|
HC THORACENTESIS ASPIRATN WO GUID
|
Facility
|
IP
|
$2,907.00
|
|
|
Service Code
|
CPT 32554
|
| Hospital Charge Code |
900800117
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$581.40 |
| Max. Negotiated Rate |
$2,470.95 |
| Rate for Payer: Adventist Health Commercial |
$581.40
|
| Rate for Payer: Cash Price |
$1,598.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,162.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,162.80
|
| Rate for Payer: Galaxy Health WC |
$2,470.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,744.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,938.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,107.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,799.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$697.68
|
| Rate for Payer: Multiplan Commercial |
$2,325.60
|
| Rate for Payer: Networks By Design Commercial |
$1,889.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,470.95
|
|
|
HC THORACIC FACET JONT INJ,EA ADL
|
Facility
|
OP
|
$2,615.00
|
|
|
Service Code
|
CPT 64491
|
| Hospital Charge Code |
909000231
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$133.85 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: EPIC Health Plan Commercial |
$1,046.00
|
| Rate for Payer: Adventist Health Commercial |
$523.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,222.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,438.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,961.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$1,438.25
|
| Rate for Payer: Cash Price |
$1,438.25
|
| Rate for Payer: Cash Price |
$1,438.25
|
| Rate for Payer: Cigna of CA HMO |
$1,673.60
|
| Rate for Payer: Cigna of CA PPO |
$1,935.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,222.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,222.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,222.75
|
| Rate for Payer: EPIC Health Plan Senior |
$1,046.00
|
| Rate for Payer: Galaxy Health WC |
$2,222.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,569.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$133.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,744.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$151.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,618.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$627.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,830.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,830.50
|
| Rate for Payer: Multiplan Commercial |
$2,092.00
|
| Rate for Payer: Networks By Design Commercial |
$1,699.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,222.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,569.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,222.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,222.75
|
| Rate for Payer: Vantage Medical Group Senior |
$2,222.75
|
|
|
HC THORACIC FACET JONT INJ,EA ADL
|
Facility
|
IP
|
$2,615.00
|
|
|
Service Code
|
CPT 64491
|
| Hospital Charge Code |
909000231
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$523.00 |
| Max. Negotiated Rate |
$2,222.75 |
| Rate for Payer: Adventist Health Commercial |
$523.00
|
| Rate for Payer: Cash Price |
$1,438.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,046.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,046.00
|
| Rate for Payer: Galaxy Health WC |
$2,222.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,569.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,744.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$996.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,618.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$627.60
|
| Rate for Payer: Multiplan Commercial |
$2,092.00
|
| Rate for Payer: Networks By Design Commercial |
$1,699.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,222.75
|
|
|
HC THORACIC SPINE 2VIEWS
|
Facility
|
OP
|
$796.00
|
|
|
Service Code
|
CPT 72070
|
| Hospital Charge Code |
909001311
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$47.11 |
| Max. Negotiated Rate |
$676.60 |
| Rate for Payer: Adventist Health Commercial |
$159.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$522.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$183.73
|
| Rate for Payer: Blue Shield of California Commercial |
$487.15
|
| Rate for Payer: Blue Shield of California EPN |
$321.58
|
| Rate for Payer: Cash Price |
$437.80
|
| Rate for Payer: Cash Price |
$437.80
|
| Rate for Payer: Cigna of CA HMO |
$509.44
|
| Rate for Payer: Cigna of CA PPO |
$589.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Galaxy Health WC |
$676.60
|
| Rate for Payer: Global Benefits Group Commercial |
$477.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$47.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$530.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$191.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| Rate for Payer: Multiplan Commercial |
$636.80
|
| Rate for Payer: Networks By Design Commercial |
$517.40
|
| Rate for Payer: Prime Health Services Commercial |
$676.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$477.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$477.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC THORACIC SPINE 2VIEWS
|
Facility
|
IP
|
$796.00
|
|
|
Service Code
|
CPT 72070
|
| Hospital Charge Code |
909001311
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$159.20 |
| Max. Negotiated Rate |
$676.60 |
| Rate for Payer: Adventist Health Commercial |
$159.20
|
| Rate for Payer: Cash Price |
$437.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$318.40
|
| Rate for Payer: EPIC Health Plan Senior |
$318.40
|
| Rate for Payer: Galaxy Health WC |
$676.60
|
| Rate for Payer: Global Benefits Group Commercial |
