|
HC TRANSCATH RMVL REPL SC LEADLESS PMKR RA
|
Facility
|
OP
|
$53,470.00
|
|
|
Service Code
|
CPT 0825T
|
| Hospital Charge Code |
906819775
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,245.00 |
| Max. Negotiated Rate |
$46,256.43 |
| Rate for Payer: Adventist Health Commercial |
$10,694.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5,245.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$36,733.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36,518.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26,780.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24,345.49
|
| 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 |
$24,061.50
|
| Rate for Payer: Cash Price |
$24,061.50
|
| Rate for Payer: Cash Price |
$24,061.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$34,755.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36,518.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$26,780.04
|
| Rate for Payer: Dignity Health Senior |
$24,345.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$24,345.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$33,097.93
|
| Rate for Payer: Heritage Provider Network Senior |
$29,944.95
|
| Rate for Payer: Humana Medicare |
$24,345.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24,345.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$46,256.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,678.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28,727.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13,367.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30,675.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30,675.32
|
| Rate for Payer: Multiplan Commercial |
$40,102.50
|
| Rate for Payer: Multiplan WC |
$33,283.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$26,780.04
|
| Rate for Payer: TriValley Medical Group Senior |
$26,780.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36,518.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26,780.04
|
| Rate for Payer: Vantage Medical Group Senior |
$24,345.49
|
|
|
HC TRANSCATH RMVL SC LEADLESS PMKR RA
|
Facility
|
OP
|
$8,747.00
|
|
|
Service Code
|
CPT 0824T
|
| Hospital Charge Code |
906819774
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,583.21 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,749.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,009.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| 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 |
$3,936.15
|
| Rate for Payer: Cash Price |
$3,936.15
|
| Rate for Payer: Cash Price |
$3,936.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,685.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: Dignity Health Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,982.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,414.39
|
| Rate for Payer: Heritage Provider Network Senior |
$4,898.54
|
| Rate for Payer: Humana Medicare |
$3,982.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,982.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,566.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,583.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,699.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,186.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,018.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,018.01
|
| Rate for Payer: Multiplan Commercial |
$6,560.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,380.80
|
| Rate for Payer: TriValley Medical Group Senior |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC TRANSCATH RMVL SC LEADLESS PMKR RA
|
Facility
|
IP
|
$8,747.00
|
|
|
Service Code
|
CPT 0824T
|
| Hospital Charge Code |
906819774
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,583.21 |
| Max. Negotiated Rate |
$6,560.25 |
| Rate for Payer: Adventist Health Commercial |
$1,749.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,009.19
|
| Rate for Payer: Cash Price |
$3,936.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,921.72
|
| Rate for Payer: Heritage Provider Network Senior |
$5,921.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,583.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,186.75
|
| Rate for Payer: Multiplan Commercial |
$6,560.25
|
|
|
HC TRANSCATH SEPTAL REDUCT THER
|
Facility
|
IP
|
$24,728.00
|
|
|
Service Code
|
CPT 93583
|
| Hospital Charge Code |
906820293
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,475.77 |
| Max. Negotiated Rate |
$18,546.00 |
| Rate for Payer: Adventist Health Commercial |
$4,945.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16,988.14
|
| Rate for Payer: Cash Price |
$11,127.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$16,740.86
|
| Rate for Payer: Heritage Provider Network Senior |
$16,740.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,475.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,182.00
|
| Rate for Payer: Multiplan Commercial |
$18,546.00
|
|
|
HC TRANSCATH SEPTAL REDUCT THER
|
Facility
|
OP
|
$24,728.00
|
|
|
Service Code
|
CPT 93583
|
| Hospital Charge Code |
906820293
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$785.01 |
| Max. Negotiated Rate |
$21,018.80 |
| Rate for Payer: Adventist Health Commercial |
$4,945.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5,935.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16,988.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,018.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13,600.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18,546.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,576.00
|
| 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 |
$11,127.60
|
| Rate for Payer: Cash Price |
$11,127.60
|
| Rate for Payer: Cash Price |
$11,127.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16,073.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,018.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$21,018.80
|
