|
HC TRANSCATH MITRAL VALVE ANNUL
|
Facility
|
OP
|
$59,559.00
|
|
|
Service Code
|
CPT 0544T
|
| Hospital Charge Code |
906810544
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,984.00 |
| Max. Negotiated Rate |
$50,625.15 |
| Rate for Payer: Adventist Health Commercial |
$11,911.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$40,917.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$50,625.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32,757.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$44,669.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,717.00
|
| 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 |
$32,757.45
|
| Rate for Payer: Cash Price |
$32,757.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$38,713.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$50,625.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$50,625.15
|
| Rate for Payer: Dignity Health Senior |
$50,625.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$36,867.02
|
| Rate for Payer: Heritage Provider Network Senior |
$36,867.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$28,409.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,780.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14,889.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$41,691.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$41,691.30
|
| Rate for Payer: Multiplan Commercial |
$44,669.25
|
| 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 |
$50,625.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$50,625.15
|
| Rate for Payer: Vantage Medical Group Senior |
$50,625.15
|
|
|
HC TRANSCATH MITRAL VALVE ANNUL
|
Facility
|
IP
|
$59,559.00
|
|
|
Service Code
|
CPT 0544T
|
| Hospital Charge Code |
906810544
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$10,780.18 |
| Max. Negotiated Rate |
$44,669.25 |
| Rate for Payer: Adventist Health Commercial |
$11,911.80
|
| Rate for Payer: Cash Price |
$32,757.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$40,321.44
|
| Rate for Payer: Heritage Provider Network Senior |
$40,321.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,780.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14,889.75
|
| Rate for Payer: Multiplan Commercial |
$44,669.25
|
|
|
HC TRANSCATH MITRAL VALVE REPAIR
|
Facility
|
OP
|
$5,640.00
|
|
|
Service Code
|
CPT 33418
|
| Hospital Charge Code |
906811487
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,020.84 |
| Max. Negotiated Rate |
$14,720.00 |
| Rate for Payer: Adventist Health Commercial |
$1,128.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,874.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,794.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,102.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,230.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,720.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$3,102.00
|
| Rate for Payer: Cash Price |
$3,102.00
|
| Rate for Payer: Cash Price |
$3,102.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,666.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,794.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,794.00
|
| Rate for Payer: Dignity Health Senior |
$4,794.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,491.16
|
| Rate for Payer: Heritage Provider Network Senior |
$3,491.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,583.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,690.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,020.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,410.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,948.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,948.00
|
| Rate for Payer: Multiplan Commercial |
$4,230.00
|
| 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 |
$4,794.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,794.00
|
| Rate for Payer: Vantage Medical Group Senior |
$4,794.00
|
|
|
HC TRANSCATH MITRAL VALVE REPAIR
|
Facility
|
OP
|
$78,157.00
|
|
|
Service Code
|
CPT 33418
|
| Hospital Charge Code |
906820021
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,583.19 |
| Max. Negotiated Rate |
$66,433.45 |
| Rate for Payer: Adventist Health Commercial |
$15,631.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$53,693.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$66,433.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$42,986.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$58,617.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,720.00
|
| 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 |
$42,986.35
|
| Rate for Payer: Cash Price |
$42,986.35
|
| Rate for Payer: Cash Price |
$42,986.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$50,802.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$66,433.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$66,433.45
|
| Rate for Payer: Dignity Health Senior |
$66,433.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$48,379.18
|
| Rate for Payer: Heritage Provider Network Senior |
$48,379.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,583.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$37,280.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,146.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19,539.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$54,709.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$54,709.90
|
| Rate for Payer: Multiplan Commercial |
$58,617.75
|
| 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 |
$66,433.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$66,433.45
|
| Rate for Payer: Vantage Medical Group Senior |
$66,433.45
|
|
|
HC TRANSCATH MITRAL VALVE REPAIR
|
Facility
|
IP
|
$78,157.00
|
|
|
Service Code
|
CPT 33418
|
| Hospital Charge Code |
906820021
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$14,146.42 |