$477.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$530.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$303.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$492.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$191.04
|
| Rate for Payer: Multiplan Commercial |
$636.80
|
| Rate for Payer: Networks By Design Commercial |
$517.40
|
| Rate for Payer: Prime Health Services Commercial |
$676.60
|
|
|
HC THORACIC SPINE 3VIEWS
|
Facility
|
OP
|
$873.00
|
|
|
Service Code
|
CPT 72072
|
| Hospital Charge Code |
909001310
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$51.79 |
| Max. Negotiated Rate |
$742.05 |
| Rate for Payer: Adventist Health Commercial |
$174.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$572.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$208.80
|
| Rate for Payer: Blue Shield of California Commercial |
$534.28
|
| Rate for Payer: Blue Shield of California EPN |
$352.69
|
| Rate for Payer: Cash Price |
$480.15
|
| Rate for Payer: Cash Price |
$480.15
|
| Rate for Payer: Cigna of CA HMO |
$558.72
|
| Rate for Payer: Cigna of CA PPO |
$646.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Galaxy Health WC |
$742.05
|
| Rate for Payer: Global Benefits Group Commercial |
$523.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$51.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$582.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$209.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| Rate for Payer: Multiplan Commercial |
$698.40
|
| Rate for Payer: Networks By Design Commercial |
$567.45
|
| Rate for Payer: Prime Health Services Commercial |
$742.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$523.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$523.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC THORACIC SPINE 3VIEWS
|
Facility
|
IP
|
$873.00
|
|
|
Service Code
|
CPT 72072
|
| Hospital Charge Code |
909001310
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$174.60 |
| Max. Negotiated Rate |
$742.05 |
| Rate for Payer: Adventist Health Commercial |
$174.60
|
| Rate for Payer: Cash Price |
$480.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$349.20
|
| Rate for Payer: EPIC Health Plan Senior |
$349.20
|
| Rate for Payer: Galaxy Health WC |
$742.05
|
| Rate for Payer: Global Benefits Group Commercial |
$523.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$582.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$332.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$540.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$209.52
|
| Rate for Payer: Multiplan Commercial |
$698.40
|
| Rate for Payer: Networks By Design Commercial |
$567.45
|
| Rate for Payer: Prime Health Services Commercial |
$742.05
|
|
|
HC THORACIC SPINE 4 VIEWS
|
Facility
|
OP
|
$1,176.00
|
|
|
Service Code
|
CPT 72074
|
| Hospital Charge Code |
909001313
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$58.98 |
| Max. Negotiated Rate |
$999.60 |
| Rate for Payer: Adventist Health Commercial |
$235.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$771.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$257.88
|
| Rate for Payer: Blue Shield of California Commercial |
$719.71
|
| Rate for Payer: Blue Shield of California EPN |
$475.10
|
| Rate for Payer: Cash Price |
$646.80
|
| Rate for Payer: Cash Price |
$646.80
|
| Rate for Payer: Cigna of CA HMO |
$752.64
|
| Rate for Payer: Cigna of CA PPO |
$870.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Galaxy Health WC |
$999.60
|
| Rate for Payer: Global Benefits Group Commercial |
$705.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$58.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$784.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$282.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| Rate for Payer: Multiplan Commercial |
$940.80
|
| Rate for Payer: Networks By Design Commercial |
$764.40
|
| Rate for Payer: Prime Health Services Commercial |
$999.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$705.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$705.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC THORACIC SPINE 4 VIEWS
|
Facility
|
IP
|
$1,176.00
|
|
|
Service Code
|
CPT 72074
|
| Hospital Charge Code |
909001313
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$235.20 |
| Max. Negotiated Rate |
$999.60 |
| Rate for Payer: Adventist Health Commercial |
$235.20
|
| Rate for Payer: Cash Price |
$646.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$470.40
|
| Rate for Payer: EPIC Health Plan Senior |
$470.40
|
| Rate for Payer: Galaxy Health WC |
$999.60
|
| Rate for Payer: Global Benefits Group Commercial |
$705.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$784.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$448.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$727.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$282.24
|
| Rate for Payer: Multiplan Commercial |
$940.80
|
| Rate for Payer: Networks By Design Commercial |
$764.40
|
| Rate for Payer: Prime Health Services Commercial |
$999.60
|
|
|
HC THORACOTOMY CARDIAC
|
Facility
|
IP
|
$3,682.00
|
|
|
Service Code
|
CPT 32160
|
| Hospital Charge Code |
900501127
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$736.40 |
| Max. Negotiated Rate |
$3,129.70 |
| Rate for Payer: Adventist Health Commercial |
$736.40
|
| Rate for Payer: Cash Price |
$2,025.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,472.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,472.80
|
| Rate for Payer: Galaxy Health WC |
$3,129.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,209.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,455.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,402.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,279.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$883.68
|
| Rate for Payer: Multiplan Commercial |
$2,945.60
|
