|
HC THROMBOLYSIS, INTRACORONARY
|
Facility
|
IP
|
$1,512.00
|
|
|
Service Code
|
CPT 92975
|
| Hospital Charge Code |
906811110
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$362.88 |
| Max. Negotiated Rate |
$1,285.20 |
| Rate for Payer: Cash Price |
$680.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$604.80
|
| Rate for Payer: Galaxy Health WC |
$1,285.20
|
| Rate for Payer: Global Benefits Group Commercial |
$907.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,008.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$576.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$362.88
|
| Rate for Payer: Multiplan Commercial |
$1,209.60
|
| Rate for Payer: Networks By Design Commercial |
$982.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,285.20
|
|
|
HC THROMBOLYSIS, INTRACORONARY
|
Facility
|
OP
|
$1,512.00
|
|
|
Service Code
|
CPT 92975
|
| Hospital Charge Code |
906811110
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$362.88 |
| Max. Negotiated Rate |
$6,668.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,634.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,285.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$831.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$831.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$907.20
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$680.40
|
| Rate for Payer: Cash Price |
$680.40
|
| Rate for Payer: Cash Price |
$680.40
|
| Rate for Payer: Cigna of CA PPO |
$1,118.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,285.20
|
| Rate for Payer: Dignity Health Media |
$1,285.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,285.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$604.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$604.80
|
| Rate for Payer: Galaxy Health WC |
$1,285.20
|
| Rate for Payer: Global Benefits Group Commercial |
$907.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,134.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,008.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$639.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$362.88
|
| Rate for Payer: Multiplan Commercial |
$1,209.60
|
| Rate for Payer: Networks By Design Commercial |
$982.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,285.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$907.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$907.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,285.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,285.20
|
| Rate for Payer: Vantage Medical Group Senior |
$1,285.20
|
|
|
HC THROMBOLYSIS VEIN
|
Facility
|
IP
|
$3,394.00
|
|
|
Service Code
|
CPT 37212
|
| Hospital Charge Code |
909020155
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$814.56 |
| Max. Negotiated Rate |
$2,884.90 |
| Rate for Payer: Cash Price |
$1,527.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,357.60
|
| Rate for Payer: Galaxy Health WC |
$2,884.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,036.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,263.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,293.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$814.56
|
| Rate for Payer: Multiplan Commercial |
$2,715.20
|
| Rate for Payer: Networks By Design Commercial |
$2,206.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,884.90
|
|
|
HC THROMBOLYSIS VEIN
|
Facility
|
OP
|
$3,394.00
|
|
|
Service Code
|
CPT 37212
|
| Hospital Charge Code |
909020155
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$548.91 |
| Max. Negotiated Rate |
$6,531.38 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,036.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,005.85
|
| Rate for Payer: Blue Shield of California EPN |
$1,591.79
|
| Rate for Payer: Cash Price |
$1,527.30
|
| Rate for Payer: Cash Price |
$1,527.30
|
| Rate for Payer: Cigna of CA HMO |
$2,172.16
|
| Rate for Payer: Cigna of CA PPO |
$2,511.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Media |
$3,982.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,376.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,982.55
|
| Rate for Payer: Galaxy Health WC |
$2,884.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,036.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,545.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,531.38
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,531.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6,451.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$6,451.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,982.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,263.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$548.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,982.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$814.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,018.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,336.62
|
