|
HC TANGNTL BX SKIN SINGLE LESION
|
Facility
|
OP
|
$487.00
|
|
|
Service Code
|
CPT 11102
|
| Hospital Charge Code |
900511102
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$88.15 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$97.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$334.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$250.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,706.95
|
| Rate for Payer: Blue Shield of California EPN |
$4,045.41
|
| Rate for Payer: Cash Price |
$219.15
|
| Rate for Payer: Cash Price |
$219.15
|
| Rate for Payer: Cash Price |
$219.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$316.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$375.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$275.15
|
| Rate for Payer: Dignity Health Senior |
$250.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$250.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$301.45
|
| Rate for Payer: Heritage Provider Network Senior |
$307.67
|
| Rate for Payer: Humana Medicare |
$250.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$139.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$250.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$475.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$88.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$295.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$315.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$315.18
|
| Rate for Payer: Multiplan Commercial |
$365.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$275.15
|
| Rate for Payer: TriValley Medical Group Senior |
$275.15
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Vantage Medical Group Senior |
$250.14
|
|
|
HC TARSORRHAPHY
|
Facility
|
OP
|
$3,966.00
|
|
|
Service Code
|
CPT 67880
|
| Hospital Charge Code |
900501730
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$717.85 |
| Max. Negotiated Rate |
$5,505.00 |
| Rate for Payer: Adventist Health Commercial |
$793.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,724.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,379.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,211.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,919.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Cash Price |
$1,784.70
|
| Rate for Payer: Cash Price |
$1,784.70
|
| Rate for Payer: Cash Price |
$1,784.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,577.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,379.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,211.64
|
| Rate for Payer: Dignity Health Senior |
$2,919.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,577.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,919.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,684.98
|
| Rate for Payer: Heritage Provider Network Senior |
$2,684.98
|
| Rate for Payer: Humana Medicare |
$2,919.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,919.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,911.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$717.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,445.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$991.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,678.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,678.78
|
| Rate for Payer: Multiplan Commercial |
$2,974.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,440.05
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,325.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,379.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,211.64
|
| Rate for Payer: Vantage Medical Group Senior |
$2,919.67
|
|
|
HC TARSORRHAPHY
|
Facility
|
IP
|
$3,966.00
|
|
|
Service Code
|
CPT 67880
|
| Hospital Charge Code |
900501730
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$717.85 |
| Max. Negotiated Rate |
$2,974.50 |
| Rate for Payer: Adventist Health Commercial |
$793.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,724.64
|
| Rate for Payer: Cash Price |
$1,784.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,684.98
|
| Rate for Payer: Heritage Provider Network Senior |
$2,684.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$717.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$991.50
|
| Rate for Payer: Multiplan Commercial |
$2,974.50
|
|
|
HC TAVR W PROS VALVE CAROTID
|
Facility
|
IP
|
$26,797.00
|
|
|
Service Code
|
CPT 33999
|
| Hospital Charge Code |
906820334
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,850.26 |
| Max. Negotiated Rate |
$20,097.75 |
| Rate for Payer: Adventist Health Commercial |
$5,359.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18,409.54
|
| Rate for Payer: Cash Price |
$12,058.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$18,141.57
|
| Rate for Payer: Heritage Provider Network Senior |
$18,141.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,850.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,699.25
|
| Rate for Payer: Multiplan Commercial |
$20,097.75
|
|
|
HC TAVR W PROS VALVE CAROTID
|
Facility
|
OP
|
$26,797.00
|
|
|
Service Code
|
CPT 33999
|
| Hospital Charge Code |
906820334
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$784.90 |
| Max. Negotiated Rate |
$20,097.75 |
| Rate for Payer: Adventist Health Commercial |
$5,359.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18,409.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$784.90
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$12,058.65
|
| Rate for Payer: Cash Price |
$12,058.65
|
| Rate for Payer: Cash Price |
$12,058.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$17,418.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$863.39
|
| Rate for Payer: Dignity Health Senior |
$784.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$784.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$16,587.34
|
| Rate for Payer: Heritage Provider Network Senior |
$965.43
|
| Rate for Payer: Humana Medicare |
