|
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: Aetna of CA Non-Gatekeeper |
$17,681.66
|
| Rate for Payer: Cash Price |
$12,355.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$18,587.71
|
| Rate for Payer: Heritage Provider Network Senior |
$18,587.71
|
| Rate for Payer: Kaiser Foundation Hospitals 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
|
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: Aetna of CA Non-Gatekeeper |
$17,681.66
|
| Rate for Payer: Cash Price |
$12,355.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$18,587.71
|
| Rate for Payer: Heritage Provider Network Senior |
$18,587.71
|
| Rate for Payer: Kaiser Foundation Hospitals 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 Non-Gatekeeper |
$16,967.81
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$13,733.49
|
| 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 |
$12,355.20
|
| Rate for Payer: Cash Price |
$12,355.20
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$13,096.51
|
| Rate for Payer: Kaiser Foundation Hospitals 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/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: Aetna of CA Non-Gatekeeper |
$17,681.66
|
| Rate for Payer: Cash Price |
$12,355.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$18,587.71
|
| Rate for Payer: Heritage Provider Network Senior |
$18,587.71
|
| Rate for Payer: Kaiser Foundation Hospitals 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 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 Non-Gatekeeper |
$16,967.81
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$13,733.49
|
| 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 |
$12,355.20
|
| Rate for Payer: Cash Price |
$12,355.20
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$13,096.51
|
| Rate for Payer: Kaiser Foundation Hospitals 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/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 W CORONARY STENT
|
Facility
|
OP
|
$15,843.00
|
|
|
Service Code
|
CPT 92933
|
| Hospital Charge Code |
906811438
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,867.58 |
| Max. Negotiated Rate |
$44,797.35 |
| Rate for Payer: Adventist Health Commercial |
$3,168.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,790.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,935.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23,577.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,309.00
|
| 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 |
$7,129.35
|
| Rate for Payer: Cash Price |
$7,129.35
|
| Rate for Payer: Cash Price |
$7,129.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,935.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23,577.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,556.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$23,577.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,806.82
|
| Rate for Payer: Heritage Provider Network Senior |
$29,000.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23,577.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$44,797.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,867.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27,114.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,960.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$31,593.92
|
| Rate for Payer: Multiplan Commercial |
$11,882.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$25,935.31
|
| Rate for Payer: TriValley Medical Group Senior |
$23,577.55
|
| 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 |
$35,366.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,935.31
|
| Rate for Payer: Vantage Medical Group Senior |
$23,577.55
|
|
|
HC ATHERECTOMY W CORONARY STENT
|
Facility
|
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: Aetna of CA Non-Gatekeeper |
$10,202.89
|
| Rate for Payer: Cash Price |
$7,129.35
|
| Rate for Payer: Cash Price |
$7,129.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Foundation Hospitals 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
|
$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: Aetna of CA Non-Gatekeeper |
$13,471.19
|
| Rate for Payer: Cash Price |
$9,413.10
|
| Rate for Payer: Cash Price |
$9,413.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Foundation Hospitals 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 |
$483.00 |
| Max. Negotiated Rate |
$44,797.35 |
| Rate for Payer: Adventist Health Commercial |
$4,183.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12,927.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,935.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23,577.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,185.00
|
| 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 |
$9,413.10
|
| Rate for Payer: Cash Price |
$9,413.10
|
| Rate for Payer: Cash Price |
$9,413.10
|
| Rate for Payer: Cash Price |
$9,413.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13,596.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,935.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23,577.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,341.62
|
| Rate for Payer: EPIC Health Plan Medicare |
$23,577.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$12,948.24
|
| Rate for Payer: Heritage Provider Network Senior |
$29,000.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23,577.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$44,797.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,786.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27,114.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,229.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$31,593.92
|
| Rate for Payer: Multiplan Commercial |
$15,688.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$25,935.31
|
| Rate for Payer: TriValley Medical Group Senior |
$23,577.55
|
| 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 |
$35,366.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,935.31
|
| Rate for Payer: Vantage Medical Group Senior |
$23,577.55
|
|
|
HC ATHERECTOMY W CORO STENT ADD
|
Facility
|
IP
|
$22,307.00
|
|
|
Service Code
|
CPT C9603
|
