|
HC TRANSCATH RENAL DENERVATION
|
Facility
IP
|
$10,307.00
|
|
|
Service Code
|
CPT 0338T
|
| Hospital Charge Code |
906811473
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,865.57 |
| Max. Negotiated Rate |
$7,730.25 |
| Rate for Payer: Adventist Health Commercial |
$2,061.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,080.91
|
| Rate for Payer: Cash Price |
$4,638.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,977.84
|
| Rate for Payer: Heritage Provider Network Senior |
$6,977.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,865.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,576.75
|
| Rate for Payer: Multiplan Commercial |
$7,730.25
|
|
|
HC TRANSCATH RENAL DENERVATION
|
Facility
OP
|
$10,307.00
|
|
|
Service Code
|
CPT 0338T
|
| Hospital Charge Code |
906811473
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,865.57 |
| Max. Negotiated Rate |
$13,568.56 |
| Rate for Payer: Adventist Health Commercial |
$2,061.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,224.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,080.91
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10,712.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7,855.48
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7,141.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,400.65
|
| Rate for Payer: Blue Shield of California EPN |
$6,050.21
|
| Rate for Payer: Cash Price |
$4,638.15
|
| Rate for Payer: Cash Price |
$4,638.15
|
| Rate for Payer: Cash Price |
$4,638.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,699.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,712.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,855.48
|
| Rate for Payer: Dignity Health Senior |
$7,141.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,141.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,380.03
|
| Rate for Payer: Heritage Provider Network Senior |
$6,380.03
|
| Rate for Payer: Humana Medicare |
$7,141.35
|
| Rate for Payer: IEHP Medicare Advantage |
$7,141.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13,568.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,865.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,426.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,576.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,998.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,998.10
|
| Rate for Payer: Multiplan Commercial |
$7,730.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$7,141.35
|
| Rate for Payer: TriValley Medical Group Senior |
$7,141.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,712.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,855.48
|
| Rate for Payer: Vantage Medical Group Senior |
$7,141.35
|
|
|
HC TRANSCATH RENAL DENERVATION
|
Facility
OP
|
$12,334.00
|
|
|
Service Code
|
CPT 0338T
|
| Hospital Charge Code |
906820002
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,224.17 |
| Max. Negotiated Rate |
$13,568.56 |
| Rate for Payer: Adventist Health Commercial |
$2,466.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,224.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,473.46
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10,712.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7,855.48
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7,141.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,659.41
|
| Rate for Payer: Blue Shield of California EPN |
$7,240.06
|
| Rate for Payer: Cash Price |
$5,550.30
|
| Rate for Payer: Cash Price |
$5,550.30
|
| Rate for Payer: Cash Price |
$5,550.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8,017.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,712.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,855.48
|
| Rate for Payer: Dignity Health Senior |
$7,141.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,141.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,634.75
|
| Rate for Payer: Heritage Provider Network Senior |
$7,634.75
|
| Rate for Payer: Humana Medicare |
$7,141.35
|
| Rate for Payer: IEHP Medicare Advantage |
$7,141.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13,568.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,232.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,426.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,083.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,998.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,998.10
|
| Rate for Payer: Multiplan Commercial |
$9,250.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$7,141.35
|
| Rate for Payer: TriValley Medical Group Senior |
$7,141.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,712.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,855.48
|
| Rate for Payer: Vantage Medical Group Senior |
$7,141.35
|
|
|
HC TRANSCATH RENAL DENERVATION BILATERAL
|
Facility
OP
|
$18,501.00
|
|
|
Service Code
|
CPT 0339T
|
| Hospital Charge Code |
906820003
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,672.10 |
| Max. Negotiated Rate |
$13,875.75 |
| Rate for Payer: Adventist Health Commercial |
$3,700.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,672.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12,710.19
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10,712.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7,855.48
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7,141.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,489.12
