|
HC TRANSCATH PLCMT INT STNT OPEN PERC INIT VEIN
|
Facility
|
OP
|
$26,207.00
|
|
|
Service Code
|
CPT 37238
|
| Hospital Charge Code |
906820011
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$27,377.73 |
| Rate for Payer: Adventist Health Commercial |
$5,241.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18,004.21
|
| 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 |
$14,413.85
|
| Rate for Payer: Cash Price |
$14,413.85
|
| Rate for Payer: Cash Price |
$14,413.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$17,034.55
|
| 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 |
$16,222.13
|
| 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 |
$4,743.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,570.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,551.75
|
| 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 |
$19,655.25
|
| 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 PULM VALVE IMPLANT
|
Facility
|
IP
|
$74,249.00
|
|
|
Service Code
|
CPT 33477
|
| Hospital Charge Code |
906820256
|
|
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 PULM VALVE IMPLANT
|
Facility
|
OP
|
$74,249.00
|
|
|
Service Code
|
CPT 33477
|
| Hospital Charge Code |
906820256
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,808.18 |
| 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: 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: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,808.18
|
| 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 RENAL DENERVATION
|
Facility
|
OP
|
$11,717.00
|
|
|
Service Code
|
CPT 0338T
|
| Hospital Charge Code |
906820002
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$10,866.52 |
| Rate for Payer: Adventist Health Commercial |
$2,343.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,049.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,968.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,244.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,004.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,147.37
|
| Rate for Payer: Blue Shield of California EPN |
$5,717.90
|
| Rate for Payer: Cash Price |
$6,444.35
|
| Rate for Payer: Cash Price |
$6,444.35
|
| Rate for Payer: Cash Price |
$6,444.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,616.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,968.78
|
| Rate for Payer: Dignity Health Senior |
$7,244.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,244.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,252.82
|
| Rate for Payer: Heritage Provider Network Senior |
$7,252.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,244.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5,589.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,120.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,331.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,929.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,127.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,127.88
|
| Rate for Payer: Multiplan Commercial |
$8,787.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$7,244.35
|
| Rate for Payer: TriValley Medical Group Senior |
$7,244.35
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5,858.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,858.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,968.78
|
| Rate for Payer: Vantage Medical Group Senior |
$7,244.35
|
|
|
HC TRANSCATH RENAL DENERVATION
|
Facility
|
IP
|
$11,717.00
|
|
|
Service Code
|
CPT 0338T
|
| Hospital Charge Code |
906820002
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,120.78 |
| Max. Negotiated Rate |
$8,787.75 |
| Rate for Payer: Adventist Health Commercial |
$2,343.40
|
| Rate for Payer: Cash Price |
$6,444.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,932.41
|
| Rate for Payer: Heritage Provider Network Senior |
$7,932.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,120.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,929.25
|
| Rate for Payer: Multiplan Commercial |
$8,787.75
|
|
|
HC TRANSCATH RENAL DENERVATION
|
Facility
|
OP
|
$11,261.00
|
|
|
Service Code
|
CPT 0338T
|
| Hospital Charge Code |
906811473
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$10,866.52 |
| Rate for Payer: Adventist Health Commercial |
$2,252.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,736.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,968.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,244.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,004.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,869.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,495.37
|
| Rate for Payer: Cash Price |
$6,193.55
|
| Rate for Payer: Cash Price |
$6,193.55
|
| Rate for Payer: Cash Price |
$6,193.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,319.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,968.78
|
| Rate for Payer: Dignity Health Senior |
$7,244.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,244.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,970.56
|
| Rate for Payer: Heritage Provider Network Senior |
$6,970.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,244.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5,371.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,038.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,331.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,815.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,127.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,127.88
|
| Rate for Payer: Multiplan Commercial |
$8,445.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$7,244.35
|
| Rate for Payer: TriValley Medical Group Senior |
$7,244.35
