|
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
|
|
|
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, INTRACORONARY
|
Facility
|
OP
|
$1,477.00
|
|
|
Service Code
|
CPT 92975
|
| Hospital Charge Code |
906811110
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$295.40 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$295.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,255.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$812.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,107.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$812.35
|
| Rate for Payer: Cash Price |
$812.35
|
| Rate for Payer: Cash Price |
$812.35
|
| Rate for Payer: Cigna of CA HMO |
$960.05
|
| Rate for Payer: Cigna of CA PPO |
$1,092.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,255.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,255.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,255.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$590.80
|
| Rate for Payer: EPIC Health Plan Senior |
$590.80
|
| Rate for Payer: Galaxy Health WC |
$1,255.45
|
| Rate for Payer: Global Benefits Group Commercial |
$886.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$565.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$985.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$639.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$914.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$354.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,033.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,033.90
|
| Rate for Payer: Multiplan Commercial |
$1,181.60
|
| Rate for Payer: Networks By Design Commercial |
$960.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,255.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$886.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$886.20
|
| 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 |
$1,255.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,255.45
|
| Rate for Payer: Vantage Medical Group Senior |
$1,255.45
|
|
|
HC THROMBOLYSIS, INTRACORONARY
|
Facility
|
IP
|
$1,477.00
|
|
|
Service Code
|
CPT 92975
|
| Hospital Charge Code |
906811110
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$295.40 |
| Max. Negotiated Rate |
$1,255.45 |
| Rate for Payer: Adventist Health Commercial |
$295.40
|
| Rate for Payer: Cash Price |
$812.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$590.80
|
| Rate for Payer: EPIC Health Plan Senior |
$590.80
|
| Rate for Payer: Galaxy Health WC |
$1,255.45
|
| Rate for Payer: Global Benefits Group Commercial |
$886.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$985.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$562.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$914.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$354.48
|
| Rate for Payer: Multiplan Commercial |
$1,181.60
|
| Rate for Payer: Networks By Design Commercial |
$960.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,255.45
|
|
|
HC THROMBOLYSIS, INTRACORONARY
|
Facility
|
IP
|
$1,436.00
|
|
|
Service Code
|
CPT 92975
|
| Hospital Charge Code |
906820029
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$287.20 |
| Max. Negotiated Rate |
$1,220.60 |
| Rate for Payer: Adventist Health Commercial |
$287.20
|
| Rate for Payer: Cash Price |
$789.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$574.40
|
| Rate for Payer: EPIC Health Plan Senior |
$574.40
|
| Rate for Payer: Galaxy Health WC |
$1,220.60
|
| Rate for Payer: Global Benefits Group Commercial |
$861.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$957.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$547.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$888.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$344.64
|
| Rate for Payer: Multiplan Commercial |
$1,148.80
|
| Rate for Payer: Networks By Design Commercial |
$933.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,220.60
|
|
|
HC THROMBOLYSIS, INTRACORONARY
|
Facility
|
OP
|
$1,436.00
|
|
|
Service Code
|
CPT 92975
|
| Hospital Charge Code |
906820029
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$287.20 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$287.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,220.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$789.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,077.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$789.80
|
| Rate for Payer: Cash Price |
$789.80
|
| Rate for Payer: Cash Price |
$789.80
|
| Rate for Payer: Cigna of CA HMO |
$933.40
|
| Rate for Payer: Cigna of CA PPO |
$1,062.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,220.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,220.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,220.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$574.40
|
| Rate for Payer: EPIC Health Plan Senior |
$574.40
|
| Rate for Payer: Galaxy Health WC |
$1,220.60
|
| Rate for Payer: Global Benefits Group Commercial |
$861.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$565.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$957.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$639.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$888.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$344.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,005.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,005.20
|