| Rate for Payer: Multiplan Commercial |
$2,715.20
|
| Rate for Payer: Networks By Design Commercial |
$2,206.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,884.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,036.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,036.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,697.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,697.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,697.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,697.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC THROMBO SUBSEQUENT DAY
|
Facility
|
IP
|
$7,207.00
|
|
|
Service Code
|
CPT 37213
|
| Hospital Charge Code |
909020156
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,729.68 |
| Max. Negotiated Rate |
$6,125.95 |
| Rate for Payer: Cash Price |
$3,243.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,882.80
|
| Rate for Payer: Galaxy Health WC |
$6,125.95
|
| Rate for Payer: Global Benefits Group Commercial |
$4,324.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,807.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,745.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,729.68
|
| Rate for Payer: Multiplan Commercial |
$5,765.60
|
| Rate for Payer: Networks By Design Commercial |
$4,684.55
|
| Rate for Payer: Prime Health Services Commercial |
$6,125.95
|
|
|
HC THROMBO SUBSEQUENT DAY
|
Facility
|
OP
|
$7,207.00
|
|
|
Service Code
|
CPT 37213
|
| Hospital Charge Code |
909020156
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$382.68 |
| Max. Negotiated Rate |
$9,590.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$4,324.20
|
| Rate for Payer: Blue Shield of California Commercial |
$4,259.34
|
| Rate for Payer: Blue Shield of California EPN |
$3,380.08
|
| Rate for Payer: Cash Price |
$3,243.15
|
| Rate for Payer: Cash Price |
$3,243.15
|
| Rate for Payer: Cigna of CA HMO |
$4,612.48
|
| Rate for Payer: Cigna of CA PPO |
$5,333.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Media |
$3,982.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,376.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,982.55
|
| Rate for Payer: Galaxy Health WC |
$6,125.95
|
| Rate for Payer: Global Benefits Group Commercial |
$4,324.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,405.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,531.38
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,531.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6,451.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$6,451.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,982.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,807.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$382.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,982.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,729.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,018.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,336.62
|
| Rate for Payer: Multiplan Commercial |
$5,765.60
|
| Rate for Payer: Networks By Design Commercial |
$4,684.55
|
| Rate for Payer: Prime Health Services Commercial |
$6,125.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,324.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,324.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,603.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,603.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,603.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,603.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC THROM DIALYSIS CRCT W STNT PLC
|
Facility
|
OP
|
$52,242.00
|
|
|
Service Code
|
CPT 36906
|
| Hospital Charge Code |
909036906
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,058.45 |
| Max. Negotiated Rate |
$67,976.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$11,370.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24,099.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21,908.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: Blue Distinction Transplant |
$31,345.20
|
| Rate for Payer: Blue Shield of California Commercial |
$10,844.87
|
| Rate for Payer: Blue Shield of California EPN |
$7,058.45
|
| Rate for Payer: Cash Price |
$23,508.90
|
| Rate for Payer: Cash Price |
$23,508.90
|
| Rate for Payer: Cigna of CA PPO |
$38,659.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Dignity Health Media |
$21,908.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$24,099.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$29,577.10
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$21,908.96
|
| Rate for Payer: EPIC Health Plan Transplant |
$21,908.96
|
| Rate for Payer: Galaxy Health WC |
$44,405.70
|
| Rate for Payer: Global Benefits Group Commercial |
$31,345.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$39,181.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$35,930.69
|
| Rate for Payer: Heritage Provider Network Transplant |
