|
HC ATHERECTOMY W CORONARY STENT
|
Facility
|
OP
|
$18,563.00
|
|
|
Service Code
|
CPT 92933
|
| Hospital Charge Code |
906811438
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$842.63 |
| Max. Negotiated Rate |
$41,627.02 |
| Rate for Payer: Adventist Health Commercial |
$3,712.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,470.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12,752.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24,099.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21,908.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,496.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,562.15
|
| Rate for Payer: Blue Shield of California EPN |
$6,499.32
|
| Rate for Payer: Cash Price |
$8,353.35
|
| Rate for Payer: Cash Price |
$8,353.35
|
| Rate for Payer: Cash Price |
$8,353.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$24,099.86
|
| Rate for Payer: Dignity Health Senior |
$21,908.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,556.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$21,908.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,490.50
|
| Rate for Payer: Heritage Provider Network Senior |
$26,948.02
|
| Rate for Payer: Humana Medicare |
$21,908.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$842.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21,908.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$41,627.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,359.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25,852.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,640.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27,605.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27,605.29
|
| Rate for Payer: Multiplan Commercial |
$13,922.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$24,099.86
|
| Rate for Payer: TriValley Medical Group Senior |
$21,908.96
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13,479.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,381.00
|
| 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 |
906820241
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$842.63 |
| Max. Negotiated Rate |
$41,627.02 |
| Rate for Payer: Adventist Health Commercial |
$10,651.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,470.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$36,588.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24,099.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21,908.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,496.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,562.15
|
| Rate for Payer: Blue Shield of California EPN |
$6,499.32
|
| Rate for Payer: Cash Price |
$23,966.55
|
| Rate for Payer: Cash Price |
$23,966.55
|
| Rate for Payer: Cash Price |
$23,966.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$24,099.86
|
| Rate for Payer: Dignity Health Senior |
$21,908.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,556.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$21,908.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$32,967.32
|
| Rate for Payer: Heritage Provider Network Senior |
$26,948.02
|
| Rate for Payer: Humana Medicare |
$21,908.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$842.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21,908.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$41,627.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,639.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25,852.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13,314.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27,605.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27,605.29
|
| Rate for Payer: Multiplan Commercial |
$39,944.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$24,099.86
|
| Rate for Payer: TriValley Medical Group Senior |
$21,908.96
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13,479.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,381.00
|
| 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 CORO STENT ADD
|
Facility
|
OP
|
$30,813.00
|
|
|
Service Code
|
CPT C9603
|
| Hospital Charge Code |
906820260
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$460.00 |
| Max. Negotiated Rate |
$26,191.05 |
| Rate for Payer: Adventist Health Commercial |
$6,162.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$16,469.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21,168.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26,191.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16,947.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23,109.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,742.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,562.15
|
| Rate for Payer: Blue Shield of California EPN |
$6,499.32
|
| 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/PPO |
$20,028.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26,191.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$26,191.05
|
| Rate for Payer: Dignity Health Senior |
$26,191.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$20,028.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$19,073.25
|
| Rate for Payer: Heritage Provider Network Senior |
$19,073.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$14,851.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,577.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,703.25
|
| Rate for Payer: Multiplan Commercial |