| Rate for Payer: Multiplan Commercial |
$1,148.80
|
| Rate for Payer: Networks By Design Commercial |
$933.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,220.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$861.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$861.60
|
| 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 |
$1,220.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,220.60
|
| Rate for Payer: Vantage Medical Group Senior |
$1,220.60
|
|
|
HC THROMBOLYSIS VEIN
|
Facility
|
IP
|
$4,725.00
|
|
|
Service Code
|
CPT 37212
|
| Hospital Charge Code |
906820225
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$945.00 |
| Max. Negotiated Rate |
$4,016.25 |
| Rate for Payer: Adventist Health Commercial |
$945.00
|
| Rate for Payer: Cash Price |
$2,598.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,890.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,890.00
|
| Rate for Payer: Galaxy Health WC |
$4,016.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,835.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,151.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,800.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,924.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,134.00
|
| Rate for Payer: Multiplan Commercial |
$3,780.00
|
| Rate for Payer: Networks By Design Commercial |
$3,071.25
|
| Rate for Payer: Prime Health Services Commercial |
$4,016.25
|
|
|
HC THROMBOLYSIS VEIN
|
Facility
|
IP
|
$2,740.00
|
|
|
Service Code
|
CPT 37212
|
| Hospital Charge Code |
909020155
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$548.00 |
| Max. Negotiated Rate |
$2,329.00 |
| Rate for Payer: Adventist Health Commercial |
$548.00
|
| Rate for Payer: Cash Price |
$1,507.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,096.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,096.00
|
| Rate for Payer: Galaxy Health WC |
$2,329.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,644.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,827.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,043.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,696.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$657.60
|
| Rate for Payer: Multiplan Commercial |
$2,192.00
|
| Rate for Payer: Networks By Design Commercial |
$1,781.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,329.00
|
|
|
HC THROMBOLYSIS VEIN
|
Facility
|
OP
|
$2,740.00
|
|
|
Service Code
|
CPT 37212
|
| Hospital Charge Code |
909020155
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$485.35 |
| Max. Negotiated Rate |
$6,558.70 |
| Rate for Payer: Adventist Health Commercial |
$548.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| 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 |
$1,676.88
|
| Rate for Payer: Blue Shield of California EPN |
$1,106.96
|
| Rate for Payer: Cash Price |
$1,507.00
|
| Rate for Payer: Cash Price |
$1,507.00
|
| Rate for Payer: Cash Price |
$1,507.00
|
| Rate for Payer: Cigna of CA HMO |
$1,753.60
|
| Rate for Payer: Cigna of CA PPO |
$2,027.60
|
| 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 |
$2,329.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,644.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$485.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,827.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$548.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$657.60
|
| 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 |
$2,192.00
|
| Rate for Payer: Networks By Design Commercial |
$1,781.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,329.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,644.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,644.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,370.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,370.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,370.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,370.00
|
| 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 VEIN
|
Facility
|
OP
|
$4,725.00
|
|
|
Service Code
|
CPT 37212
|
| Hospital Charge Code |
906820225
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$485.35 |
| Max. Negotiated Rate |
$6,558.70 |
| Rate for Payer: Adventist Health Commercial |
$945.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| 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 |
$2,891.70
|
| Rate for Payer: Blue Shield of California EPN |
$1,908.90
|
| Rate for Payer: Cash Price |
$2,598.75
|
| Rate for Payer: Cash Price |
$2,598.75
|
| Rate for Payer: Cash Price |
$2,598.75
|
| Rate for Payer: Cigna of CA HMO |
$3,024.00
|
| Rate for Payer: Cigna of CA PPO |
$3,496.50
|
| 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 |
$4,016.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,835.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$485.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,151.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$548.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,134.00
|
| 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 |
$3,780.00
|
| Rate for Payer: Networks By Design Commercial |
$3,071.25
|
| Rate for Payer: Prime Health Services Commercial |
$4,016.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,835.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,835.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,362.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,362.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,362.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,362.50