| Rate for Payer: Dignity Health Senior |
$21,018.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,836.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$15,306.63
|
| Rate for Payer: Heritage Provider Network Senior |
$15,306.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$785.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$11,918.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,475.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,182.00
|
| Rate for Payer: Multiplan Commercial |
$18,546.00
|
| 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 |
$21,018.80
|
| Rate for Payer: Vantage Medical Group Senior |
$21,018.80
|
|
|
HC TRANSCATH THRPY EMBOLIZATION
|
Facility
|
IP
|
$8,608.00
|
|
|
Service Code
|
CPT 75894
|
| Hospital Charge Code |
906820133
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,558.05 |
| Max. Negotiated Rate |
$6,456.00 |
| Rate for Payer: Adventist Health Commercial |
$1,721.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,913.70
|
| Rate for Payer: Cash Price |
$3,873.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,827.62
|
| Rate for Payer: Heritage Provider Network Senior |
$5,827.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,558.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,152.00
|
| Rate for Payer: Multiplan Commercial |
$6,456.00
|
|
|
HC TRANSCATH THRPY EMBOLIZATION
|
Facility
|
OP
|
$7,923.00
|
|
|
Service Code
|
CPT 75894
|
| Hospital Charge Code |
906812173
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,434.06 |
| Max. Negotiated Rate |
$6,734.55 |
| Rate for Payer: Adventist Health Commercial |
$1,584.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,972.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,443.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,734.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,357.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,942.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,747.69
|
| Rate for Payer: Blue Shield of California Commercial |
$4,927.76
|
| Rate for Payer: Blue Shield of California EPN |
$2,802.27
|
| Rate for Payer: Cash Price |
$3,565.35
|
| Rate for Payer: Cash Price |
$3,565.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,149.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,734.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,734.55
|
| Rate for Payer: Dignity Health Senior |
$6,734.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,149.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,904.34
|
| Rate for Payer: Heritage Provider Network Senior |
$4,904.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,818.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,434.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,980.75
|
| Rate for Payer: Multiplan Commercial |
$5,942.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,734.55
|
| Rate for Payer: Vantage Medical Group Senior |
$6,734.55
|
|
|
HC TRANSCATH THRPY EMBOLIZATION
|
Facility
|
IP
|
$7,923.00
|
|
|
Service Code
|
CPT 75894
|
| Hospital Charge Code |
906812173
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,434.06 |
| Max. Negotiated Rate |
$5,942.25 |
| Rate for Payer: Adventist Health Commercial |
$1,584.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,443.10
|
| Rate for Payer: Cash Price |
$3,565.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,363.87
|
| Rate for Payer: Heritage Provider Network Senior |
$5,363.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,434.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,980.75
|
| Rate for Payer: Multiplan Commercial |
$5,942.25
|
|
|
HC TRANSCATH THRPY EMBOLIZATION
|
Facility
|
OP
|
$8,608.00
|
|
|
Service Code
|
CPT 75894
|
| Hospital Charge Code |
906820133
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,558.05 |
| Max. Negotiated Rate |
$7,316.80 |
| Rate for Payer: Adventist Health Commercial |
$1,721.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,972.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,913.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,316.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,734.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,456.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,747.69
|
| Rate for Payer: Blue Shield of California Commercial |
$4,927.76
|
| Rate for Payer: Blue Shield of California EPN |
$2,802.27
|
| Rate for Payer: Cash Price |
$3,873.60
|
| Rate for Payer: Cash Price |
$3,873.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,595.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,316.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,316.80
|
| Rate for Payer: Dignity Health Senior |
$7,316.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,595.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,328.35
|
| Rate for Payer: Heritage Provider Network Senior |
$5,328.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,149.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,558.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,152.00
|
| Rate for Payer: Multiplan Commercial |
$6,456.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,316.80
|
| Rate for Payer: Vantage Medical Group Senior |
$7,316.80
|
|
|
HC TRANSCATH TRICUSP VALVE ADDT
|
Facility
|
OP
|
$21,606.00
|
|
|
Service Code
|
CPT 0570T
|
| Hospital Charge Code |
906810570
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$933.56 |
| Max. Negotiated Rate |
$18,365.10 |
| Rate for Payer: Adventist Health Commercial |
$4,321.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14,843.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18,365.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11,883.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16,204.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,742.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,086.22
|
| Rate for Payer: Blue Shield of California EPN |
