|
HC TRANSCATH PLCMT INT STNT OPEN PERC INIT ART
|
Facility
|
OP
|
$29,803.00
|
|
|
Service Code
|
CPT 37236
|
| Hospital Charge Code |
906811478
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$659.23 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$5,960.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,409.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,712.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$3,490.94
|
| Rate for Payer: Cash Price |
$13,411.35
|
| Rate for Payer: Cash Price |
$13,411.35
|
| Rate for Payer: Cash Price |
$13,411.35
|
| Rate for Payer: Cigna of CA HMO |
$19,073.92
|
| Rate for Payer: Cigna of CA PPO |
$22,054.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,850.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,409.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,452.60
|
| Rate for Payer: EPIC Health Plan Senior |
$14,409.33
|
| Rate for Payer: Galaxy Health WC |
$25,332.55
|
| Rate for Payer: Global Benefits Group Commercial |
$17,881.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$23,631.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$659.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,409.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19,878.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$745.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,409.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,152.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,155.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,308.50
|
| Rate for Payer: Multiplan Commercial |
$23,842.40
|
| Rate for Payer: Multiplan WC |
$22,958.69
|
| Rate for Payer: Networks By Design Commercial |
$19,371.95
|
| Rate for Payer: Prime Health Services Commercial |
$25,332.55
|
| Rate for Payer: Prime Health Services WC |
$22,724.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17,881.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$31,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$14,409.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Vantage Medical Group Senior |
$14,409.33
|
|
|
HC TRANSCATH PLCMT INT STNT OPEN PERC INIT ART
|
Facility
|
IP
|
$29,803.00
|
|
|
Service Code
|
CPT 37236
|
| Hospital Charge Code |
906811478
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,960.60 |
| Max. Negotiated Rate |
$25,332.55 |
| Rate for Payer: Adventist Health Commercial |
$5,960.60
|
| Rate for Payer: Cash Price |
$13,411.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,921.20
|
| Rate for Payer: EPIC Health Plan Senior |
$11,921.20
|
| Rate for Payer: Galaxy Health WC |
$25,332.55
|
| Rate for Payer: Global Benefits Group Commercial |
$17,881.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19,878.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,354.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18,448.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,152.72
|
| Rate for Payer: Multiplan Commercial |
$23,842.40
|
| Rate for Payer: Networks By Design Commercial |
$19,371.95
|
| Rate for Payer: Prime Health Services Commercial |
$25,332.55
|
|
|
HC TRANSCATH PLCMT INT STNT OPEN PERC INIT VEIN
|
Facility
|
OP
|
$26,965.00
|
|
|
Service Code
|
CPT 37238
|
| Hospital Charge Code |
906811480
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$462.22 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$5,393.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,409.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,712.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$3,490.94
|
| Rate for Payer: Cash Price |
$12,134.25
|
| Rate for Payer: Cash Price |
$12,134.25
|
| Rate for Payer: Cash Price |
$12,134.25
|
| Rate for Payer: Cigna of CA HMO |
$17,257.60
|
| Rate for Payer: Cigna of CA PPO |
$19,954.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,850.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,409.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,452.60
|
| Rate for Payer: EPIC Health Plan Senior |
$14,409.33
|
| Rate for Payer: Galaxy Health WC |
$22,920.25
|
| Rate for Payer: Global Benefits Group Commercial |
$16,179.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$23,631.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$462.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,409.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17,985.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$522.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,409.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,471.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,155.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,308.50
|
| Rate for Payer: Multiplan Commercial |
$21,572.00
|
| Rate for Payer: Multiplan WC |
$22,958.69
|
| Rate for Payer: Networks By Design Commercial |
$17,527.25
|
| Rate for Payer: Prime Health Services Commercial |
$22,920.25
|
| Rate for Payer: Prime Health Services WC |
$22,724.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16,179.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$31,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$14,409.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Vantage Medical Group Senior |
