|
HC TRANS CATH CLOSURE/ASD
|
Facility
|
IP
|
$31,046.00
|
|
|
Service Code
|
CPT 93580
|
| Hospital Charge Code |
906812218
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,982.00 |
| Max. Negotiated Rate |
$23,284.50 |
| Rate for Payer: Adventist Health Commercial |
$6,209.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19,993.62
|
| Rate for Payer: Cash Price |
$13,970.70
|
| Rate for Payer: Cash Price |
$13,970.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5,619.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,761.50
|
| Rate for Payer: Multiplan Commercial |
$23,284.50
|
|
|
HC TRANS CATH CLOSURE/ASD
|
Facility
|
OP
|
$31,046.00
|
|
|
Service Code
|
CPT 93580
|
| Hospital Charge Code |
906812218
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,619.33 |
| Max. Negotiated Rate |
$44,797.35 |
| Rate for Payer: Adventist Health Commercial |
$6,209.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19,186.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,935.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23,577.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,728.00
|
| 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 |
$13,970.70
|
| Rate for Payer: Cash Price |
$13,970.70
|
| Rate for Payer: Cash Price |
$13,970.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,935.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23,577.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,317.14
|
| Rate for Payer: EPIC Health Plan Medicare |
$23,577.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$19,217.47
|
| Rate for Payer: Heritage Provider Network Senior |
$29,000.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23,577.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$44,797.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5,619.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27,114.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,761.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$31,593.92
|
| Rate for Payer: Multiplan Commercial |
$23,284.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$25,935.31
|
| Rate for Payer: TriValley Medical Group Senior |
$23,577.55
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18,767.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,783.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,935.31
|
| Rate for Payer: Vantage Medical Group Senior |
$23,577.55
|
|
|
HC TRANS CATH CLOSURE/VSD
|
Facility
|
IP
|
$22,574.00
|
|
|
Service Code
|
CPT 93581
|
| Hospital Charge Code |
906812219
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,085.89 |
| Max. Negotiated Rate |
$16,930.50 |
| Rate for Payer: Adventist Health Commercial |
$4,514.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14,537.66
|
| Rate for Payer: Cash Price |
$10,158.30
|
| Rate for Payer: Cash Price |
$10,158.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,085.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,643.50
|
| Rate for Payer: Multiplan Commercial |
$16,930.50
|
|
|
HC TRANS CATH CLOSURE/VSD
|
Facility
|
OP
|
$22,574.00
|
|
|
Service Code
|
CPT 93581
|
| Hospital Charge Code |
906812219
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,085.89 |
| Max. Negotiated Rate |
$44,797.35 |
| Rate for Payer: Adventist Health Commercial |
$4,514.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13,950.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,935.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23,577.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,728.00
|
| 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 |
$10,158.30
|
| Rate for Payer: Cash Price |
$10,158.30
|
| Rate for Payer: Cash Price |
$10,158.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,935.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23,577.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,318.66
|
| Rate for Payer: EPIC Health Plan Medicare |
$23,577.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$13,973.31
|
| Rate for Payer: Heritage Provider Network Senior |
$29,000.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23,577.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$44,797.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,085.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27,114.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,643.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$31,593.92
|
| Rate for Payer: Multiplan Commercial |
$16,930.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$25,935.31
|
| Rate for Payer: TriValley Medical Group Senior |
$23,577.55
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18,767.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,783.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,935.31
|
| Rate for Payer: Vantage Medical Group Senior |
$23,577.55
|
|
|
HC TRANSCATHETER BIOPSY
|
Facility
|
IP
|
$4,578.00
|
|
|
Service Code
|
CPT 75970
|
| Hospital Charge Code |
909081664
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$828.62 |
| Max. Negotiated Rate |
$3,433.50 |
| Rate for Payer: Adventist Health Commercial |
$915.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,948.23
|
| Rate for Payer: Cash Price |
$2,060.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,099.31
|
| Rate for Payer: Heritage Provider Network Senior |
$3,099.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$828.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,144.50
|
| Rate for Payer: Multiplan Commercial |
$3,433.50
|
|
|
HC TRANSCATHETER BIOPSY
|
Facility
|
OP
|
$4,578.00
|
|
|
Service Code
|
CPT 75970
|
| Hospital Charge Code |
909081664
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$828.62 |
| Max. Negotiated Rate |
$3,891.30 |
| Rate for Payer: Adventist Health Commercial |