|
| Rate for Payer: Blue Shield of California EPN |
$10,860.09
|
| Rate for Payer: Cash Price |
$8,325.45
|
| Rate for Payer: Cash Price |
$8,325.45
|
| Rate for Payer: Cash Price |
$8,325.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12,025.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,712.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,855.48
|
| Rate for Payer: Dignity Health Senior |
$7,141.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,141.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,452.12
|
| Rate for Payer: Heritage Provider Network Senior |
$11,452.12
|
| Rate for Payer: Humana Medicare |
$7,141.35
|
| Rate for Payer: IEHP Medicare Advantage |
$7,141.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13,568.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,348.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,426.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,625.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,998.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,998.10
|
| Rate for Payer: Multiplan Commercial |
$13,875.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$7,141.35
|
| Rate for Payer: TriValley Medical Group Senior |
$7,141.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,712.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,855.48
|
| Rate for Payer: Vantage Medical Group Senior |
$7,141.35
|
|
|
HC TRANSCATH RENAL DENERVATION BILATERAL
|
Facility
IP
|
$18,501.00
|
|
|
Service Code
|
CPT 0339T
|
| Hospital Charge Code |
906820003
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$3,348.68 |
| Max. Negotiated Rate |
$13,875.75 |
| Rate for Payer: Adventist Health Commercial |
$3,700.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12,710.19
|
| Rate for Payer: Cash Price |
$8,325.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$12,525.18
|
| Rate for Payer: Heritage Provider Network Senior |
$12,525.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,348.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,625.25
|
| Rate for Payer: Multiplan Commercial |
$13,875.75
|
|
|
HC TRANSCATH RENAL DENERVATION BILATERAL
|
Facility
OP
|
$15,461.00
|
|
|
Service Code
|
CPT 0339T
|
| Hospital Charge Code |
906811474
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,672.10 |
| Max. Negotiated Rate |
$13,568.56 |
| Rate for Payer: Adventist Health Commercial |
$3,092.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,672.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10,621.71
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10,712.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7,855.48
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7,141.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,601.28
|
| Rate for Payer: Blue Shield of California EPN |
$9,075.61
|
| Rate for Payer: Cash Price |
$6,957.45
|
| Rate for Payer: Cash Price |
$6,957.45
|
| Rate for Payer: Cash Price |
$6,957.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10,049.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,712.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,855.48
|
| Rate for Payer: Dignity Health Senior |
$7,141.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,141.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,570.36
|
| Rate for Payer: Heritage Provider Network Senior |
$9,570.36
|
| Rate for Payer: Humana Medicare |
$7,141.35
|
| Rate for Payer: IEHP Medicare Advantage |
$7,141.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13,568.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,798.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,426.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,865.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,998.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,998.10
|
| Rate for Payer: Multiplan Commercial |
$11,595.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$7,141.35
|
| Rate for Payer: TriValley Medical Group Senior |
$7,141.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,712.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,855.48
|
| Rate for Payer: Vantage Medical Group Senior |
$7,141.35
|
|
|
HC TRANSCATH RENAL DENERVATION BILATERAL
|
Facility
IP
|
$15,461.00
|
|
|
Service Code
|
CPT 0339T
|
| Hospital Charge Code |
906811474
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,798.44 |
| Max. Negotiated Rate |
$11,595.75 |
| Rate for Payer: Adventist Health Commercial |
$3,092.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10,621.71
|
| Rate for Payer: Cash Price |
$6,957.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$10,467.10
|
| Rate for Payer: Heritage Provider Network Senior |
$10,467.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,798.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,865.25
|
| Rate for Payer: Multiplan Commercial |
$11,595.75
|
|
|
HC TRANSCATH RMVL DC LEADLESS PMKR RA PM COMPNT
|
Facility
OP
|
$8,747.00
|
|
|
Service Code
|
CPT 0799T
|
| Hospital Charge Code |
906819781
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,583.21 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,749.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,009.19
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$3,936.15
|
| Rate for Payer: Cash Price |
$3,936.15
|
| Rate for Payer: Cash Price |