$14,409.33
|
|
|
HC TRANSCATH PLCMT INT STNT OPEN PERC INIT VEIN
|
Facility
|
IP
|
$26,965.00
|
|
|
Service Code
|
CPT 37238
|
| Hospital Charge Code |
906811480
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,393.00 |
| Max. Negotiated Rate |
$22,920.25 |
| Rate for Payer: Adventist Health Commercial |
$5,393.00
|
| Rate for Payer: Cash Price |
$12,134.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,786.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10,786.00
|
| Rate for Payer: Galaxy Health WC |
$22,920.25
|
| Rate for Payer: Global Benefits Group Commercial |
$16,179.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17,985.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,273.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,691.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,471.60
|
| Rate for Payer: Multiplan Commercial |
$21,572.00
|
| Rate for Payer: Networks By Design Commercial |
$17,527.25
|
| Rate for Payer: Prime Health Services Commercial |
$22,920.25
|
|
|
HC TRANSCATH PULM VALVE IMPLANT
|
Facility
|
IP
|
$74,249.00
|
|
|
Service Code
|
CPT 33477
|
| Hospital Charge Code |
906820256
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$14,849.80 |
| Max. Negotiated Rate |
$63,111.65 |
| Rate for Payer: Adventist Health Commercial |
$14,849.80
|
| Rate for Payer: Cash Price |
$33,412.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$29,699.60
|
| Rate for Payer: EPIC Health Plan Senior |
$29,699.60
|
| Rate for Payer: Galaxy Health WC |
$63,111.65
|
| Rate for Payer: Global Benefits Group Commercial |
$44,549.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$49,524.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28,288.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$45,960.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17,819.76
|
| Rate for Payer: Multiplan Commercial |
$59,399.20
|
| Rate for Payer: Networks By Design Commercial |
$48,261.85
|
| Rate for Payer: Prime Health Services Commercial |
$63,111.65
|
|
|
HC TRANSCATH PULM VALVE IMPLANT
|
Facility
|
IP
|
$76,398.00
|
|
|
Service Code
|
CPT 33477
|
| Hospital Charge Code |
906811427
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$15,279.60 |
| Max. Negotiated Rate |
$64,938.30 |
| Rate for Payer: Adventist Health Commercial |
$15,279.60
|
| Rate for Payer: Cash Price |
$34,379.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$30,559.20
|
| Rate for Payer: EPIC Health Plan Senior |
$30,559.20
|
| Rate for Payer: Galaxy Health WC |
$64,938.30
|
| Rate for Payer: Global Benefits Group Commercial |
$45,838.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50,957.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29,107.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$47,290.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18,335.52
|
| Rate for Payer: Multiplan Commercial |
$61,118.40
|
| Rate for Payer: Networks By Design Commercial |
$49,658.70
|
| Rate for Payer: Prime Health Services Commercial |
$64,938.30
|
|
|
HC TRANSCATH PULM VALVE IMPLANT
|
Facility
|
OP
|
$76,398.00
|
|
|
Service Code
|
CPT 33477
|
| Hospital Charge Code |
906811427
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$570.02 |
| Max. Negotiated Rate |
$64,938.30 |
| Rate for Payer: Adventist Health Commercial |
$15,279.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64,938.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$42,018.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$57,298.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,561.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$570.02
|
| Rate for Payer: Cash Price |
$34,379.10
|
| Rate for Payer: Cash Price |
$34,379.10
|
| Rate for Payer: Cash Price |
$34,379.10
|
| Rate for Payer: Cigna of CA HMO |
$48,894.72
|
| Rate for Payer: Cigna of CA PPO |
$56,534.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64,938.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$64,938.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$64,938.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$30,559.20
|
| Rate for Payer: EPIC Health Plan Senior |
$30,559.20
|
| Rate for Payer: Galaxy Health WC |
$64,938.30
|
| Rate for Payer: Global Benefits Group Commercial |
$45,838.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,875.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50,957.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,120.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$47,290.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18,335.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$53,478.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$53,478.60
|
| Rate for Payer: Multiplan Commercial |
$61,118.40
|
| Rate for Payer: Networks By Design Commercial |
$49,658.70
|
| Rate for Payer: Prime Health Services Commercial |
$64,938.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$45,838.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64,938.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$64,938.30
|
| Rate for Payer: Vantage Medical Group Senior |