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5,630.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,630.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,968.78
|
| Rate for Payer: Vantage Medical Group Senior |
$7,244.35
|
|
|
HC TRANSCATH RENAL DENERVATION
|
Facility
|
IP
|
$11,261.00
|
|
|
Service Code
|
CPT 0338T
|
| Hospital Charge Code |
906811473
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,038.24 |
| Max. Negotiated Rate |
$8,445.75 |
| Rate for Payer: Adventist Health Commercial |
$2,252.20
|
| Rate for Payer: Cash Price |
$6,193.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,623.70
|
| Rate for Payer: Heritage Provider Network Senior |
$7,623.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,038.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,815.25
|
| Rate for Payer: Multiplan Commercial |
$8,445.75
|
|
|
HC TRANSCATH RENAL DENERVATION BILATERAL
|
Facility
|
OP
|
$17,576.00
|
|
|
Service Code
|
CPT 0339T
|
| Hospital Charge Code |
906820003
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$13,182.00 |
| Rate for Payer: Adventist Health Commercial |
$3,515.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12,074.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,968.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,244.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,004.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,721.36
|
| Rate for Payer: Blue Shield of California EPN |
$8,577.09
|
| Rate for Payer: Cash Price |
$9,666.80
|
| Rate for Payer: Cash Price |
$9,666.80
|
| Rate for Payer: Cash Price |
$9,666.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11,424.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,968.78
|
| Rate for Payer: Dignity Health Senior |
$7,244.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,244.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$10,879.54
|
| Rate for Payer: Heritage Provider Network Senior |
$10,879.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,244.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8,383.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,181.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,331.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,394.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,127.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,127.88
|
| Rate for Payer: Multiplan Commercial |
$13,182.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$7,244.35
|
| Rate for Payer: TriValley Medical Group Senior |
$7,244.35
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8,788.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,788.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,968.78
|
| Rate for Payer: Vantage Medical Group Senior |
$7,244.35
|
|
|
HC TRANSCATH RENAL DENERVATION BILATERAL
|
Facility
|
OP
|
$16,891.00
|
|
|
Service Code
|
CPT 0339T
|
| Hospital Charge Code |
906811474
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$12,668.25 |
| Rate for Payer: Adventist Health Commercial |
$3,378.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11,604.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,968.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,244.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,004.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,303.51
|
| Rate for Payer: Blue Shield of California EPN |
$8,242.81
|
| Rate for Payer: Cash Price |
$9,290.05
|
| Rate for Payer: Cash Price |
$9,290.05
|
| Rate for Payer: Cash Price |
$9,290.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10,979.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,968.78
|
| Rate for Payer: Dignity Health Senior |
$7,244.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,244.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$10,455.53
|
| Rate for Payer: Heritage Provider Network Senior |
$10,455.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,244.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8,057.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,057.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,331.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,222.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,127.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,127.88
|
| Rate for Payer: Multiplan Commercial |
$12,668.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$7,244.35
|
| Rate for Payer: TriValley Medical Group Senior |
$7,244.35
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8,445.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,445.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,968.78
|
| Rate for Payer: Vantage Medical Group Senior |
$7,244.35
|
|
|
HC TRANSCATH RENAL DENERVATION BILATERAL
|
Facility
|
IP
|
$17,576.00
|
|
|
Service Code
|
CPT 0339T
|
| Hospital Charge Code |
906820003
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$3,181.26 |
| Max. Negotiated Rate |
$13,182.00 |
| Rate for Payer: Adventist Health Commercial |
$3,515.20
|
| Rate for Payer: Cash Price |
$9,666.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,898.95
|
| Rate for Payer: Heritage Provider Network Senior |
$11,898.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,181.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,394.00
|
| Rate for Payer: Multiplan Commercial |
$13,182.00
|
|
|
HC TRANSCATH RENAL DENERVATION BILATERAL
|
Facility
|
IP
|
$16,891.00
|
|
|
Service Code
|
CPT 0339T
|
| Hospital Charge Code |
906811474
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$3,057.27 |
| Max. Negotiated Rate |
$12,668.25 |
| Rate for Payer: Adventist Health Commercial |
$3,378.20
|
| Rate for Payer: Cash Price |
$9,290.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,435.21
