|
HC TAVR W PROS VALVE CAROTID
|
Facility
|
OP
|
$25,457.00
|
|
|
Service Code
|
CPT 33999
|
| Hospital Charge Code |
906820334
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$785.56 |
| Max. Negotiated Rate |
$19,092.75 |
| Rate for Payer: Adventist Health Commercial |
$5,091.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17,488.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$864.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$785.56
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$14,001.35
|
| Rate for Payer: Cash Price |
$14,001.35
|
| Rate for Payer: Cash Price |
$14,001.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16,547.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$864.12
|
| Rate for Payer: Dignity Health Senior |
$785.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$785.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$15,757.88
|
| Rate for Payer: Heritage Provider Network Senior |
$966.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$785.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,492.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,607.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$903.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,364.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$989.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$989.81
|
| Rate for Payer: Multiplan Commercial |
$19,092.75
|
| Rate for Payer: Multiplan WC |
$1,251.66
|
| Rate for Payer: TriValley Medical Group Commercial |
$864.12
|
| Rate for Payer: TriValley Medical Group Senior |
$864.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$864.12
|
| Rate for Payer: Vantage Medical Group Senior |
$785.56
|
|
|
HC TAVR W PROS VALVE CAROTID
|
Facility
|
IP
|
$25,457.00
|
|
|
Service Code
|
CPT 33999
|
| Hospital Charge Code |
906820334
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,607.72 |
| Max. Negotiated Rate |
$19,092.75 |
| Rate for Payer: Adventist Health Commercial |
$5,091.40
|
| Rate for Payer: Cash Price |
$14,001.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$17,234.39
|
| Rate for Payer: Heritage Provider Network Senior |
$17,234.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,607.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,364.25
|
| Rate for Payer: Multiplan Commercial |
$19,092.75
|
|
|
HC TAVR W PROS VALVE CAROTID
|
Facility
|
OP
|
$53,164.00
|
|
|
Service Code
|
CPT 33999
|
| Hospital Charge Code |
906813416
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$785.56 |
| Max. Negotiated Rate |
$39,873.00 |
| Rate for Payer: Adventist Health Commercial |
$10,632.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$36,523.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$864.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$785.56
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$29,240.20
|
| Rate for Payer: Cash Price |
$29,240.20
|
| Rate for Payer: Cash Price |
$29,240.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$34,556.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$864.12
|
| Rate for Payer: Dignity Health Senior |
$785.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$785.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$32,908.52
|
| Rate for Payer: Heritage Provider Network Senior |
$966.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$785.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,492.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,622.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$903.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13,291.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$989.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$989.81
|
| Rate for Payer: Multiplan Commercial |
$39,873.00
|
| Rate for Payer: Multiplan WC |
$1,251.66
|
| Rate for Payer: TriValley Medical Group Commercial |
$864.12
|
| Rate for Payer: TriValley Medical Group Senior |
$864.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$864.12
|
| Rate for Payer: Vantage Medical Group Senior |
$785.56
|
|
|
HC TAVR W PROS VALVE CAROTID
|
Facility
|
IP
|
$53,164.00
|
|
|
Service Code
|
CPT 33999
|
| Hospital Charge Code |
906813416
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$9,622.68 |
| Max. Negotiated Rate |
$39,873.00 |
| Rate for Payer: Adventist Health Commercial |
$10,632.80
|
| Rate for Payer: Cash Price |
$29,240.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$35,992.03
|
| Rate for Payer: Heritage Provider Network Senior |
$35,992.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,622.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13,291.00
|
| Rate for Payer: Multiplan Commercial |
$39,873.00
|
|
|
HC TAVR W PROS VALVE OPN AXLRY
|
Facility
|
OP
|
$26,111.00
|
|
|
Service Code
|
CPT 33363
|
| Hospital Charge Code |
906820333
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$396.25 |
| Max. Negotiated Rate |
$22,194.35 |
| Rate for Payer: Adventist Health Commercial |
$5,222.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17,938.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22,194.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14,361.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19,583.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,720.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,829.24
|
| Rate for Payer: Blue Shield of California EPN |
$8,674.01
|
| Rate for Payer: Cash Price |
$14,361.05
|
| Rate for Payer: Cash Price |
$14,361.05
|
| Rate for Payer: Cash Price |
$14,361.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16,972.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22,194.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$22,194.35
|
| Rate for Payer: Dignity Health Senior |
$22,194.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$16,162.71
|
| Rate for Payer: Heritage Provider Network Senior |