$784.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$784.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,491.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,850.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$926.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,699.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$988.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$988.97
|
| Rate for Payer: Multiplan Commercial |
$20,097.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$863.39
|
| Rate for Payer: TriValley Medical Group Senior |
$863.39
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,600.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,188.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: Vantage Medical Group Senior |
$784.90
|
|
|
HC TAVR W PROS VALVE CAROTID
|
Facility
|
IP
|
$62,290.00
|
|
|
Service Code
|
CPT 33999
|
| Hospital Charge Code |
906813416
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$11,274.49 |
| Max. Negotiated Rate |
$46,717.50 |
| Rate for Payer: Adventist Health Commercial |
$12,458.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$42,793.23
|
| Rate for Payer: Cash Price |
$28,030.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$42,170.33
|
| Rate for Payer: Heritage Provider Network Senior |
$42,170.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,274.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15,572.50
|
| Rate for Payer: Multiplan Commercial |
$46,717.50
|
|
|
HC TAVR W PROS VALVE CAROTID
|
Facility
|
OP
|
$62,290.00
|
|
|
Service Code
|
CPT 33999
|
| Hospital Charge Code |
906813416
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$784.90 |
| Max. Negotiated Rate |
$46,717.50 |
| Rate for Payer: Adventist Health Commercial |
$12,458.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$42,793.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$784.90
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$28,030.50
|
| Rate for Payer: Cash Price |
$28,030.50
|
| Rate for Payer: Cash Price |
$28,030.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$40,488.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$863.39
|
| Rate for Payer: Dignity Health Senior |
$784.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$784.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$38,557.51
|
| Rate for Payer: Heritage Provider Network Senior |
$965.43
|
| Rate for Payer: Humana Medicare |
$784.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$784.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,491.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,274.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$926.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15,572.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$988.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$988.97
|
| Rate for Payer: Multiplan Commercial |
$46,717.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$863.39
|
| Rate for Payer: TriValley Medical Group Senior |
$863.39
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,600.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,188.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: Vantage Medical Group Senior |
$784.90
|
|
|
HC TAVR W PROS VALVE OPN AXLRY
|
Facility
|
IP
|
$27,485.00
|
|
|
Service Code
|
CPT 33363
|
| Hospital Charge Code |
906820333
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,974.78 |
| Max. Negotiated Rate |
$20,613.75 |
| Rate for Payer: Adventist Health Commercial |
$5,497.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18,882.20
|
| Rate for Payer: Cash Price |
$12,368.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$18,607.34
|
| Rate for Payer: Heritage Provider Network Senior |
$18,607.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,974.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,871.25
|
| Rate for Payer: Multiplan Commercial |
$20,613.75
|
|
|
HC TAVR W PROS VALVE OPN AXLRY
|
Facility
|
IP
|
$63,249.00
|
|
|
Service Code
|
CPT 33363
|
| Hospital Charge Code |
906813410
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$11,448.07 |
| Max. Negotiated Rate |
$47,436.75 |
| Rate for Payer: Adventist Health Commercial |
$12,649.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$43,452.06
|
| Rate for Payer: Cash Price |
$28,462.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$42,819.57
|
| Rate for Payer: Heritage Provider Network Senior |
$42,819.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,448.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15,812.25
|
| Rate for Payer: Multiplan Commercial |
$47,436.75
|
|
|
HC TAVR W PROS VALVE OPN AXLRY
|
Facility
|
OP
|
$27,485.00
|
|
|
Service Code
|
CPT 33363
|
| Hospital Charge Code |
906820333
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$381.34 |
| Max. Negotiated Rate |
$23,362.25 |
| Rate for Payer: Adventist Health Commercial |
$5,497.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18,882.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23,362.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,116.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20,613.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,496.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,500.11
|
| Rate for Payer: Blue Shield of California EPN |
$9,024.37
|
| Rate for Payer: Cash Price |
$12,368.25
|
| Rate for Payer: Cash Price |
$12,368.25
|
| Rate for Payer: Cash Price |
$12,368.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$17,865.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23,362.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$23,362.25
|
| Rate for Payer: Dignity Health Senior |
$23,362.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$17,013.22
|
| Rate for Payer: Heritage Provider Network Senior |
$17,013.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$381.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13,247.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,974.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,871.25