| Max. Negotiated Rate |
$58,617.75 |
| Rate for Payer: Adventist Health Commercial |
$15,631.40
|
| Rate for Payer: Cash Price |
$42,986.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$52,912.29
|
| Rate for Payer: Heritage Provider Network Senior |
$52,912.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,146.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19,539.25
|
| Rate for Payer: Multiplan Commercial |
$58,617.75
|
|
|
HC TRANSCATH MITRAL VALVE REPAIR
|
Facility
|
IP
|
$5,640.00
|
|
|
Service Code
|
CPT 33418
|
| Hospital Charge Code |
906811487
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,020.84 |
| Max. Negotiated Rate |
$4,230.00 |
| Rate for Payer: Adventist Health Commercial |
$1,128.00
|
| Rate for Payer: Cash Price |
$3,102.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,818.28
|
| Rate for Payer: Heritage Provider Network Senior |
$3,818.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,020.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,410.00
|
| Rate for Payer: Multiplan Commercial |
$4,230.00
|
|
|
HC TRANSCATH MITRAL VLVE IMPL/REP
|
Facility
|
IP
|
$56,581.00
|
|
|
Service Code
|
CPT 0483T
|
| Hospital Charge Code |
906800483
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$10,241.16 |
| Max. Negotiated Rate |
$42,435.75 |
| Rate for Payer: Adventist Health Commercial |
$11,316.20
|
| Rate for Payer: Cash Price |
$31,119.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$38,305.34
|
| Rate for Payer: Heritage Provider Network Senior |
$38,305.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,241.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14,145.25
|
| Rate for Payer: Multiplan Commercial |
$42,435.75
|
|
|
HC TRANSCATH MITRAL VLVE IMPL/REP
|
Facility
|
OP
|
$56,581.00
|
|
|
Service Code
|
CPT 0483T
|
| Hospital Charge Code |
906800483
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,984.00 |
| Max. Negotiated Rate |
$48,093.85 |
| Rate for Payer: Adventist Health Commercial |
$11,316.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$38,871.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$48,093.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$31,119.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42,435.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,717.00
|
| 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 |
$31,119.55
|
| Rate for Payer: Cash Price |
$31,119.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$36,777.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$48,093.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$48,093.85
|
| Rate for Payer: Dignity Health Senior |
$48,093.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$35,023.64
|
| Rate for Payer: Heritage Provider Network Senior |
$35,023.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$26,989.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,241.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14,145.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$39,606.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$39,606.70
|
| Rate for Payer: Multiplan Commercial |
$42,435.75
|
| 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 |
$48,093.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$48,093.85
|
| Rate for Payer: Vantage Medical Group Senior |
$48,093.85
|
|
|
HC TRANSCATH MITRAL VLVE IMPL/REP
|
Facility
|
IP
|
$74,249.00
|
|
|
Service Code
|
CPT 0483T
|
| Hospital Charge Code |
906820204
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$13,439.07 |
| Max. Negotiated Rate |
$55,686.75 |
| Rate for Payer: Adventist Health Commercial |
$14,849.80
|
| Rate for Payer: Cash Price |
$40,836.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$50,266.57
|
| Rate for Payer: Heritage Provider Network Senior |
$50,266.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,439.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18,562.25
|
| Rate for Payer: Multiplan Commercial |
$55,686.75
|
|
|
HC TRANSCATH MITRAL VLVE IMPL/REP
|
Facility
|
OP
|
$74,249.00
|
|
|
Service Code
|
CPT 0483T
|
| Hospital Charge Code |
906820204
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,984.00 |
| Max. Negotiated Rate |
$63,111.65 |
| Rate for Payer: Adventist Health Commercial |
$14,849.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$51,009.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$63,111.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$40,836.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$55,686.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,717.00
|
| 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 |
$40,836.95
|
| Rate for Payer: Cash Price |
$40,836.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$48,261.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$63,111.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$63,111.65
|
| Rate for Payer: Dignity Health Senior |
$63,111.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$45,960.13
|
| Rate for Payer: Heritage Provider Network Senior |
$45,960.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$35,416.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,439.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18,562.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$51,974.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$51,974.30
|
| Rate for Payer: Multiplan Commercial |
$55,686.75
|
| 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 |
$63,111.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$63,111.65
|
| Rate for Payer: Vantage Medical Group Senior |
$63,111.65
|
|
|
HC TRANSCATH PLCMT INT STNT OPEN PERC ADDL ART
|
Facility
|
OP
|
$13,341.00
|
|
|
Service Code
|
CPT 37237
|
| Hospital Charge Code |
906820010
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$14,160.00 |