$23,109.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$547.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$460.00
|
| 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
|
Facility
|
OP
|
$26,136.00
|
|
|
Service Code
|
CPT C9603
|
| Hospital Charge Code |
906811462
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$460.00 |
| Max. Negotiated Rate |
$22,215.60 |
| Rate for Payer: Adventist Health Commercial |
$5,227.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$13,969.69
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17,955.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22,215.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14,374.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19,602.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,742.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,562.15
|
| Rate for Payer: Blue Shield of California EPN |
$6,499.32
|
| Rate for Payer: Cash Price |
$11,761.20
|
| Rate for Payer: Cash Price |
$11,761.20
|
| Rate for Payer: Cash Price |
$11,761.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16,988.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22,215.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$22,215.60
|
| Rate for Payer: Dignity Health Senior |
$22,215.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$16,988.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$16,178.18
|
| Rate for Payer: Heritage Provider Network Senior |
$16,178.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12,597.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,730.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,534.00
|
| Rate for Payer: Multiplan Commercial |
$19,602.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$547.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$460.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22,215.60
|
| Rate for Payer: Vantage Medical Group Senior |
$22,215.60
|
|
|
HC ATHERECTOMY W CORO STENT ADD
|
Facility
|
IP
|
$30,813.00
|
|
|
Service Code
|
CPT C9603
|
| Hospital Charge Code |
906820260
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$4,982.00 |
| Max. Negotiated Rate |
$23,109.75 |
| Rate for Payer: Adventist Health Commercial |
$6,162.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21,168.53
|
| Rate for Payer: Cash Price |
$13,865.85
|
| Rate for Payer: Cash Price |
$13,865.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,577.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,703.25
|
| Rate for Payer: Multiplan Commercial |
$23,109.75
|
|
|
HC ATHERECTOMY W CORO STENT ADD
|
Facility
|
IP
|
$26,136.00
|
|
|
Service Code
|
CPT C9603
|
| Hospital Charge Code |
906811462
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$4,730.62 |
| Max. Negotiated Rate |
$19,602.00 |
| Rate for Payer: Adventist Health Commercial |
$5,227.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17,955.43
|
| Rate for Payer: Cash Price |
$11,761.20
|
| Rate for Payer: Cash Price |
$11,761.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,730.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,534.00
|
| Rate for Payer: Multiplan Commercial |
$19,602.00
|
|
|
HC ATHERECTOMY W CORO STENT ADD'L
|
Facility
|
IP
|
$18,563.00
|
|
|
Service Code
|
CPT 92934
|
| Hospital Charge Code |
906811439
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,359.90 |
| Max. Negotiated Rate |
$13,922.25 |
| Rate for Payer: Adventist Health Commercial |
$3,712.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12,752.78
|
| Rate for Payer: Cash Price |
$8,353.35
|
| Rate for Payer: Cash Price |
$8,353.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,359.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,640.75
|
| Rate for Payer: Multiplan Commercial |
$13,922.25
|
|
|
HC ATHERECTOMY W CORO STENT ADD'L
|
Facility
|
OP
|
$22,729.00
|
|
|
Service Code
|
CPT 92934
|
| Hospital Charge Code |
906820242
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$851.30 |
| Max. Negotiated Rate |
$19,319.65 |
| Rate for Payer: Adventist Health Commercial |
$4,545.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$851.30
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15,614.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19,319.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12,500.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17,046.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,562.15
|
| Rate for Payer: Blue Shield of California EPN |
$6,499.32
|
| Rate for Payer: Cash Price |
$10,228.05
|
| Rate for Payer: Cash Price |
$10,228.05
|
| Rate for Payer: Cash Price |
$10,228.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19,319.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$19,319.65
|
| Rate for Payer: Dignity Health Senior |
$19,319.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,556.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$14,069.25
|
| Rate for Payer: Heritage Provider Network Senior |
$14,069.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$10,955.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,113.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,682.25
|
| Rate for Payer: Multiplan Commercial |
$17,046.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13,479.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,381.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19,319.65
|
| Rate for Payer: Vantage Medical Group Senior |
$19,319.65
|
|
|
HC ATHERECTOMY W CORO STENT ADD'L
|
Facility
|
IP
|
$22,729.00
|
|
|
Service Code