|
| Rate for Payer: Heritage Provider Network Senior |
$11,435.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,057.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,222.75
|
| Rate for Payer: Multiplan Commercial |
$12,668.25
|
|
|
HC TRANSCATH RMVL DC LEADLESS PMKR RA PM COMPNT
|
Facility
|
OP
|
$7,466.00
|
|
|
Service Code
|
CPT 0799T
|
| Hospital Charge Code |
906819781
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,493.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,129.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$4,106.30
|
| Rate for Payer: Cash Price |
$4,106.30
|
| Rate for Payer: Cash Price |
$4,106.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,852.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Senior |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,999.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,621.45
|
| Rate for Payer: Heritage Provider Network Senior |
$4,919.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,598.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,351.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,599.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,866.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,039.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,039.00
|
| Rate for Payer: Multiplan Commercial |
$5,599.50
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,399.13
|
| Rate for Payer: TriValley Medical Group Senior |
$4,399.13
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,733.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,733.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC TRANSCATH RMVL DC LEADLESS PMKR RA PM COMPNT
|
Facility
|
IP
|
$7,466.00
|
|
|
Service Code
|
CPT 0799T
|
| Hospital Charge Code |
906819781
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,351.35 |
| Max. Negotiated Rate |
$5,599.50 |
| Rate for Payer: Adventist Health Commercial |
$1,493.20
|
| Rate for Payer: Cash Price |
$4,106.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,054.48
|
| Rate for Payer: Heritage Provider Network Senior |
$5,054.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,351.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,866.50
|
| Rate for Payer: Multiplan Commercial |
$5,599.50
|
|
|
HC TRANSCATH RMVL DC LEADLESS PMKR RA RV COMP SYS
|
Facility
|
IP
|
$7,466.00
|
|
|
Service Code
|
CPT 0798T
|
| Hospital Charge Code |
906819780
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,351.35 |
| Max. Negotiated Rate |
$5,599.50 |
| Rate for Payer: Adventist Health Commercial |
$1,493.20
|
| Rate for Payer: Cash Price |
$4,106.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,054.48
|
| Rate for Payer: Heritage Provider Network Senior |
$5,054.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,351.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,866.50
|
| Rate for Payer: Multiplan Commercial |
$5,599.50
|
|
|
HC TRANSCATH RMVL DC LEADLESS PMKR RA RV COMP SYS
|
Facility
|
OP
|
$7,466.00
|
|
|
Service Code
|
CPT 0798T
|
| Hospital Charge Code |
906819780
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,493.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,129.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$4,106.30
|
| Rate for Payer: Cash Price |
$4,106.30
|
| Rate for Payer: Cash Price |
$4,106.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,852.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Senior |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,999.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,621.45
|
| Rate for Payer: Heritage Provider Network Senior |
$4,919.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,598.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,351.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,599.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,866.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,039.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,039.00
|
| Rate for Payer: Multiplan Commercial |
$5,599.50
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,399.13
|
| Rate for Payer: TriValley Medical Group Senior |
$4,399.13
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,733.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,733.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC TRANSCATH RMVL DC LEADLESS PMKR RA RV PM COMPNT
|
Facility
|
OP
|
$7,466.00
|
|
|
Service Code
|
CPT 0800T
|
| Hospital Charge Code |
906819782
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,493.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,129.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$4,106.30
|
| Rate for Payer: Cash Price |
$4,106.30
|
| Rate for Payer: Cash Price |
$4,106.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,852.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Senior |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,999.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,621.45
|
| Rate for Payer: Heritage Provider Network Senior |
$4,919.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,598.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,351.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,599.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,866.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,039.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,039.00
|
| Rate for Payer: Multiplan Commercial |
$5,599.50
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,399.13
|
| Rate for Payer: TriValley Medical Group Senior |
$4,399.13
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,733.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,733.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC TRANSCATH RMVL DC LEADLESS PMKR RA RV PM COMPNT
