|
HC AST INDIVIDUAL
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
CPT 84450
|
| Hospital Charge Code |
900910232
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.74 |
| Max. Negotiated Rate |
$73.50 |
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Cash Price |
$53.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$66.35
|
| Rate for Payer: Heritage Provider Network Senior |
$66.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.50
|
| Rate for Payer: Multiplan Commercial |
$73.50
|
|
|
HC ATHERECTOMY AORTA
|
Facility
|
IP
|
$27,456.00
|
|
| Hospital Charge Code |
909080029
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,969.54 |
| Max. Negotiated Rate |
$20,592.00 |
| Rate for Payer: Adventist Health Commercial |
$5,491.20
|
| Rate for Payer: Cash Price |
$15,100.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$18,587.71
|
| Rate for Payer: Heritage Provider Network Senior |
$18,587.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,969.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,864.00
|
| Rate for Payer: Multiplan Commercial |
$20,592.00
|
|
|
HC ATHERECTOMY AORTA
|
Facility
|
OP
|
$27,456.00
|
|
| Hospital Charge Code |
909080029
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,969.54 |
| Max. Negotiated Rate |
$23,337.60 |
| Rate for Payer: Adventist Health Commercial |
$5,491.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18,862.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23,337.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,100.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20,592.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$15,100.80
|
| Rate for Payer: Cash Price |
$15,100.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$17,846.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23,337.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$23,337.60
|
| Rate for Payer: Dignity Health Senior |
$23,337.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$16,473.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$16,995.26
|
| Rate for Payer: Heritage Provider Network Senior |
$16,995.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13,096.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,969.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,864.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19,219.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,219.20
|
| Rate for Payer: Multiplan Commercial |
$20,592.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13,728.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13,728.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23,337.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23,337.60
|
| Rate for Payer: Vantage Medical Group Senior |
$23,337.60
|
|
|
HC ATHERECTOMY BRACH/CEPH BRANCH
|
Facility
|
OP
|
$27,456.00
|
|
| Hospital Charge Code |
909080031
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,969.54 |
| Max. Negotiated Rate |
$23,337.60 |
| Rate for Payer: Adventist Health Commercial |
$5,491.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18,862.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23,337.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,100.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20,592.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$15,100.80
|
| Rate for Payer: Cash Price |
$15,100.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$17,846.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23,337.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$23,337.60
|
| Rate for Payer: Dignity Health Senior |
$23,337.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$16,473.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$16,995.26
|
| Rate for Payer: Heritage Provider Network Senior |
$16,995.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13,096.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,969.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,864.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19,219.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,219.20
|
| Rate for Payer: Multiplan Commercial |
$20,592.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13,728.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13,728.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23,337.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23,337.60
|
| Rate for Payer: Vantage Medical Group Senior |
$23,337.60
|
|
|
HC ATHERECTOMY BRACH/CEPH BRANCH
|
Facility
|
IP
|
$27,456.00
|
|
| Hospital Charge Code |
909080031
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,969.54 |
| Max. Negotiated Rate |
$20,592.00 |
| Rate for Payer: Adventist Health Commercial |
$5,491.20
|
| Rate for Payer: Cash Price |
$15,100.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$18,587.71
|
| Rate for Payer: Heritage Provider Network Senior |
$18,587.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,969.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,864.00
|
| Rate for Payer: Multiplan Commercial |
$20,592.00
|
|
|
HC ATHERECTOMY, EA ADD VISCERAL
|
Facility
|
OP
|
$1,230.00
|
|
|
Service Code
|
CPT 75996
|
| Hospital Charge Code |
909080035
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$222.63 |
| Max. Negotiated Rate |
$1,045.50 |
| Rate for Payer: Adventist Health Commercial |
$246.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$657.43
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$845.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,045.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$676.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$922.50
|
| Rate for Payer: Blue Shield of California Commercial |
$750.30
|
| Rate for Payer: Blue Shield of California EPN |
$600.24
|
| Rate for Payer: Cash Price |
$676.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$799.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,045.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,045.50
|
| Rate for Payer: Dignity Health Senior |