|
CPT 92934
|
| Hospital Charge Code |
906820242
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,113.95 |
| Max. Negotiated Rate |
$17,046.75 |
| Rate for Payer: Adventist Health Commercial |
$4,545.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15,614.82
|
| Rate for Payer: Cash Price |
$10,228.05
|
| Rate for Payer: Cash Price |
$10,228.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,113.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,682.25
|
| Rate for Payer: Multiplan Commercial |
$17,046.75
|
|
|
HC ATHERECTOMY W CORO STENT ADD'L
|
Facility
|
OP
|
$18,563.00
|
|
|
Service Code
|
CPT 92934
|
| Hospital Charge Code |
906811439
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$851.30 |
| Max. Negotiated Rate |
$15,778.55 |
| Rate for Payer: Adventist Health Commercial |
$3,712.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$851.30
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12,752.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15,778.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,209.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,922.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,562.15
|
| Rate for Payer: Blue Shield of California EPN |
$6,499.32
|
| Rate for Payer: Cash Price |
$8,353.35
|
| Rate for Payer: Cash Price |
$8,353.35
|
| Rate for Payer: Cash Price |
$8,353.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15,778.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,778.55
|
| Rate for Payer: Dignity Health Senior |
$15,778.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,556.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,490.50
|
| Rate for Payer: Heritage Provider Network Senior |
$11,490.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8,947.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,359.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,640.75
|
| Rate for Payer: Multiplan Commercial |
$13,922.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13,479.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,381.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,778.55
|
| Rate for Payer: Vantage Medical Group Senior |
$15,778.55
|
|
|
HC ATHERECTOMY W PTCA
|
Facility
|
OP
|
$22,354.00
|
|
|
Service Code
|
CPT 92924
|
| Hospital Charge Code |
906811434
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$806.93 |
| Max. Negotiated Rate |
$26,115.92 |
| Rate for Payer: Adventist Health Commercial |
$4,470.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,407.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15,357.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,119.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,745.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,496.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,562.15
|
| Rate for Payer: Blue Shield of California EPN |
$6,499.32
|
| Rate for Payer: Cash Price |
$10,059.30
|
| Rate for Payer: Cash Price |
$10,059.30
|
| Rate for Payer: Cash Price |
$10,059.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,119.74
|
| Rate for Payer: Dignity Health Senior |
$13,745.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,556.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$13,745.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$13,837.13
|
| Rate for Payer: Heritage Provider Network Senior |
$16,906.62
|
| Rate for Payer: Humana Medicare |
$13,745.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$806.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13,745.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$26,115.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,046.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,219.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,588.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,318.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17,318.98
|
| Rate for Payer: Multiplan Commercial |
$16,765.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$15,119.74
|
| Rate for Payer: TriValley Medical Group Senior |
$13,745.22
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,002.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14,303.00
|
| 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
|
OP
|
$26,744.00
|
|
|
Service Code
|
CPT 92924
|
| Hospital Charge Code |
906820237
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$806.93 |
| Max. Negotiated Rate |
$26,115.92 |
| Rate for Payer: Adventist Health Commercial |
$5,348.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,407.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18,373.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,119.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,745.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,496.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,562.15
|
| Rate for Payer: Blue Shield of California EPN |
$6,499.32
|
| Rate for Payer: Cash Price |
$12,034.80
|
| Rate for Payer: Cash Price |
$12,034.80
|
| Rate for Payer: Cash Price |
$12,034.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,119.74
|
| Rate for Payer: Dignity Health Senior |
$13,745.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,556.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$13,745.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$16,554.54
|
| Rate for Payer: Heritage Provider Network Senior |
$16,906.62
|
| Rate for Payer: Humana Medicare |