$16,162.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$396.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12,454.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,726.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,527.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,277.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18,277.70
|
| Rate for Payer: Multiplan Commercial |
$19,583.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22,194.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22,194.35
|
| Rate for Payer: Vantage Medical Group Senior |
$22,194.35
|
|
|
HC TAVR W PROS VALVE OPN AXLRY
|
Facility
|
IP
|
$26,111.00
|
|
|
Service Code
|
CPT 33363
|
| Hospital Charge Code |
906820333
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,726.09 |
| Max. Negotiated Rate |
$19,583.25 |
| Rate for Payer: Adventist Health Commercial |
$5,222.20
|
| Rate for Payer: Cash Price |
$14,361.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$17,677.15
|
| Rate for Payer: Heritage Provider Network Senior |
$17,677.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,726.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,527.75
|
| Rate for Payer: Multiplan Commercial |
$19,583.25
|
|
|
HC TAVR W PROS VALVE OPN AXLRY
|
Facility
|
IP
|
$53,983.00
|
|
|
Service Code
|
CPT 33363
|
| Hospital Charge Code |
906813410
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$9,770.92 |
| Max. Negotiated Rate |
$40,487.25 |
| Rate for Payer: Adventist Health Commercial |
$10,796.60
|
| Rate for Payer: Cash Price |
$29,690.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$36,546.49
|
| Rate for Payer: Heritage Provider Network Senior |
$36,546.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,770.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13,495.75
|
| Rate for Payer: Multiplan Commercial |
$40,487.25
|
|
|
HC TAVR W PROS VALVE OPN AXLRY
|
Facility
|
OP
|
$53,983.00
|
|
|
Service Code
|
CPT 33363
|
| Hospital Charge Code |
906813410
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$396.25 |
| Max. Negotiated Rate |
$45,885.55 |
| Rate for Payer: Adventist Health Commercial |
$10,796.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$37,086.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$45,885.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29,690.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$40,487.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,720.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,829.24
|
| Rate for Payer: Blue Shield of California EPN |
$8,674.01
|
| Rate for Payer: Cash Price |
$29,690.65
|
| Rate for Payer: Cash Price |
$29,690.65
|
| Rate for Payer: Cash Price |
$29,690.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$35,088.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$45,885.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$45,885.55
|
| Rate for Payer: Dignity Health Senior |
$45,885.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$33,415.48
|
| Rate for Payer: Heritage Provider Network Senior |
$33,415.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$396.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$25,749.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,770.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13,495.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$37,788.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$37,788.10
|
| Rate for Payer: Multiplan Commercial |
$40,487.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$45,885.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45,885.55
|
| Rate for Payer: Vantage Medical Group Senior |
$45,885.55
|
|
|
HC TAVR W PROS VALVE OPN FMRL
|
Facility
|
OP
|
$25,204.00
|
|
|
Service Code
|
CPT 33362
|
| Hospital Charge Code |
906820332
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,911.91 |
| Max. Negotiated Rate |
$21,423.40 |
| Rate for Payer: Adventist Health Commercial |
$5,040.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17,315.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,423.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13,862.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18,903.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,720.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,829.24
|
| Rate for Payer: Blue Shield of California EPN |
$8,674.01
|
| Rate for Payer: Cash Price |
$13,862.20
|
| Rate for Payer: Cash Price |
$13,862.20
|
| Rate for Payer: Cash Price |
$13,862.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16,382.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,423.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$21,423.40
|
| Rate for Payer: Dignity Health Senior |
$21,423.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$15,601.28
|
| Rate for Payer: Heritage Provider Network Senior |
$15,601.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,911.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12,022.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,561.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,301.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,642.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17,642.80
|
| Rate for Payer: Multiplan Commercial |
$18,903.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,423.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21,423.40
|
| Rate for Payer: Vantage Medical Group Senior |
$21,423.40
|
|
|
HC TAVR W PROS VALVE OPN FMRL
|
Facility
|
IP
|
$52,428.00
|
|
|
Service Code
|
CPT 33362
|
| Hospital Charge Code |
906813409
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$9,489.47 |
| Max. Negotiated Rate |
$39,321.00 |
| Rate for Payer: Adventist Health Commercial |
$10,485.60
|
| Rate for Payer: Cash Price |
$28,835.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$35,493.76
|
| Rate for Payer: Heritage Provider Network Senior |
