|
HC TRANSCATH RMVL SC LEADLESS PMKR RA
|
Facility
|
IP
|
$7,466.00
|
|
|
Service Code
|
CPT 0824T
|
| Hospital Charge Code |
906819774
|
|
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 SC LEADLESS PMKR RA
|
Facility
|
OP
|
$7,466.00
|
|
|
Service Code
|
CPT 0824T
|
| Hospital Charge Code |
906819774
|
|
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 SEPTAL REDUCT THER
|
Facility
|
OP
|
$23,492.00
|
|
|
Service Code
|
CPT 93583
|
| Hospital Charge Code |
906820293
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$19,968.20 |
| Rate for Payer: Adventist Health Commercial |
$4,698.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16,139.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19,968.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12,920.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17,619.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,354.00
|
| 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 |
$12,920.60
|
| Rate for Payer: Cash Price |
$12,920.60
|
| Rate for Payer: Cash Price |
$12,920.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15,269.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19,968.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$19,968.20
|
| Rate for Payer: Dignity Health Senior |
$19,968.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,095.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$14,541.55
|
| Rate for Payer: Heritage Provider Network Senior |
$14,541.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$815.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$11,205.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,252.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,873.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16,444.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16,444.40
|
| Rate for Payer: Multiplan Commercial |
$17,619.00
|
| 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 |
$19,968.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19,968.20
|
| Rate for Payer: Vantage Medical Group Senior |
$19,968.20
|
|
|
HC TRANSCATH SEPTAL REDUCT THER
|
Facility
|
IP
|
$23,492.00
|
|
|
Service Code
|
CPT 93583
|
| Hospital Charge Code |
906820293
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,252.05 |
| Max. Negotiated Rate |
$17,619.00 |
| Rate for Payer: Adventist Health Commercial |
$4,698.40
|
| Rate for Payer: Cash Price |
$12,920.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$15,904.08
|
| Rate for Payer: Heritage Provider Network Senior |
$15,904.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,252.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,873.00
|
| Rate for Payer: Multiplan Commercial |
$17,619.00
|
|
|
HC TRANSCATH THRPY EMBOLIZATION
|
Facility
|
IP
|
$8,178.00
|
|
|
Service Code
|
CPT 75894
|
| Hospital Charge Code |
906820133
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,480.22 |
| Max. Negotiated Rate |
$6,133.50 |
| Rate for Payer: Adventist Health Commercial |
$1,635.60
|
| Rate for Payer: Cash Price |
$4,497.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,536.51
|
| Rate for Payer: Heritage Provider Network Senior |
$5,536.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,480.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,044.50
|
| Rate for Payer: Multiplan Commercial |
$6,133.50
|
|
|
HC TRANSCATH THRPY EMBOLIZATION
|
Facility
|
IP
|
$8,656.00
|
|
|
Service Code
|
CPT 75894
|
| Hospital Charge Code |
906812173
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,566.74 |
| Max. Negotiated Rate |
$6,492.00 |
| Rate for Payer: Adventist Health Commercial |
$1,731.20
|
| Rate for Payer: Cash Price |
$4,760.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,860.11
|
| Rate for Payer: Heritage Provider Network Senior |
$5,860.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,566.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,164.00
|
| Rate for Payer: Multiplan Commercial |
$6,492.00
|
|
|
HC TRANSCATH THRPY EMBOLIZATION
|
Facility
|
OP
|
$8,178.00
|
|
|
Service Code
|
CPT 75894
|
| Hospital Charge Code |
906820133
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,480.22 |
| Max. Negotiated Rate |
$6,951.30 |
| Rate for Payer: Adventist Health Commercial |
$1,635.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,371.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,618.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,951.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,497.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,133.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,269.10
|
| Rate for Payer: Blue Shield of California Commercial |
$5,075.81
|
| Rate for Payer: Blue Shield of California EPN |
$4,081.80
|
| Rate for Payer: Cash Price |
$4,497.90
|
| Rate for Payer: Cash Price |
$4,497.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,315.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,951.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,951.30
|
| Rate for Payer: Dignity Health Senior |
$6,951.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,315.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,062.18
|
| Rate for Payer: Heritage Provider Network Senior |
$5,062.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,900.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,480.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,044.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,724.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,724.60
|
| Rate for Payer: Multiplan Commercial |
$6,133.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4,089.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4,089.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,951.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,951.30
|
| Rate for Payer: Vantage Medical Group Senior |
$6,951.30
|
|
|
HC TRANSCATH THRPY EMBOLIZATION
|
Facility
|
OP
|
$8,656.00
|
|
|
Service Code
|
CPT 75894
|
| Hospital Charge Code |
906812173
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,566.74 |
| Max. Negotiated Rate |
$7,357.60 |
| Rate for Payer: Adventist Health Commercial |
$1,731.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,626.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,946.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,357.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,760.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,492.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,269.10
|
| Rate for Payer: Blue Shield of California Commercial |
$5,075.81
|
| Rate for Payer: Blue Shield of California EPN |
$4,081.80
|
| Rate for Payer: Cash Price |
$4,760.80
|
| Rate for Payer: Cash Price |