| Rate for Payer: Adventist Health Commercial |
$2,668.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,165.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,339.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,337.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,005.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$7,337.55
|
| Rate for Payer: Cash Price |
$7,337.55
|
| Rate for Payer: Cash Price |
$7,337.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8,671.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,339.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,339.85
|
| Rate for Payer: Dignity Health Senior |
$11,339.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,258.08
|
| Rate for Payer: Heritage Provider Network Senior |
$8,258.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$59.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6,363.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,414.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,335.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,338.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,338.70
|
| Rate for Payer: Multiplan Commercial |
$10,005.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14,160.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,956.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,339.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,339.85
|
| Rate for Payer: Vantage Medical Group Senior |
$11,339.85
|
|
|
HC TRANSCATH PLCMT INT STNT OPEN PERC ADDL ART
|
Facility
|
OP
|
$9,529.00
|
|
|
Service Code
|
CPT 37237
|
| Hospital Charge Code |
906811479
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$14,160.00 |
| Rate for Payer: Adventist Health Commercial |
$1,905.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,546.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,099.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,240.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,146.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| 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 |
$5,240.95
|
| Rate for Payer: Cash Price |
$5,240.95
|
| Rate for Payer: Cash Price |
$5,240.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,193.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,099.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,099.65
|
| Rate for Payer: Dignity Health Senior |
$8,099.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,898.45
|
| Rate for Payer: Heritage Provider Network Senior |
$5,898.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$59.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,545.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,724.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,382.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,670.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,670.30
|
| Rate for Payer: Multiplan Commercial |
$7,146.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14,160.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,956.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,099.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,099.65
|
| Rate for Payer: Vantage Medical Group Senior |
$8,099.65
|
|
|
HC TRANSCATH PLCMT INT STNT OPEN PERC ADDL ART
|
Facility
|
IP
|
$13,341.00
|
|
|
Service Code
|
CPT 37237
|
| Hospital Charge Code |
906820010
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,414.72 |
| Max. Negotiated Rate |
$10,005.75 |
| Rate for Payer: Adventist Health Commercial |
$2,668.20
|
| Rate for Payer: Cash Price |
$7,337.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,031.86
|
| Rate for Payer: Heritage Provider Network Senior |
$9,031.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,414.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,335.25
|
| Rate for Payer: Multiplan Commercial |
$10,005.75
|
|
|
HC TRANSCATH PLCMT INT STNT OPEN PERC ADDL ART
|
Facility
|
IP
|
$9,529.00
|
|
|
Service Code
|
CPT 37237
|
| Hospital Charge Code |
906811479
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,724.75 |
| Max. Negotiated Rate |
$7,146.75 |
| Rate for Payer: Adventist Health Commercial |
$1,905.80
|
| Rate for Payer: Cash Price |
$5,240.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,451.13
|
| Rate for Payer: Heritage Provider Network Senior |
$6,451.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,724.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,382.25
|
| Rate for Payer: Multiplan Commercial |
$7,146.75
|
|
|
HC TRANSCATH PLCMT INT STNT OPENPERC ADDL VEIN
|
Facility
|
IP
|
$9,529.00
|
|
|
Service Code
|
CPT 37239
|
| Hospital Charge Code |
906811481
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,724.75 |
| Max. Negotiated Rate |
$7,146.75 |
| Rate for Payer: Adventist Health Commercial |
$1,905.80
|
| Rate for Payer: Cash Price |
$5,240.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,451.13
|
| Rate for Payer: Heritage Provider Network Senior |
$6,451.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,724.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,382.25
|
| Rate for Payer: Multiplan Commercial |
$7,146.75
|
|
|
HC TRANSCATH PLCMT INT STNT OPENPERC ADDL VEIN
|
Facility
|
OP
|
$12,675.00
|
|
|
Service Code
|
CPT 37239
|
| Hospital Charge Code |
906820012
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$14,160.00 |
| Rate for Payer: Adventist Health Commercial |
$2,535.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,707.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,773.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,971.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,506.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| 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 |
$6,971.25
|
| Rate for Payer: Cash Price |
$6,971.25
|
| Rate for Payer: Cash Price |