|
| 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 THROMBO SUBSEQUENT DAY
|
Facility
|
IP
|
$5,819.00
|
|
|
Service Code
|
CPT 37213
|
| Hospital Charge Code |
909020156
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,163.80 |
| Max. Negotiated Rate |
$4,946.15 |
| Rate for Payer: Adventist Health Commercial |
$1,163.80
|
| Rate for Payer: Cash Price |
$3,200.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,327.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,327.60
|
| Rate for Payer: Galaxy Health WC |
$4,946.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,491.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,881.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,217.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,601.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,396.56
|
| Rate for Payer: Multiplan Commercial |
$4,655.20
|
| Rate for Payer: Networks By Design Commercial |
$3,782.35
|
| Rate for Payer: Prime Health Services Commercial |
$4,946.15
|
|
|
HC THROMBO SUBSEQUENT DAY
|
Facility
|
OP
|
$5,819.00
|
|
|
Service Code
|
CPT 37213
|
| Hospital Charge Code |
909020156
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$338.37 |
| Max. Negotiated Rate |
$9,590.00 |
| Rate for Payer: Adventist Health Commercial |
$1,163.80
|
| 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 |
$3,561.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,350.88
|
| Rate for Payer: Cash Price |
$3,200.45
|
| Rate for Payer: Cash Price |
$3,200.45
|
| Rate for Payer: Cash Price |
$3,200.45
|
| Rate for Payer: Cigna of CA HMO |
$3,724.16
|
| Rate for Payer: Cigna of CA PPO |
$4,306.06
|
| 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 |
$4,946.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,491.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$338.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,881.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$382.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,396.56
|
| 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 |
$4,655.20
|
| Rate for Payer: Networks By Design Commercial |
$3,782.35
|
| Rate for Payer: Prime Health Services Commercial |
$4,946.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,491.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,491.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,909.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,909.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,909.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,909.50
|
| 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 THROMBO SUBSEQUENT DAY
|
Facility
|
IP
|
$10,033.00
|
|
|
Service Code
|
CPT 37213
|
| Hospital Charge Code |
906820226
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,006.60 |
| Max. Negotiated Rate |
$8,528.05 |
| Rate for Payer: Adventist Health Commercial |
$2,006.60
|
| Rate for Payer: Cash Price |
$5,518.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,013.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,013.20
|
| Rate for Payer: Galaxy Health WC |
$8,528.05
|
| Rate for Payer: Global Benefits Group Commercial |
$6,019.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,692.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,822.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,210.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,407.92
|
| Rate for Payer: Multiplan Commercial |
$8,026.40
|
| Rate for Payer: Networks By Design Commercial |
$6,521.45
|
| Rate for Payer: Prime Health Services Commercial |
$8,528.05
|
|
|
HC THROMBO SUBSEQUENT DAY
|
Facility
|
OP
|
$10,033.00
|
|
|
Service Code
|
CPT 37213
|
| Hospital Charge Code |
906820226
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$338.37 |
| Max. Negotiated Rate |
$9,590.00 |
| Rate for Payer: Adventist Health Commercial |
$2,006.60
|
| 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 |
$6,140.20
|
| Rate for Payer: Blue Shield of California EPN |
$4,053.33
|
| Rate for Payer: Cash Price |
$5,518.15
|
| Rate for Payer: Cash Price |
$5,518.15
|
| Rate for Payer: Cash Price |
$5,518.15
|
| Rate for Payer: Cigna of CA HMO |
$6,421.12
|
| Rate for Payer: Cigna of CA PPO |
$7,424.42
|
| 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 |
$8,528.05
|
| Rate for Payer: Global Benefits Group Commercial |
$6,019.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$338.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,692.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$382.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,407.92
|
| 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 |
$8,026.40
|
| Rate for Payer: Networks By Design Commercial |
$6,521.45
|
| Rate for Payer: Prime Health Services Commercial |
$8,528.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,019.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,019.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,016.50
|
| Rate for Payer: United Healthcare All Other HMO |
$5,016.50
|
| Rate for Payer: United Healthcare HMO Rider |
$5,016.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,016.50
|
| 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 THROM DIALYSIS CRCT W STNT PLC
|
Facility
|
IP
|
$51,066.00
|
|
|
Service Code
|
CPT 36906
|