$4,760.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,626.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,357.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,357.60
|
| Rate for Payer: Dignity Health Senior |
$7,357.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,626.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,358.06
|
| Rate for Payer: Heritage Provider Network Senior |
$5,358.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,128.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,566.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,164.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,059.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,059.20
|
| Rate for Payer: Multiplan Commercial |
$6,492.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4,328.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4,328.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,357.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,357.60
|
| Rate for Payer: Vantage Medical Group Senior |
$7,357.60
|
|
|
HC TRANSCATH TRICUSP VALVE ADDT
|
Facility
|
IP
|
$24,198.00
|
|
|
Service Code
|
CPT 0570T
|
| Hospital Charge Code |
906820273
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,379.84 |
| Max. Negotiated Rate |
$18,148.50 |
| Rate for Payer: Adventist Health Commercial |
$4,839.60
|
| Rate for Payer: Cash Price |
$13,308.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$16,382.05
|
| Rate for Payer: Heritage Provider Network Senior |
$16,382.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,379.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,049.50
|
| Rate for Payer: Multiplan Commercial |
$18,148.50
|
|
|
HC TRANSCATH TRICUSP VALVE ADDT
|
Facility
|
IP
|
$18,441.00
|
|
|
Service Code
|
CPT 0570T
|
| Hospital Charge Code |
906810570
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,337.82 |
| Max. Negotiated Rate |
$13,830.75 |
| Rate for Payer: Adventist Health Commercial |
$3,688.20
|
| Rate for Payer: Cash Price |
$10,142.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$12,484.56
|
| Rate for Payer: Heritage Provider Network Senior |
$12,484.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,337.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,610.25
|
| Rate for Payer: Multiplan Commercial |
$13,830.75
|
|
|
HC TRANSCATH TRICUSP VALVE ADDT
|
Facility
|
OP
|
$24,198.00
|
|
|
Service Code
|
CPT 0570T
|
| Hospital Charge Code |
906820273
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,984.00 |
| Max. Negotiated Rate |
$20,568.30 |
| Rate for Payer: Adventist Health Commercial |
$4,839.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16,624.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20,568.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13,308.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18,148.50
|
| 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 |
$13,308.90
|
| Rate for Payer: Cash Price |
$13,308.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15,728.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20,568.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$20,568.30
|
| Rate for Payer: Dignity Health Senior |
$20,568.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$14,978.56
|
| Rate for Payer: Heritage Provider Network Senior |
$14,978.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$11,542.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,379.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,049.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16,938.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16,938.60
|
| Rate for Payer: Multiplan Commercial |
$18,148.50
|
| 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 |
$20,568.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20,568.30
|
| Rate for Payer: Vantage Medical Group Senior |
$20,568.30
|
|
|
HC TRANSCATH TRICUSP VALVE ADDT
|
Facility
|
OP
|
$18,441.00
|
|
|
Service Code
|
CPT 0570T
|
| Hospital Charge Code |
906810570
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,984.00 |
| Max. Negotiated Rate |
$15,674.85 |
| Rate for Payer: Adventist Health Commercial |
$3,688.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12,668.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15,674.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,142.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,830.75
|
| 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 |
$10,142.55
|
| Rate for Payer: Cash Price |
$10,142.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11,986.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15,674.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,674.85
|
| Rate for Payer: Dignity Health Senior |
$15,674.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,414.98
|
| Rate for Payer: Heritage Provider Network Senior |
$11,414.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8,796.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,337.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,610.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12,908.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12,908.70
|
| Rate for Payer: Multiplan Commercial |
$13,830.75
|
| 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 |
$15,674.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,674.85
|
| Rate for Payer: Vantage Medical Group Senior |
$15,674.85
|
|
|
HC TRANSCATH TRICUSP VALVE ANNUL
|
Facility
|
IP
|
$78,157.00
|
|
|
Service Code
|
CPT 0545T
|
| Hospital Charge Code |
906820271
|
|
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 TRICUSP VALVE ANNUL
|
Facility
|
OP
|
$59,559.00
|
|
|
Service Code
|
CPT 0545T
|
| Hospital Charge Code |
906810545
|
|
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 TRICUSP VALVE ANNUL
|
Facility
|
IP
|
$59,559.00
|
|
|
Service Code
|
CPT 0545T
|
| Hospital Charge Code |
906810545
|
|
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 TRICUSP VALVE ANNUL
|
Facility
|
OP
|
$78,157.00
|
|
|
Service Code
|
CPT 0545T
|
| Hospital Charge Code |
906820271
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,984.00 |
| 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 |
$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 |
$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: 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 TRICUSPVALVE IMPLANT
|
Facility
|
OP
|
$89,881.00
|
|
|
Service Code
|
CPT 0646T
|
| Hospital Charge Code |
906820300
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,984.00 |
| Max. Negotiated Rate |
$76,398.85 |
| Rate for Payer: Adventist Health Commercial |