$3,936.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,685.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: Dignity Health Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,982.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,414.39
|
| Rate for Payer: Heritage Provider Network Senior |
$4,898.54
|
| Rate for Payer: Humana Medicare |
$3,982.55
|
| Rate for Payer: IEHP Medicare Advantage |
$3,982.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,566.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,583.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,699.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,186.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,018.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,018.01
|
| Rate for Payer: Multiplan Commercial |
$6,560.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,380.80
|
| Rate for Payer: TriValley Medical Group Senior |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC TRANSCATH RMVL DC LEADLESS PMKR RA PM COMPNT
|
Facility
IP
|
$8,747.00
|
|
|
Service Code
|
CPT 0799T
|
| Hospital Charge Code |
906819781
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,583.21 |
| Max. Negotiated Rate |
$6,560.25 |
| Rate for Payer: Adventist Health Commercial |
$1,749.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,009.19
|
| Rate for Payer: Cash Price |
$3,936.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,921.72
|
| Rate for Payer: Heritage Provider Network Senior |
$5,921.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,583.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,186.75
|
| Rate for Payer: Multiplan Commercial |
$6,560.25
|
|
|
HC TRANSCATH RMVL DC LEADLESS PMKR RA RV COMP SYS
|
Facility
IP
|
$8,747.00
|
|
|
Service Code
|
CPT 0798T
|
| Hospital Charge Code |
906819780
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,583.21 |
| Max. Negotiated Rate |
$6,560.25 |
| Rate for Payer: Adventist Health Commercial |
$1,749.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,009.19
|
| Rate for Payer: Cash Price |
$3,936.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,921.72
|
| Rate for Payer: Heritage Provider Network Senior |
$5,921.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,583.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,186.75
|
| Rate for Payer: Multiplan Commercial |
$6,560.25
|
|
|
HC TRANSCATH RMVL DC LEADLESS PMKR RA RV COMP SYS
|
Facility
OP
|
$8,747.00
|
|
|
Service Code
|
CPT 0798T
|
| Hospital Charge Code |
906819780
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,583.21 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,749.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5,088.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,009.19
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$3,936.15
|
| Rate for Payer: Cash Price |
$3,936.15
|
| Rate for Payer: Cash Price |
$3,936.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,685.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: Dignity Health Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,982.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,414.39
|
| Rate for Payer: Heritage Provider Network Senior |
$4,898.54
|
| Rate for Payer: Humana Medicare |
$3,982.55
|
| Rate for Payer: IEHP Medicare Advantage |
$3,982.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,566.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,583.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,699.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,186.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,018.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,018.01
|
| Rate for Payer: Multiplan Commercial |
$6,560.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,380.80
|
| Rate for Payer: TriValley Medical Group Senior |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC TRANSCATH RMVL DC LEADLESS PMKR RA RV PM COMPNT
|
Facility
OP
|
$8,747.00
|
|
|
Service Code
|
CPT 0800T
|
| Hospital Charge Code |
906819782
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,583.21 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,749.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,009.19
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$3,936.15
|
| Rate for Payer: Cash Price |
$3,936.15
|
| Rate for Payer: Cash Price |
$3,936.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,685.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: Dignity Health Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,982.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,414.39
|
| Rate for Payer: Heritage Provider Network Senior |
$4,898.54
|
| Rate for Payer: Humana Medicare |
$3,982.55
|
| Rate for Payer: IEHP Medicare Advantage |
$3,982.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,566.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,583.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,699.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,186.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,018.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,018.01
|
| Rate for Payer: Multiplan Commercial |
$6,560.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,380.80
|
| Rate for Payer: TriValley Medical Group Senior |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC TRANSCATH RMVL DC LEADLESS PMKR RA RV PM COMPNT
|
Facility