$13,745.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$806.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13,745.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$26,115.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,840.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,219.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,686.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,318.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17,318.98
|
| Rate for Payer: Multiplan Commercial |
$20,058.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$15,119.74
|
| Rate for Payer: TriValley Medical Group Senior |
$13,745.22
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,002.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14,303.00
|
| 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 |
906820237
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,840.66 |
| Max. Negotiated Rate |
$20,058.00 |
| Rate for Payer: Adventist Health Commercial |
$5,348.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18,373.13
|
| Rate for Payer: Cash Price |
$12,034.80
|
| Rate for Payer: Cash Price |
$12,034.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,840.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,686.00
|
| Rate for Payer: Multiplan Commercial |
$20,058.00
|
|
|
HC ATHERECTOMY W PTCA
|
Facility
|
IP
|
$22,354.00
|
|
|
Service Code
|
CPT 92924
|
| Hospital Charge Code |
906811434
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,046.07 |
| Max. Negotiated Rate |
$16,765.50 |
| Rate for Payer: Adventist Health Commercial |
$4,470.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15,357.20
|
| Rate for Payer: Cash Price |
$10,059.30
|
| Rate for Payer: Cash Price |
$10,059.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,046.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,588.50
|
| Rate for Payer: Multiplan Commercial |
$16,765.50
|
|
|
HC ATHERECTOMY W PTCA ADD'L VESSEL
|
Facility
|
OP
|
$23,303.00
|
|
|
Service Code
|
CPT 92925
|
| Hospital Charge Code |
906811435
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$729.69 |
| Max. Negotiated Rate |
$19,807.55 |
| Rate for Payer: Adventist Health Commercial |
$4,660.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$729.69
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16,009.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19,807.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12,816.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17,477.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,562.15
|
| Rate for Payer: Blue Shield of California EPN |
$6,499.32
|
| Rate for Payer: Cash Price |
$10,486.35
|
| Rate for Payer: Cash Price |
$10,486.35
|
| Rate for Payer: Cash Price |
$10,486.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19,807.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$19,807.55
|
| Rate for Payer: Dignity Health Senior |
$19,807.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,556.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$14,424.56
|
| Rate for Payer: Heritage Provider Network Senior |
$14,424.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$11,232.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,217.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,825.75
|
| Rate for Payer: Multiplan Commercial |
$17,477.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,002.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14,303.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19,807.55
|
| Rate for Payer: Vantage Medical Group Senior |
$19,807.55
|
|
|
HC ATHERECTOMY W PTCA ADD'L VESSEL
|
Facility
|
IP
|
$10,699.00
|
|
|
Service Code
|
CPT 92925
|
| Hospital Charge Code |
906820238
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,936.52 |
| Max. Negotiated Rate |
$8,024.25 |
| Rate for Payer: Adventist Health Commercial |
$2,139.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,350.21
|
| Rate for Payer: Cash Price |
$4,814.55
|
| Rate for Payer: Cash Price |
$4,814.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,936.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,674.75
|
| Rate for Payer: Multiplan Commercial |
$8,024.25
|
|
|
HC ATHERECTOMY W PTCA ADD'L VESSEL
|
Facility
|
OP
|
$10,699.00
|
|
|
Service Code
|
CPT 92925
|
| Hospital Charge Code |
906820238
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$729.69 |
| Max. Negotiated Rate |
$17,002.00 |
| Rate for Payer: Adventist Health Commercial |
$2,139.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$729.69
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,350.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,094.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,884.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,024.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,562.15
|
| Rate for Payer: Blue Shield of California EPN |
$6,499.32
|
| Rate for Payer: Cash Price |
$4,814.55
|
| Rate for Payer: Cash Price |
$4,814.55
|
| Rate for Payer: Cash Price |
$4,814.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,094.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,094.15
|
| Rate for Payer: Dignity Health Senior |
$9,094.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,556.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,622.68
|
| Rate for Payer: Heritage Provider Network Senior |
$6,622.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5,156.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,936.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,674.75