$1,045.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$799.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$761.37
|
| Rate for Payer: Heritage Provider Network Senior |
$761.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$586.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$222.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$307.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$861.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$861.00
|
| Rate for Payer: Multiplan Commercial |
$922.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$615.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$615.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,045.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,045.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,045.50
|
|
|
HC ATHERECTOMY, EA ADD VISCERAL
|
Facility
|
IP
|
$1,230.00
|
|
|
Service Code
|
CPT 75996
|
| Hospital Charge Code |
909080035
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$222.63 |
| Max. Negotiated Rate |
$922.50 |
| Rate for Payer: Adventist Health Commercial |
$246.00
|
| Rate for Payer: Cash Price |
$676.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$832.71
|
| Rate for Payer: Heritage Provider Network Senior |
$832.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$222.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$307.50
|
| Rate for Payer: Multiplan Commercial |
$922.50
|
|
|
HC ATHERECTOMY ILIAC
|
Facility
|
IP
|
$27,456.00
|
|
| Hospital Charge Code |
909080049
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,969.54 |
| Max. Negotiated Rate |
$20,592.00 |
| Rate for Payer: Adventist Health Commercial |
$5,491.20
|
| Rate for Payer: Cash Price |
$15,100.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$18,587.71
|
| Rate for Payer: Heritage Provider Network Senior |
$18,587.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,969.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,864.00
|
| Rate for Payer: Multiplan Commercial |
$20,592.00
|
|
|
HC ATHERECTOMY ILIAC
|
Facility
|
OP
|
$27,456.00
|
|
| Hospital Charge Code |
909080049
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,969.54 |
| Max. Negotiated Rate |
$23,337.60 |
| Rate for Payer: Adventist Health Commercial |
$5,491.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18,862.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23,337.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,100.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20,592.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$15,100.80
|
| Rate for Payer: Cash Price |
$15,100.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$17,846.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23,337.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$23,337.60
|
| Rate for Payer: Dignity Health Senior |
$23,337.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$16,473.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$16,995.26
|
| Rate for Payer: Heritage Provider Network Senior |
$16,995.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13,096.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,969.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,864.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19,219.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,219.20
|
| Rate for Payer: Multiplan Commercial |
$20,592.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13,728.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13,728.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23,337.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23,337.60
|
| Rate for Payer: Vantage Medical Group Senior |
$23,337.60
|
|
|
HC ATHERECTOMY, RENAL
|
Facility
|
OP
|
$2,458.00
|
|
|
Service Code
|
CPT 75994
|
| Hospital Charge Code |
909080033
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$444.90 |
| Max. Negotiated Rate |
$2,089.30 |
| Rate for Payer: Adventist Health Commercial |
$491.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,313.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,688.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,089.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,351.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,843.50
|
| Rate for Payer: Blue Shield of California Commercial |
$1,499.38
|
| Rate for Payer: Blue Shield of California EPN |
$1,199.50
|
| Rate for Payer: Cash Price |
$1,351.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,597.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,089.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,089.30
|
| Rate for Payer: Dignity Health Senior |
$2,089.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,597.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,521.50
|
| Rate for Payer: Heritage Provider Network Senior |
$1,521.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,172.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$444.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$614.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,720.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,720.60
|
| Rate for Payer: Multiplan Commercial |
$1,843.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,229.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,229.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,089.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,089.30
|
| Rate for Payer: Vantage Medical Group Senior |
$2,089.30
|
|
|
HC ATHERECTOMY, RENAL
|
Facility
|
IP
|
$2,458.00
|
|
|
Service Code
|
CPT 75994
|
| Hospital Charge Code |
909080033
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$444.90 |
| Max. Negotiated Rate |
$1,843.50 |
| Rate for Payer: Adventist Health Commercial |
$491.60
|
| Rate for Payer: Cash Price |
$1,351.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,664.07
|
| Rate for Payer: Heritage Provider Network Senior |
$1,664.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$444.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$614.50