| Hospital Charge Code |
906811462
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$4,037.57 |
| Max. Negotiated Rate |
$16,730.25 |
| Rate for Payer: Adventist Health Commercial |
$4,461.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14,365.71
|
| Rate for Payer: Cash Price |
$10,038.15
|
| Rate for Payer: Cash Price |
$10,038.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,037.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,576.75
|
| Rate for Payer: Multiplan Commercial |
$16,730.25
|
|
|
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 Non-Gatekeeper |
$13,785.73
|
| 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 |
$12,185.00
|
| 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 |
$10,038.15
|
| Rate for Payer: Cash Price |
$10,038.15
|
| Rate for Payer: Cash Price |
$10,038.15
|
| 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 Medicare Advantage |
$18,960.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,161.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$13,808.03
|
| Rate for Payer: Heritage Provider Network Senior |
$13,808.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$10,640.44
|
| Rate for Payer: Kaiser Foundation Hospitals 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/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
|
|
|
HC ATHERECTOMY W CORO STENT ADD'L
|
Facility
|
IP
|
$15,843.00
|
|
|
Service Code
|
CPT 92934
|
| Hospital Charge Code |
906811439
|
|
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: Aetna of CA Non-Gatekeeper |
$10,202.89
|
| Rate for Payer: Cash Price |
$7,129.35
|
| Rate for Payer: Cash Price |
$7,129.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Foundation Hospitals 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 CORO STENT ADD'L
|
Facility
|
OP
|
$15,843.00
|
|
|
Service Code
|
CPT 92934
|
| Hospital Charge Code |
906811439
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,867.58 |
| Max. Negotiated Rate |
$14,160.00 |
| Rate for Payer: Adventist Health Commercial |
$3,168.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,790.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,466.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,713.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11,882.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,245.00
|
| 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 |
$7,129.35
|
| Rate for Payer: Cash Price |
$7,129.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,466.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$13,466.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13,466.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,556.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,806.82
|
| Rate for Payer: Heritage Provider Network Senior |
$9,806.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7,557.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,867.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,960.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$11,090.10
|
| Rate for Payer: Multiplan Commercial |
$11,882.25
|
| 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 |
$13,466.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13,466.55
|
| Rate for Payer: Vantage Medical Group Senior |
$13,466.55
|
|
|
HC ATHERECTOMY W PTCA
|
Facility
|
OP
|
$19,079.00
|
|
|
Service Code
|
CPT 92924
|
| Hospital Charge Code |
906811434
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,453.30 |
| Max. Negotiated Rate |
$28,210.74 |
| Rate for Payer: Adventist Health Commercial |
$3,815.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11,790.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16,332.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,847.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,309.00
|
| 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 |
$8,585.55
|
| Rate for Payer: Cash Price |
$8,585.55
|
| Rate for Payer: Cash Price |
$8,585.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$16,332.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,847.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,556.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$14,847.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,809.90
|
| Rate for Payer: Heritage Provider Network Senior |
$18,262.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,847.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$28,210.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,453.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17,074.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,769.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19,896.00
|
| Rate for Payer: Multiplan Commercial |
$14,309.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$16,332.54
|
| Rate for Payer: TriValley Medical Group Senior |
$14,847.76
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,861.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,025.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16,332.54
|
| Rate for Payer: Vantage Medical Group Senior |
$14,847.76
|
|
|
HC ATHERECTOMY W PTCA
|
Facility
|
IP
|
$19,079.00
|
|
|
Service Code
|
CPT 92924
|
| Hospital Charge Code |
906811434
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,453.30 |
| Max. Negotiated Rate |
$14,309.25 |
| Rate for Payer: Adventist Health Commercial |
$3,815.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12,286.88
|
| Rate for Payer: Cash Price |
$8,585.55
|
| Rate for Payer: Cash Price |
$8,585.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,453.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,769.75
|
| Rate for Payer: Multiplan Commercial |
$14,309.25
|
|
|
HC ATHERECTOMY W PTCA ADD'L VESSEL
|
Facility
|
IP
|
$8,639.00
|
|
|
Service Code
|
CPT 92925
|
| Hospital Charge Code |
906811435
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,563.66 |
| Max. Negotiated Rate |
$6,479.25 |
| Rate for Payer: Adventist Health Commercial |
$1,727.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,563.52
|
| Rate for Payer: Cash Price |
$3,887.55
|
| Rate for Payer: Cash Price |
