|
HC TRANSCATH THRPY EMBOLIZATION
|
Facility
IP
|
$8,608.00
|
|
|
Service Code
|
CPT 75894
|
| Hospital Charge Code |
906820133
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,558.05 |
| Max. Negotiated Rate |
$6,456.00 |
| Rate for Payer: Adventist Health Commercial |
$1,721.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,913.70
|
| Rate for Payer: Cash Price |
$3,873.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,827.62
|
| Rate for Payer: Heritage Provider Network Senior |
$5,827.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,558.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,152.00
|
| Rate for Payer: Multiplan Commercial |
$6,456.00
|
|
|
HC TRANSCATH THRPY EMBOLIZATION
|
Facility
IP
|
$7,923.00
|
|
|
Service Code
|
CPT 75894
|
| Hospital Charge Code |
906812173
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,434.06 |
| Max. Negotiated Rate |
$5,942.25 |
| Rate for Payer: Adventist Health Commercial |
$1,584.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,443.10
|
| Rate for Payer: Cash Price |
$3,565.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,363.87
|
| Rate for Payer: Heritage Provider Network Senior |
$5,363.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,434.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,980.75
|
| Rate for Payer: Multiplan Commercial |
$5,942.25
|
|
|
HC TRANSCATH THRPY EMBOLIZATION
|
Facility
OP
|
$8,608.00
|
|
|
Service Code
|
CPT 75894
|
| Hospital Charge Code |
906820133
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,558.05 |
| Max. Negotiated Rate |
$7,316.80 |
| Rate for Payer: Adventist Health Commercial |
$1,721.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,972.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,913.70
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7,316.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,734.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6,456.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,747.69
|
| Rate for Payer: Blue Shield of California Commercial |
$4,927.76
|
| Rate for Payer: Blue Shield of California EPN |
$2,802.27
|
| Rate for Payer: Cash Price |
$3,873.60
|
| Rate for Payer: Cash Price |
$3,873.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,595.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,316.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,316.80
|
| Rate for Payer: Dignity Health Senior |
$7,316.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,595.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,328.35
|
| Rate for Payer: Heritage Provider Network Senior |
$5,328.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,149.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,558.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,152.00
|
| Rate for Payer: Multiplan Commercial |
$6,456.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,316.80
|
| Rate for Payer: Vantage Medical Group Senior |
$7,316.80
|
|
|
HC TRANSCATH THRPY EMBOLIZATION
|
Facility
OP
|
$7,923.00
|
|
|
Service Code
|
CPT 75894
|
| Hospital Charge Code |
906812173
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,434.06 |
| Max. Negotiated Rate |
$6,734.55 |
| Rate for Payer: Adventist Health Commercial |
$1,584.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,972.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,443.10
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,734.55
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,357.65
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5,942.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,747.69
|
| Rate for Payer: Blue Shield of California Commercial |
$4,927.76
|
| Rate for Payer: Blue Shield of California EPN |
$2,802.27
|
| Rate for Payer: Cash Price |
$3,565.35
|
| Rate for Payer: Cash Price |
$3,565.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,149.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,734.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,734.55
|
| Rate for Payer: Dignity Health Senior |
$6,734.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,149.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,904.34
|
| Rate for Payer: Heritage Provider Network Senior |
$4,904.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,818.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,434.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,980.75
|
| Rate for Payer: Multiplan Commercial |
$5,942.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,734.55
|
| Rate for Payer: Vantage Medical Group Senior |
$6,734.55
|
|
|
HC TRANSCATH TRICUSP VALVE ADDT
|
Facility
IP
|
$25,472.00
|
|
|
Service Code
|
CPT 0570T
|
| Hospital Charge Code |
906820273
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,610.43 |
| Max. Negotiated Rate |
$19,104.00 |
| Rate for Payer: Adventist Health Commercial |
$5,094.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17,499.26
|
| Rate for Payer: Cash Price |
$11,462.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$17,244.54
|
| Rate for Payer: Heritage Provider Network Senior |
$17,244.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,610.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,368.00
|
| Rate for Payer: Multiplan Commercial |
$19,104.00
|
|
|
HC TRANSCATH TRICUSP VALVE ADDT
|
Facility
IP
|
$21,606.00
|
|
|
Service Code
|
CPT 0570T
|
| Hospital Charge Code |
906810570
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,910.69 |
| Max. Negotiated Rate |
$16,204.50 |
| Rate for Payer: Adventist Health Commercial |
$4,321.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14,843.32
|
| Rate for Payer: Cash Price |
$9,722.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$14,627.26