|
| Rate for Payer: Multiplan Commercial |
$1,843.50
|
|
|
HC ATHERECTOMY RENAL OR VISCERAL
|
Facility
|
OP
|
$27,456.00
|
|
| Hospital Charge Code |
909080028
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,969.54 |
| Max. Negotiated Rate |
$23,337.60 |
| Rate for Payer: Adventist Health Commercial |
$5,491.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18,862.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23,337.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,100.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20,592.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$15,100.80
|
| Rate for Payer: Cash Price |
$15,100.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$17,846.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23,337.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$23,337.60
|
| Rate for Payer: Dignity Health Senior |
$23,337.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$16,473.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$16,995.26
|
| Rate for Payer: Heritage Provider Network Senior |
$16,995.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13,096.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,969.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,864.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19,219.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,219.20
|
| Rate for Payer: Multiplan Commercial |
$20,592.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13,728.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13,728.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23,337.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23,337.60
|
| Rate for Payer: Vantage Medical Group Senior |
$23,337.60
|
|
|
HC ATHERECTOMY RENAL OR VISCERAL
|
Facility
|
IP
|
$27,456.00
|
|
| Hospital Charge Code |
909080028
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,969.54 |
| Max. Negotiated Rate |
$20,592.00 |
| Rate for Payer: Adventist Health Commercial |
$5,491.20
|
| Rate for Payer: Cash Price |
$15,100.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$18,587.71
|
| Rate for Payer: Heritage Provider Network Senior |
$18,587.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,969.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,864.00
|
| Rate for Payer: Multiplan Commercial |
$20,592.00
|
|
|
HC ATHERECTOMY, VISCERAL
|
Facility
|
IP
|
$2,458.00
|
|
|
Service Code
|
CPT 75995
|
| Hospital Charge Code |
909080034
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$444.90 |
| Max. Negotiated Rate |
$1,843.50 |
| Rate for Payer: Adventist Health Commercial |
$491.60
|
| Rate for Payer: Cash Price |
$1,351.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,664.07
|
| Rate for Payer: Heritage Provider Network Senior |
$1,664.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$444.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$614.50
|
| Rate for Payer: Multiplan Commercial |
$1,843.50
|
|
|
HC ATHERECTOMY, VISCERAL
|
Facility
|
OP
|
$2,458.00
|
|
|
Service Code
|
CPT 75995
|
| Hospital Charge Code |
909080034
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$444.90 |
| Max. Negotiated Rate |
$2,089.30 |
| Rate for Payer: Adventist Health Commercial |
$491.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,313.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,688.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,089.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,351.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,843.50
|
| Rate for Payer: Blue Shield of California Commercial |
$1,499.38
|
| Rate for Payer: Blue Shield of California EPN |
$1,199.50
|
| Rate for Payer: Cash Price |
$1,351.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,597.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,089.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,089.30
|
| Rate for Payer: Dignity Health Senior |
$2,089.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,597.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,521.50
|
| Rate for Payer: Heritage Provider Network Senior |
$1,521.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,172.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$444.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$614.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,720.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,720.60
|
| Rate for Payer: Multiplan Commercial |
$1,843.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,229.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,229.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,089.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,089.30
|
| Rate for Payer: Vantage Medical Group Senior |
$2,089.30
|
|
|
HC ATHERECTOMY W CORONARY STENT
|
Facility
|
OP
|
$15,843.00
|
|
|
Service Code
|
CPT 92933
|
| Hospital Charge Code |
906811438
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$43,350.04 |
| Rate for Payer: Adventist Health Commercial |
$3,168.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10,884.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22,815.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,720.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$8,713.65
|
| Rate for Payer: Cash Price |
$8,713.65
|
| Rate for Payer: Cash Price |
$8,713.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,097.39
|
| Rate for Payer: Dignity Health Senior |
$22,815.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,556.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$22,815.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,806.82
|
| Rate for Payer: Heritage Provider Network Senior |
$28,063.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$875.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,815.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$43,350.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,867.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26,238.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,960.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28,747.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28,747.92