$64,938.30
|
|
|
HC TRANSCATH PULM VALVE IMPLANT
|
Facility
|
OP
|
$74,249.00
|
|
|
Service Code
|
CPT 33477
|
| Hospital Charge Code |
906820256
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$570.02 |
| Max. Negotiated Rate |
$63,111.65 |
| Rate for Payer: Adventist Health Commercial |
$14,849.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$63,111.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$40,836.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$55,686.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,561.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$570.02
|
| Rate for Payer: Cash Price |
$33,412.05
|
| Rate for Payer: Cash Price |
$33,412.05
|
| Rate for Payer: Cash Price |
$33,412.05
|
| Rate for Payer: Cigna of CA HMO |
$47,519.36
|
| Rate for Payer: Cigna of CA PPO |
$54,944.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$63,111.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$63,111.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$63,111.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$29,699.60
|
| Rate for Payer: EPIC Health Plan Senior |
$29,699.60
|
| Rate for Payer: Galaxy Health WC |
$63,111.65
|
| Rate for Payer: Global Benefits Group Commercial |
$44,549.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,875.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$49,524.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,120.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$45,960.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17,819.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$51,974.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$51,974.30
|
| Rate for Payer: Multiplan Commercial |
$59,399.20
|
| Rate for Payer: Networks By Design Commercial |
$48,261.85
|
| Rate for Payer: Prime Health Services Commercial |
$63,111.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$44,549.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$63,111.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$63,111.65
|
| Rate for Payer: Vantage Medical Group Senior |
$63,111.65
|
|
|
HC TRANSCATH RENAL DENERVATION
|
Facility
|
IP
|
$12,056.00
|
|
|
Service Code
|
CPT 0338T
|
| Hospital Charge Code |
906811473
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,411.20 |
| Max. Negotiated Rate |
$10,247.60 |
| Rate for Payer: Adventist Health Commercial |
$2,411.20
|
| Rate for Payer: Cash Price |
$5,425.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,822.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,822.40
|
| Rate for Payer: Galaxy Health WC |
$10,247.60
|
| Rate for Payer: Global Benefits Group Commercial |
$7,233.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,041.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,593.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,462.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,893.44
|
| Rate for Payer: Multiplan Commercial |
$9,644.80
|
| Rate for Payer: Networks By Design Commercial |
$7,836.40
|
| Rate for Payer: Prime Health Services Commercial |
$10,247.60
|
|
|
HC TRANSCATH RENAL DENERVATION
|
Facility
|
OP
|
$12,056.00
|
|
|
Service Code
|
CPT 0338T
|
| Hospital Charge Code |
906811473
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,411.20 |
| Max. Negotiated Rate |
$11,880.73 |
| Rate for Payer: Adventist Health Commercial |
$2,411.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,370.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,968.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,244.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,378.27
|
| Rate for Payer: Blue Shield of California EPN |
$4,870.62
|
| Rate for Payer: Cash Price |
$5,425.20
|
| Rate for Payer: Cash Price |
$5,425.20
|
| Rate for Payer: Cash Price |
$5,425.20
|
| Rate for Payer: Cigna of CA HMO |
$7,715.84
|
| Rate for Payer: Cigna of CA PPO |
$8,921.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,968.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,244.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,779.87
|
| Rate for Payer: EPIC Health Plan Senior |
$7,244.35
|
| Rate for Payer: Galaxy Health WC |
$10,247.60
|
| Rate for Payer: Global Benefits Group Commercial |
$7,233.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,880.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,244.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,041.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,593.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,244.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,893.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,127.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,707.43
|
| Rate for Payer: Multiplan Commercial |
$9,644.80
|
| Rate for Payer: Networks By Design Commercial |
$7,836.40
|
| Rate for Payer: Prime Health Services Commercial |
$10,247.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,233.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,233.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,028.00
|
| Rate for Payer: United Healthcare All Other HMO |
