO |
$27,445.00
|
| Rate for Payer: United Healthcare HMO Rider |
$17,214.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,742.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24,099.86
|
| Rate for Payer: Vantage Medical Group Senior |
$21,908.96
|
|
|
HC ATHERECTOMY W CORONARY STENT
|
Facility
IP
|
$35,129.00
|
|
|
Service Code
|
CPT C9602
|
| Hospital Charge Code |
906811461
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$8,430.96 |
| Max. Negotiated Rate |
$29,859.65 |
| Rate for Payer: Cash Price |
$15,808.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,051.60
|
| Rate for Payer: Galaxy Health WC |
$29,859.65
|
| Rate for Payer: Global Benefits Group Commercial |
$21,077.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23,431.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,384.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,430.96
|
| Rate for Payer: Multiplan Commercial |
$28,103.20
|
| Rate for Payer: Networks By Design Commercial |
$22,833.85
|
| Rate for Payer: Prime Health Services Commercial |
$29,859.65
|
|
|
HC ATHERECTOMY W CORONARY STENT
|
Facility
IP
|
$53,259.00
|
|
|
Service Code
|
CPT 92933
|
| Hospital Charge Code |
906811438
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$12,782.16 |
| Max. Negotiated Rate |
$45,270.15 |
| Rate for Payer: Cash Price |
$23,966.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$21,303.60
|
| Rate for Payer: Galaxy Health WC |
$45,270.15
|
| Rate for Payer: Global Benefits Group Commercial |
$31,955.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35,523.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20,291.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12,782.16
|
| Rate for Payer: Multiplan Commercial |
$42,607.20
|
| Rate for Payer: Networks By Design Commercial |
$34,618.35
|
| Rate for Payer: Prime Health Services Commercial |
$45,270.15
|
|
|
HC ATHERECTOMY W CORO STENT ADD
|
Facility
IP
|
$30,813.00
|
|
|
Service Code
|
CPT C9603
|
| Hospital Charge Code |
906811462
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$7,395.12 |
| Max. Negotiated Rate |
$26,191.05 |
| Rate for Payer: Cash Price |
$13,865.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,325.20
|
| Rate for Payer: Galaxy Health WC |
$26,191.05
|
| Rate for Payer: Global Benefits Group Commercial |
$18,487.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20,552.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,739.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,395.12
|
| Rate for Payer: Multiplan Commercial |
$24,650.40
|
| Rate for Payer: Networks By Design Commercial |
$20,028.45
|
| Rate for Payer: Prime Health Services Commercial |
$26,191.05
|
|
|
HC ATHERECTOMY W CORO STENT ADD
|
Facility
OP
|
$30,813.00
|
|
|
Service Code
|
CPT C9603
|
| Hospital Charge Code |
906811462
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$643.00 |
| Max. Negotiated Rate |
$26,191.05 |
| Rate for Payer: Aetna of CA HMO/PPO |
$20,210.25
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$26,191.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$16,947.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$16,947.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,375.00
|
| Rate for Payer: BCBS Transplant Transplant |
$18,487.80
|
| Rate for Payer: Blue Shield of California Commercial |
$5,803.51
|
| Rate for Payer: Blue Shield of California EPN |
$3,777.25
|
| Rate for Payer: Cash Price |
$13,865.85
|
| Rate for Payer: Cash Price |
$13,865.85
|
| Rate for Payer: Cash Price |
$13,865.85
|
| Rate for Payer: Cigna of CA HMO |
$19,720.32
|
| Rate for Payer: Cigna of CA PPO |
$22,801.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26,191.05
|
| Rate for Payer: Dignity Health Media |
$26,191.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$26,191.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,325.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$12,325.20
|
| Rate for Payer: Galaxy Health WC |
$26,191.05
|
| Rate for Payer: Global Benefits Group Commercial |
$18,487.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$23,109.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20,552.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,739.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,395.12
|
| Rate for Payer: Multiplan Commercial |
$24,650.40
|
| Rate for Payer: Networks By Design Commercial |
$20,028.45
|
| Rate for Payer: Prime Health Services Commercial |
$26,191.05
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$18,487.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18,487.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18,487.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,078.00
|
| Rate for Payer: United Healthcare All Other HMO |
$827.00
|
| Rate for Payer: United Healthcare HMO Rider |
$702.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$643.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26,191.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26,191.05
|
| Rate for Payer: Vantage Medical Group Senior |
$26,191.05
|
|
|
HC ATHERECTOMY W CORO STENT ADD'L
|
Facility
IP
|
$22,729.00
|
|
|
Service Code
|
CPT 92934
|
| Hospital Charge Code |
906811439
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,454.96 |
| Max. Negotiated Rate |
$19,319.65 |
| Rate for Payer: Cash Price |
$10,228.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,091.60
|
| Rate for Payer: Galaxy Health WC |
$19,319.65
|
| Rate for Payer: Global Benefits Group Commercial |
$13,637.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15,160.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,659.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,454.96
|
| Rate for Payer: Multiplan Commercial |
$18,183.20
|
| Rate for Payer: Networks By Design Commercial |
$14,773.85
|
| Rate for Payer: Prime Health Services Commercial |
$19,319.65
|
|
|
HC ATHERECTOMY W CORO STENT ADD'L
|
Facility
OP
|
$22,729.00
|
|
|
Service Code
|
CPT 92934
|
| Hospital Charge Code |
906811439
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,433.27 |