|
| Rate for Payer: Multiplan Commercial |
$20,613.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23,362.25
|
| Rate for Payer: Vantage Medical Group Senior |
$23,362.25
|
|
|
HC TAVR W PROS VALVE OPN AXLRY
|
Facility
|
OP
|
$63,249.00
|
|
|
Service Code
|
CPT 33363
|
| Hospital Charge Code |
906813410
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$381.34 |
| Max. Negotiated Rate |
$53,761.65 |
| Rate for Payer: Adventist Health Commercial |
$12,649.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$43,452.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$53,761.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34,786.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$47,436.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,496.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,500.11
|
| Rate for Payer: Blue Shield of California EPN |
$9,024.37
|
| Rate for Payer: Cash Price |
$28,462.05
|
| Rate for Payer: Cash Price |
$28,462.05
|
| Rate for Payer: Cash Price |
$28,462.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$41,111.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$53,761.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$53,761.65
|
| Rate for Payer: Dignity Health Senior |
$53,761.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$39,151.13
|
| Rate for Payer: Heritage Provider Network Senior |
$39,151.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$381.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$30,486.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,448.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15,812.25
|
| Rate for Payer: Multiplan Commercial |
$47,436.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$53,761.65
|
| Rate for Payer: Vantage Medical Group Senior |
$53,761.65
|
|
|
HC TAVR W PROS VALVE OPN FMRL
|
Facility
|
IP
|
$26,531.00
|
|
|
Service Code
|
CPT 33362
|
| Hospital Charge Code |
906820332
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,802.11 |
| Max. Negotiated Rate |
$19,898.25 |
| Rate for Payer: Adventist Health Commercial |
$5,306.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18,226.80
|
| Rate for Payer: Cash Price |
$11,938.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$17,961.49
|
| Rate for Payer: Heritage Provider Network Senior |
$17,961.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,802.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,632.75
|
| Rate for Payer: Multiplan Commercial |
$19,898.25
|
|
|
HC TAVR W PROS VALVE OPN FMRL
|
Facility
|
OP
|
$26,531.00
|
|
|
Service Code
|
CPT 33362
|
| Hospital Charge Code |
906820332
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,841.10 |
| Max. Negotiated Rate |
$22,551.35 |
| Rate for Payer: Adventist Health Commercial |
$5,306.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18,226.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22,551.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14,592.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19,898.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,496.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,500.11
|
| Rate for Payer: Blue Shield of California EPN |
$9,024.37
|
| Rate for Payer: Cash Price |
$11,938.95
|
| Rate for Payer: Cash Price |
$11,938.95
|
| Rate for Payer: Cash Price |
$11,938.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$17,245.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22,551.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$22,551.35
|
| Rate for Payer: Dignity Health Senior |
$22,551.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$16,422.69
|
| Rate for Payer: Heritage Provider Network Senior |
$16,422.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,841.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12,787.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,802.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,632.75
|
| Rate for Payer: Multiplan Commercial |
$19,898.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22,551.35
|
| Rate for Payer: Vantage Medical Group Senior |
$22,551.35
|
|
|
HC TAVR W PROS VALVE OPN FMRL
|
Facility
|
OP
|
$61,428.00
|
|
|
Service Code
|
CPT 33362
|
| Hospital Charge Code |
906813409
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,841.10 |
| Max. Negotiated Rate |
$52,213.80 |
| Rate for Payer: Adventist Health Commercial |
$12,285.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$42,201.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52,213.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$33,785.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$46,071.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,496.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,500.11
|
| Rate for Payer: Blue Shield of California EPN |
$9,024.37
|
| Rate for Payer: Cash Price |
$27,642.60
|
| Rate for Payer: Cash Price |
$27,642.60
|
| Rate for Payer: Cash Price |
$27,642.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$39,928.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52,213.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$52,213.80
|
| Rate for Payer: Dignity Health Senior |
$52,213.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$38,023.93
|
| Rate for Payer: Heritage Provider Network Senior |
$38,023.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,841.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$29,608.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,118.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15,357.00
|
| Rate for Payer: Multiplan Commercial |
$46,071.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52,213.80
|
| Rate for Payer: Vantage Medical Group Senior |
$52,213.80
|
|
|
HC TAVR W PROS VALVE OPN FMRL
|
Facility
|
IP
|
$61,428.00
|
|
|
Service Code
|
CPT 33362
|
| Hospital Charge Code |
906813409