$6,028.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6,028.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,028.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,244.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,968.78
|
| Rate for Payer: Vantage Medical Group Senior |
$7,244.35
|
|
|
HC TRANSCATH RENAL DENERVATION BILATERAL
|
Facility
|
OP
|
$18,085.00
|
|
|
Service Code
|
CPT 0339T
|
| Hospital Charge Code |
906811474
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$3,617.00 |
| Max. Negotiated Rate |
$15,372.25 |
| Rate for Payer: EPIC Health Plan Commercial |
$9,779.87
|
| Rate for Payer: EPIC Health Plan Senior |
$7,244.35
|
| Rate for Payer: Adventist Health Commercial |
$3,617.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,370.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,968.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,244.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,068.02
|
| Rate for Payer: Blue Shield of California EPN |
$7,306.34
|
| Rate for Payer: Cash Price |
$8,138.25
|
| Rate for Payer: Cash Price |
$8,138.25
|
| Rate for Payer: Cash Price |
$8,138.25
|
| Rate for Payer: Cigna of CA HMO |
$11,574.40
|
| Rate for Payer: Cigna of CA PPO |
$13,382.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,968.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,244.35
|
| Rate for Payer: Galaxy Health WC |
$15,372.25
|
| Rate for Payer: Global Benefits Group Commercial |
$10,851.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,880.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,244.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,062.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,890.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,244.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,340.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,127.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,707.43
|
| Rate for Payer: Multiplan Commercial |
$14,468.00
|
| Rate for Payer: Networks By Design Commercial |
$11,755.25
|
| Rate for Payer: Prime Health Services Commercial |
$15,372.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,851.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10,851.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,042.50
|
| Rate for Payer: United Healthcare All Other HMO |
$9,042.50
|
| Rate for Payer: United Healthcare HMO Rider |
$9,042.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,042.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,244.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,968.78
|
| Rate for Payer: Vantage Medical Group Senior |
$7,244.35
|
|
|
HC TRANSCATH RENAL DENERVATION BILATERAL
|
Facility
|
IP
|
$18,085.00
|
|
|
Service Code
|
CPT 0339T
|
| Hospital Charge Code |
906811474
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$3,617.00 |
| Max. Negotiated Rate |
$15,372.25 |
| Rate for Payer: Adventist Health Commercial |
$3,617.00
|
| Rate for Payer: Cash Price |
$8,138.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,234.00
|
| Rate for Payer: EPIC Health Plan Senior |
$7,234.00
|
| Rate for Payer: Galaxy Health WC |
$15,372.25
|
| Rate for Payer: Global Benefits Group Commercial |
$10,851.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,062.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,890.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,194.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,340.40
|
| Rate for Payer: Multiplan Commercial |
$14,468.00
|
| Rate for Payer: Networks By Design Commercial |
$11,755.25
|
| Rate for Payer: Prime Health Services Commercial |
$15,372.25
|
|
|
HC TRANSCATH RMVL DC LEADLESS PMKR RA PM COMPNT
|
Facility
|
OP
|
$7,149.00
|
|
|
Service Code
|
CPT 0799T
|
| Hospital Charge Code |
906819781
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$570.02 |
| Max. Negotiated Rate |
$12,491.00 |
| Rate for Payer: Adventist Health Commercial |
$1,429.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,390.20
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$570.02
|
| Rate for Payer: Cash Price |
$3,217.05
|
| Rate for Payer: Cash Price |
$3,217.05
|
| Rate for Payer: Cash Price |
$3,217.05
|
| Rate for Payer: Cigna of CA HMO |
$4,575.36
|
| Rate for Payer: Cigna of CA PPO |
$5,290.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,398.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3,999.21
|
| Rate for Payer: Galaxy Health WC |
$6,076.65
|
| Rate for Payer: Global Benefits Group Commercial |
$4,289.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,768.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,723.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,715.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,039.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,358.94
|
| Rate for Payer: Multiplan Commercial |
$5,719.20
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: Networks By Design Commercial |
$4,646.85
|
| Rate for Payer: Prime Health Services Commercial |
$6,076.65
|
| Rate for Payer: Prime Health Services WC |