|
| Rate for Payer: Heritage Provider Network Senior |
$14,627.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,910.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,401.50
|
| Rate for Payer: Multiplan Commercial |
$16,204.50
|
|
|
HC TRANSCATH TRICUSP VALVE ADDT
|
Facility
OP
|
$21,606.00
|
|
|
Service Code
|
CPT 0570T
|
| Hospital Charge Code |
906810570
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$933.56 |
| Max. Negotiated Rate |
$18,365.10 |
| Rate for Payer: Adventist Health Commercial |
$4,321.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14,843.32
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$18,365.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$11,883.30
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$16,204.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,742.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,086.22
|
| Rate for Payer: Blue Shield of California EPN |
$933.56
|
| Rate for Payer: Cash Price |
$9,722.70
|
| Rate for Payer: Cash Price |
$9,722.70
|
| Rate for Payer: Cash Price |
$9,722.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14,043.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18,365.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$18,365.10
|
| Rate for Payer: Dignity Health Senior |
$18,365.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$13,374.11
|
| Rate for Payer: Heritage Provider Network Senior |
$13,374.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$10,414.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,910.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,401.50
|
| Rate for Payer: Multiplan Commercial |
$16,204.50
|
| 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 |
$18,365.10
|
| Rate for Payer: Vantage Medical Group Senior |
$18,365.10
|
|
|
HC TRANSCATH TRICUSP VALVE ADDT
|
Facility
OP
|
$25,472.00
|
|
|
Service Code
|
CPT 0570T
|
| Hospital Charge Code |
906820273
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$933.56 |
| Max. Negotiated Rate |
$21,651.20 |
| Rate for Payer: Adventist Health Commercial |
$5,094.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17,499.26
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$21,651.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14,009.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$19,104.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,742.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,086.22
|
| Rate for Payer: Blue Shield of California EPN |
$933.56
|
| Rate for Payer: Cash Price |
$11,462.40
|
| Rate for Payer: Cash Price |
$11,462.40
|
| Rate for Payer: Cash Price |
$11,462.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16,556.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,651.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$21,651.20
|
| Rate for Payer: Dignity Health Senior |
$21,651.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$15,767.17
|
| Rate for Payer: Heritage Provider Network Senior |
$15,767.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12,277.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,610.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,368.00
|
| Rate for Payer: Multiplan Commercial |
$19,104.00
|
| 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 |
$21,651.20
|
| Rate for Payer: Vantage Medical Group Senior |
$21,651.20
|
|
|
HC TRANSCATH TRICUSP VALVE ANNUL
|
Facility
IP
|
$82,271.00
|
|
|
Service Code
|
CPT 0545T
|
| Hospital Charge Code |
906820271
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$14,891.05 |
| Max. Negotiated Rate |
$61,703.25 |
| Rate for Payer: Adventist Health Commercial |
$16,454.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$56,520.18
|
| Rate for Payer: Cash Price |
$37,021.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$55,697.47
|
| Rate for Payer: Heritage Provider Network Senior |
$55,697.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,891.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20,567.75
|
| Rate for Payer: Multiplan Commercial |
$61,703.25
|
|
|
HC TRANSCATH TRICUSP VALVE ANNUL
|
Facility
IP
|
$69,783.00
|
|
|
Service Code
|
CPT 0545T
|
| Hospital Charge Code |
906810545
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$12,630.72 |
| Max. Negotiated Rate |
$52,337.25 |
| Rate for Payer: Adventist Health Commercial |
$13,956.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$47,940.92
|
| Rate for Payer: Cash Price |
$31,402.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$47,243.09
|
| Rate for Payer: Heritage Provider Network Senior |
$47,243.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,630.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17,445.75
|
| Rate for Payer: Multiplan Commercial |
$52,337.25
|
|
|
HC TRANSCATH TRICUSP VALVE ANNUL
|
Facility
OP
|
$82,271.00
|
|
|
Service Code
|
CPT 0545T
|
| Hospital Charge Code |
906820271
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$933.56 |
| Max. Negotiated Rate |
$69,930.35 |
| Rate for Payer: Adventist Health Commercial |
$16,454.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$56,520.18
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$69,930.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$45,249.05
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$61,703.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,742.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,086.22
|
| Rate for Payer: Blue Shield of California EPN |
$933.56
|
| Rate for Payer: Cash Price |
$37,021.95
|
| Rate for Payer: Cash Price |
$37,021.95
|
| Rate for Payer: Cash Price |