$933.56
|
| Rate for Payer: Cash Price |
$9,722.70
|
| Rate for Payer: Cash Price |
$9,722.70
|
| Rate for Payer: Cash Price |
$9,722.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14,043.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18,365.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$18,365.10
|
| Rate for Payer: Dignity Health Senior |
$18,365.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$13,374.11
|
| Rate for Payer: Heritage Provider Network Senior |
$13,374.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$10,414.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,910.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,401.50
|
| Rate for Payer: Multiplan Commercial |
$16,204.50
|
| 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 |
$18,365.10
|
| Rate for Payer: Vantage Medical Group Senior |
$18,365.10
|
|
|
HC TRANSCATH TRICUSP VALVE ADDT
|
Facility
|
IP
|
$25,472.00
|
|
|
Service Code
|
CPT 0570T
|
| Hospital Charge Code |
906820273
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,610.43 |
| Max. Negotiated Rate |
$19,104.00 |
| Rate for Payer: Adventist Health Commercial |
$5,094.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17,499.26
|
| Rate for Payer: Cash Price |
$11,462.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$17,244.54
|
| Rate for Payer: Heritage Provider Network Senior |
$17,244.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,610.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,368.00
|
| Rate for Payer: Multiplan Commercial |
$19,104.00
|
|
|
HC TRANSCATH TRICUSP VALVE ADDT
|
Facility
|
OP
|
$25,472.00
|
|
|
Service Code
|
CPT 0570T
|
| Hospital Charge Code |
906820273
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$933.56 |
| Max. Negotiated Rate |
$21,651.20 |
| Rate for Payer: Adventist Health Commercial |
$5,094.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17,499.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,651.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14,009.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19,104.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,742.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,086.22
|
| Rate for Payer: Blue Shield of California EPN |
$933.56
|
| Rate for Payer: Cash Price |
$11,462.40
|
| Rate for Payer: Cash Price |
$11,462.40
|
| Rate for Payer: Cash Price |
$11,462.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16,556.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,651.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$21,651.20
|
| Rate for Payer: Dignity Health Senior |
$21,651.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$15,767.17
|
| Rate for Payer: Heritage Provider Network Senior |
$15,767.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12,277.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,610.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,368.00
|
| Rate for Payer: Multiplan Commercial |
$19,104.00
|
| 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 |
$21,651.20
|
| Rate for Payer: Vantage Medical Group Senior |
$21,651.20
|
|
|
HC TRANSCATH TRICUSP VALVE ADDT
|
Facility
|
IP
|
$21,606.00
|
|
|
Service Code
|
CPT 0570T
|
| Hospital Charge Code |
906810570
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,910.69 |
| Max. Negotiated Rate |
$16,204.50 |
| Rate for Payer: Adventist Health Commercial |
$4,321.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14,843.32
|
| Rate for Payer: Cash Price |
$9,722.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$14,627.26
|
| Rate for Payer: Heritage Provider Network Senior |
$14,627.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,910.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,401.50
|
| Rate for Payer: Multiplan Commercial |
$16,204.50
|
|
|
HC TRANSCATH TRICUSP VALVE ANNUL
|
Facility
|
OP
|
$82,271.00
|
|
|
Service Code
|
CPT 0545T
|
| Hospital Charge Code |
906820271
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$933.56 |
| Max. Negotiated Rate |
$69,930.35 |
| Rate for Payer: Adventist Health Commercial |
$16,454.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$56,520.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$69,930.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45,249.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$61,703.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,742.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,086.22
|
| Rate for Payer: Blue Shield of California EPN |
$933.56
|
| Rate for Payer: Cash Price |
$37,021.95
|
| Rate for Payer: Cash Price |
$37,021.95
|
| Rate for Payer: Cash Price |
$37,021.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$53,476.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$69,930.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$69,930.35
|
| Rate for Payer: Dignity Health Senior |
$69,930.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$50,925.75
|
| Rate for Payer: Heritage Provider Network Senior |
$50,925.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$39,654.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,891.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20,567.75
|
| Rate for Payer: Multiplan Commercial |
$61,703.25
|
| 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 |
$69,930.35
|
| Rate for Payer: Vantage Medical Group Senior |
$69,930.35
|
|
|
HC TRANSCATH TRICUSP VALVE ANNUL
|
Facility
|
IP
|
$69,783.00
|
|
|
Service Code
|
CPT 0545T
|
| Hospital Charge Code |
906810545
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$12,630.72 |
| Max. Negotiated Rate |
$52,337.25 |
| Rate for Payer: Adventist Health Commercial |
$13,956.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$47,940.92
|
| Rate for Payer: Cash Price |
$31,402.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$47,243.09
|
| Rate for Payer: Heritage Provider Network Senior |