| Max. Negotiated Rate |
$27,445.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,433.27
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$19,319.65
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$12,500.95
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$12,500.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: BCBS Transplant Transplant |
$13,637.40
|
| Rate for Payer: Blue Shield of California Commercial |
$5,803.51
|
| Rate for Payer: Blue Shield of California EPN |
$3,777.25
|
| Rate for Payer: Cash Price |
$10,228.05
|
| Rate for Payer: Cash Price |
$10,228.05
|
| Rate for Payer: Cigna of CA PPO |
$16,819.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19,319.65
|
| Rate for Payer: Dignity Health Media |
$19,319.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$19,319.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,091.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$9,091.60
|
| Rate for Payer: Galaxy Health WC |
$19,319.65
|
| Rate for Payer: Global Benefits Group Commercial |
$13,637.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$17,046.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15,160.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,454.96
|
| Rate for Payer: Multiplan Commercial |
$18,183.20
|
| Rate for Payer: Networks By Design Commercial |
$14,773.85
|
| Rate for Payer: Prime Health Services Commercial |
$19,319.65
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$13,637.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13,637.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13,637.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$16,813.00
|
| Rate for Payer: United Healthcare All Other HMO |
$27,445.00
|
| Rate for Payer: United Healthcare HMO Rider |
$17,214.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,742.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19,319.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19,319.65
|
| Rate for Payer: Vantage Medical Group Senior |
$19,319.65
|
|
|
HC ATHERECTOMY W PTCA
|
Facility
OP
|
$26,744.00
|
|
|
Service Code
|
CPT 92924
|
| Hospital Charge Code |
906811434
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$982.79 |
| Max. Negotiated Rate |
$48,045.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4,023.66
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$20,617.83
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$15,119.74
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13,745.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,375.00
|
| Rate for Payer: BCBS Transplant Transplant |
$16,046.40
|
| Rate for Payer: Blue Shield of California Commercial |
$5,803.51
|
| Rate for Payer: Blue Shield of California EPN |
$3,777.25
|
| Rate for Payer: Cash Price |
$12,034.80
|
| Rate for Payer: Cash Price |
$12,034.80
|
| Rate for Payer: Cigna of CA PPO |
$19,790.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Dignity Health Media |
$13,745.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,119.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,556.05
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$13,745.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$13,745.22
|
| Rate for Payer: Galaxy Health WC |
$22,732.40
|
| Rate for Payer: Global Benefits Group Commercial |
$16,046.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$20,058.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$22,542.16
|
| Rate for Payer: Heritage Provider Network Transplant |
$22,542.16
|
| Rate for Payer: IEHP Medi-Cal |
$22,267.26
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$22,267.26
|
| Rate for Payer: IEHP Medicare Advantage |
$13,745.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17,838.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$982.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,745.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,418.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,318.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18,418.59
|
| Rate for Payer: Multiplan Commercial |
$21,395.20
|
| Rate for Payer: Networks By Design Commercial |
$17,383.60
|
| Rate for Payer: Prime Health Services Commercial |
$22,732.40
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$16,046.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16,046.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16,046.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$29,673.00
|
| Rate for Payer: United Healthcare All Other HMO |
$48,045.00
|
| Rate for Payer: United Healthcare HMO Rider |
$31,101.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28,895.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,119.74
|
| Rate for Payer: Vantage Medical Group Senior |
$13,745.22
|
|
|
HC ATHERECTOMY W PTCA
|
Facility
IP
|
$26,744.00
|
|
|
Service Code
|
CPT 92924
|
| Hospital Charge Code |
906811434
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$6,418.56 |
| Max. Negotiated Rate |
$22,732.40 |
| Rate for Payer: Cash Price |
$12,034.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,697.60
|
| Rate for Payer: Galaxy Health WC |
$22,732.40
|
| Rate for Payer: Global Benefits Group Commercial |
$16,046.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17,838.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,189.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,418.56
|
| Rate for Payer: Multiplan Commercial |
$21,395.20
|
| Rate for Payer: Networks By Design Commercial |
$17,383.60
|
| Rate for Payer: Prime Health Services Commercial |
$22,732.40
|
|
|
HC ATHERECTOMY W PTCA ADD'L VESSEL
|
Facility
IP
|
$10,699.00
|
|
|
Service Code
|
CPT 92925
|
| Hospital Charge Code |
906811435
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,567.76 |
| Max. Negotiated Rate |
$9,094.15 |
| Rate for Payer: Cash Price |
$4,814.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,279.60
|
| Rate for Payer: Galaxy Health WC |
$9,094.15
|
| Rate for Payer: Global Benefits Group Commercial |