$37,021.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$53,476.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$69,930.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$69,930.35
|
| Rate for Payer: Dignity Health Senior |
$69,930.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$50,925.75
|
| Rate for Payer: Heritage Provider Network Senior |
$50,925.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$39,654.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,891.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20,567.75
|
| Rate for Payer: Multiplan Commercial |
$61,703.25
|
| 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 |
$69,930.35
|
| Rate for Payer: Vantage Medical Group Senior |
$69,930.35
|
|
|
HC TRANSCATH TRICUSP VALVE ANNUL
|
Facility
OP
|
$69,783.00
|
|
|
Service Code
|
CPT 0545T
|
| Hospital Charge Code |
906810545
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$933.56 |
| Max. Negotiated Rate |
$59,315.55 |
| Rate for Payer: Adventist Health Commercial |
$13,956.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$47,940.92
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$59,315.55
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$38,380.65
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$52,337.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,742.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,086.22
|
| Rate for Payer: Blue Shield of California EPN |
$933.56
|
| Rate for Payer: Cash Price |
$31,402.35
|
| Rate for Payer: Cash Price |
$31,402.35
|
| Rate for Payer: Cash Price |
$31,402.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$45,358.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$59,315.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$59,315.55
|
| Rate for Payer: Dignity Health Senior |
$59,315.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$43,195.68
|
| Rate for Payer: Heritage Provider Network Senior |
$43,195.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$33,635.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,630.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17,445.75
|
| Rate for Payer: Multiplan Commercial |
$52,337.25
|
| 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 |
$59,315.55
|
| Rate for Payer: Vantage Medical Group Senior |
$59,315.55
|
|
|
HC TRANSCATH TRICUSPVALVE IMPLANT
|
Facility
IP
|
$94,612.00
|
|
|
Service Code
|
CPT 0646T
|
| Hospital Charge Code |
906820300
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$17,124.77 |
| Max. Negotiated Rate |
$70,959.00 |
| Rate for Payer: Adventist Health Commercial |
$18,922.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$64,998.44
|
| Rate for Payer: Cash Price |
$42,575.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$64,052.32
|
| Rate for Payer: Heritage Provider Network Senior |
$64,052.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17,124.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23,653.00
|
| Rate for Payer: Multiplan Commercial |
$70,959.00
|
|
|
HC TRANSCATH TRICUSPVALVE IMPLANT
|
Facility
OP
|
$94,612.00
|
|
|
Service Code
|
CPT 0646T
|
| Hospital Charge Code |
906820300
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$933.56 |
| Max. Negotiated Rate |
$80,420.20 |
| Rate for Payer: Adventist Health Commercial |
$18,922.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$64,998.44
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$80,420.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$52,036.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$70,959.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,086.22
|
| Rate for Payer: Blue Shield of California EPN |
$933.56
|
| Rate for Payer: Cash Price |
$42,575.40
|
| Rate for Payer: Cash Price |
$42,575.40
|
| Rate for Payer: Cash Price |
$42,575.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$61,497.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$80,420.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$80,420.20
|
| Rate for Payer: Dignity Health Senior |
$80,420.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$58,564.83
|
| Rate for Payer: Heritage Provider Network Senior |
$58,564.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$45,602.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17,124.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23,653.00
|
| Rate for Payer: Multiplan Commercial |
$70,959.00
|
| 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 |
$80,420.20
|
| Rate for Payer: Vantage Medical Group Senior |
$80,420.20
|
|
|
HC TRANSCATH TRICUSP VALVE REPAIR
|
Facility
IP
|
$82,271.00
|
|
|
Service Code
|
CPT 0569T
|
| Hospital Charge Code |
906820272
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$14,891.05 |
| Max. Negotiated Rate |
$61,703.25 |
| Rate for Payer: Adventist Health Commercial |
$16,454.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$56,520.18
|
| Rate for Payer: Cash Price |
$37,021.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$55,697.47
|
| Rate for Payer: Heritage Provider Network Senior |
$55,697.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,891.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20,567.75
|
| Rate for Payer: Multiplan Commercial |
$61,703.25
|
|
|
HC TRANSCATH TRICUSP VALVE REPAIR
|
Facility
OP
|
$82,271.00
|
|
|
Service Code
|
CPT 0569T
|
| Hospital Charge Code |
906820272
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$933.56 |
| Max. Negotiated Rate |
$69,930.35 |
| Rate for Payer: Adventist Health Commercial |
$16,454.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$56,520.18
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$69,930.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$45,249.05