|
| Rate for Payer: Multiplan Commercial |
$11,882.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$25,097.39
|
| Rate for Payer: TriValley Medical Group Senior |
$22,815.81
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14,160.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,956.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Vantage Medical Group Senior |
$22,815.81
|
|
|
HC ATHERECTOMY W CORONARY STENT
|
Facility
|
IP
|
$50,596.00
|
|
|
Service Code
|
CPT 92933
|
| Hospital Charge Code |
906820241
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,982.00 |
| Max. Negotiated Rate |
$37,947.00 |
| Rate for Payer: Adventist Health Commercial |
$10,119.20
|
| Rate for Payer: Cash Price |
$27,827.80
|
| Rate for Payer: Cash Price |
$27,827.80
|
| 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 |
$9,157.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12,649.00
|
| Rate for Payer: Multiplan Commercial |
$37,947.00
|
|
|
HC ATHERECTOMY W CORONARY STENT
|
Facility
|
IP
|
$15,843.00
|
|
|
Service Code
|
CPT 92933
|
| Hospital Charge Code |
906811438
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,867.58 |
| Max. Negotiated Rate |
$11,882.25 |
| Rate for Payer: Adventist Health Commercial |
$3,168.60
|
| Rate for Payer: Cash Price |
$8,713.65
|
| Rate for Payer: Cash Price |
$8,713.65
|
| 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 |
$2,867.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,960.75
|
| Rate for Payer: Multiplan Commercial |
$11,882.25
|
|
|
HC ATHERECTOMY W CORONARY STENT
|
Facility
|
IP
|
$33,373.00
|
|
|
Service Code
|
CPT C9602
|
| Hospital Charge Code |
906820259
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$4,982.00 |
| Max. Negotiated Rate |
$25,029.75 |
| Rate for Payer: Adventist Health Commercial |
$6,674.60
|
| Rate for Payer: Cash Price |
$18,355.15
|
| Rate for Payer: Cash Price |
$18,355.15
|
| 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 |
$6,040.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,343.25
|
| Rate for Payer: Multiplan Commercial |
$25,029.75
|
|
|
HC ATHERECTOMY W CORONARY STENT
|
Facility
|
IP
|
$20,918.00
|
|
|
Service Code
|
CPT C9602
|
| Hospital Charge Code |
906811461
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$3,786.16 |
| Max. Negotiated Rate |
$15,688.50 |
| Rate for Payer: Adventist Health Commercial |
$4,183.60
|
| Rate for Payer: Cash Price |
$11,504.90
|
| Rate for Payer: Cash Price |
$11,504.90
|
| 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 |
$3,786.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,229.50
|
| Rate for Payer: Multiplan Commercial |
$15,688.50
|
|
|
HC ATHERECTOMY W CORONARY STENT
|
Facility
|
OP
|
$20,918.00
|
|
|
Service Code
|
CPT C9602
|
| Hospital Charge Code |
906811461
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$43,350.04 |
| Rate for Payer: Adventist Health Commercial |
$4,183.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14,370.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22,815.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,717.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$11,504.90
|
| Rate for Payer: Cash Price |
$11,504.90
|
| Rate for Payer: Cash Price |
$11,504.90
|
| Rate for Payer: Cash Price |
$11,504.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13,596.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,097.39
|
| Rate for Payer: Dignity Health Senior |
$22,815.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,596.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$22,815.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$12,948.24
|
| Rate for Payer: Heritage Provider Network Senior |
$28,063.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,815.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$43,350.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,786.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26,238.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,229.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28,747.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28,747.92
|
| Rate for Payer: Multiplan Commercial |
$15,688.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$25,097.39
|
| Rate for Payer: TriValley Medical Group Senior |
$22,815.81
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$575.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$483.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Vantage Medical Group Senior |
$22,815.81
|
|
|
HC ATHERECTOMY W CORONARY STENT
|
Facility
|
OP
|
$50,596.00
|
|
|
Service Code
|
CPT 92933
|
| Hospital Charge Code |
906820241
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$43,350.04 |
| Rate for Payer: Adventist Health Commercial |
$10,119.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$34,759.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22,815.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,720.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$27,827.80
|
| Rate for Payer: Cash Price |
$27,827.80
|
| Rate for Payer: Cash Price |
$27,827.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,097.39
|
| Rate for Payer: Dignity Health Senior |
$22,815.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,556.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$22,815.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$31,318.92
|
| Rate for Payer: Heritage Provider Network Senior |
$28,063.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$875.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,815.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$43,350.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,157.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26,238.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12,649.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28,747.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28,747.92