|
Facility
|
IP
|
$7,466.00
|
|
|
Service Code
|
CPT 0800T
|
| Hospital Charge Code |
906819782
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,351.35 |
| Max. Negotiated Rate |
$5,599.50 |
| Rate for Payer: Adventist Health Commercial |
$1,493.20
|
| Rate for Payer: Cash Price |
$4,106.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,054.48
|
| Rate for Payer: Heritage Provider Network Senior |
$5,054.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,351.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,866.50
|
| Rate for Payer: Multiplan Commercial |
$5,599.50
|
|
|
HC TRANSCATH RMVL REPL DC LEADLESS PMKR RA PM COMPNT
|
Facility
|
OP
|
$45,636.00
|
|
|
Service Code
|
CPT 0802T
|
| Hospital Charge Code |
906819784
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$46,040.46 |
| Rate for Payer: Adventist Health Commercial |
$9,127.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$31,351.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36,347.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26,655.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24,231.82
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$25,099.80
|
| Rate for Payer: Cash Price |
$25,099.80
|
| Rate for Payer: Cash Price |
$25,099.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$29,663.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36,347.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$26,655.00
|
| Rate for Payer: Dignity Health Senior |
$24,231.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$24,231.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$28,248.68
|
| Rate for Payer: Heritage Provider Network Senior |
$29,805.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24,231.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$46,040.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,260.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27,866.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,409.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30,532.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30,532.09
|
| Rate for Payer: Multiplan Commercial |
$34,227.00
|
| Rate for Payer: Multiplan WC |
$38,609.08
|
| Rate for Payer: TriValley Medical Group Commercial |
$26,655.00
|
| Rate for Payer: TriValley Medical Group Senior |
$26,655.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$22,818.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$22,818.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36,347.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26,655.00
|
| Rate for Payer: Vantage Medical Group Senior |
$24,231.82
|
|
|
HC TRANSCATH RMVL REPL DC LEADLESS PMKR RA PM COMPNT
|
Facility
|
IP
|
$45,636.00
|
|
|
Service Code
|
CPT 0802T
|
| Hospital Charge Code |
906819784
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$8,260.12 |
| Max. Negotiated Rate |
$34,227.00 |
| Rate for Payer: Adventist Health Commercial |
$9,127.20
|
| Rate for Payer: Cash Price |
$25,099.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$30,895.57
|
| Rate for Payer: Heritage Provider Network Senior |
$30,895.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,260.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,409.00
|
| Rate for Payer: Multiplan Commercial |
$34,227.00
|
|
|
HC TRANSCATH RMVL REPL DC LEADLESS PMKR RA RV
|
Facility
|
IP
|
$45,636.00
|
|
|
Service Code
|
CPT 0801T
|
| Hospital Charge Code |
906819783
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$8,260.12 |
| Max. Negotiated Rate |
$34,227.00 |
| Rate for Payer: Adventist Health Commercial |
$9,127.20
|
| Rate for Payer: Cash Price |
$25,099.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$30,895.57
|
| Rate for Payer: Heritage Provider Network Senior |
$30,895.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,260.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,409.00
|
| Rate for Payer: Multiplan Commercial |
$34,227.00
|
|
|
HC TRANSCATH RMVL REPL DC LEADLESS PMKR RA RV
|
Facility
|
OP
|
$45,636.00
|
|
|
Service Code
|
CPT 0801T
|
| Hospital Charge Code |
906819783
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$46,040.46 |
| Rate for Payer: Adventist Health Commercial |
$9,127.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$31,351.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36,347.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26,655.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24,231.82
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$25,099.80
|
| Rate for Payer: Cash Price |
$25,099.80
|
| Rate for Payer: Cash Price |
$25,099.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$29,663.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36,347.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$26,655.00
|
| Rate for Payer: Dignity Health Senior |
$24,231.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$24,231.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$28,248.68
|
| Rate for Payer: Heritage Provider Network Senior |
$29,805.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24,231.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$46,040.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,260.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27,866.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,409.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30,532.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30,532.09
|
| Rate for Payer: Multiplan Commercial |
$34,227.00
|
| Rate for Payer: Multiplan WC |
$38,609.08
|
| Rate for Payer: TriValley Medical Group Commercial |
$26,655.00
|
| Rate for Payer: TriValley Medical Group Senior |