IP
|
$8,747.00
|
|
|
Service Code
|
CPT 0800T
|
| Hospital Charge Code |
906819782
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,583.21 |
| Max. Negotiated Rate |
$6,560.25 |
| Rate for Payer: Adventist Health Commercial |
$1,749.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,009.19
|
| Rate for Payer: Cash Price |
$3,936.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,921.72
|
| Rate for Payer: Heritage Provider Network Senior |
$5,921.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,583.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,186.75
|
| Rate for Payer: Multiplan Commercial |
$6,560.25
|
|
|
HC TRANSCATH RMVL REPL DC LEADLESS PMKR RA PM COMPNT
|
Facility
OP
|
$53,470.00
|
|
|
Service Code
|
CPT 0802T
|
| Hospital Charge Code |
906819784
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,088.00 |
| Max. Negotiated Rate |
$46,256.43 |
| Rate for Payer: Adventist Health Commercial |
$10,694.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5,088.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$36,733.89
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$36,518.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$26,780.04
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$24,345.49
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$24,061.50
|
| Rate for Payer: Cash Price |
$24,061.50
|
| Rate for Payer: Cash Price |
$24,061.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$34,755.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36,518.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$26,780.04
|
| Rate for Payer: Dignity Health Senior |
$24,345.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$24,345.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$33,097.93
|
| Rate for Payer: Heritage Provider Network Senior |
$29,944.95
|
| Rate for Payer: Humana Medicare |
$24,345.49
|
| Rate for Payer: IEHP Medicare Advantage |
$24,345.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$46,256.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,678.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28,727.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13,367.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30,675.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30,675.32
|
| Rate for Payer: Multiplan Commercial |
$40,102.50
|
| Rate for Payer: Multiplan WC |
$33,283.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$26,780.04
|
| Rate for Payer: TriValley Medical Group Senior |
$26,780.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36,518.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26,780.04
|
| Rate for Payer: Vantage Medical Group Senior |
$24,345.49
|
|
|
HC TRANSCATH RMVL REPL DC LEADLESS PMKR RA PM COMPNT
|
Facility
IP
|
$53,470.00
|
|
|
Service Code
|
CPT 0802T
|
| Hospital Charge Code |
906819784
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$9,678.07 |
| Max. Negotiated Rate |
$40,102.50 |
| Rate for Payer: Adventist Health Commercial |
$10,694.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$36,733.89
|
| Rate for Payer: Cash Price |
$24,061.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$36,199.19
|
| Rate for Payer: Heritage Provider Network Senior |
$36,199.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,678.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13,367.50
|
| Rate for Payer: Multiplan Commercial |
$40,102.50
|
|
|
HC TRANSCATH RMVL REPL DC LEADLESS PMKR RA RV
|
Facility
OP
|
$53,470.00
|
|
|
Service Code
|
CPT 0801T
|
| Hospital Charge Code |
906819783
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,420.00 |
| Max. Negotiated Rate |
$46,256.43 |
| Rate for Payer: Adventist Health Commercial |
$10,694.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,420.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$36,733.89
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$36,518.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$26,780.04
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$24,345.49
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$24,061.50
|
| Rate for Payer: Cash Price |
$24,061.50
|
| Rate for Payer: Cash Price |
$24,061.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$34,755.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36,518.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$26,780.04
|
| Rate for Payer: Dignity Health Senior |
$24,345.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$24,345.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$33,097.93
|
| Rate for Payer: Heritage Provider Network Senior |
$29,944.95
|
| Rate for Payer: Humana Medicare |
$24,345.49
|
| Rate for Payer: IEHP Medicare Advantage |
$24,345.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$46,256.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,678.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28,727.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13,367.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30,675.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30,675.32
|
| Rate for Payer: Multiplan Commercial |
$40,102.50
|
| Rate for Payer: Multiplan WC |
$33,283.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$26,780.04
|
| Rate for Payer: TriValley Medical Group Senior |
$26,780.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36,518.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26,780.04