| Hospital Charge Code |
909036906
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$10,213.20 |
| Max. Negotiated Rate |
$43,406.10 |
| Rate for Payer: Adventist Health Commercial |
$10,213.20
|
| Rate for Payer: Cash Price |
$28,086.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$20,426.40
|
| Rate for Payer: EPIC Health Plan Senior |
$20,426.40
|
| Rate for Payer: Galaxy Health WC |
$43,406.10
|
| Rate for Payer: Global Benefits Group Commercial |
$30,639.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34,061.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19,456.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31,609.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12,255.84
|
| Rate for Payer: Multiplan Commercial |
$40,852.80
|
| Rate for Payer: Networks By Design Commercial |
$33,192.90
|
| Rate for Payer: Prime Health Services Commercial |
$43,406.10
|
|
|
HC THROM DIALYSIS CRCT W STNT PLC
|
Facility
|
OP
|
$51,066.00
|
|
|
Service Code
|
CPT 36906
|
| Hospital Charge Code |
909036906
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,415.66 |
| Max. Negotiated Rate |
$71,375.00 |
| Rate for Payer: Adventist Health Commercial |
$10,213.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,370.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22,815.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$7,415.66
|
| Rate for Payer: Cash Price |
$28,086.30
|
| Rate for Payer: Cash Price |
$28,086.30
|
| Rate for Payer: Cash Price |
$28,086.30
|
| Rate for Payer: Cigna of CA HMO |
$32,682.24
|
| Rate for Payer: Cigna of CA PPO |
$37,788.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,097.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22,815.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$30,801.34
|
| Rate for Payer: EPIC Health Plan Senior |
$22,815.81
|
| Rate for Payer: Galaxy Health WC |
$43,406.10
|
| Rate for Payer: Global Benefits Group Commercial |
$30,639.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$37,417.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10,516.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,815.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34,061.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,893.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,815.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12,255.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28,747.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30,573.19
|
| Rate for Payer: Multiplan Commercial |
$40,852.80
|
| Rate for Payer: Multiplan WC |
$36,352.92
|
| Rate for Payer: Networks By Design Commercial |
$33,192.90
|
| Rate for Payer: Prime Health Services Commercial |
$43,406.10
|
| Rate for Payer: Prime Health Services WC |
$35,981.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30,639.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$60,866.00
|
| Rate for Payer: United Healthcare All Other HMO |
$71,375.00
|
| Rate for Payer: United Healthcare HMO Rider |
$57,385.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$52,575.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$22,815.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Vantage Medical Group Senior |
$22,815.81
|
|
|
HC THROM DIALYSIS CRCT W TRAN BLN
|
Facility
|
OP
|
$29,554.00
|
|
|
Service Code
|
CPT 36905
|
| Hospital Charge Code |
909036905
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,481.33 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$5,910.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,370.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,409.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,712.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$7,415.66
|
| Rate for Payer: Cash Price |
$16,254.70
|
| Rate for Payer: Cash Price |
$16,254.70
|
| Rate for Payer: Cash Price |
$16,254.70
|
| Rate for Payer: Cigna of CA HMO |
$18,914.56
|
| Rate for Payer: Cigna of CA PPO |
$21,869.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,850.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,409.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,452.60
|
| Rate for Payer: EPIC Health Plan Senior |
$14,409.33
|
| Rate for Payer: Galaxy Health WC |
$25,120.90
|
| Rate for Payer: Global Benefits Group Commercial |
$17,732.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$23,631.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,481.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,409.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19,712.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,937.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,409.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,092.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,155.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,308.50
|
| Rate for Payer: Multiplan Commercial |
$23,643.20
|
| Rate for Payer: Multiplan WC |
$22,958.69
|
| Rate for Payer: Networks By Design Commercial |
$19,210.10
|
| Rate for Payer: Prime Health Services Commercial |
$25,120.90
|
| Rate for Payer: Prime Health Services WC |
$22,724.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17,732.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$31,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$14,409.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Vantage Medical Group Senior |
$14,409.33
|
|
|
HC THROM DIALYSIS CRCT W TRAN BLN