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$11,118.47 |
| Max. Negotiated Rate |
$46,071.00 |
| Rate for Payer: Adventist Health Commercial |
$12,285.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$42,201.04
|
| Rate for Payer: Cash Price |
$27,642.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$41,586.76
|
| Rate for Payer: Heritage Provider Network Senior |
$41,586.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,118.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15,357.00
|
| Rate for Payer: Multiplan Commercial |
$46,071.00
|
|
|
HC TAVR W PROS VALVE OPN ILIAC
|
Facility
|
OP
|
$63,684.00
|
|
|
Service Code
|
CPT 33364
|
| Hospital Charge Code |
906820339
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,031.60 |
| Max. Negotiated Rate |
$54,131.40 |
| Rate for Payer: Adventist Health Commercial |
$12,736.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$43,750.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$54,131.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$35,026.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$47,763.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,496.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,500.11
|
| Rate for Payer: Blue Shield of California EPN |
$9,024.37
|
| Rate for Payer: Cash Price |
$28,657.80
|
| Rate for Payer: Cash Price |
$28,657.80
|
| Rate for Payer: Cash Price |
$28,657.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$41,394.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$54,131.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$54,131.40
|
| Rate for Payer: Dignity Health Senior |
$54,131.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$39,420.40
|
| Rate for Payer: Heritage Provider Network Senior |
$39,420.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,031.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$30,695.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,526.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15,921.00
|
| Rate for Payer: Multiplan Commercial |
$47,763.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$54,131.40
|
| Rate for Payer: Vantage Medical Group Senior |
$54,131.40
|
|
|
HC TAVR W PROS VALVE OPN ILIAC
|
Facility
|
IP
|
$63,684.00
|
|
|
Service Code
|
CPT 33364
|
| Hospital Charge Code |
906813412
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$11,526.80 |
| Max. Negotiated Rate |
$47,763.00 |
| Rate for Payer: Adventist Health Commercial |
$12,736.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$43,750.91
|
| Rate for Payer: Cash Price |
$28,657.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$43,114.07
|
| Rate for Payer: Heritage Provider Network Senior |
$43,114.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,526.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15,921.00
|
| Rate for Payer: Multiplan Commercial |
$47,763.00
|
|
|
HC TAVR W PROS VALVE OPN ILIAC
|
Facility
|
OP
|
$63,684.00
|
|
|
Service Code
|
CPT 33364
|
| Hospital Charge Code |
906813412
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,031.60 |
| Max. Negotiated Rate |
$54,131.40 |
| Rate for Payer: Adventist Health Commercial |
$12,736.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$43,750.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$54,131.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$35,026.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$47,763.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,496.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,500.11
|
| Rate for Payer: Blue Shield of California EPN |
$9,024.37
|
| Rate for Payer: Cash Price |
$28,657.80
|
| Rate for Payer: Cash Price |
$28,657.80
|
| Rate for Payer: Cash Price |
$28,657.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$41,394.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$54,131.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$54,131.40
|
| Rate for Payer: Dignity Health Senior |
$54,131.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$39,420.40
|
| Rate for Payer: Heritage Provider Network Senior |
$39,420.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,031.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$30,695.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,526.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15,921.00
|
| Rate for Payer: Multiplan Commercial |
$47,763.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$54,131.40
|
| Rate for Payer: Vantage Medical Group Senior |
$54,131.40
|
|
|
HC TAVR W PROS VALVE OPN ILIAC
|
Facility
|
IP
|
$63,684.00
|
|
|
Service Code
|
CPT 33364
|
| Hospital Charge Code |
906820339
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$11,526.80 |
| Max. Negotiated Rate |
$47,763.00 |
| Rate for Payer: Adventist Health Commercial |
$12,736.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$43,750.91
|
| Rate for Payer: Cash Price |
$28,657.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$43,114.07
|
| Rate for Payer: Heritage Provider Network Senior |
$43,114.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,526.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15,921.00
|
| Rate for Payer: Multiplan Commercial |
$47,763.00
|
|
|
HC TAVR W PROS VALVE PERC FMRL
|
Facility
|
OP
|
$56,794.00
|
|
|
Service Code
|
CPT 33361
|
| Hospital Charge Code |
906813408
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$336.27 |
| Max. Negotiated Rate |
$48,274.90 |
| Rate for Payer: Adventist Health Commercial |
$11,358.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$39,017.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$48,274.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$31,236.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42,595.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,792.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$25,557.30
|
| Rate for Payer: Cash Price |
$25,557.30
|
| Rate for Payer: Cash Price |