|
| Rate for Payer: Vantage Medical Group Senior |
$24,345.49
|
|
|
HC TRANSCATH RMVL REPL DC LEADLESS PMKR RA RV
|
Facility
IP
|
$53,470.00
|
|
|
Service Code
|
CPT 0801T
|
| Hospital Charge Code |
906819783
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$9,678.07 |
| Max. Negotiated Rate |
$40,102.50 |
| Rate for Payer: Adventist Health Commercial |
$10,694.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$36,733.89
|
| Rate for Payer: Cash Price |
$24,061.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$36,199.19
|
| Rate for Payer: Heritage Provider Network Senior |
$36,199.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,678.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13,367.50
|
| Rate for Payer: Multiplan Commercial |
$40,102.50
|
|
|
HC TRANSCATH RMVL REPL DC LEADLESS PMKR RV PM COMPNT
|
Facility
IP
|
$53,470.00
|
|
|
Service Code
|
CPT 0803T
|
| Hospital Charge Code |
906819785
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$9,678.07 |
| Max. Negotiated Rate |
$40,102.50 |
| Rate for Payer: Adventist Health Commercial |
$10,694.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$36,733.89
|
| Rate for Payer: Cash Price |
$24,061.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$36,199.19
|
| Rate for Payer: Heritage Provider Network Senior |
$36,199.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,678.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13,367.50
|
| Rate for Payer: Multiplan Commercial |
$40,102.50
|
|
|
HC TRANSCATH RMVL REPL DC LEADLESS PMKR RV PM COMPNT
|
Facility
OP
|
$53,470.00
|
|
|
Service Code
|
CPT 0803T
|
| Hospital Charge Code |
906819785
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,088.00 |
| Max. Negotiated Rate |
$46,256.43 |
| Rate for Payer: Adventist Health Commercial |
$10,694.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5,088.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$36,733.89
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$36,518.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$26,780.04
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$24,345.49
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$24,061.50
|
| Rate for Payer: Cash Price |
$24,061.50
|
| Rate for Payer: Cash Price |
$24,061.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$34,755.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36,518.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$26,780.04
|
| Rate for Payer: Dignity Health Senior |
$24,345.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$24,345.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$33,097.93
|
| Rate for Payer: Heritage Provider Network Senior |
$29,944.95
|
| Rate for Payer: Humana Medicare |
$24,345.49
|
| Rate for Payer: IEHP Medicare Advantage |
$24,345.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$46,256.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,678.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28,727.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13,367.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30,675.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30,675.32
|
| Rate for Payer: Multiplan Commercial |
$40,102.50
|
| Rate for Payer: Multiplan WC |
$33,283.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$26,780.04
|
| Rate for Payer: TriValley Medical Group Senior |
$26,780.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36,518.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26,780.04
|
| Rate for Payer: Vantage Medical Group Senior |
$24,345.49
|
|
|
HC TRANSCATH RMVL REPL SC LEADLESS PMKR RA
|
Facility
IP
|
$53,470.00
|
|
|
Service Code
|
CPT 0825T
|
| Hospital Charge Code |
906819775
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$9,678.07 |
| Max. Negotiated Rate |
$40,102.50 |
| Rate for Payer: Adventist Health Commercial |
$10,694.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$36,733.89
|
| Rate for Payer: Cash Price |
$24,061.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$36,199.19
|
| Rate for Payer: Heritage Provider Network Senior |
$36,199.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,678.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13,367.50
|
| Rate for Payer: Multiplan Commercial |
$40,102.50
|
|
|
HC TRANSCATH RMVL REPL SC LEADLESS PMKR RA
|
Facility
OP
|
$53,470.00
|
|
|
Service Code
|
CPT 0825T
|
| Hospital Charge Code |
906819775
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,245.00 |
| Max. Negotiated Rate |
$46,256.43 |
| Rate for Payer: Adventist Health Commercial |
$10,694.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5,245.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$36,733.89
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$36,518.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$26,780.04
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$24,345.49
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$24,061.50
|
| Rate for Payer: Cash Price |
$24,061.50
|
| Rate for Payer: Cash Price |
$24,061.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$34,755.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36,518.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$26,780.04
|
| Rate for Payer: Dignity Health Senior |
$24,345.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$24,345.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$33,097.93