$915.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,829.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,891.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,517.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,433.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,118.56
|
| Rate for Payer: Blue Shield of California Commercial |
$2,427.79
|
| Rate for Payer: Blue Shield of California EPN |
$1,952.35
|
| Rate for Payer: Cash Price |
$2,060.10
|
| Rate for Payer: Cash Price |
$2,060.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,975.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,891.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,891.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,891.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,701.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,833.78
|
| Rate for Payer: Heritage Provider Network Senior |
$2,833.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,183.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$828.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,144.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,204.60
|
| Rate for Payer: Multiplan Commercial |
$3,433.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,289.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,289.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,891.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,891.30
|
| Rate for Payer: Vantage Medical Group Senior |
$3,891.30
|
|
|
HC TRANSCATHETER BIOPSY
|
Facility
|
OP
|
$13,096.00
|
|
|
Service Code
|
CPT 37200
|
| Hospital Charge Code |
909081356
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,370.38 |
| Max. Negotiated Rate |
$10,735.29 |
| Rate for Payer: Adventist Health Commercial |
$2,619.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,093.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,735.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,872.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,156.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,988.56
|
| Rate for Payer: Blue Shield of California EPN |
$6,390.85
|
| Rate for Payer: Cash Price |
$5,893.20
|
| Rate for Payer: Cash Price |
$5,893.20
|
| Rate for Payer: Cash Price |
$5,893.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8,512.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,735.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,872.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,156.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,156.86
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,106.42
|
| Rate for Payer: Heritage Provider Network Senior |
$8,106.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,156.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$6,246.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,370.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,230.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,274.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9,590.19
|
| Rate for Payer: Multiplan Commercial |
$9,822.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$7,156.86
|
| Rate for Payer: TriValley Medical Group Senior |
$7,156.86
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,548.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,548.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,735.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,872.55
|
| Rate for Payer: Vantage Medical Group Senior |
$7,156.86
|
|
|
HC TRANSCATHETER BIOPSY
|
Facility
|
IP
|
$13,096.00
|
|
|
Service Code
|
CPT 37200
|
| Hospital Charge Code |
909081356
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,370.38 |
| Max. Negotiated Rate |
$9,822.00 |
| Rate for Payer: Adventist Health Commercial |
$2,619.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,433.82
|
| Rate for Payer: Cash Price |
$5,893.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,865.99
|
| Rate for Payer: Heritage Provider Network Senior |
$8,865.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,370.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,274.00
|
| Rate for Payer: Multiplan Commercial |
$9,822.00
|
|
|
HC TRANSCATHETER RETRIEVAL
|
Facility
|
OP
|
$20,447.00
|
|
|
Service Code
|
CPT 37197
|
| Hospital Charge Code |
906811451
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,700.91 |
| Max. Negotiated Rate |
$15,335.25 |
| Rate for Payer: Adventist Health Commercial |
$4,089.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12,636.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,061.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,245.00
|
| 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 |
$9,201.15
|
| Rate for Payer: Cash Price |
$9,201.15
|
| Rate for Payer: Cash Price |
$9,201.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,467.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,061.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,061.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$12,656.69
|
| Rate for Payer: Heritage Provider Network Senior |
$4,995.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7,715.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,700.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,670.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,111.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,441.81
|
| Rate for Payer: Multiplan Commercial |
$15,335.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,467.15
|
| Rate for Payer: TriValley Medical Group Senior |
$4,061.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10,001.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,445.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Vantage Medical Group Senior |
$4,061.05
|
|
|
HC TRANSCATHETER RETRIEVAL
|
Facility
|
IP
|
$20,447.00
|
|
|
Service Code
|
CPT 37197
|
| Hospital Charge Code |
906811451