$35,930.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$35,492.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$35,492.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21,908.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34,845.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,893.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21,908.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12,538.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27,605.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29,358.01
|
| Rate for Payer: Multiplan Commercial |
$41,793.60
|
| Rate for Payer: Multiplan WC |
$29,952.68
|
| Rate for Payer: Networks By Design Commercial |
$33,957.30
|
| Rate for Payer: Prime Health Services Commercial |
$44,405.70
|
| Rate for Payer: Prime Health Services WC |
$29,647.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$31,345.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$57,775.00
|
| Rate for Payer: United Healthcare All Other HMO |
$67,976.00
|
| Rate for Payer: United Healthcare HMO Rider |
$54,652.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$49,976.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24,099.86
|
| Rate for Payer: Vantage Medical Group Senior |
$21,908.96
|
|
|
HC THROM DIALYSIS CRCT W STNT PLC
|
Facility
|
IP
|
$52,242.00
|
|
|
Service Code
|
CPT 36906
|
| Hospital Charge Code |
909036906
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$12,538.08 |
| Max. Negotiated Rate |
$44,405.70 |
| Rate for Payer: Cash Price |
$23,508.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$20,896.80
|
| Rate for Payer: Galaxy Health WC |
$44,405.70
|
| Rate for Payer: Global Benefits Group Commercial |
$31,345.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34,845.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19,904.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12,538.08
|
| Rate for Payer: Multiplan Commercial |
$41,793.60
|
| Rate for Payer: Networks By Design Commercial |
$33,957.30
|
| Rate for Payer: Prime Health Services Commercial |
$44,405.70
|
|
|
HC THROM DIALYSIS CRCT W TRAN BLN
|
Facility
|
IP
|
$30,234.00
|
|
|
Service Code
|
CPT 36905
|
| Hospital Charge Code |
909036905
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,256.16 |
| Max. Negotiated Rate |
$25,698.90 |
| Rate for Payer: Cash Price |
$13,605.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,093.60
|
| Rate for Payer: Galaxy Health WC |
$25,698.90
|
| Rate for Payer: Global Benefits Group Commercial |
$18,140.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20,166.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,519.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,256.16
|
| Rate for Payer: Multiplan Commercial |
$24,187.20
|
| Rate for Payer: Networks By Design Commercial |
$19,652.10
|
| Rate for Payer: Prime Health Services Commercial |
$25,698.90
|
|
|
HC THROM DIALYSIS CRCT W TRAN BLN
|
Facility
|
OP
|
$30,234.00
|
|
|
Service Code
|
CPT 36905
|
| Hospital Charge Code |
909036905
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,937.22 |
| Max. Negotiated Rate |
$48,045.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$11,370.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,119.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,745.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,049.00
|
| Rate for Payer: Blue Distinction Transplant |
$18,140.40
|
| Rate for Payer: Blue Shield of California Commercial |
$10,844.87
|
| Rate for Payer: Blue Shield of California EPN |
$7,058.45
|
| Rate for Payer: Cash Price |
$13,605.30
|
| Rate for Payer: Cash Price |
$13,605.30
|
| Rate for Payer: Cigna of CA PPO |
$22,373.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Dignity Health Media |
$13,745.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,119.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,556.05
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$13,745.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$13,745.22
|
| Rate for Payer: Galaxy Health WC |
$25,698.90
|
| Rate for Payer: Global Benefits Group Commercial |
$18,140.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$22,675.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$22,542.16
|
| Rate for Payer: Heritage Provider Network Transplant |
$22,542.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22,267.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$22,267.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13,745.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20,166.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,937.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,745.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,256.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,318.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18,418.59
|
| Rate for Payer: Multiplan Commercial |
$24,187.20
|
| Rate for Payer: Multiplan WC |
$18,791.68