| Rate for Payer: Networks By Design Commercial |
$2,393.30
|
| Rate for Payer: Prime Health Services Commercial |
$3,129.70
|
|
|
HC THORACOTOMY CARDIAC
|
Facility
|
OP
|
$3,682.00
|
|
|
Service Code
|
CPT 32160
|
| Hospital Charge Code |
900501127
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$187.64 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$736.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,129.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,025.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,761.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,922.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$2,025.10
|
| Rate for Payer: Cash Price |
$2,025.10
|
| Rate for Payer: Cash Price |
$2,025.10
|
| Rate for Payer: Cigna of CA HMO |
$2,356.48
|
| Rate for Payer: Cigna of CA PPO |
$2,724.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,129.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,129.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,129.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,472.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,472.80
|
| Rate for Payer: Galaxy Health WC |
$3,129.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,209.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$187.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,455.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$212.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,279.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$883.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,577.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,577.40
|
| Rate for Payer: Multiplan Commercial |
$2,945.60
|
| Rate for Payer: Networks By Design Commercial |
$2,393.30
|
| Rate for Payer: Prime Health Services Commercial |
$3,129.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,209.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,129.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,129.70
|
| Rate for Payer: Vantage Medical Group Senior |
$3,129.70
|
|
|
HC THORACOTOMY; WITH EXPLORATION
|
Facility
|
OP
|
$1,833.00
|
|
|
Service Code
|
CPT 32100
|
| Hospital Charge Code |
900502100
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$170.13 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$366.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,558.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,008.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,374.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,561.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$1,008.15
|
| Rate for Payer: Cash Price |
$1,008.15
|
| Rate for Payer: Cash Price |
$1,008.15
|
| Rate for Payer: Cigna of CA HMO |
$1,173.12
|
| Rate for Payer: Cigna of CA PPO |
$1,356.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,558.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,558.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,558.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$733.20
|
| Rate for Payer: EPIC Health Plan Senior |
$733.20
|
| Rate for Payer: Galaxy Health WC |
$1,558.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,099.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$170.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,222.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$192.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,134.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$439.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,283.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,283.10
|
| Rate for Payer: Multiplan Commercial |
$1,466.40
|
| Rate for Payer: Networks By Design Commercial |
$1,191.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,558.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,099.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,558.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,558.05
|
| Rate for Payer: Vantage Medical Group Senior |
$1,558.05
|
|
|
HC THORACOTOMY; WITH EXPLORATION
|
Facility
|
IP
|
$1,833.00
|
|
|
Service Code
|
CPT 32100
|
| Hospital Charge Code |
900502100
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$366.60 |
| Max. Negotiated Rate |
$1,558.05 |
| Rate for Payer: Adventist Health Commercial |
$366.60
|
| Rate for Payer: Cash Price |
$1,008.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$733.20
|
| Rate for Payer: EPIC Health Plan Senior |
$733.20
|
| Rate for Payer: Galaxy Health WC |
$1,558.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,099.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,222.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$698.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,134.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$439.92
|
| Rate for Payer: Multiplan Commercial |
$1,466.40
|
| Rate for Payer: Networks By Design Commercial |
$1,191.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,558.05
|
|
|
HC THROMBECTOMY CATH, 6&7F HYDROL
|
Facility
|
OP
|
$1,440.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909081406
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$288.00 |
| Max. Negotiated Rate |
$1,224.00 |
| Rate for Payer: Adventist Health Commercial |
$288.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,224.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$792.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,080.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$834.05
|
| Rate for Payer: Blue Shield of California Commercial |
$1,062.72
|
| Rate for Payer: Blue Shield of California EPN |
$699.84
|
| Rate for Payer: Cash Price |
$792.00
|
| Rate for Payer: Cigna of CA HMO |
$1,008.00
|
| Rate for Payer: Cigna of CA PPO |
$1,008.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,224.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,224.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,224.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$576.00