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,700.91 |
| Max. Negotiated Rate |
$15,335.25 |
| Rate for Payer: Adventist Health Commercial |
$4,089.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13,167.87
|
| Rate for Payer: Cash Price |
$9,201.15
|
| Rate for Payer: Cash Price |
$9,201.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,700.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,111.75
|
| Rate for Payer: Multiplan Commercial |
$15,335.25
|
|
|
HC TRANSCATH INSRTN DC LEADLESS PMKR RA PM COMPNT
|
Facility
|
IP
|
$45,636.00
|
|
|
Service Code
|
CPT 0796T
|
| Hospital Charge Code |
906819778
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$8,260.12 |
| Max. Negotiated Rate |
$34,227.00 |
| Rate for Payer: Adventist Health Commercial |
$9,127.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$29,389.58
|
| Rate for Payer: Cash Price |
$20,536.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$30,895.57
|
| Rate for Payer: Heritage Provider Network Senior |
$30,895.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8,260.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,409.00
|
| Rate for Payer: Multiplan Commercial |
$34,227.00
|
|
|
HC TRANSCATH INSRTN DC LEADLESS PMKR RA PM COMPNT
|
Facility
|
OP
|
$45,636.00
|
|
|
Service Code
|
CPT 0796T
|
| Hospital Charge Code |
906819778
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,178.49 |
| Max. Negotiated Rate |
$47,070.12 |
| Rate for Payer: Adventist Health Commercial |
$9,127.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$28,203.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37,160.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27,251.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24,773.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22,827.13
|
| 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 |
$20,536.20
|
| Rate for Payer: Cash Price |
$20,536.20
|
| Rate for Payer: Cash Price |
$20,536.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$29,663.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37,160.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$27,251.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24,773.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$24,773.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$28,248.68
|
| Rate for Payer: Heritage Provider Network Senior |
$30,471.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24,773.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$47,070.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8,260.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28,489.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,409.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$33,196.82
|
| Rate for Payer: Multiplan Commercial |
$34,227.00
|
| Rate for Payer: Multiplan WC |
$38,609.08
|
| Rate for Payer: TriValley Medical Group Commercial |
$27,251.12
|
| Rate for Payer: TriValley Medical Group Senior |
$27,251.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$22,818.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$22,818.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37,160.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27,251.12
|
| Rate for Payer: Vantage Medical Group Senior |
$24,773.75
|
|
|
HC TRANSCATH INSRTN DC LEADLESS PMKR RA RV COMP SYS
|
Facility
|
OP
|
$45,636.00
|
|
|
Service Code
|
CPT 0795T
|
| Hospital Charge Code |
906819777
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,178.49 |
| Max. Negotiated Rate |
$47,070.12 |
| Rate for Payer: Adventist Health Commercial |
$9,127.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$28,203.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37,160.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27,251.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24,773.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22,827.13
|
| 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 |
$20,536.20
|
| Rate for Payer: Cash Price |
$20,536.20
|
| Rate for Payer: Cash Price |
$20,536.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$29,663.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37,160.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$27,251.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24,773.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$24,773.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$28,248.68
|
| Rate for Payer: Heritage Provider Network Senior |
$30,471.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24,773.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$47,070.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8,260.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28,489.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,409.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$33,196.82
|
| Rate for Payer: Multiplan Commercial |
$34,227.00
|
| Rate for Payer: Multiplan WC |
$38,609.08
|
| Rate for Payer: TriValley Medical Group Commercial |
$27,251.12
|
| Rate for Payer: TriValley Medical Group Senior |
$27,251.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$22,818.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$22,818.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37,160.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27,251.12
|
| Rate for Payer: Vantage Medical Group Senior |
$24,773.75
|
|
|
HC TRANSCATH INSRTN DC LEADLESS PMKR RA RV COMP SYS
|
Facility
|
IP
|
$45,636.00
|
|
|
Service Code
|
CPT 0795T
|
| Hospital Charge Code |
906819777
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$8,260.12 |
| Max. Negotiated Rate |
$34,227.00 |
| Rate for Payer: Adventist Health Commercial |
$9,127.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$29,389.58
|
| Rate for Payer: Cash Price |
$20,536.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$30,895.57
|
| Rate for Payer: Heritage Provider Network Senior |