$17,976.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$61,748.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76,398.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$49,434.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67,410.75
|
| 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 |
$49,434.55
|
| Rate for Payer: Cash Price |
$49,434.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$58,422.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76,398.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$76,398.85
|
| Rate for Payer: Dignity Health Senior |
$76,398.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$55,636.34
|
| Rate for Payer: Heritage Provider Network Senior |
$55,636.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$42,873.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16,268.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22,470.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$62,916.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$62,916.70
|
| Rate for Payer: Multiplan Commercial |
$67,410.75
|
| 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 |
$76,398.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$76,398.85
|
| Rate for Payer: Vantage Medical Group Senior |
$76,398.85
|
|
|
HC TRANSCATH TRICUSPVALVE IMPLANT
|
Facility
|
IP
|
$65,993.00
|
|
|
Service Code
|
CPT 0646T
|
| Hospital Charge Code |
906803799
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$11,944.73 |
| Max. Negotiated Rate |
$49,494.75 |
| Rate for Payer: Adventist Health Commercial |
$13,198.60
|
| Rate for Payer: Cash Price |
$36,296.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$44,677.26
|
| Rate for Payer: Heritage Provider Network Senior |
$44,677.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,944.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16,498.25
|
| Rate for Payer: Multiplan Commercial |
$49,494.75
|
|
|
HC TRANSCATH TRICUSPVALVE IMPLANT
|
Facility
|
OP
|
$65,993.00
|
|
|
Service Code
|
CPT 0646T
|
| Hospital Charge Code |
906803799
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,984.00 |
| Max. Negotiated Rate |
$56,094.05 |
| Rate for Payer: Adventist Health Commercial |
$13,198.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$45,337.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$56,094.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$36,296.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$49,494.75
|
| 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 |
$36,296.15
|
| Rate for Payer: Cash Price |
$36,296.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$42,895.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$56,094.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$56,094.05
|
| Rate for Payer: Dignity Health Senior |
$56,094.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$40,849.67
|
| Rate for Payer: Heritage Provider Network Senior |
$40,849.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$31,478.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,944.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16,498.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$46,195.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$46,195.10
|
| Rate for Payer: Multiplan Commercial |
$49,494.75
|
| 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 |
$56,094.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56,094.05
|
| Rate for Payer: Vantage Medical Group Senior |
$56,094.05
|
|
|
HC TRANSCATH TRICUSPVALVE IMPLANT
|
Facility
|
IP
|
$89,881.00
|
|
|
Service Code
|
CPT 0646T
|
| Hospital Charge Code |
906820300
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$16,268.46 |
| Max. Negotiated Rate |
$67,410.75 |
| Rate for Payer: Adventist Health Commercial |
$17,976.20
|
| Rate for Payer: Cash Price |
$49,434.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$60,849.44
|
| Rate for Payer: Heritage Provider Network Senior |
$60,849.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16,268.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22,470.25
|
| Rate for Payer: Multiplan Commercial |
$67,410.75
|
|
|
HC TRANSCATH TRICUSP VALVE REPAIR
|
Facility
|
OP
|
$59,559.00
|
|
|
Service Code
|
CPT 0569T
|
| Hospital Charge Code |
906810569
|
|
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 TRICUSP VALVE REPAIR
|
Facility
|
OP
|
$78,157.00
|
|
|
Service Code
|
CPT 0569T
|
| Hospital Charge Code |
906820272
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,984.00 |
| 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 |
$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 |
$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: 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 TRICUSP VALVE REPAIR
|
Facility
|
IP
|
$59,559.00
|
|
|
Service Code
|
CPT 0569T
|
| Hospital Charge Code |
906810569
|
|
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 TRICUSP VALVE REPAIR
|
Facility
|
IP
|
$78,157.00
|
|
|
Service Code
|
CPT 0569T
|
| Hospital Charge Code |
906820272
|
|
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 TRANSCRANIAL DUPLEX/DOPPLER
|
Facility
|
OP
|
$1,090.00
|
|
|
Service Code
|
CPT 93888
|
| Hospital Charge Code |
906601144
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$135.12 |
| Max. Negotiated Rate |
$1,077.00 |
| Rate for Payer: Adventist Health Commercial |
$218.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$582.61
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$748.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Blue Shield of California Commercial |
$602.59
|
| Rate for Payer: Blue Shield of California EPN |
$484.58
|
| Rate for Payer: Cash Price |
$599.50
|
| Rate for Payer: Cash Price |
$599.50
|
| Rate for Payer: Cash Price |
$599.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$708.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Senior |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$708.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$135.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$674.71
|
| Rate for Payer: Heritage Provider Network Senior |
$674.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$210.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$519.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$197.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$155.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$272.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$170.25
|
| Rate for Payer: Multiplan Commercial |
$817.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$148.63
|
| Rate for Payer: TriValley Medical Group Senior |
$135.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,077.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$908.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