|
| Rate for Payer: EPIC Health Plan Senior |
$576.00
|
| Rate for Payer: Galaxy Health WC |
$1,224.00
|
| Rate for Payer: Global Benefits Group Commercial |
$864.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$960.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$548.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$891.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$345.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,008.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,008.00
|
| Rate for Payer: Multiplan Commercial |
$1,152.00
|
| Rate for Payer: Networks By Design Commercial |
$720.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,224.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$864.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$864.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$540.43
|
| Rate for Payer: United Healthcare All Other HMO |
$526.03
|
| Rate for Payer: United Healthcare HMO Rider |
$514.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$471.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,224.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,224.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,224.00
|
|
|
HC THROMBECTOMY CATH, 6&7F HYDROL
|
Facility
|
IP
|
$1,440.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909081406
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$288.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$288.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$792.00
|
| Rate for Payer: Cash Price |
$792.00
|
| Rate for Payer: Cigna of CA HMO |
$1,008.00
|
| Rate for Payer: Cigna of CA PPO |
$1,008.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$576.00
|
| Rate for Payer: EPIC Health Plan Senior |
$576.00
|
| Rate for Payer: Galaxy Health WC |
$1,224.00
|
| Rate for Payer: Global Benefits Group Commercial |
$864.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$960.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$548.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$891.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$345.60
|
| Rate for Payer: Multiplan Commercial |
$1,152.00
|
| Rate for Payer: Networks By Design Commercial |
$720.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,224.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$540.43
|
| Rate for Payer: United Healthcare All Other HMO |
$526.03
|
| Rate for Payer: United Healthcare HMO Rider |
$514.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$471.60
|
|
|
HC THROMBIN TIME
|
Facility
|
OP
|
$173.00
|
|
|
Service Code
|
CPT 85670
|
| Hospital Charge Code |
900910021
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.67 |
| Max. Negotiated Rate |
$147.05 |
| Rate for Payer: Adventist Health Commercial |
$34.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$113.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$57.12
|
| Rate for Payer: Blue Shield of California Commercial |
$115.74
|
| Rate for Payer: Blue Shield of California EPN |
$76.47
|
| Rate for Payer: Cash Price |
$95.15
|
| Rate for Payer: Cash Price |
$95.15
|
| Rate for Payer: Cigna of CA HMO |
$110.72
|
| Rate for Payer: Cigna of CA PPO |
$128.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.79
|
| Rate for Payer: EPIC Health Plan Senior |
$5.77
|
| Rate for Payer: Galaxy Health WC |
$147.05
|
| Rate for Payer: Global Benefits Group Commercial |
$103.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$115.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.73
|
| Rate for Payer: Multiplan Commercial |
$138.40
|
| Rate for Payer: Networks By Design Commercial |
$112.45
|
| Rate for Payer: Prime Health Services Commercial |
$147.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$103.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$103.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.67
|
| Rate for Payer: United Healthcare All Other HMO |
$4.67
|
| Rate for Payer: United Healthcare HMO Rider |
$4.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.67
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.35
|
| Rate for Payer: Vantage Medical Group Senior |
$5.77
|
|
|
HC THROMBIN TIME
|
Facility
|
IP
|
$173.00
|
|
|
Service Code
|
CPT 85670
|
| Hospital Charge Code |
900910021
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$34.60 |
| Max. Negotiated Rate |
$147.05 |
| Rate for Payer: Adventist Health Commercial |
$34.60
|
| Rate for Payer: Cash Price |
$95.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.20
|
| Rate for Payer: EPIC Health Plan Senior |
$69.20
|
| Rate for Payer: Galaxy Health WC |
$147.05
|
| Rate for Payer: Global Benefits Group Commercial |
$103.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$115.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$107.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.52
|
| Rate for Payer: Multiplan Commercial |
$138.40
|
| Rate for Payer: Networks By Design Commercial |
$112.45
|
| Rate for Payer: Prime Health Services Commercial |
$147.05
|
|
|
HC THROMBOELASTOGRAPH
|
Facility
|
IP
|
$533.00
|
|
|
Service Code
|
CPT 85396
|
| Hospital Charge Code |
900912024
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$106.60 |
| Max. Negotiated Rate |
$453.05 |
| Rate for Payer: Adventist Health Commercial |
$106.60
|
| Rate for Payer: Cash Price |
$293.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$213.20
|
| Rate for Payer: EPIC Health Plan Senior |
$213.20
|
| Rate for Payer: Galaxy Health WC |
$453.05
|
| Rate for Payer: Global Benefits Group Commercial |
$319.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$355.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$203.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$329.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.92