|
| Rate for Payer: Multiplan Commercial |
$8,024.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,002.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14,303.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,094.15
|
| Rate for Payer: Vantage Medical Group Senior |
$9,094.15
|
|
|
HC ATHERECTOMY W PTCA ADD'L VESSEL
|
Facility
|
IP
|
$23,303.00
|
|
|
Service Code
|
CPT 92925
|
| Hospital Charge Code |
906811435
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,217.84 |
| Max. Negotiated Rate |
$17,477.25 |
| Rate for Payer: Adventist Health Commercial |
$4,660.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16,009.16
|
| Rate for Payer: Cash Price |
$10,486.35
|
| Rate for Payer: Cash Price |
$10,486.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,217.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,825.75
|
| Rate for Payer: Multiplan Commercial |
$17,477.25
|
|
|
HC ATHRECTOMY AORTA
|
Facility
|
OP
|
$38,541.00
|
|
|
Service Code
|
CPT 0236T
|
| Hospital Charge Code |
909020080
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,728.00 |
| Max. Negotiated Rate |
$28,905.75 |
| Rate for Payer: Adventist Health Commercial |
$7,708.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26,477.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,119.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,745.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,500.11
|
| Rate for Payer: Blue Shield of California EPN |
$9,024.37
|
| Rate for Payer: Cash Price |
$17,343.45
|
| Rate for Payer: Cash Price |
$17,343.45
|
| Rate for Payer: Cash Price |
$17,343.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$25,051.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,119.74
|
| Rate for Payer: Dignity Health Senior |
$13,745.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$23,124.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$13,745.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$23,856.88
|
| Rate for Payer: Heritage Provider Network Senior |
$16,906.62
|
| Rate for Payer: Humana Medicare |
$13,745.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13,745.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$26,115.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,975.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,219.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,635.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,318.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17,318.98
|
| Rate for Payer: Multiplan Commercial |
$28,905.75
|
| Rate for Payer: Multiplan WC |
$18,791.68
|
| Rate for Payer: TriValley Medical Group Commercial |
$15,119.74
|
| Rate for Payer: TriValley Medical Group Senior |
$15,119.74
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,002.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14,303.00
|
| 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 ATHRECTOMY AORTA
|
Facility
|
IP
|
$38,541.00
|
|
|
Service Code
|
CPT 0236T
|
| Hospital Charge Code |
909020080
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,975.92 |
| Max. Negotiated Rate |
$28,905.75 |
| Rate for Payer: Adventist Health Commercial |
$7,708.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26,477.67
|
| Rate for Payer: Cash Price |
$17,343.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$26,092.26
|
| Rate for Payer: Heritage Provider Network Senior |
$26,092.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,975.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,635.25
|
| Rate for Payer: Multiplan Commercial |
$28,905.75
|
|
|
HC ATHRECTOMY AORTA
|
Facility
|
OP
|
$32,366.00
|
|
|
Service Code
|
CPT 0236T
|
| Hospital Charge Code |
906820163
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,728.00 |
| Max. Negotiated Rate |
$26,115.92 |
| Rate for Payer: Adventist Health Commercial |
$6,473.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$22,235.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,119.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,745.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,500.11
|
| Rate for Payer: Blue Shield of California EPN |
$9,024.37
|
| Rate for Payer: Cash Price |
$14,564.70
|
| Rate for Payer: Cash Price |
$14,564.70
|
| Rate for Payer: Cash Price |
$14,564.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$21,037.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,119.74
|
| Rate for Payer: Dignity Health Senior |
$13,745.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,419.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$13,745.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$20,034.55
|
| Rate for Payer: Heritage Provider Network Senior |
$16,906.62
|
| Rate for Payer: Humana Medicare |
$13,745.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13,745.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$26,115.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,858.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,219.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,091.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,318.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17,318.98
|
| Rate for Payer: Multiplan Commercial |
$24,274.50
|
| Rate for Payer: Multiplan WC |
$18,791.68
|
| Rate for Payer: TriValley Medical Group Commercial |
$15,119.74
|
| Rate for Payer: TriValley Medical Group Senior |
$15,119.74
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,002.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14,303.00