$35,493.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,489.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13,107.00
|
| Rate for Payer: Multiplan Commercial |
$39,321.00
|
|
|
HC TAVR W PROS VALVE OPN FMRL
|
Facility
|
OP
|
$52,428.00
|
|
|
Service Code
|
CPT 33362
|
| Hospital Charge Code |
906813409
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,911.91 |
| Max. Negotiated Rate |
$44,563.80 |
| Rate for Payer: Adventist Health Commercial |
$10,485.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$36,018.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$44,563.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28,835.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$39,321.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,720.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,829.24
|
| Rate for Payer: Blue Shield of California EPN |
$8,674.01
|
| Rate for Payer: Cash Price |
$28,835.40
|
| Rate for Payer: Cash Price |
$28,835.40
|
| Rate for Payer: Cash Price |
$28,835.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$34,078.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$44,563.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$44,563.80
|
| Rate for Payer: Dignity Health Senior |
$44,563.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$32,452.93
|
| Rate for Payer: Heritage Provider Network Senior |
$32,452.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,911.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$25,008.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,489.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13,107.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$36,699.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$36,699.60
|
| Rate for Payer: Multiplan Commercial |
$39,321.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$44,563.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$44,563.80
|
| Rate for Payer: Vantage Medical Group Senior |
$44,563.80
|
|
|
HC TAVR W PROS VALVE OPN FMRL
|
Facility
|
IP
|
$25,204.00
|
|
|
Service Code
|
CPT 33362
|
| Hospital Charge Code |
906820332
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,561.92 |
| Max. Negotiated Rate |
$18,903.00 |
| Rate for Payer: Adventist Health Commercial |
$5,040.80
|
| Rate for Payer: Cash Price |
$13,862.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$17,063.11
|
| Rate for Payer: Heritage Provider Network Senior |
$17,063.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,561.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,301.00
|
| Rate for Payer: Multiplan Commercial |
$18,903.00
|
|
|
HC TAVR W PROS VALVE OPN ILIAC
|
Facility
|
IP
|
$60,500.00
|
|
|
Service Code
|
CPT 33364
|
| Hospital Charge Code |
906820339
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$10,950.50 |
| Max. Negotiated Rate |
$45,375.00 |
| Rate for Payer: Adventist Health Commercial |
$12,100.00
|
| Rate for Payer: Cash Price |
$33,275.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$40,958.50
|
| Rate for Payer: Heritage Provider Network Senior |
$40,958.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,950.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15,125.00
|
| Rate for Payer: Multiplan Commercial |
$45,375.00
|
|
|
HC TAVR W PROS VALVE OPN ILIAC
|
Facility
|
OP
|
$54,354.00
|
|
|
Service Code
|
CPT 33364
|
| Hospital Charge Code |
906813412
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,109.74 |
| Max. Negotiated Rate |
$46,200.90 |
| Rate for Payer: Adventist Health Commercial |
$10,870.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$37,341.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$46,200.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29,894.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$40,765.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,720.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,829.24
|
| Rate for Payer: Blue Shield of California EPN |
$8,674.01
|
| Rate for Payer: Cash Price |
$29,894.70
|
| Rate for Payer: Cash Price |
$29,894.70
|
| Rate for Payer: Cash Price |
$29,894.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$35,330.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46,200.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$46,200.90
|
| Rate for Payer: Dignity Health Senior |
$46,200.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$33,645.13
|
| Rate for Payer: Heritage Provider Network Senior |
$33,645.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,109.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$25,926.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,838.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13,588.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$38,047.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$38,047.80
|
| Rate for Payer: Multiplan Commercial |
$40,765.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46,200.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$46,200.90
|
| Rate for Payer: Vantage Medical Group Senior |
$46,200.90
|
|
|
HC TAVR W PROS VALVE OPN ILIAC
|
Facility
|
IP
|
$54,354.00
|
|
|
Service Code
|
CPT 33364
|
| Hospital Charge Code |
906813412
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$9,838.07 |
| Max. Negotiated Rate |
$40,765.50 |
| Rate for Payer: Adventist Health Commercial |
$10,870.80
|
| Rate for Payer: Cash Price |
$29,894.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$36,797.66
|
| Rate for Payer: Heritage Provider Network Senior |
$36,797.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,838.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13,588.50
|
| Rate for Payer: Multiplan Commercial |
$40,765.50
|
|
|
HC TAVR W PROS VALVE OPN ILIAC
|
Facility
|
OP
|
$60,500.00
|
|
|
Service Code
|
CPT 33364
|
| Hospital Charge Code |
906820339
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,109.74 |