|
| Rate for Payer: Networks By Design Commercial |
$19,652.10
|
| Rate for Payer: Prime Health Services Commercial |
$25,698.90
|
| Rate for Payer: Prime Health Services WC |
$18,599.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18,140.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$29,673.00
|
| Rate for Payer: United Healthcare All Other HMO |
$48,045.00
|
| Rate for Payer: United Healthcare HMO Rider |
$31,101.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28,895.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,119.74
|
| Rate for Payer: Vantage Medical Group Senior |
$13,745.22
|
|
|
HC THRPTC INTVN 1ST 15 MIN
|
Facility
|
OP
|
$63.00
|
|
|
Service Code
|
CPT 97129
|
| Hospital Charge Code |
905107129
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$15.12 |
| Max. Negotiated Rate |
$421.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$112.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$53.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$34.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: Blue Distinction Transplant |
$37.80
|
| Rate for Payer: Blue Shield of California Commercial |
$407.00
|
| Rate for Payer: Blue Shield of California EPN |
$293.00
|
| Rate for Payer: Cash Price |
$28.35
|
| Rate for Payer: Cash Price |
$28.35
|
| Rate for Payer: Cash Price |
$28.35
|
| Rate for Payer: Cash Price |
$28.35
|
| Rate for Payer: Cigna of CA HMO |
$40.32
|
| Rate for Payer: Cigna of CA PPO |
$46.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$53.55
|
| Rate for Payer: Dignity Health Media |
$53.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$53.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$25.20
|
| Rate for Payer: Galaxy Health WC |
$53.55
|
| Rate for Payer: Global Benefits Group Commercial |
$37.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$47.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.12
|
| Rate for Payer: Multiplan Commercial |
$50.40
|
| Rate for Payer: Networks By Design Commercial |
$40.95
|
| Rate for Payer: Prime Health Services Commercial |
$53.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$37.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$37.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$53.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$53.55
|
| Rate for Payer: Vantage Medical Group Senior |
$53.55
|
|
|
HC THRPTC INTVN 1ST 15 MIN
|
Facility
|
IP
|
$63.00
|
|
|
Service Code
|
CPT 97129
|
| Hospital Charge Code |
905107129
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$15.12 |
| Max. Negotiated Rate |
$53.55 |
| Rate for Payer: Cash Price |
$28.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.20
|
| Rate for Payer: Galaxy Health WC |
$53.55
|
| Rate for Payer: Global Benefits Group Commercial |
$37.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.12
|
| Rate for Payer: Multiplan Commercial |
$50.40
|
| Rate for Payer: Networks By Design Commercial |
$40.95
|
| Rate for Payer: Prime Health Services Commercial |
$53.55
|
|
|
HC THRPTC INTVN 1ST 15 MIN OT
|
Facility
|
IP
|
$63.00
|
|
|
Service Code
|
CPT 97129
|
| Hospital Charge Code |
905107131
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$15.12 |
| Max. Negotiated Rate |
$53.55 |
| Rate for Payer: Cash Price |
$28.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.20
|
| Rate for Payer: Galaxy Health WC |
$53.55
|
| Rate for Payer: Global Benefits Group Commercial |
$37.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.12
|
| Rate for Payer: Multiplan Commercial |
$50.40
|
| Rate for Payer: Networks By Design Commercial |
$40.95
|
| Rate for Payer: Prime Health Services Commercial |
$53.55
|
|
|
HC THRPTC INTVN 1ST 15 MIN OT
|
Facility
|
OP
|
$63.00
|
|
|
Service Code
|
CPT 97129
|
| Hospital Charge Code |
905107131
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$15.12 |
| Max. Negotiated Rate |
$421.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$112.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$53.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$34.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: Blue Distinction Transplant |
$37.80
|
| Rate for Payer: Blue Shield of California Commercial |
$407.00
|
| Rate for Payer: Blue Shield of California EPN |
$293.00
|
| Rate for Payer: Cash Price |
$28.35
|
| Rate for Payer: Cash Price |
$28.35
|
| Rate for Payer: Cash Price |
$28.35
|
| Rate for Payer: Cash Price |
$28.35
|
| Rate for Payer: Cigna of CA HMO |
$40.32
|
| Rate for Payer: Cigna of CA PPO |
$46.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$53.55
|
| Rate for Payer: Dignity Health Media |
$53.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$53.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$25.20
|
| Rate for Payer: Galaxy Health WC |
$53.55
|
| Rate for Payer: Global Benefits Group Commercial |
$37.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$47.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.12