|
| Rate for Payer: Multiplan Commercial |
$426.40
|
| Rate for Payer: Networks By Design Commercial |
$346.45
|
| Rate for Payer: Prime Health Services Commercial |
$453.05
|
|
|
HC THROMBOELASTOGRAPH
|
Facility
|
OP
|
$533.00
|
|
|
Service Code
|
CPT 85396
|
| Hospital Charge Code |
900912024
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$15.98 |
| Max. Negotiated Rate |
$453.05 |
| Rate for Payer: Adventist Health Commercial |
$106.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$349.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$453.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$293.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$399.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$158.40
|
| Rate for Payer: Blue Shield of California Commercial |
$356.58
|
| Rate for Payer: Blue Shield of California EPN |
$235.59
|
| Rate for Payer: Cash Price |
$293.15
|
| Rate for Payer: Cash Price |
$293.15
|
| Rate for Payer: Cigna of CA HMO |
$341.12
|
| Rate for Payer: Cigna of CA PPO |
$394.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$453.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$453.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$453.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$213.20
|
| Rate for Payer: EPIC Health Plan Senior |
$213.20
|
| Rate for Payer: Galaxy Health WC |
$453.05
|
| Rate for Payer: Global Benefits Group Commercial |
$319.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$29.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$355.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$329.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$373.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$373.10
|
| Rate for Payer: Multiplan Commercial |
$426.40
|
| Rate for Payer: Networks By Design Commercial |
$346.45
|
| Rate for Payer: Prime Health Services Commercial |
$453.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$319.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$319.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.98
|
| Rate for Payer: United Healthcare All Other HMO |
$15.98
|
| Rate for Payer: United Healthcare HMO Rider |
$15.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$453.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$453.05
|
| Rate for Payer: Vantage Medical Group Senior |
$453.05
|
|
|
HC THROMBOLYSIS ART
|
Facility
|
IP
|
$3,290.00
|
|
|
Service Code
|
CPT 37211
|
| Hospital Charge Code |
909020164
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$658.00 |
| Max. Negotiated Rate |
$2,796.50 |
| Rate for Payer: Adventist Health Commercial |
$658.00
|
| Rate for Payer: Cash Price |
$1,809.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,316.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,316.00
|
| Rate for Payer: Galaxy Health WC |
$2,796.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,974.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,194.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,253.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,036.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$789.60
|
| Rate for Payer: Multiplan Commercial |
$2,632.00
|
| Rate for Payer: Networks By Design Commercial |
$2,138.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,796.50
|
|
|
HC THROMBOLYSIS ART
|
Facility
|
OP
|
$5,671.00
|
|
|
Service Code
|
CPT 37211
|
| Hospital Charge Code |
906820230
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$551.66 |
| Max. Negotiated Rate |
$11,264.31 |
| Rate for Payer: Adventist Health Commercial |
$1,134.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,555.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,868.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,470.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,291.08
|
| Rate for Payer: Cash Price |
$3,119.05
|
| Rate for Payer: Cash Price |
$3,119.05
|
| Rate for Payer: Cash Price |
$3,119.05
|
| Rate for Payer: Cigna of CA HMO |
$3,629.44
|
| Rate for Payer: Cigna of CA PPO |
$4,196.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,555.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,868.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,272.45
|
| Rate for Payer: EPIC Health Plan Senior |
$6,868.48
|
| Rate for Payer: Galaxy Health WC |
$4,820.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,402.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,264.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$551.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,868.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,782.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$623.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,868.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,361.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,654.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,203.76
|
| Rate for Payer: Multiplan Commercial |
$4,536.80
|
| Rate for Payer: Networks By Design Commercial |
$3,686.15
|
| Rate for Payer: Prime Health Services Commercial |
$4,820.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,402.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,402.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,835.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,835.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,835.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,835.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$6,868.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,555.33
|
| Rate for Payer: Vantage Medical Group Senior |
$6,868.48
|
|
|
HC THROMBOLYSIS ART
|
Facility
|
IP
|
$5,671.00
|
|
|
Service Code
|
CPT 37211
|
| Hospital Charge Code |
906820230
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,134.20 |
| Max. Negotiated Rate |