| Max. Negotiated Rate |
$51,425.00 |
| Rate for Payer: Adventist Health Commercial |
$12,100.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$41,563.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$51,425.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$33,275.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$45,375.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,720.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,829.24
|
| Rate for Payer: Blue Shield of California EPN |
$8,674.01
|
| Rate for Payer: Cash Price |
$33,275.00
|
| Rate for Payer: Cash Price |
$33,275.00
|
| Rate for Payer: Cash Price |
$33,275.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$39,325.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$51,425.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$51,425.00
|
| Rate for Payer: Dignity Health Senior |
$51,425.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$37,449.50
|
| Rate for Payer: Heritage Provider Network Senior |
$37,449.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,109.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$28,858.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,950.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15,125.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$42,350.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$42,350.00
|
| Rate for Payer: Multiplan Commercial |
$45,375.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$51,425.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$51,425.00
|
| Rate for Payer: Vantage Medical Group Senior |
$51,425.00
|
|
|
HC TAVR W PROS VALVE PERC FMRL
|
Facility
|
OP
|
$23,018.00
|
|
|
Service Code
|
CPT 33361
|
| Hospital Charge Code |
906820331
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$349.21 |
| Max. Negotiated Rate |
$19,565.30 |
| Rate for Payer: Adventist Health Commercial |
$4,603.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15,813.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19,565.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12,659.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17,263.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,680.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$12,659.90
|
| Rate for Payer: Cash Price |
$12,659.90
|
| Rate for Payer: Cash Price |
$12,659.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14,961.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19,565.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$19,565.30
|
| Rate for Payer: Dignity Health Senior |
$19,565.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$14,248.14
|
| Rate for Payer: Heritage Provider Network Senior |
$14,248.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$349.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$10,979.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,166.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,754.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16,112.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16,112.60
|
| Rate for Payer: Multiplan Commercial |
$17,263.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19,565.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19,565.30
|
| Rate for Payer: Vantage Medical Group Senior |
$19,565.30
|
|
|
HC TAVR W PROS VALVE PERC FMRL
|
Facility
|
IP
|
$23,018.00
|
|
|
Service Code
|
CPT 33361
|
| Hospital Charge Code |
906820331
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,166.26 |
| Max. Negotiated Rate |
$17,263.50 |
| Rate for Payer: Adventist Health Commercial |
$4,603.60
|
| Rate for Payer: Cash Price |
$12,659.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$15,583.19
|
| Rate for Payer: Heritage Provider Network Senior |
$15,583.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,166.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,754.50
|
| Rate for Payer: Multiplan Commercial |
$17,263.50
|
|
|
HC TAVR W PROS VALVE PERC FMRL
|
Facility
|
IP
|
$48,473.00
|
|
|
Service Code
|
CPT 33361
|
| Hospital Charge Code |
906813408
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$8,773.61 |
| Max. Negotiated Rate |
$36,354.75 |
| Rate for Payer: Adventist Health Commercial |
$9,694.60
|
| Rate for Payer: Cash Price |
$26,660.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$32,816.22
|
| Rate for Payer: Heritage Provider Network Senior |
$32,816.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,773.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12,118.25
|
| Rate for Payer: Multiplan Commercial |
$36,354.75
|
|
|
HC TAVR W PROS VALVE PERC FMRL
|
Facility
|
OP
|
$48,473.00
|
|
|
Service Code
|
CPT 33361
|
| Hospital Charge Code |
906813408
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$349.21 |
| Max. Negotiated Rate |
$41,202.05 |
| Rate for Payer: Adventist Health Commercial |
$9,694.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$33,300.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$41,202.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26,660.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$36,354.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,680.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$26,660.15
|
| Rate for Payer: Cash Price |
$26,660.15
|
| Rate for Payer: Cash Price |
$26,660.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$31,507.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$41,202.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$41,202.05
|
| Rate for Payer: Dignity Health Senior |
$41,202.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$30,004.79
|
| Rate for Payer: Heritage Provider Network Senior |
$30,004.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$349.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$23,121.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,773.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12,118.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33,931.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33,931.10