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$61,703.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,742.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,086.22
|
| Rate for Payer: Blue Shield of California EPN |
$933.56
|
| Rate for Payer: Cash Price |
$37,021.95
|
| Rate for Payer: Cash Price |
$37,021.95
|
| Rate for Payer: Cash Price |
$37,021.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$53,476.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$69,930.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$69,930.35
|
| Rate for Payer: Dignity Health Senior |
$69,930.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$50,925.75
|
| Rate for Payer: Heritage Provider Network Senior |
$50,925.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$39,654.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,891.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20,567.75
|
| Rate for Payer: Multiplan Commercial |
$61,703.25
|
| 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 |
$69,930.35
|
| Rate for Payer: Vantage Medical Group Senior |
$69,930.35
|
|
|
HC TRANSCATH TRICUSP VALVE REPAIR
|
Facility
IP
|
$69,783.00
|
|
|
Service Code
|
CPT 0569T
|
| Hospital Charge Code |
906810569
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$12,630.72 |
| Max. Negotiated Rate |
$52,337.25 |
| Rate for Payer: Adventist Health Commercial |
$13,956.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$47,940.92
|
| Rate for Payer: Cash Price |
$31,402.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$47,243.09
|
| Rate for Payer: Heritage Provider Network Senior |
$47,243.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,630.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17,445.75
|
| Rate for Payer: Multiplan Commercial |
$52,337.25
|
|
|
HC TRANSCATH TRICUSP VALVE REPAIR
|
Facility
OP
|
$69,783.00
|
|
|
Service Code
|
CPT 0569T
|
| Hospital Charge Code |
906810569
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$933.56 |
| Max. Negotiated Rate |
$59,315.55 |
| Rate for Payer: Adventist Health Commercial |
$13,956.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$47,940.92
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$59,315.55
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$38,380.65
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$52,337.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,742.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,086.22
|
| Rate for Payer: Blue Shield of California EPN |
$933.56
|
| Rate for Payer: Cash Price |
$31,402.35
|
| Rate for Payer: Cash Price |
$31,402.35
|
| Rate for Payer: Cash Price |
$31,402.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$45,358.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$59,315.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$59,315.55
|
| Rate for Payer: Dignity Health Senior |
$59,315.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$43,195.68
|
| Rate for Payer: Heritage Provider Network Senior |
$43,195.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$33,635.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,630.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17,445.75
|
| Rate for Payer: Multiplan Commercial |
$52,337.25
|
| 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 |
$59,315.55
|
| Rate for Payer: Vantage Medical Group Senior |
$59,315.55
|
|
|
HC TRANSCRANIAL DUPLEX/DOPPLER
|
Facility
OP
|
$1,349.00
|
|
|
Service Code
|
CPT 93888
|
| Hospital Charge Code |
906601144
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$137.36 |
| Max. Negotiated Rate |
$1,025.00 |
| Rate for Payer: Adventist Health Commercial |
$269.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$149.98
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$926.76
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Blue Shield of California Commercial |
$585.02
|
| Rate for Payer: Blue Shield of California EPN |
$332.68
|
| Rate for Payer: Cash Price |
$607.05
|
| Rate for Payer: Cash Price |
$607.05
|
| Rate for Payer: Cash Price |
$607.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$876.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: Dignity Health Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$876.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$137.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$835.03
|
| Rate for Payer: Heritage Provider Network Senior |
$835.03
|
| Rate for Payer: Humana Medicare |
$137.36
|
| Rate for Payer: IEHP Medi-Cal |
$203.05
|
| Rate for Payer: IEHP Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$260.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$244.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$337.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$173.07
|
| Rate for Payer: Multiplan Commercial |
$1,011.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$151.10
|
| Rate for Payer: TriValley Medical Group Senior |
$137.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,025.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$864.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC TRANSCRANIAL DUPLEX/DOPPLER
|
Facility
OP
|
$2,729.00
|
|
|
Service Code
|
CPT 93886
|
| Hospital Charge Code |
906601143
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$305.57 |
| Max. Negotiated Rate |
$2,046.75 |
| Rate for Payer: Adventist Health Commercial |
$545.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$369.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,874.82
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$306.16
|
| Rate for Payer: Blue Shield of California Commercial |
$858.74
|
| Rate for Payer: Blue Shield of California EPN |
$488.34
|
| Rate for Payer: Cash Price |
$1,228.05
|
| Rate for Payer: Cash Price |
$1,228.05
|