$3,887.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,563.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,159.75
|
| Rate for Payer: Multiplan Commercial |
$6,479.25
|
|
|
HC ATHERECTOMY W PTCA ADD'L VESSEL
|
Facility
|
OP
|
$8,639.00
|
|
|
Service Code
|
CPT 92925
|
| Hospital Charge Code |
906811435
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,563.66 |
| Max. Negotiated Rate |
$17,861.00 |
| Rate for Payer: Adventist Health Commercial |
$1,727.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,338.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,343.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,751.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,479.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,245.00
|
| 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 |
$3,887.55
|
| Rate for Payer: Cash Price |
$3,887.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,343.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,343.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,343.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,556.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,347.54
|
| Rate for Payer: Heritage Provider Network Senior |
$5,347.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4,120.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,563.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,159.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,047.30
|
| Rate for Payer: Multiplan Commercial |
$6,479.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,861.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,025.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,343.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,343.15
|
| Rate for Payer: Vantage Medical Group Senior |
$7,343.15
|
|
|
HC ATHRECTOMY AORTA
|
Facility
|
IP
|
$42,106.00
|
|
|
Service Code
|
CPT 0236T
|
| Hospital Charge Code |
909020080
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,621.19 |
| Max. Negotiated Rate |
$31,579.50 |
| Rate for Payer: Adventist Health Commercial |
$8,421.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$27,116.26
|
| Rate for Payer: Cash Price |
$18,947.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$28,505.76
|
| Rate for Payer: Heritage Provider Network Senior |
$28,505.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7,621.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10,526.50
|
| Rate for Payer: Multiplan Commercial |
$31,579.50
|
|
|
HC ATHRECTOMY AORTA
|
Facility
|
OP
|
$42,106.00
|
|
|
Service Code
|
CPT 0236T
|
| Hospital Charge Code |
909020080
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,621.19 |
| Max. Negotiated Rate |
$31,579.50 |
| Rate for Payer: Adventist Health Commercial |
$8,421.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26,021.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16,332.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,847.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,435.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,829.24
|
| Rate for Payer: Blue Shield of California EPN |
$8,674.01
|
| Rate for Payer: Cash Price |
$18,947.70
|
| Rate for Payer: Cash Price |
$18,947.70
|
| Rate for Payer: Cash Price |
$18,947.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$27,368.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$16,332.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,847.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$25,263.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$14,847.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$26,063.61
|
| Rate for Payer: Heritage Provider Network Senior |
$18,262.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,847.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$28,210.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7,621.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17,074.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10,526.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19,896.00
|
| Rate for Payer: Multiplan Commercial |
$31,579.50
|
| Rate for Payer: Multiplan WC |
$22,958.69
|
| Rate for Payer: TriValley Medical Group Commercial |
$16,332.54
|
| Rate for Payer: TriValley Medical Group Senior |
$16,332.54
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,861.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,025.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16,332.54
|
| Rate for Payer: Vantage Medical Group Senior |
$14,847.76
|
|
|
HC ATHRECTOMY BRACHIOCEPHALIC
|
Facility
|
OP
|
$36,702.00
|
|
|
Service Code
|
CPT 0237T
|
| Hospital Charge Code |
909020079
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,643.06 |
| Max. Negotiated Rate |
$28,210.74 |
| Rate for Payer: Adventist Health Commercial |
$7,340.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$22,681.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16,332.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,847.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,435.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,829.24
|
| Rate for Payer: Blue Shield of California EPN |
$8,674.01
|
| Rate for Payer: Cash Price |
$16,515.90
|
| Rate for Payer: Cash Price |
$16,515.90
|
| Rate for Payer: Cash Price |
$16,515.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$23,856.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$16,332.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,847.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$22,021.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$14,847.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$22,718.54
|
| Rate for Payer: Heritage Provider Network Senior |
$18,262.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,847.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$28,210.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6,643.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17,074.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,175.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19,896.00
|
| Rate for Payer: Multiplan Commercial |
$27,526.50
|
| Rate for Payer: Multiplan WC |
$22,958.69
|
| Rate for Payer: TriValley Medical Group Commercial |