$6,419.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,136.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,076.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,567.76
|
| Rate for Payer: Multiplan Commercial |
$8,559.20
|
| Rate for Payer: Networks By Design Commercial |
$6,954.35
|
| Rate for Payer: Prime Health Services Commercial |
$9,094.15
|
|
|
HC ATHERECTOMY W PTCA ADD'L VESSEL
|
Facility
OP
|
$10,699.00
|
|
|
Service Code
|
CPT 92925
|
| Hospital Charge Code |
906811435
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,085.66 |
| Max. Negotiated Rate |
$48,045.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,085.66
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9,094.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5,884.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5,884.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: BCBS Transplant Transplant |
$6,419.40
|
| Rate for Payer: Blue Shield of California Commercial |
$5,803.51
|
| Rate for Payer: Blue Shield of California EPN |
$3,777.25
|
| Rate for Payer: Cash Price |
$4,814.55
|
| Rate for Payer: Cash Price |
$4,814.55
|
| Rate for Payer: Cigna of CA PPO |
$7,917.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,094.15
|
| Rate for Payer: Dignity Health Media |
$9,094.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,094.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,279.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,279.60
|
| Rate for Payer: Galaxy Health WC |
$9,094.15
|
| Rate for Payer: Global Benefits Group Commercial |
$6,419.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$8,024.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,136.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,567.76
|
| Rate for Payer: Multiplan Commercial |
$8,559.20
|
| Rate for Payer: Networks By Design Commercial |
$6,954.35
|
| Rate for Payer: Prime Health Services Commercial |
$9,094.15
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$6,419.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,419.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,419.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$29,673.00
|
| Rate for Payer: United Healthcare All Other HMO |
$48,045.00
|
| Rate for Payer: United Healthcare HMO Rider |
$31,101.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28,895.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,094.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,094.15
|
| Rate for Payer: Vantage Medical Group Senior |
$9,094.15
|
|
|
HC ATHRECTOMY AORTA
|
Facility
IP
|
$32,366.00
|
|
|
Service Code
|
CPT 0236T
|
| Hospital Charge Code |
909020080
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,767.84 |
| Max. Negotiated Rate |
$27,511.10 |
| Rate for Payer: Cash Price |
$14,564.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,946.40
|
| Rate for Payer: Galaxy Health WC |
$27,511.10
|
| Rate for Payer: Global Benefits Group Commercial |
$19,419.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21,588.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,331.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,767.84
|
| Rate for Payer: Multiplan Commercial |
$25,892.80
|
| Rate for Payer: Networks By Design Commercial |
$21,037.90
|
| Rate for Payer: Prime Health Services Commercial |
$27,511.10
|
|
|
HC ATHRECTOMY AORTA
|
Facility
OP
|
$32,366.00
|
|
|
Service Code
|
CPT 0236T
|
| Hospital Charge Code |
909020080
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,244.75 |
| Max. Negotiated Rate |
$48,045.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$20,617.83
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$15,119.74
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13,745.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,049.00
|
| Rate for Payer: BCBS Transplant Transplant |
$19,419.60
|
| Rate for Payer: Blue Shield of California Commercial |
$8,058.23
|
| Rate for Payer: Blue Shield of California EPN |
$5,244.75
|
| Rate for Payer: Cash Price |
$14,564.70
|
| Rate for Payer: Cash Price |
$14,564.70
|
| Rate for Payer: Cigna of CA PPO |
$23,950.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Dignity Health Media |
$13,745.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,119.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,556.05
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$13,745.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$13,745.22
|
| Rate for Payer: Galaxy Health WC |
$27,511.10
|
| Rate for Payer: Global Benefits Group Commercial |
$19,419.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$24,274.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$22,542.16
|
| Rate for Payer: Heritage Provider Network Transplant |
$22,542.16
|
| Rate for Payer: IEHP Medi-Cal |
$22,267.26
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$22,267.26
|
| Rate for Payer: IEHP Medicare Advantage |
$13,745.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21,588.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,331.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,745.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,767.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,318.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18,418.59
|
| Rate for Payer: Multiplan Commercial |
$25,892.80
|
| Rate for Payer: Multiplan WC |
$18,791.68
|
| Rate for Payer: Networks By Design Commercial |
$21,037.90
|
| Rate for Payer: Prime Health Services Commercial |
$27,511.10
|
| Rate for Payer: Prime Health Services WC |
$18,599.92
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$19,419.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19,419.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$29,673.00
|
| Rate for Payer: United Healthcare All Other HMO |
$48,045.00
|
| Rate for Payer: United Healthcare HMO Rider |
$31,101.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28,895.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,119.74
|
| Rate for Payer: Vantage Medical Group Senior |
$13,745.22
|
|