$6,971.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8,238.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,773.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,773.75
|
| Rate for Payer: Dignity Health Senior |
$10,773.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,845.82
|
| Rate for Payer: Heritage Provider Network Senior |
$7,845.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$41.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6,045.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,294.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,168.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,872.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,872.50
|
| Rate for Payer: Multiplan Commercial |
$9,506.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14,160.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,956.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,773.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,773.75
|
| Rate for Payer: Vantage Medical Group Senior |
$10,773.75
|
|
|
HC TRANSCATH PLCMT INT STNT OPENPERC ADDL VEIN
|
Facility
|
OP
|
$9,529.00
|
|
|
Service Code
|
CPT 37239
|
| Hospital Charge Code |
906811481
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$14,160.00 |
| Rate for Payer: Adventist Health Commercial |
$1,905.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,546.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,099.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,240.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,146.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| 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 |
$5,240.95
|
| Rate for Payer: Cash Price |
$5,240.95
|
| Rate for Payer: Cash Price |
$5,240.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,193.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,099.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,099.65
|
| Rate for Payer: Dignity Health Senior |
$8,099.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,898.45
|
| Rate for Payer: Heritage Provider Network Senior |
$5,898.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$41.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,545.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,724.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,382.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,670.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,670.30
|
| Rate for Payer: Multiplan Commercial |
$7,146.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14,160.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,956.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,099.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,099.65
|
| Rate for Payer: Vantage Medical Group Senior |
$8,099.65
|
|
|
HC TRANSCATH PLCMT INT STNT OPENPERC ADDL VEIN
|
Facility
|
IP
|
$12,675.00
|
|
|
Service Code
|
CPT 37239
|
| Hospital Charge Code |
906820012
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,294.18 |
| Max. Negotiated Rate |
$9,506.25 |
| Rate for Payer: Adventist Health Commercial |
$2,535.00
|
| Rate for Payer: Cash Price |
$6,971.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,580.98
|
| Rate for Payer: Heritage Provider Network Senior |
$8,580.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,294.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,168.75
|
| Rate for Payer: Multiplan Commercial |
$9,506.25
|
|
|
HC TRANSCATH PLCMT INT STNT OPEN PERC INIT ART
|
Facility
|
IP
|
$24,620.00
|
|
|
Service Code
|
CPT 37236
|
| Hospital Charge Code |
906811478
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,456.22 |
| Max. Negotiated Rate |
$18,465.00 |
| Rate for Payer: Adventist Health Commercial |
$4,924.00
|
| Rate for Payer: Cash Price |
$13,541.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$16,667.74
|
| Rate for Payer: Heritage Provider Network Senior |
$16,667.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,456.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,155.00
|
| Rate for Payer: Multiplan Commercial |
$18,465.00
|
|
|
HC TRANSCATH PLCMT INT STNT OPEN PERC INIT ART
|
Facility
|
OP
|
$28,965.00
|
|
|
Service Code
|
CPT 37236
|
| Hospital Charge Code |
906820009
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$27,377.73 |
| Rate for Payer: Adventist Health Commercial |
$5,793.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19,898.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,409.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,111.00
|
| 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 |
$15,930.75
|
| Rate for Payer: Cash Price |
$15,930.75
|
| Rate for Payer: Cash Price |
$15,930.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$18,827.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,850.26
|
| Rate for Payer: Dignity Health Senior |
$14,409.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$14,409.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$17,929.33
|
| Rate for Payer: Heritage Provider Network Senior |
$17,723.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$635.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,409.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$27,377.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,242.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,570.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,241.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,155.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18,155.76
|
| Rate for Payer: Multiplan Commercial |
$21,723.75
|
| Rate for Payer: Multiplan WC |
$22,958.69
|
| Rate for Payer: TriValley Medical Group Commercial |
$15,850.26
|
| Rate for Payer: TriValley Medical Group Senior |
$15,850.26