$6,307.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,289.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,574.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,574.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,574.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,574.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,999.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC TRANSCATH RMVL DC LEADLESS PMKR RA PM COMPNT
|
Facility
|
IP
|
$7,149.00
|
|
|
Service Code
|
CPT 0799T
|
| Hospital Charge Code |
906819781
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,429.80 |
| Max. Negotiated Rate |
$6,076.65 |
| Rate for Payer: Adventist Health Commercial |
$1,429.80
|
| Rate for Payer: Cash Price |
$3,217.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,859.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,859.60
|
| Rate for Payer: Galaxy Health WC |
$6,076.65
|
| Rate for Payer: Global Benefits Group Commercial |
$4,289.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,768.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,723.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,425.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,715.76
|
| Rate for Payer: Multiplan Commercial |
$5,719.20
|
| Rate for Payer: Networks By Design Commercial |
$4,646.85
|
| Rate for Payer: Prime Health Services Commercial |
$6,076.65
|
|
|
HC TRANSCATH RMVL DC LEADLESS PMKR RA RV COMP SYS
|
Facility
|
OP
|
$7,149.00
|
|
|
Service Code
|
CPT 0798T
|
| Hospital Charge Code |
906819780
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$570.02 |
| Max. Negotiated Rate |
$13,086.00 |
| Rate for Payer: Adventist Health Commercial |
$1,429.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13,086.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,390.20
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$570.02
|
| Rate for Payer: Cash Price |
$3,217.05
|
| Rate for Payer: Cash Price |
$3,217.05
|
| Rate for Payer: Cash Price |
$3,217.05
|
| Rate for Payer: Cigna of CA HMO |
$4,575.36
|
| Rate for Payer: Cigna of CA PPO |
$5,290.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,398.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3,999.21
|
| Rate for Payer: Galaxy Health WC |
$6,076.65
|
| Rate for Payer: Global Benefits Group Commercial |
$4,289.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,768.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,723.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,715.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,039.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,358.94
|
| Rate for Payer: Multiplan Commercial |
$5,719.20
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: Networks By Design Commercial |
$4,646.85
|
| Rate for Payer: Prime Health Services Commercial |
$6,076.65
|
| Rate for Payer: Prime Health Services WC |
$6,307.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,289.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,574.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,574.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,574.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,574.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,999.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC TRANSCATH RMVL DC LEADLESS PMKR RA RV COMP SYS
|
Facility
|
IP
|
$7,149.00
|
|
|
Service Code
|
CPT 0798T
|
| Hospital Charge Code |
906819780
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,429.80 |
| Max. Negotiated Rate |
$6,076.65 |
| Rate for Payer: Adventist Health Commercial |
$1,429.80
|
| Rate for Payer: Cash Price |
$3,217.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,859.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,859.60
|
| Rate for Payer: Galaxy Health WC |
$6,076.65
|
| Rate for Payer: Global Benefits Group Commercial |
$4,289.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,768.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,723.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,425.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,715.76
|
| Rate for Payer: Multiplan Commercial |
$5,719.20
|
| Rate for Payer: Networks By Design Commercial |
$4,646.85
|
| Rate for Payer: Prime Health Services Commercial |
$6,076.65
|
|
|
HC TRANSCATH RMVL DC LEADLESS PMKR RA RV PM COMPNT
|
Facility
|
OP
|
$7,149.00
|
|
|
Service Code
|
CPT 0800T
|
| Hospital Charge Code |
906819782
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$570.02 |
| Max. Negotiated Rate |
$12,491.00 |
| Rate for Payer: Adventist Health Commercial |
$1,429.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,390.20
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$570.02
|
| Rate for Payer: Cash Price |
$3,217.05
|
| Rate for Payer: Cash Price |
$3,217.05
|
| Rate for Payer: Cash Price |
$3,217.05
|
| Rate for Payer: Cigna of CA HMO |
$4,575.36
|
| Rate for Payer: Cigna of CA PPO |
$5,290.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,398.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3,999.21
|
| Rate for Payer: Galaxy Health WC |
$6,076.65
|
| Rate for Payer: Global Benefits Group Commercial |