|
Facility
|
OP
|
$28,722.00
|
|
|
Service Code
|
CPT 36905
|
| Hospital Charge Code |
906820282
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,481.33 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$5,744.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,370.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,409.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,712.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$7,415.66
|
| Rate for Payer: Cash Price |
$15,797.10
|
| Rate for Payer: Cash Price |
$15,797.10
|
| Rate for Payer: Cash Price |
$15,797.10
|
| Rate for Payer: Cigna of CA HMO |
$18,382.08
|
| Rate for Payer: Cigna of CA PPO |
$21,254.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,850.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,409.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,452.60
|
| Rate for Payer: EPIC Health Plan Senior |
$14,409.33
|
| Rate for Payer: Galaxy Health WC |
$24,413.70
|
| Rate for Payer: Global Benefits Group Commercial |
$17,233.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$23,631.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,481.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,409.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19,157.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,937.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,409.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,893.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,155.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,308.50
|
| Rate for Payer: Multiplan Commercial |
$22,977.60
|
| Rate for Payer: Multiplan WC |
$22,958.69
|
| Rate for Payer: Networks By Design Commercial |
$18,669.30
|
| Rate for Payer: Prime Health Services Commercial |
$24,413.70
|
| Rate for Payer: Prime Health Services WC |
$22,724.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17,233.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$31,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$14,409.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Vantage Medical Group Senior |
$14,409.33
|
|
|
HC THROM DIALYSIS CRCT W TRAN BLN
|
Facility
|
IP
|
$28,722.00
|
|
|
Service Code
|
CPT 36905
|
| Hospital Charge Code |
906820282
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,744.40 |
| Max. Negotiated Rate |
$24,413.70 |
| Rate for Payer: Adventist Health Commercial |
$5,744.40
|
| Rate for Payer: Cash Price |
$15,797.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,488.80
|
| Rate for Payer: EPIC Health Plan Senior |
$11,488.80
|
| Rate for Payer: Galaxy Health WC |
$24,413.70
|
| Rate for Payer: Global Benefits Group Commercial |
$17,233.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19,157.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,943.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17,778.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,893.28
|
| Rate for Payer: Multiplan Commercial |
$22,977.60
|
| Rate for Payer: Networks By Design Commercial |
$18,669.30
|
| Rate for Payer: Prime Health Services Commercial |
$24,413.70
|
|
|
HC THROM DIALYSIS CRCT W TRAN BLN
|
Facility
|
IP
|
$29,554.00
|
|
|
Service Code
|
CPT 36905
|
| Hospital Charge Code |
909036905
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,910.80 |
| Max. Negotiated Rate |
$25,120.90 |
| Rate for Payer: Adventist Health Commercial |
$5,910.80
|
| Rate for Payer: Cash Price |
$16,254.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,821.60
|
| Rate for Payer: EPIC Health Plan Senior |
$11,821.60
|
| Rate for Payer: Galaxy Health WC |
$25,120.90
|
| Rate for Payer: Global Benefits Group Commercial |
$17,732.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19,712.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,260.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18,293.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,092.96
|
| Rate for Payer: Multiplan Commercial |
$23,643.20
|
| Rate for Payer: Networks By Design Commercial |
$19,210.10
|
| Rate for Payer: Prime Health Services Commercial |
$25,120.90
|
|
|
HC THRPTC INTVN 1ST 15 MIN
|
Facility
|
OP
|
$66.00
|
|
|
Service Code
|
CPT 97129
|
| Hospital Charge Code |
905107129
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$15.84 |
| Max. Negotiated Rate |
$457.00 |
| Rate for Payer: Adventist Health Commercial |
$27.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$43.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$56.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$36.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$49.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cigna of CA HMO |
$42.24
|
| Rate for Payer: Cigna of CA PPO |
$48.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$56.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$56.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.40
|
| Rate for Payer: EPIC Health Plan Senior |
$26.40
|
| Rate for Payer: Galaxy Health WC |
$56.10
|
| Rate for Payer: Global Benefits Group Commercial |
$39.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$34.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$44.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$40.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$46.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$46.20
|
| Rate for Payer: Multiplan Commercial |
$52.80
|
| Rate for Payer: Networks By Design Commercial |