$16,332.54
|
| Rate for Payer: TriValley Medical Group Senior |
$16,332.54
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,861.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,025.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16,332.54
|
| Rate for Payer: Vantage Medical Group Senior |
$14,847.76
|
|
|
HC ATHRECTOMY BRACHIOCEPHALIC
|
Facility
|
IP
|
$36,702.00
|
|
|
Service Code
|
CPT 0237T
|
| Hospital Charge Code |
909020079
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,643.06 |
| Max. Negotiated Rate |
$27,526.50 |
| Rate for Payer: Adventist Health Commercial |
$7,340.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$23,636.09
|
| Rate for Payer: Cash Price |
$16,515.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$24,847.25
|
| Rate for Payer: Heritage Provider Network Senior |
$24,847.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6,643.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,175.50
|
| Rate for Payer: Multiplan Commercial |
$27,526.50
|
|
|
HC ATHRECTOMY FEM/POP
|
Facility
|
OP
|
$22,453.00
|
|
|
Service Code
|
CPT 37225
|
| Hospital Charge Code |
909020066
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,063.99 |
| Max. Negotiated Rate |
$36,352.92 |
| Rate for Payer: Adventist Health Commercial |
$4,490.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13,875.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19,085.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12,349.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16,839.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,435.00
|
| 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 |
$10,103.85
|
| Rate for Payer: Cash Price |
$10,103.85
|
| Rate for Payer: Cash Price |
$10,103.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14,594.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19,085.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$19,085.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19,085.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$13,898.41
|
| Rate for Payer: Heritage Provider Network Senior |
$13,898.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$10,710.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,063.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,613.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15,717.10
|
| Rate for Payer: Multiplan Commercial |
$16,839.75
|
| Rate for Payer: Multiplan WC |
$36,352.92
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,861.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,025.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19,085.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19,085.05
|
| Rate for Payer: Vantage Medical Group Senior |
$19,085.05
|
|
|
HC ATHRECTOMY FEM/POP
|
Facility
|
IP
|
$22,453.00
|
|
|
Service Code
|
CPT 37225
|
| Hospital Charge Code |
909020066
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,063.99 |
| Max. Negotiated Rate |
$16,839.75 |
| Rate for Payer: Adventist Health Commercial |
$4,490.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14,459.73
|
| Rate for Payer: Cash Price |
$10,103.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$15,200.68
|
| Rate for Payer: Heritage Provider Network Senior |
$15,200.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,063.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,613.25
|
| Rate for Payer: Multiplan Commercial |
$16,839.75
|
|
|
HC ATHRECTOMY ILIAC
|
Facility
|
OP
|
$29,550.00
|
|
|
Service Code
|
CPT 0238T
|
| Hospital Charge Code |
909020081
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,348.55 |
| Max. Negotiated Rate |
$44,797.35 |
| Rate for Payer: Adventist Health Commercial |
$5,910.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18,261.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,935.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23,577.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,435.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,829.24
|
| Rate for Payer: Blue Shield of California EPN |
$8,674.01
|
| Rate for Payer: Cash Price |
$13,297.50
|
| Rate for Payer: Cash Price |
$13,297.50
|
| Rate for Payer: Cash Price |
$13,297.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$19,207.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,935.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23,577.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$17,730.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$23,577.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$18,291.45
|
| Rate for Payer: Heritage Provider Network Senior |
$29,000.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23,577.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$44,797.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5,348.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27,114.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,387.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$31,593.92
|
| Rate for Payer: Multiplan Commercial |
$22,162.50
|
| Rate for Payer: Multiplan WC |
$36,352.92
|
| Rate for Payer: TriValley Medical Group Commercial |
$25,935.31
|
| Rate for Payer: TriValley Medical Group Senior |
$25,935.31
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,861.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,025.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,935.31
|
| Rate for Payer: Vantage Medical Group Senior |
$23,577.55
|
|
|
HC ATHRECTOMY ILIAC
|
Facility
|
IP
|
$29,550.00
|
|
|
Service Code
|
CPT 0238T
|
| Hospital Charge Code |
909020081
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,348.55 |
| Max. Negotiated Rate |
$22,162.50 |
| Rate for Payer: Adventist Health Commercial |
$5,910.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19,030.20
|
| Rate for Payer: Cash Price |
$13,297.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$20,005.35
|
| Rate for Payer: Heritage Provider Network Senior |
$20,005.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5,348.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,387.50
|
| Rate for Payer: Multiplan Commercial |
$22,162.50
|
|