$30,895.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8,260.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,409.00
|
| Rate for Payer: Multiplan Commercial |
$34,227.00
|
|
|
HC TRANSCATH INSRTN DC LEADLESS PMKR RV PM COMPNT
|
Facility
|
OP
|
$45,636.00
|
|
|
Service Code
|
CPT 0797T
|
| Hospital Charge Code |
906819779
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,178.49 |
| Max. Negotiated Rate |
$47,070.12 |
| Rate for Payer: Adventist Health Commercial |
$9,127.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$28,203.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37,160.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27,251.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24,773.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22,827.13
|
| 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 |
$20,536.20
|
| Rate for Payer: Cash Price |
$20,536.20
|
| Rate for Payer: Cash Price |
$20,536.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$29,663.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37,160.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$27,251.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24,773.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$24,773.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$28,248.68
|
| Rate for Payer: Heritage Provider Network Senior |
$30,471.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24,773.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$47,070.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8,260.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28,489.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,409.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$33,196.82
|
| Rate for Payer: Multiplan Commercial |
$34,227.00
|
| Rate for Payer: Multiplan WC |
$38,609.08
|
| Rate for Payer: TriValley Medical Group Commercial |
$27,251.12
|
| Rate for Payer: TriValley Medical Group Senior |
$27,251.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$22,818.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$22,818.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37,160.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27,251.12
|
| Rate for Payer: Vantage Medical Group Senior |
$24,773.75
|
|
|
HC TRANSCATH INSRTN DC LEADLESS PMKR RV PM COMPNT
|
Facility
|
IP
|
$45,636.00
|
|
|
Service Code
|
CPT 0797T
|
| Hospital Charge Code |
906819779
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$8,260.12 |
| Max. Negotiated Rate |
$34,227.00 |
| Rate for Payer: Adventist Health Commercial |
$9,127.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$29,389.58
|
| Rate for Payer: Cash Price |
$20,536.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$30,895.57
|
| Rate for Payer: Heritage Provider Network Senior |
$30,895.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8,260.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,409.00
|
| Rate for Payer: Multiplan Commercial |
$34,227.00
|
|
|
HC TRANSCATH INSRTN SC LEADLESS PMKR RA
|
Facility
|
IP
|
$45,636.00
|
|
|
Service Code
|
CPT 0823T
|
| Hospital Charge Code |
906819773
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$8,260.12 |
| Max. Negotiated Rate |
$34,227.00 |
| Rate for Payer: Adventist Health Commercial |
$9,127.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$29,389.58
|
| Rate for Payer: Cash Price |
$20,536.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$30,895.57
|
| Rate for Payer: Heritage Provider Network Senior |
$30,895.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8,260.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,409.00
|
| Rate for Payer: Multiplan Commercial |
$34,227.00
|
|
|
HC TRANSCATH INSRTN SC LEADLESS PMKR RA
|
Facility
|
OP
|
$45,636.00
|
|
|
Service Code
|
CPT 0823T
|
| Hospital Charge Code |
906819773
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,178.49 |
| Max. Negotiated Rate |
$47,070.12 |
| Rate for Payer: Adventist Health Commercial |
$9,127.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$28,203.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37,160.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27,251.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24,773.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22,827.13
|
| 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 |
$20,536.20
|
| Rate for Payer: Cash Price |
$20,536.20
|
| Rate for Payer: Cash Price |
$20,536.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$29,663.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37,160.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$27,251.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24,773.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$24,773.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$28,248.68
|
| Rate for Payer: Heritage Provider Network Senior |
$30,471.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24,773.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$47,070.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8,260.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28,489.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,409.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$33,196.82
|
| Rate for Payer: Multiplan Commercial |
$34,227.00
|
| Rate for Payer: Multiplan WC |
$38,609.08
|
| Rate for Payer: TriValley Medical Group Commercial |
$27,251.12
|
| Rate for Payer: TriValley Medical Group Senior |
$27,251.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$22,818.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$22,818.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37,160.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27,251.12
|
| Rate for Payer: Vantage Medical Group Senior |
$24,773.75
|
|
|
HC TRANSCATH MITRAL VAL REPAIR AD
|
Facility
|
OP
|
$18,441.00