$4,289.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,768.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,723.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,715.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,039.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,358.94
|
| Rate for Payer: Multiplan Commercial |
$5,719.20
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: Networks By Design Commercial |
$4,646.85
|
| Rate for Payer: Prime Health Services Commercial |
$6,076.65
|
| Rate for Payer: Prime Health Services WC |
$6,307.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,289.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,574.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,574.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,574.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,574.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,999.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC TRANSCATH RMVL DC LEADLESS PMKR RA RV PM COMPNT
|
Facility
|
IP
|
$7,149.00
|
|
|
Service Code
|
CPT 0800T
|
| Hospital Charge Code |
906819782
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,429.80 |
| Max. Negotiated Rate |
$6,076.65 |
| Rate for Payer: Adventist Health Commercial |
$1,429.80
|
| Rate for Payer: Cash Price |
$3,217.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,859.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,859.60
|
| Rate for Payer: Galaxy Health WC |
$6,076.65
|
| Rate for Payer: Global Benefits Group Commercial |
$4,289.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,768.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,723.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,425.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,715.76
|
| Rate for Payer: Multiplan Commercial |
$5,719.20
|
| Rate for Payer: Networks By Design Commercial |
$4,646.85
|
| Rate for Payer: Prime Health Services Commercial |
$6,076.65
|
|
|
HC TRANSCATH RMVL REPL DC LEADLESS PMKR RA PM COMPNT
|
Facility
|
IP
|
$43,704.00
|
|
|
Service Code
|
CPT 0802T
|
| Hospital Charge Code |
906819784
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$8,740.80 |
| Max. Negotiated Rate |
$37,148.40 |
| Rate for Payer: Adventist Health Commercial |
$8,740.80
|
| Rate for Payer: Cash Price |
$19,666.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$17,481.60
|
| Rate for Payer: EPIC Health Plan Senior |
$17,481.60
|
| Rate for Payer: Galaxy Health WC |
$37,148.40
|
| Rate for Payer: Global Benefits Group Commercial |
$26,222.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29,150.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16,651.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27,052.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10,488.96
|
| Rate for Payer: Multiplan Commercial |
$34,963.20
|
| Rate for Payer: Networks By Design Commercial |
$28,407.60
|
| Rate for Payer: Prime Health Services Commercial |
$37,148.40
|
|
|
HC TRANSCATH RMVL REPL DC LEADLESS PMKR RA PM COMPNT
|
Facility
|
OP
|
$43,704.00
|
|
|
Service Code
|
CPT 0802T
|
| Hospital Charge Code |
906819784
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$570.02 |
| Max. Negotiated Rate |
$39,740.18 |
| Rate for Payer: Adventist Health Commercial |
$8,740.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13,086.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36,347.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26,655.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24,231.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26,838.63
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$570.02
|
| Rate for Payer: Cash Price |
$19,666.80
|
| Rate for Payer: Cash Price |
$19,666.80
|
| Rate for Payer: Cash Price |
$19,666.80
|
| Rate for Payer: Cigna of CA HMO |
$27,970.56
|
| Rate for Payer: Cigna of CA PPO |
$32,340.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36,347.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$26,655.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24,231.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$32,712.96
|
| Rate for Payer: EPIC Health Plan Senior |
$24,231.82
|
| Rate for Payer: Galaxy Health WC |
$37,148.40
|
| Rate for Payer: Global Benefits Group Commercial |
$26,222.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$39,740.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24,231.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29,150.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16,651.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24,231.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10,488.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30,532.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32,470.64
|
| Rate for Payer: Multiplan Commercial |
$34,963.20
|
| Rate for Payer: Multiplan WC |
$38,609.08
|
| Rate for Payer: Networks By Design Commercial |
$28,407.60
|
| Rate for Payer: Prime Health Services Commercial |
$37,148.40
|
| Rate for Payer: Prime Health Services WC |
$38,215.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26,222.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$21,852.00
|
| Rate for Payer: United Healthcare All Other HMO |