$25,557.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$36,916.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$48,274.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$48,274.90
|
| Rate for Payer: Dignity Health Senior |
$48,274.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$35,155.49
|
| Rate for Payer: Heritage Provider Network Senior |
$35,155.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$336.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$27,374.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,279.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14,198.50
|
| Rate for Payer: Multiplan Commercial |
$42,595.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$48,274.90
|
| Rate for Payer: Vantage Medical Group Senior |
$48,274.90
|
|
|
HC TAVR W PROS VALVE PERC FMRL
|
Facility
|
IP
|
$56,794.00
|
|
|
Service Code
|
CPT 33361
|
| Hospital Charge Code |
906813408
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$10,279.71 |
| Max. Negotiated Rate |
$42,595.50 |
| Rate for Payer: Adventist Health Commercial |
$11,358.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$39,017.48
|
| Rate for Payer: Cash Price |
$25,557.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$38,449.54
|
| Rate for Payer: Heritage Provider Network Senior |
$38,449.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,279.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14,198.50
|
| Rate for Payer: Multiplan Commercial |
$42,595.50
|
|
|
HC TAVR W PROS VALVE PERC FMRL
|
Facility
|
OP
|
$24,229.00
|
|
|
Service Code
|
CPT 33361
|
| Hospital Charge Code |
906820331
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$336.27 |
| Max. Negotiated Rate |
$20,594.65 |
| Rate for Payer: Adventist Health Commercial |
$4,845.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16,645.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20,594.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13,325.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18,171.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,792.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$10,903.05
|
| Rate for Payer: Cash Price |
$10,903.05
|
| Rate for Payer: Cash Price |
$10,903.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15,748.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20,594.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$20,594.65
|
| Rate for Payer: Dignity Health Senior |
$20,594.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$14,997.75
|
| Rate for Payer: Heritage Provider Network Senior |
$14,997.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$336.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$11,678.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,385.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,057.25
|
| Rate for Payer: Multiplan Commercial |
$18,171.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20,594.65
|
| Rate for Payer: Vantage Medical Group Senior |
$20,594.65
|
|
|
HC TAVR W PROS VALVE PERC FMRL
|
Facility
|
IP
|
$24,229.00
|
|
|
Service Code
|
CPT 33361
|
| Hospital Charge Code |
906820331
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,385.45 |
| Max. Negotiated Rate |
$18,171.75 |
| Rate for Payer: Adventist Health Commercial |
$4,845.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16,645.32
|
| Rate for Payer: Cash Price |
$10,903.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$16,403.03
|
| Rate for Payer: Heritage Provider Network Senior |
$16,403.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,385.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,057.25
|
| Rate for Payer: Multiplan Commercial |
$18,171.75
|
|
|
HC TAVR W PROS VALVE TRNSAORTIC
|
Facility
|
IP
|
$67,098.00
|
|
|
Service Code
|
CPT 33365
|
| Hospital Charge Code |
906813413
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$12,144.74 |
| Max. Negotiated Rate |
$50,323.50 |
| Rate for Payer: Adventist Health Commercial |
$13,419.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$46,096.33
|
| Rate for Payer: Cash Price |
$30,194.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$45,425.35
|
| Rate for Payer: Heritage Provider Network Senior |
$45,425.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,144.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16,774.50
|
| Rate for Payer: Multiplan Commercial |
$50,323.50
|
|
|
HC TAVR W PROS VALVE TRNSAORTIC
|
Facility
|
OP
|
$67,098.00
|
|
|
Service Code
|
CPT 33365
|
| Hospital Charge Code |
906820340
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$442.56 |
| Max. Negotiated Rate |
$57,033.30 |
| Rate for Payer: Adventist Health Commercial |
$13,419.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$46,096.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$57,033.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$36,903.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$50,323.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,496.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,500.11
|
| Rate for Payer: Blue Shield of California EPN |
$9,024.37
|
| Rate for Payer: Cash Price |
$30,194.10
|
| Rate for Payer: Cash Price |
$30,194.10
|
| Rate for Payer: Cash Price |
$30,194.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$43,613.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$57,033.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$57,033.30
|
| Rate for Payer: Dignity Health Senior |
$57,033.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$41,533.66
|
| Rate for Payer: Heritage Provider Network Senior |
$41,533.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$442.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$32,341.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,144.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16,774.50
|
| Rate for Payer: Multiplan Commercial |
$50,323.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$57,033.30
|
| Rate for Payer: Vantage Medical Group Senior |
$57,033.30
|
|