|
|
|
Service Code
|
CPT 33419
|
| Hospital Charge Code |
906811489
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$918.00 |
| Max. Negotiated Rate |
$15,674.85 |
| Rate for Payer: Adventist Health Commercial |
$3,688.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11,396.54
|
| 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 |
$15,309.00
|
| 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 |
$8,298.45
|
| Rate for Payer: Cash Price |
$8,298.45
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$8,796.36
|
| Rate for Payer: Kaiser Foundation Hospitals 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/Medicare |
$12,908.70
|
| Rate for Payer: Multiplan Commercial |
$13,830.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| 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 MITRAL VAL REPAIR AD
|
Facility
|
IP
|
$18,441.00
|
|
|
Service Code
|
CPT 33419
|
| Hospital Charge Code |
906811489
|
|
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: Aetna of CA Non-Gatekeeper |
$11,876.00
|
| Rate for Payer: Cash Price |
$8,298.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$12,484.56
|
| Rate for Payer: Heritage Provider Network Senior |
$12,484.56
|
| Rate for Payer: Kaiser Foundation Hospitals 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 MITRAL VALVE ANNUL
|
Facility
|
OP
|
$59,559.00
|
|
|
Service Code
|
CPT 0544T
|
| Hospital Charge Code |
906810544
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,984.00 |
| Max. Negotiated Rate |
$50,625.15 |
| Rate for Payer: Adventist Health Commercial |
$11,911.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$36,807.46
|
| 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 |
$12,185.00
|
| 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 |
$26,801.55
|
| Rate for Payer: Cash Price |
$26,801.55
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$28,409.64
|
| Rate for Payer: Kaiser Foundation Hospitals 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/Medicare |
$41,691.30
|
| Rate for Payer: Multiplan Commercial |
$44,669.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$50,625.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$50,625.15
|
| Rate for Payer: Vantage Medical Group Senior |
$50,625.15
|
|
|
HC TRANSCATH MITRAL VALVE ANNUL
|
Facility
|
IP
|
$59,559.00
|
|
|
Service Code
|
CPT 0544T
|
| Hospital Charge Code |
906810544
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$10,780.18 |
| Max. Negotiated Rate |
$44,669.25 |
| Rate for Payer: Adventist Health Commercial |
$11,911.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$38,356.00
|
| Rate for Payer: Cash Price |
$26,801.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$40,321.44
|
| Rate for Payer: Heritage Provider Network Senior |
$40,321.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10,780.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14,889.75
|
| Rate for Payer: Multiplan Commercial |
$44,669.25
|
|
|
HC TRANSCATH MITRAL VALVE REPAIR
|
Facility
|
IP
|
$5,640.00
|
|
|
Service Code
|
CPT 33418
|
| Hospital Charge Code |
906811487
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,020.84 |
| Max. Negotiated Rate |
$4,230.00 |
| Rate for Payer: Adventist Health Commercial |
$1,128.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,632.16
|
| Rate for Payer: Cash Price |
$2,538.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,818.28
|
| Rate for Payer: Heritage Provider Network Senior |
$3,818.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,020.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,410.00
|
| Rate for Payer: Multiplan Commercial |
$4,230.00
|
|
|
HC TRANSCATH MITRAL VALVE REPAIR
|
Facility
|
OP
|
$5,640.00
|
|
|
Service Code
|
CPT 33418
|
| Hospital Charge Code |
906811487
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,020.84 |
| Max. Negotiated Rate |
$15,309.00 |
| Rate for Payer: Adventist Health Commercial |
$1,128.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,485.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,794.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,102.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,230.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,309.00
|
| 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 |
$2,538.00
|
| Rate for Payer: Cash Price |
$2,538.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,666.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,794.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,794.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,794.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,491.16
|
| Rate for Payer: Heritage Provider Network Senior |
$3,491.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,690.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,020.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,410.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,948.00
|
| Rate for Payer: Multiplan Commercial |
$4,230.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,794.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,794.00
|
| Rate for Payer: Vantage Medical Group Senior |
$4,794.00
|
|
|
HC TRANSCATH MITRAL VLVE IMPL/REP
|
Facility
|
IP
|
$56,581.00
|
|
|
Service Code
|
CPT 0483T
|
| Hospital Charge Code |
906800483
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$10,241.16 |
| Max. Negotiated Rate |
$42,435.75 |
| Rate for Payer: Adventist Health Commercial |
$11,316.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$36,438.16
|
| Rate for Payer: Cash Price |
$25,461.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$38,305.34
|
| Rate for Payer: Heritage Provider Network Senior |
$38,305.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10,241.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14,145.25
|
| Rate for Payer: Multiplan Commercial |
$42,435.75
|
|