$26,655.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$22,818.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$22,818.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36,347.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26,655.00
|
| Rate for Payer: Vantage Medical Group Senior |
$24,231.82
|
|
|
HC TRANSCATH RMVL REPL DC LEADLESS PMKR RV PM COMPNT
|
Facility
|
IP
|
$45,636.00
|
|
|
Service Code
|
CPT 0803T
|
| Hospital Charge Code |
906819785
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$8,260.12 |
| Max. Negotiated Rate |
$34,227.00 |
| Rate for Payer: Adventist Health Commercial |
$9,127.20
|
| Rate for Payer: Cash Price |
$25,099.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$30,895.57
|
| Rate for Payer: Heritage Provider Network Senior |
$30,895.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,260.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,409.00
|
| Rate for Payer: Multiplan Commercial |
$34,227.00
|
|
|
HC TRANSCATH RMVL REPL DC LEADLESS PMKR RV PM COMPNT
|
Facility
|
OP
|
$45,636.00
|
|
|
Service Code
|
CPT 0803T
|
| Hospital Charge Code |
906819785
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$46,040.46 |
| Rate for Payer: Adventist Health Commercial |
$9,127.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$31,351.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36,347.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26,655.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24,231.82
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$25,099.80
|
| Rate for Payer: Cash Price |
$25,099.80
|
| Rate for Payer: Cash Price |
$25,099.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$29,663.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36,347.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$26,655.00
|
| Rate for Payer: Dignity Health Senior |
$24,231.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$24,231.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$28,248.68
|
| Rate for Payer: Heritage Provider Network Senior |
$29,805.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24,231.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$46,040.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,260.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27,866.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,409.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30,532.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30,532.09
|
| Rate for Payer: Multiplan Commercial |
$34,227.00
|
| Rate for Payer: Multiplan WC |
$38,609.08
|
| Rate for Payer: TriValley Medical Group Commercial |
$26,655.00
|
| Rate for Payer: TriValley Medical Group Senior |
$26,655.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$22,818.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$22,818.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36,347.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26,655.00
|
| Rate for Payer: Vantage Medical Group Senior |
$24,231.82
|
|
|
HC TRANSCATH RMVL REPL SC LEADLESS PMKR RA
|
Facility
|
OP
|
$45,636.00
|
|
|
Service Code
|
CPT 0825T
|
| Hospital Charge Code |
906819775
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$46,040.46 |
| Rate for Payer: Adventist Health Commercial |
$9,127.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$31,351.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36,347.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26,655.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24,231.82
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$25,099.80
|
| Rate for Payer: Cash Price |
$25,099.80
|
| Rate for Payer: Cash Price |
$25,099.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$29,663.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36,347.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$26,655.00
|
| Rate for Payer: Dignity Health Senior |
$24,231.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$24,231.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$28,248.68
|
| Rate for Payer: Heritage Provider Network Senior |
$29,805.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24,231.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$46,040.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,260.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27,866.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,409.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30,532.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30,532.09
|
| Rate for Payer: Multiplan Commercial |
$34,227.00
|
| Rate for Payer: Multiplan WC |
$38,609.08
|
| Rate for Payer: TriValley Medical Group Commercial |
$26,655.00
|
| Rate for Payer: TriValley Medical Group Senior |
$26,655.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$22,818.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$22,818.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36,347.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26,655.00
|
| Rate for Payer: Vantage Medical Group Senior |
$24,231.82
|
|
|
HC TRANSCATH RMVL REPL SC LEADLESS PMKR RA
|
Facility
|
IP
|
$45,636.00
|
|
|
Service Code
|
CPT 0825T
|
| Hospital Charge Code |
906819775
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$8,260.12 |
| Max. Negotiated Rate |
$34,227.00 |
| Rate for Payer: Adventist Health Commercial |
$9,127.20
|
| Rate for Payer: Cash Price |
$25,099.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$30,895.57
|
| Rate for Payer: Heritage Provider Network Senior |
$30,895.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,260.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,409.00
|
| Rate for Payer: Multiplan Commercial |
$34,227.00
|
|