|
| Rate for Payer: Heritage Provider Network Senior |
$29,944.95
|
| Rate for Payer: Humana Medicare |
$24,345.49
|
| Rate for Payer: IEHP Medicare Advantage |
$24,345.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$46,256.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,678.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28,727.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13,367.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30,675.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30,675.32
|
| Rate for Payer: Multiplan Commercial |
$40,102.50
|
| Rate for Payer: Multiplan WC |
$33,283.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$26,780.04
|
| Rate for Payer: TriValley Medical Group Senior |
$26,780.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36,518.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26,780.04
|
| Rate for Payer: Vantage Medical Group Senior |
$24,345.49
|
|
|
HC TRANSCATH RMVL SC LEADLESS PMKR RA
|
Facility
IP
|
$8,747.00
|
|
|
Service Code
|
CPT 0824T
|
| Hospital Charge Code |
906819774
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,583.21 |
| Max. Negotiated Rate |
$6,560.25 |
| Rate for Payer: Adventist Health Commercial |
$1,749.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,009.19
|
| Rate for Payer: Cash Price |
$3,936.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,921.72
|
| Rate for Payer: Heritage Provider Network Senior |
$5,921.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,583.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,186.75
|
| Rate for Payer: Multiplan Commercial |
$6,560.25
|
|
|
HC TRANSCATH RMVL SC LEADLESS PMKR RA
|
Facility
OP
|
$8,747.00
|
|
|
Service Code
|
CPT 0824T
|
| Hospital Charge Code |
906819774
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,583.21 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,749.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,009.19
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$3,936.15
|
| Rate for Payer: Cash Price |
$3,936.15
|
| Rate for Payer: Cash Price |
$3,936.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,685.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: Dignity Health Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,982.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,414.39
|
| Rate for Payer: Heritage Provider Network Senior |
$4,898.54
|
| Rate for Payer: Humana Medicare |
$3,982.55
|
| Rate for Payer: IEHP Medicare Advantage |
$3,982.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,566.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,583.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,699.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,186.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,018.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,018.01
|
| Rate for Payer: Multiplan Commercial |
$6,560.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,380.80
|
| Rate for Payer: TriValley Medical Group Senior |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC TRANSCATH SEPTAL REDUCT THER
|
Facility
IP
|
$24,728.00
|
|
|
Service Code
|
CPT 93583
|
| Hospital Charge Code |
906820293
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,475.77 |
| Max. Negotiated Rate |
$18,546.00 |
| Rate for Payer: Adventist Health Commercial |
$4,945.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16,988.14
|
| Rate for Payer: Cash Price |
$11,127.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$16,740.86
|
| Rate for Payer: Heritage Provider Network Senior |
$16,740.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,475.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,182.00
|
| Rate for Payer: Multiplan Commercial |
$18,546.00
|
|
|
HC TRANSCATH SEPTAL REDUCT THER
|
Facility
OP
|
$24,728.00
|
|
|
Service Code
|
CPT 93583
|
| Hospital Charge Code |
906820293
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$785.01 |
| Max. Negotiated Rate |
$21,018.80 |
| Rate for Payer: Adventist Health Commercial |
$4,945.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5,935.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16,988.14
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$21,018.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13,600.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$18,546.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,576.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$11,127.60
|
| Rate for Payer: Cash Price |
$11,127.60
|
| Rate for Payer: Cash Price |
$11,127.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16,073.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,018.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$21,018.80
|
| Rate for Payer: Dignity Health Senior |
$21,018.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,836.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$15,306.63
|
| Rate for Payer: Heritage Provider Network Senior |
$15,306.63
|
| Rate for Payer: IEHP Medi-Cal |
$785.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$11,918.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,475.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,182.00
|
| Rate for Payer: Multiplan Commercial |
$18,546.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21,018.80
|
| Rate for Payer: Vantage Medical Group Senior |
$21,018.80
|
|