$21,852.00
|
| Rate for Payer: United Healthcare HMO Rider |
$21,852.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21,852.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$24,231.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36,347.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26,655.00
|
| Rate for Payer: Vantage Medical Group Senior |
$24,231.82
|
|
|
HC TRANSCATH RMVL REPL DC LEADLESS PMKR RA RV
|
Facility
|
OP
|
$43,704.00
|
|
|
Service Code
|
CPT 0801T
|
| Hospital Charge Code |
906819783
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$570.02 |
| Max. Negotiated Rate |
$39,740.18 |
| Rate for Payer: Adventist Health Commercial |
$8,740.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,370.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36,347.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26,655.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24,231.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26,838.63
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$570.02
|
| Rate for Payer: Cash Price |
$19,666.80
|
| Rate for Payer: Cash Price |
$19,666.80
|
| Rate for Payer: Cash Price |
$19,666.80
|
| Rate for Payer: Cigna of CA HMO |
$27,970.56
|
| Rate for Payer: Cigna of CA PPO |
$32,340.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36,347.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$26,655.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24,231.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$32,712.96
|
| Rate for Payer: EPIC Health Plan Senior |
$24,231.82
|
| Rate for Payer: Galaxy Health WC |
$37,148.40
|
| Rate for Payer: Global Benefits Group Commercial |
$26,222.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$39,740.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24,231.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29,150.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16,651.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24,231.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10,488.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30,532.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32,470.64
|
| Rate for Payer: Multiplan Commercial |
$34,963.20
|
| Rate for Payer: Multiplan WC |
$38,609.08
|
| Rate for Payer: Networks By Design Commercial |
$28,407.60
|
| Rate for Payer: Prime Health Services Commercial |
$37,148.40
|
| Rate for Payer: Prime Health Services WC |
$38,215.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26,222.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$21,852.00
|
| Rate for Payer: United Healthcare All Other HMO |
$21,852.00
|
| Rate for Payer: United Healthcare HMO Rider |
$21,852.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21,852.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$24,231.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36,347.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26,655.00
|
| Rate for Payer: Vantage Medical Group Senior |
$24,231.82
|
|
|
HC TRANSCATH RMVL REPL DC LEADLESS PMKR RA RV
|
Facility
|
IP
|
$43,704.00
|
|
|
Service Code
|
CPT 0801T
|
| Hospital Charge Code |
906819783
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$8,740.80 |
| Max. Negotiated Rate |
$37,148.40 |
| Rate for Payer: Adventist Health Commercial |
$8,740.80
|
| Rate for Payer: Cash Price |
$19,666.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$17,481.60
|
| Rate for Payer: EPIC Health Plan Senior |
$17,481.60
|
| Rate for Payer: Galaxy Health WC |
$37,148.40
|
| Rate for Payer: Global Benefits Group Commercial |
$26,222.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29,150.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16,651.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27,052.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10,488.96
|
| Rate for Payer: Multiplan Commercial |
$34,963.20
|
| Rate for Payer: Networks By Design Commercial |
$28,407.60
|
| Rate for Payer: Prime Health Services Commercial |
$37,148.40
|
|
|
HC TRANSCATH RMVL REPL DC LEADLESS PMKR RV PM COMPNT
|
Facility
|
OP
|
$43,704.00
|
|
|
Service Code
|
CPT 0803T
|
| Hospital Charge Code |
906819785
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$570.02 |
| Max. Negotiated Rate |
$39,740.18 |
| Rate for Payer: Adventist Health Commercial |
$8,740.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13,086.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36,347.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26,655.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24,231.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26,838.63
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$570.02
|
| Rate for Payer: Cash Price |
$19,666.80
|
| Rate for Payer: Cash Price |
$19,666.80
|
| Rate for Payer: Cash Price |
$19,666.80
|
| Rate for Payer: Cigna of CA HMO |
$27,970.56
|
| Rate for Payer: Cigna of CA PPO |
$32,340.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36,347.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$26,655.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24,231.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$32,712.96