$42.90
|
| Rate for Payer: Prime Health Services Commercial |
$56.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$39.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$39.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$56.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56.10
|
| Rate for Payer: Vantage Medical Group Senior |
$56.10
|
|
|
HC THRPTC INTVN 1ST 15 MIN
|
Facility
|
IP
|
$66.00
|
|
|
Service Code
|
CPT 97129
|
| Hospital Charge Code |
905107129
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$13.20 |
| Max. Negotiated Rate |
$56.10 |
| Rate for Payer: Networks By Design Commercial |
$42.90
|
| Rate for Payer: Adventist Health Commercial |
$13.20
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.40
|
| Rate for Payer: EPIC Health Plan Senior |
$26.40
|
| Rate for Payer: Galaxy Health WC |
$56.10
|
| Rate for Payer: Global Benefits Group Commercial |
$39.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$44.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$40.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.84
|
| Rate for Payer: Multiplan Commercial |
$52.80
|
| Rate for Payer: Prime Health Services Commercial |
$56.10
|
|
|
HC THRPTC INTVN 1ST 15 MIN OT
|
Facility
|
OP
|
$66.00
|
|
|
Service Code
|
CPT 97129
|
| Hospital Charge Code |
905107131
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$15.84 |
| Max. Negotiated Rate |
$457.00 |
| Rate for Payer: Adventist Health Commercial |
$27.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$43.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$56.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$36.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$49.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cigna of CA HMO |
$42.24
|
| Rate for Payer: Cigna of CA PPO |
$48.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$56.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$56.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.40
|
| Rate for Payer: EPIC Health Plan Senior |
$26.40
|
| Rate for Payer: Galaxy Health WC |
$56.10
|
| Rate for Payer: Global Benefits Group Commercial |
$39.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$34.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$44.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$40.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$46.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$46.20
|
| Rate for Payer: Multiplan Commercial |
$52.80
|
| Rate for Payer: Networks By Design Commercial |
$42.90
|
| Rate for Payer: Prime Health Services Commercial |
$56.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$39.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$39.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$56.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56.10
|
| Rate for Payer: Vantage Medical Group Senior |
$56.10
|
|
|
HC THRPTC INTVN 1ST 15 MIN OT
|
Facility
|
IP
|
$66.00
|
|
|
Service Code
|
CPT 97129
|
| Hospital Charge Code |
905107131
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$13.20 |
| Max. Negotiated Rate |
$56.10 |
| Rate for Payer: Adventist Health Commercial |
$13.20
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.40
|
| Rate for Payer: EPIC Health Plan Senior |
$26.40
|
| Rate for Payer: Galaxy Health WC |
$56.10
|
| Rate for Payer: Global Benefits Group Commercial |
$39.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$44.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$40.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.84
|
| Rate for Payer: Multiplan Commercial |
$52.80
|
| Rate for Payer: Networks By Design Commercial |
$42.90
|
| Rate for Payer: Prime Health Services Commercial |
$56.10
|
|
|
HC THRPTC INTVN 1ST 15 MIN ST
|
Facility
|
OP
|
$66.00
|
|
|
Service Code
|
CPT 97129
|
| Hospital Charge Code |
905107132
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$15.84 |
| Max. Negotiated Rate |
$457.00 |
| Rate for Payer: Adventist Health Commercial |
$27.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$43.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$56.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$36.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$49.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cigna of CA HMO |
$42.24
|
| Rate for Payer: Cigna of CA PPO |
$48.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$56.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$56.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.40
|
| Rate for Payer: EPIC Health Plan Senior |
$26.40
|
| Rate for Payer: Galaxy Health WC |
$56.10
|
| Rate for Payer: Global Benefits Group Commercial |
$39.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$34.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$44.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$40.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$46.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$46.20
|
| Rate for Payer: Multiplan Commercial |
$52.80
|
| Rate for Payer: Networks By Design Commercial |
$42.90
|
| Rate for Payer: Prime Health Services Commercial |
$56.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$39.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$39.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$56.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56.10
|
| Rate for Payer: Vantage Medical Group Senior |
$56.10
|
|