$47,243.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,630.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17,445.75
|
| Rate for Payer: Multiplan Commercial |
$52,337.25
|
|
|
HC TRANSCATH TRICUSP VALVE ANNUL
|
Facility
|
OP
|
$69,783.00
|
|
|
Service Code
|
CPT 0545T
|
| Hospital Charge Code |
906810545
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$933.56 |
| Max. Negotiated Rate |
$59,315.55 |
| Rate for Payer: Adventist Health Commercial |
$13,956.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$47,940.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$59,315.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38,380.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$52,337.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,742.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,086.22
|
| Rate for Payer: Blue Shield of California EPN |
$933.56
|
| Rate for Payer: Cash Price |
$31,402.35
|
| Rate for Payer: Cash Price |
$31,402.35
|
| Rate for Payer: Cash Price |
$31,402.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$45,358.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$59,315.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$59,315.55
|
| Rate for Payer: Dignity Health Senior |
$59,315.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$43,195.68
|
| Rate for Payer: Heritage Provider Network Senior |
$43,195.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$33,635.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,630.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17,445.75
|
| Rate for Payer: Multiplan Commercial |
$52,337.25
|
| 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 |
$59,315.55
|
| Rate for Payer: Vantage Medical Group Senior |
$59,315.55
|
|
|
HC TRANSCATH TRICUSP VALVE ANNUL
|
Facility
|
IP
|
$82,271.00
|
|
|
Service Code
|
CPT 0545T
|
| Hospital Charge Code |
906820271
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$14,891.05 |
| Max. Negotiated Rate |
$61,703.25 |
| Rate for Payer: Adventist Health Commercial |
$16,454.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$56,520.18
|
| Rate for Payer: Cash Price |
$37,021.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$55,697.47
|
| Rate for Payer: Heritage Provider Network Senior |
$55,697.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,891.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20,567.75
|
| Rate for Payer: Multiplan Commercial |
$61,703.25
|
|
|
HC TRANSCATH TRICUSPVALVE IMPLANT
|
Facility
|
OP
|
$94,612.00
|
|
|
Service Code
|
CPT 0646T
|
| Hospital Charge Code |
906820300
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$933.56 |
| Max. Negotiated Rate |
$80,420.20 |
| Rate for Payer: Adventist Health Commercial |
$18,922.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$64,998.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$80,420.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52,036.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$70,959.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,086.22
|
| Rate for Payer: Blue Shield of California EPN |
$933.56
|
| Rate for Payer: Cash Price |
$42,575.40
|
| Rate for Payer: Cash Price |
$42,575.40
|
| Rate for Payer: Cash Price |
$42,575.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$61,497.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$80,420.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$80,420.20
|
| Rate for Payer: Dignity Health Senior |
$80,420.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$58,564.83
|
| Rate for Payer: Heritage Provider Network Senior |
$58,564.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$45,602.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17,124.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23,653.00
|
| Rate for Payer: Multiplan Commercial |
$70,959.00
|
| 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 |
$80,420.20
|
| Rate for Payer: Vantage Medical Group Senior |
$80,420.20
|
|
|
HC TRANSCATH TRICUSPVALVE IMPLANT
|
Facility
|
IP
|
$94,612.00
|
|
|
Service Code
|
CPT 0646T
|
| Hospital Charge Code |
906820300
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$17,124.77 |
| Max. Negotiated Rate |
$70,959.00 |
| Rate for Payer: Adventist Health Commercial |
$18,922.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$64,998.44
|
| Rate for Payer: Cash Price |
$42,575.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$64,052.32
|
| Rate for Payer: Heritage Provider Network Senior |
$64,052.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17,124.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23,653.00
|
| Rate for Payer: Multiplan Commercial |
$70,959.00
|
|
|
HC TRANSCATH TRICUSP VALVE REPAIR
|
Facility
|
OP
|
$69,783.00
|
|
|
Service Code
|
CPT 0569T
|
| Hospital Charge Code |
906810569
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$933.56 |
| Max. Negotiated Rate |
$59,315.55 |
| Rate for Payer: Adventist Health Commercial |
$13,956.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$47,940.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$59,315.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38,380.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$52,337.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,742.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,086.22
|
| Rate for Payer: Blue Shield of California EPN |
$933.56
|
| Rate for Payer: Cash Price |
$31,402.35
|
| Rate for Payer: Cash Price |
$31,402.35
|
| Rate for Payer: Cash Price |
$31,402.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$45,358.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$59,315.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$59,315.55
|
| Rate for Payer: Dignity Health Senior |
$59,315.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$43,195.68
|
| Rate for Payer: Heritage Provider Network Senior |