|
| Rate for Payer: Multiplan Commercial |
$37,947.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$25,097.39
|
| Rate for Payer: TriValley Medical Group Senior |
$22,815.81
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14,160.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,956.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Vantage Medical Group Senior |
$22,815.81
|
|
|
HC ATHERECTOMY W CORONARY STENT
|
Facility
|
OP
|
$33,373.00
|
|
|
Service Code
|
CPT C9602
|
| Hospital Charge Code |
906820259
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$43,350.04 |
| Rate for Payer: Adventist Health Commercial |
$6,674.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$22,927.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22,815.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,717.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$18,355.15
|
| Rate for Payer: Cash Price |
$18,355.15
|
| Rate for Payer: Cash Price |
$18,355.15
|
| Rate for Payer: Cash Price |
$18,355.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$21,692.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,097.39
|
| Rate for Payer: Dignity Health Senior |
$22,815.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$21,692.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$22,815.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$20,657.89
|
| Rate for Payer: Heritage Provider Network Senior |
$28,063.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,815.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$43,350.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,040.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26,238.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,343.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28,747.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28,747.92
|
| Rate for Payer: Multiplan Commercial |
$25,029.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$25,097.39
|
| Rate for Payer: TriValley Medical Group Senior |
$22,815.81
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$575.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$483.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Vantage Medical Group Senior |
$22,815.81
|
|
|
HC ATHERECTOMY W CORO STENT ADD
|
Facility
|
OP
|
$29,272.00
|
|
|
Service Code
|
CPT C9603
|
| Hospital Charge Code |
906820260
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$483.00 |
| Max. Negotiated Rate |
$24,881.20 |
| Rate for Payer: Adventist Health Commercial |
$5,854.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$15,645.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$20,109.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24,881.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16,099.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21,954.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,717.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$16,099.60
|
| Rate for Payer: Cash Price |
$16,099.60
|
| Rate for Payer: Cash Price |
$16,099.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$19,026.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24,881.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$24,881.20
|
| Rate for Payer: Dignity Health Senior |
$24,881.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,026.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$18,119.37
|
| Rate for Payer: Heritage Provider Network Senior |
$18,119.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13,962.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,298.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,318.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20,490.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20,490.40
|
| Rate for Payer: Multiplan Commercial |
$21,954.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$575.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$483.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24,881.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24,881.20
|
| Rate for Payer: Vantage Medical Group Senior |
$24,881.20
|
|
|
HC ATHERECTOMY W CORO STENT ADD
|
Facility
|
OP
|
$22,307.00
|
|
|
Service Code
|
CPT C9603
|
| Hospital Charge Code |
906811462
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$483.00 |
| Max. Negotiated Rate |
$18,960.95 |
| Rate for Payer: Adventist Health Commercial |
$4,461.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$11,923.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15,324.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18,960.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12,268.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16,730.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,717.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$12,268.85
|
| Rate for Payer: Cash Price |
$12,268.85
|
| Rate for Payer: Cash Price |
$12,268.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14,499.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18,960.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$18,960.95
|
| Rate for Payer: Dignity Health Senior |
$18,960.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,499.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$13,808.03
|
| Rate for Payer: Heritage Provider Network Senior |
$13,808.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$10,640.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,037.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,576.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15,614.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15,614.90
|
| Rate for Payer: Multiplan Commercial |
$16,730.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$575.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$483.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18,960.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18,960.95
|
| Rate for Payer: Vantage Medical Group Senior |
$18,960.95
|
|