|
| 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 ATHRECTOMY AORTA
|
Facility
|
IP
|
$32,366.00
|
|
|
Service Code
|
CPT 0236T
|
| Hospital Charge Code |
906820163
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,858.25 |
| Max. Negotiated Rate |
$24,274.50 |
| Rate for Payer: Adventist Health Commercial |
$6,473.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$22,235.44
|
| Rate for Payer: Cash Price |
$14,564.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$21,911.78
|
| Rate for Payer: Heritage Provider Network Senior |
$21,911.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,858.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,091.50
|
| Rate for Payer: Multiplan Commercial |
$24,274.50
|
|
|
HC ATHRECTOMY BRACHIOCEPHALIC
|
Facility
|
IP
|
$33,595.00
|
|
|
Service Code
|
CPT 0237T
|
| Hospital Charge Code |
909020079
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,080.70 |
| Max. Negotiated Rate |
$25,196.25 |
| Rate for Payer: Adventist Health Commercial |
$6,719.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$23,079.76
|
| Rate for Payer: Cash Price |
$15,117.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$22,743.82
|
| Rate for Payer: Heritage Provider Network Senior |
$22,743.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,080.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,398.75
|
| Rate for Payer: Multiplan Commercial |
$25,196.25
|
|
|
HC ATHRECTOMY BRACHIOCEPHALIC
|
Facility
|
OP
|
$32,366.00
|
|
|
Service Code
|
CPT 0237T
|
| Hospital Charge Code |
906820162
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,728.00 |
| Max. Negotiated Rate |
$26,115.92 |
| Rate for Payer: Adventist Health Commercial |
$6,473.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$22,235.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,119.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,745.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,500.11
|
| Rate for Payer: Blue Shield of California EPN |
$9,024.37
|
| Rate for Payer: Cash Price |
$14,564.70
|
| Rate for Payer: Cash Price |
$14,564.70
|
| Rate for Payer: Cash Price |
$14,564.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$21,037.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,119.74
|
| Rate for Payer: Dignity Health Senior |
$13,745.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,419.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$13,745.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$20,034.55
|
| Rate for Payer: Heritage Provider Network Senior |
$16,906.62
|
| Rate for Payer: Humana Medicare |
$13,745.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13,745.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$26,115.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,858.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,219.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,091.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,318.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17,318.98
|
| Rate for Payer: Multiplan Commercial |
$24,274.50
|
| Rate for Payer: Multiplan WC |
$18,791.68
|
| Rate for Payer: TriValley Medical Group Commercial |
$15,119.74
|
| Rate for Payer: TriValley Medical Group Senior |
$15,119.74
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,002.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14,303.00
|
| 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 ATHRECTOMY BRACHIOCEPHALIC
|
Facility
|
OP
|
$33,595.00
|
|
|
Service Code
|
CPT 0237T
|
| Hospital Charge Code |
909020079
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,728.00 |
| Max. Negotiated Rate |
$26,115.92 |
| Rate for Payer: Adventist Health Commercial |
$6,719.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$23,079.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,119.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,745.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,500.11
|
| Rate for Payer: Blue Shield of California EPN |
$9,024.37
|
| Rate for Payer: Cash Price |
$15,117.75
|
| Rate for Payer: Cash Price |
$15,117.75
|
| Rate for Payer: Cash Price |
$15,117.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$21,836.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,119.74
|
| Rate for Payer: Dignity Health Senior |
$13,745.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$20,157.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$13,745.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$20,795.30
|
| Rate for Payer: Heritage Provider Network Senior |
$16,906.62
|
| Rate for Payer: Humana Medicare |
$13,745.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13,745.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$26,115.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,080.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,219.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,398.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,318.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17,318.98
|
| Rate for Payer: Multiplan Commercial |
$25,196.25
|
| Rate for Payer: Multiplan WC |
$18,791.68
|
| Rate for Payer: TriValley Medical Group Commercial |
$15,119.74
|
| Rate for Payer: TriValley Medical Group Senior |
$15,119.74
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,002.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14,303.00
|
| 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
|
|