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,861.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,025.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Vantage Medical Group Senior |
$14,409.33
|
|
|
HC TRANSCATH PLCMT INT STNT OPEN PERC INIT ART
|
Facility
|
IP
|
$28,965.00
|
|
|
Service Code
|
CPT 37236
|
| Hospital Charge Code |
906820009
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,242.66 |
| Max. Negotiated Rate |
$21,723.75 |
| Rate for Payer: Adventist Health Commercial |
$5,793.00
|
| Rate for Payer: Cash Price |
$15,930.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$19,609.31
|
| Rate for Payer: Heritage Provider Network Senior |
$19,609.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,242.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,241.25
|
| Rate for Payer: Multiplan Commercial |
$21,723.75
|
|
|
HC TRANSCATH PLCMT INT STNT OPEN PERC INIT ART
|
Facility
|
OP
|
$24,620.00
|
|
|
Service Code
|
CPT 37236
|
| Hospital Charge Code |
906811478
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$27,377.73 |
| Rate for Payer: Adventist Health Commercial |
$4,924.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16,913.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,409.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,111.00
|
| 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 |
$13,541.00
|
| Rate for Payer: Cash Price |
$13,541.00
|
| Rate for Payer: Cash Price |
$13,541.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16,003.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,850.26
|
| Rate for Payer: Dignity Health Senior |
$14,409.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$14,409.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$15,239.78
|
| Rate for Payer: Heritage Provider Network Senior |
$17,723.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$635.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,409.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$27,377.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,456.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,570.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,155.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,155.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18,155.76
|
| Rate for Payer: Multiplan Commercial |
$18,465.00
|
| Rate for Payer: Multiplan WC |
$22,958.69
|
| Rate for Payer: TriValley Medical Group Commercial |
$15,850.26
|
| Rate for Payer: TriValley Medical Group Senior |
$15,850.26
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,861.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,025.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Vantage Medical Group Senior |
$14,409.33
|
|
|
HC TRANSCATH PLCMT INT STNT OPEN PERC INIT VEIN
|
Facility
|
OP
|
$22,276.00
|
|
|
Service Code
|
CPT 37238
|
| Hospital Charge Code |
906811480
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$27,377.73 |
| Rate for Payer: Adventist Health Commercial |
$4,455.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15,303.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,409.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,111.00
|
| 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 |
$12,251.80
|
| Rate for Payer: Cash Price |
$12,251.80
|
| Rate for Payer: Cash Price |
$12,251.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14,479.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,850.26
|
| Rate for Payer: Dignity Health Senior |
$14,409.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$14,409.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$13,788.84
|
| Rate for Payer: Heritage Provider Network Senior |
$17,723.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$445.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,409.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$27,377.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,031.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,570.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,569.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,155.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18,155.76
|
| Rate for Payer: Multiplan Commercial |
$16,707.00
|
| Rate for Payer: Multiplan WC |
$22,958.69
|
| Rate for Payer: TriValley Medical Group Commercial |
$15,850.26
|
| Rate for Payer: TriValley Medical Group Senior |
$15,850.26
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,861.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,025.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Vantage Medical Group Senior |
$14,409.33
|
|
|
HC TRANSCATH PLCMT INT STNT OPEN PERC INIT VEIN
|
Facility
|
IP
|
$26,207.00
|
|
|
Service Code
|
CPT 37238
|
| Hospital Charge Code |
906820011
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,743.47 |
| Max. Negotiated Rate |
$19,655.25 |
| Rate for Payer: Adventist Health Commercial |
$5,241.40
|
| Rate for Payer: Cash Price |
$14,413.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$17,742.14
|
| Rate for Payer: Heritage Provider Network Senior |
$17,742.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,743.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,551.75
|
| Rate for Payer: Multiplan Commercial |
$19,655.25
|
|
|
HC TRANSCATH PLCMT INT STNT OPEN PERC INIT VEIN
|
Facility
|
IP
|
$22,276.00
|
|
|
Service Code
|
CPT 37238
|
| Hospital Charge Code |
906811480
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,031.96 |
| Max. Negotiated Rate |
$16,707.00 |
| Rate for Payer: Adventist Health Commercial |
$4,455.20
|
| Rate for Payer: Cash Price |
$12,251.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$15,080.85
|
| Rate for Payer: Heritage Provider Network Senior |
$15,080.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,031.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,569.00
|
| Rate for Payer: Multiplan Commercial |
$16,707.00
|
|