|
| Rate for Payer: EPIC Health Plan Senior |
$24,231.82
|
| Rate for Payer: Galaxy Health WC |
$37,148.40
|
| Rate for Payer: Global Benefits Group Commercial |
$26,222.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$39,740.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24,231.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29,150.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16,651.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24,231.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10,488.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30,532.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32,470.64
|
| Rate for Payer: Multiplan Commercial |
$34,963.20
|
| Rate for Payer: Multiplan WC |
$38,609.08
|
| Rate for Payer: Networks By Design Commercial |
$28,407.60
|
| Rate for Payer: Prime Health Services Commercial |
$37,148.40
|
| Rate for Payer: Prime Health Services WC |
$38,215.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26,222.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$21,852.00
|
| Rate for Payer: United Healthcare All Other HMO |
$21,852.00
|
| Rate for Payer: United Healthcare HMO Rider |
$21,852.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21,852.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$24,231.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36,347.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26,655.00
|
| Rate for Payer: Vantage Medical Group Senior |
$24,231.82
|
|
|
HC TRANSCATH RMVL REPL DC LEADLESS PMKR RV PM COMPNT
|
Facility
|
IP
|
$43,704.00
|
|
|
Service Code
|
CPT 0803T
|
| Hospital Charge Code |
906819785
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$8,740.80 |
| Max. Negotiated Rate |
$37,148.40 |
| Rate for Payer: Adventist Health Commercial |
$8,740.80
|
| Rate for Payer: Cash Price |
$19,666.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$17,481.60
|
| Rate for Payer: EPIC Health Plan Senior |
$17,481.60
|
| Rate for Payer: Galaxy Health WC |
$37,148.40
|
| Rate for Payer: Global Benefits Group Commercial |
$26,222.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29,150.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16,651.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27,052.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10,488.96
|
| Rate for Payer: Multiplan Commercial |
$34,963.20
|
| Rate for Payer: Networks By Design Commercial |
$28,407.60
|
| Rate for Payer: Prime Health Services Commercial |
$37,148.40
|
|
|
HC TRANSCATH RMVL REPL SC LEADLESS PMKR RA
|
Facility
|
OP
|
$43,704.00
|
|
|
Service Code
|
CPT 0825T
|
| Hospital Charge Code |
906819775
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$570.02 |
| Max. Negotiated Rate |
$39,740.18 |
| Rate for Payer: Adventist Health Commercial |
$8,740.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13,494.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36,347.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26,655.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24,231.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26,838.63
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$570.02
|
| Rate for Payer: Cash Price |
$19,666.80
|
| Rate for Payer: Cash Price |
$19,666.80
|
| Rate for Payer: Cash Price |
$19,666.80
|
| Rate for Payer: Cigna of CA HMO |
$27,970.56
|
| Rate for Payer: Cigna of CA PPO |
$32,340.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36,347.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$26,655.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24,231.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$32,712.96
|
| Rate for Payer: EPIC Health Plan Senior |
$24,231.82
|
| Rate for Payer: Galaxy Health WC |
$37,148.40
|
| Rate for Payer: Global Benefits Group Commercial |
$26,222.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$39,740.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24,231.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29,150.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16,651.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24,231.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10,488.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30,532.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32,470.64
|
| Rate for Payer: Multiplan Commercial |
$34,963.20
|
| Rate for Payer: Multiplan WC |
$38,609.08
|
| Rate for Payer: Networks By Design Commercial |
$28,407.60
|
| Rate for Payer: Prime Health Services Commercial |
$37,148.40
|
| Rate for Payer: Prime Health Services WC |
$38,215.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26,222.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$21,852.00
|
| Rate for Payer: United Healthcare All Other HMO |
$21,852.00
|
| Rate for Payer: United Healthcare HMO Rider |
$21,852.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21,852.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$24,231.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36,347.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26,655.00
|
| Rate for Payer: Vantage Medical Group Senior |
$24,231.82
|
|