$43,195.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$33,635.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,630.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17,445.75
|
| Rate for Payer: Multiplan Commercial |
$52,337.25
|
| 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 |
$59,315.55
|
| Rate for Payer: Vantage Medical Group Senior |
$59,315.55
|
|
|
HC TRANSCATH TRICUSP VALVE REPAIR
|
Facility
|
OP
|
$82,271.00
|
|
|
Service Code
|
CPT 0569T
|
| Hospital Charge Code |
906820272
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$933.56 |
| Max. Negotiated Rate |
$69,930.35 |
| Rate for Payer: Adventist Health Commercial |
$16,454.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$56,520.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$69,930.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45,249.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$61,703.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,742.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,086.22
|
| Rate for Payer: Blue Shield of California EPN |
$933.56
|
| Rate for Payer: Cash Price |
$37,021.95
|
| Rate for Payer: Cash Price |
$37,021.95
|
| Rate for Payer: Cash Price |
$37,021.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$53,476.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$69,930.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$69,930.35
|
| Rate for Payer: Dignity Health Senior |
$69,930.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$50,925.75
|
| Rate for Payer: Heritage Provider Network Senior |
$50,925.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$39,654.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,891.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20,567.75
|
| Rate for Payer: Multiplan Commercial |
$61,703.25
|
| 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 |
$69,930.35
|
| Rate for Payer: Vantage Medical Group Senior |
$69,930.35
|
|
|
HC TRANSCATH TRICUSP VALVE REPAIR
|
Facility
|
IP
|
$69,783.00
|
|
|
Service Code
|
CPT 0569T
|
| Hospital Charge Code |
906810569
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$12,630.72 |
| Max. Negotiated Rate |
$52,337.25 |
| Rate for Payer: Adventist Health Commercial |
$13,956.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$47,940.92
|
| Rate for Payer: Cash Price |
$31,402.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$47,243.09
|
| Rate for Payer: Heritage Provider Network Senior |
$47,243.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,630.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17,445.75
|
| Rate for Payer: Multiplan Commercial |
$52,337.25
|
|
|
HC TRANSCATH TRICUSP VALVE REPAIR
|
Facility
|
IP
|
$82,271.00
|
|
|
Service Code
|
CPT 0569T
|
| Hospital Charge Code |
906820272
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$14,891.05 |
| Max. Negotiated Rate |
$61,703.25 |
| Rate for Payer: Adventist Health Commercial |
$16,454.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$56,520.18
|
| Rate for Payer: Cash Price |
$37,021.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$55,697.47
|
| Rate for Payer: Heritage Provider Network Senior |
$55,697.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,891.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20,567.75
|
| Rate for Payer: Multiplan Commercial |
$61,703.25
|
|
|
HC TRANSCRANIAL DUPLEX/DOPPLER
|
Facility
|
IP
|
$1,349.00
|
|
|
Service Code
|
CPT 93888
|
| Hospital Charge Code |
906601144
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$244.17 |
| Max. Negotiated Rate |
$1,011.75 |
| Rate for Payer: Adventist Health Commercial |
$269.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$926.76
|
| Rate for Payer: Cash Price |
$607.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$913.27
|
| Rate for Payer: Heritage Provider Network Senior |
$913.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$244.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$337.25
|
| Rate for Payer: Multiplan Commercial |
$1,011.75
|
|
|
HC TRANSCRANIAL DUPLEX/DOPPLER
|
Facility
|
OP
|
$2,729.00
|
|
|
Service Code
|
CPT 93886
|
| Hospital Charge Code |
906601143
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$305.57 |
| Max. Negotiated Rate |
$2,046.75 |
| Rate for Payer: Adventist Health Commercial |
$545.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$369.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,874.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.16
|
| Rate for Payer: Blue Shield of California Commercial |
$858.74
|
| Rate for Payer: Blue Shield of California EPN |
$488.34
|
| Rate for Payer: Cash Price |
$1,228.05
|
| Rate for Payer: Cash Price |
$1,228.05
|
| Rate for Payer: Cash Price |
$1,228.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,773.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$336.78
|
| Rate for Payer: Dignity Health Senior |
$306.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,773.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$306.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,689.25
|
| Rate for Payer: Heritage Provider Network Senior |
$1,689.25
|
| Rate for Payer: Humana Medicare |
$306.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$305.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$581.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$493.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$361.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$682.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$385.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$385.76
|
| Rate for Payer: Multiplan Commercial |
$2,046.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$336.78
|
| Rate for Payer: TriValley Medical Group Senior |
$306.16
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,025.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$864.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Vantage Medical Group Senior |
$306.16
|
|