$4,820.35 |
| Rate for Payer: Adventist Health Commercial |
$1,134.20
|
| Rate for Payer: Cash Price |
$3,119.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,268.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,268.40
|
| Rate for Payer: Galaxy Health WC |
$4,820.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,402.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,782.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,160.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,510.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,361.04
|
| Rate for Payer: Multiplan Commercial |
$4,536.80
|
| Rate for Payer: Networks By Design Commercial |
$3,686.15
|
| Rate for Payer: Prime Health Services Commercial |
$4,820.35
|
|
|
HC THROMBOLYSIS ART
|
Facility
|
OP
|
$3,290.00
|
|
|
Service Code
|
CPT 37211
|
| Hospital Charge Code |
909020164
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$551.66 |
| Max. Negotiated Rate |
$11,264.31 |
| Rate for Payer: Adventist Health Commercial |
$658.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,555.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,868.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,013.48
|
| Rate for Payer: Blue Shield of California EPN |
$1,329.16
|
| Rate for Payer: Cash Price |
$1,809.50
|
| Rate for Payer: Cash Price |
$1,809.50
|
| Rate for Payer: Cash Price |
$1,809.50
|
| Rate for Payer: Cigna of CA HMO |
$2,105.60
|
| Rate for Payer: Cigna of CA PPO |
$2,434.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,555.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,868.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,272.45
|
| Rate for Payer: EPIC Health Plan Senior |
$6,868.48
|
| Rate for Payer: Galaxy Health WC |
$2,796.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,974.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,264.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$551.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,868.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,194.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$623.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,868.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$789.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,654.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,203.76
|
| Rate for Payer: Multiplan Commercial |
$2,632.00
|
| Rate for Payer: Networks By Design Commercial |
$2,138.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,796.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,974.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,974.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,645.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,645.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,645.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,645.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$6,868.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,555.33
|
| Rate for Payer: Vantage Medical Group Senior |
$6,868.48
|
|
|
HC THROMBOLYSIS COMPLETE
|
Facility
|
OP
|
$6,879.00
|
|
|
Service Code
|
CPT 37214
|
| Hospital Charge Code |
909020157
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$200.78 |
| Max. Negotiated Rate |
$9,590.00 |
| Rate for Payer: Adventist Health Commercial |
$1,375.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,209.95
|
| Rate for Payer: Blue Shield of California EPN |
$2,779.12
|
| Rate for Payer: Cash Price |
$3,783.45
|
| Rate for Payer: Cash Price |
$3,783.45
|
| Rate for Payer: Cash Price |
$3,783.45
|
| Rate for Payer: Cigna of CA HMO |
$4,402.56
|
| Rate for Payer: Cigna of CA PPO |
$5,090.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,398.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3,999.21
|
| Rate for Payer: Galaxy Health WC |
$5,847.15
|
| Rate for Payer: Global Benefits Group Commercial |
$4,127.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$200.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,588.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$227.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,650.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,039.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,358.94
|
| Rate for Payer: Multiplan Commercial |
$5,503.20
|
| Rate for Payer: Networks By Design Commercial |
$4,471.35
|
| Rate for Payer: Prime Health Services Commercial |
$5,847.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,127.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,127.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,439.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,439.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,439.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,439.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,999.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC THROMBOLYSIS COMPLETE
|
Facility
|
IP
|
$11,859.00
|
|
|
Service Code
|
CPT 37214
|
| Hospital Charge Code |
906820227
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,371.80 |
| Max. Negotiated Rate |
$10,080.15 |
| Rate for Payer: Adventist Health Commercial |
$2,371.80
|
| Rate for Payer: Cash Price |
$6,522.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,743.60
|
| Rate for Payer: EPIC Health Plan Senior |
$4,743.60
|
| Rate for Payer: Galaxy Health WC |
$10,080.15
|
| Rate for Payer: Global Benefits Group Commercial |
$7,115.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,909.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,518.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,340.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,846.16
|
| Rate for Payer: Multiplan Commercial |
$9,487.20
|
| Rate for Payer: Networks By Design Commercial |
$7,708.35
|
| Rate for Payer: Prime Health Services Commercial |
$10,080.15
|
|