| Rate for Payer: Cash Price |
$1,228.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,773.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$336.78
|
| Rate for Payer: Dignity Health Senior |
$306.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,773.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$306.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,689.25
|
| Rate for Payer: Heritage Provider Network Senior |
$1,689.25
|
| Rate for Payer: Humana Medicare |
$306.16
|
| Rate for Payer: IEHP Medi-Cal |
$305.57
|
| Rate for Payer: IEHP Medicare Advantage |
$306.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$581.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$493.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$361.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$682.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$385.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$385.76
|
| Rate for Payer: Multiplan Commercial |
$2,046.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$336.78
|
| Rate for Payer: TriValley Medical Group Senior |
$306.16
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,025.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$864.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Vantage Medical Group Senior |
$306.16
|
|
|
HC TRANSCRANIAL DUPLEX/DOPPLER
|
Facility
IP
|
$1,349.00
|
|
|
Service Code
|
CPT 93888
|
| Hospital Charge Code |
906601144
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$244.17 |
| Max. Negotiated Rate |
$1,011.75 |
| Rate for Payer: Adventist Health Commercial |
$269.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$926.76
|
| Rate for Payer: Cash Price |
$607.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$913.27
|
| Rate for Payer: Heritage Provider Network Senior |
$913.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$244.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$337.25
|
| Rate for Payer: Multiplan Commercial |
$1,011.75
|
|
|
HC TRANSCRANIAL DUPLEX/DOPPLER
|
Facility
IP
|
$2,729.00
|
|
|
Service Code
|
CPT 93886
|
| Hospital Charge Code |
906601143
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$493.95 |
| Max. Negotiated Rate |
$2,046.75 |
| Rate for Payer: Adventist Health Commercial |
$545.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,874.82
|
| Rate for Payer: Cash Price |
$1,228.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,847.53
|
| Rate for Payer: Heritage Provider Network Senior |
$1,847.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$493.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$682.25
|
| Rate for Payer: Multiplan Commercial |
$2,046.75
|
|
|
HC TRANSESOPHOGEAL CARDIAC OUTPUT
|
Facility
IP
|
$635.00
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
900800525
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$114.94 |
| Max. Negotiated Rate |
$476.25 |
| Rate for Payer: Adventist Health Commercial |
$127.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$436.24
|
| Rate for Payer: Cash Price |
$285.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$429.90
|
| Rate for Payer: Heritage Provider Network Senior |
$429.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$114.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$158.75
|
| Rate for Payer: Multiplan Commercial |
$476.25
|
|
|
HC TRANSESOPHOGEAL CARDIAC OUTPUT
|
Facility
OP
|
$635.00
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
900800525
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$114.94 |
| Max. Negotiated Rate |
$476.25 |
| Rate for Payer: Adventist Health Commercial |
$127.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$339.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$436.24
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$195.17
|
| Rate for Payer: Blue Shield of California Commercial |
$394.34
|
| Rate for Payer: Blue Shield of California EPN |
$372.74
|
| Rate for Payer: Cash Price |
$285.75
|
| Rate for Payer: Cash Price |
$285.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$412.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$292.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$214.69
|
| Rate for Payer: Dignity Health Senior |
$195.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$412.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$195.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$393.06
|
| Rate for Payer: Heritage Provider Network Senior |
$393.06
|
| Rate for Payer: Humana Medicare |
$195.17
|
| Rate for Payer: IEHP Medicare Advantage |
$195.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$370.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$114.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$230.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$158.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$245.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$245.91
|
| Rate for Payer: Multiplan Commercial |
$476.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$214.69
|
| Rate for Payer: TriValley Medical Group Senior |
$195.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: Vantage Medical Group Senior |
$195.17
|
|
|
HC TRANSFERRIN
|
Facility
IP
|
$216.00
|
|
|
Service Code
|
CPT 84466
|
| Hospital Charge Code |
900910854
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$39.10 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Adventist Health Commercial |
$43.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$148.39
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$146.23
|
| Rate for Payer: Heritage Provider Network Senior |
$146.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.00
|
| Rate for Payer: Multiplan Commercial |
$162.00
|
|