|
| Rate for Payer: Multiplan Commercial |
$36,354.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$41,202.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41,202.05
|
| Rate for Payer: Vantage Medical Group Senior |
$41,202.05
|
|
|
HC TAVR W PROS VALVE TRNSAORTIC
|
Facility
|
IP
|
$57,267.00
|
|
|
Service Code
|
CPT 33365
|
| Hospital Charge Code |
906813413
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$10,365.33 |
| Max. Negotiated Rate |
$42,950.25 |
| Rate for Payer: Adventist Health Commercial |
$11,453.40
|
| Rate for Payer: Cash Price |
$31,496.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$38,769.76
|
| Rate for Payer: Heritage Provider Network Senior |
$38,769.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,365.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14,316.75
|
| Rate for Payer: Multiplan Commercial |
$42,950.25
|
|
|
HC TAVR W PROS VALVE TRNSAORTIC
|
Facility
|
IP
|
$63,743.00
|
|
|
Service Code
|
CPT 33365
|
| Hospital Charge Code |
906820340
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$11,537.48 |
| Max. Negotiated Rate |
$47,807.25 |
| Rate for Payer: Adventist Health Commercial |
$12,748.60
|
| Rate for Payer: Cash Price |
$35,058.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$43,154.01
|
| Rate for Payer: Heritage Provider Network Senior |
$43,154.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,537.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15,935.75
|
| Rate for Payer: Multiplan Commercial |
$47,807.25
|
|
|
HC TAVR W PROS VALVE TRNSAORTIC
|
Facility
|
OP
|
$57,267.00
|
|
|
Service Code
|
CPT 33365
|
| Hospital Charge Code |
906813413
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$459.58 |
| Max. Negotiated Rate |
$48,676.95 |
| Rate for Payer: Adventist Health Commercial |
$11,453.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$39,342.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$48,676.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$31,496.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42,950.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,720.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,829.24
|
| Rate for Payer: Blue Shield of California EPN |
$8,674.01
|
| Rate for Payer: Cash Price |
$31,496.85
|
| Rate for Payer: Cash Price |
$31,496.85
|
| Rate for Payer: Cash Price |
$31,496.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$37,223.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$48,676.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$48,676.95
|
| Rate for Payer: Dignity Health Senior |
$48,676.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$35,448.27
|
| Rate for Payer: Heritage Provider Network Senior |
$35,448.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$459.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$27,316.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,365.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14,316.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$40,086.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$40,086.90
|
| Rate for Payer: Multiplan Commercial |
$42,950.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$48,676.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$48,676.95
|
| Rate for Payer: Vantage Medical Group Senior |
$48,676.95
|
|
|
HC TAVR W PROS VALVE TRNSAORTIC
|
Facility
|
OP
|
$63,743.00
|
|
|
Service Code
|
CPT 33365
|
| Hospital Charge Code |
906820340
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$459.58 |
| Max. Negotiated Rate |
$54,181.55 |
| Rate for Payer: Adventist Health Commercial |
$12,748.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$43,791.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$54,181.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$35,058.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$47,807.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,720.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,829.24
|
| Rate for Payer: Blue Shield of California EPN |
$8,674.01
|
| Rate for Payer: Cash Price |
$35,058.65
|
| Rate for Payer: Cash Price |
$35,058.65
|
| Rate for Payer: Cash Price |
$35,058.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$41,432.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$54,181.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$54,181.55
|
| Rate for Payer: Dignity Health Senior |
$54,181.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$39,456.92
|
| Rate for Payer: Heritage Provider Network Senior |
$39,456.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$459.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$30,405.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,537.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15,935.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$44,620.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$44,620.10
|
| Rate for Payer: Multiplan Commercial |
$47,807.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$54,181.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$54,181.55
|
| Rate for Payer: Vantage Medical Group Senior |
$54,181.55
|
|
|
HC TAVR W PROS VALVE TRNSAPICAL
|
Facility
|
IP
|
$52,480.00
|
|
|
Service Code
|
CPT 33366
|
| Hospital Charge Code |
906813415
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$9,498.88 |
| Max. Negotiated Rate |
$39,360.00 |
| Rate for Payer: Adventist Health Commercial |
$10,496.00
|
| Rate for Payer: Cash Price |
$28,864.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$35,528.96
|
| Rate for Payer: Heritage Provider Network Senior |
$35,528.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,498.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13,120.00
|
| Rate for Payer: Multiplan Commercial |
$39,360.00
|
|