|
| Rate for Payer: Multiplan Commercial |
$50.40
|
| Rate for Payer: Networks By Design Commercial |
$40.95
|
| Rate for Payer: Prime Health Services Commercial |
$53.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$37.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$37.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$53.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$53.55
|
| Rate for Payer: Vantage Medical Group Senior |
$53.55
|
|
|
HC THRPTC INTVN 1ST 15 MIN ST
|
Facility
|
OP
|
$63.00
|
|
|
Service Code
|
CPT 97129
|
| Hospital Charge Code |
905107132
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$15.12 |
| Max. Negotiated Rate |
$421.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$112.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$53.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$34.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: Blue Distinction Transplant |
$37.80
|
| Rate for Payer: Blue Shield of California Commercial |
$407.00
|
| Rate for Payer: Blue Shield of California EPN |
$293.00
|
| Rate for Payer: Cash Price |
$28.35
|
| Rate for Payer: Cash Price |
$28.35
|
| Rate for Payer: Cash Price |
$28.35
|
| Rate for Payer: Cash Price |
$28.35
|
| Rate for Payer: Cigna of CA HMO |
$40.32
|
| Rate for Payer: Cigna of CA PPO |
$46.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$53.55
|
| Rate for Payer: Dignity Health Media |
$53.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$53.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$25.20
|
| Rate for Payer: Galaxy Health WC |
$53.55
|
| Rate for Payer: Global Benefits Group Commercial |
$37.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$47.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.12
|
| Rate for Payer: Multiplan Commercial |
$50.40
|
| Rate for Payer: Networks By Design Commercial |
$40.95
|
| Rate for Payer: Prime Health Services Commercial |
$53.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$37.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$37.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$53.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$53.55
|
| Rate for Payer: Vantage Medical Group Senior |
$53.55
|
|
|
HC THRPTC INTVN 1ST 15 MIN ST
|
Facility
|
IP
|
$63.00
|
|
|
Service Code
|
CPT 97129
|
| Hospital Charge Code |
905107132
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$15.12 |
| Max. Negotiated Rate |
$53.55 |
| Rate for Payer: Cash Price |
$28.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.20
|
| Rate for Payer: Galaxy Health WC |
$53.55
|
| Rate for Payer: Global Benefits Group Commercial |
$37.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.12
|
| Rate for Payer: Multiplan Commercial |
$50.40
|
| Rate for Payer: Networks By Design Commercial |
$40.95
|
| Rate for Payer: Prime Health Services Commercial |
$53.55
|
|
|
HC THRPTC INTVN EA ADD 15MIN
|
Facility
|
IP
|
$61.00
|
|
|
Service Code
|
CPT 97130
|
| Hospital Charge Code |
905107130
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$14.64 |
| Max. Negotiated Rate |
$51.85 |
| Rate for Payer: Cash Price |
$27.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.40
|
| Rate for Payer: Galaxy Health WC |
$51.85
|
| Rate for Payer: Global Benefits Group Commercial |
$36.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.64
|
| Rate for Payer: Multiplan Commercial |
$48.80
|
| Rate for Payer: Networks By Design Commercial |
$39.65
|
| Rate for Payer: Prime Health Services Commercial |
$51.85
|
|
|
HC THRPTC INTVN EA ADD 15MIN
|
Facility
|
OP
|
$61.00
|
|
|
Service Code
|
CPT 97130
|
| Hospital Charge Code |
905107130
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$14.64 |
| Max. Negotiated Rate |
$421.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$109.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$51.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$33.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$33.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: Blue Distinction Transplant |
$36.60
|
| Rate for Payer: Blue Shield of California Commercial |
$407.00
|
| Rate for Payer: Blue Shield of California EPN |
$293.00
|
| Rate for Payer: Cash Price |
$27.45
|
| Rate for Payer: Cash Price |
$27.45
|
| Rate for Payer: Cash Price |
$27.45
|
| Rate for Payer: Cash Price |
$27.45
|
| Rate for Payer: Cigna of CA HMO |
$39.04
|
| Rate for Payer: Cigna of CA PPO |
$45.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$51.85
|
| Rate for Payer: Dignity Health Media |
$51.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$51.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$24.40
|
| Rate for Payer: Galaxy Health WC |
$51.85
|
| Rate for Payer: Global Benefits Group Commercial |
$36.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$45.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.64
|
| Rate for Payer: Multiplan Commercial |
$48.80
|
| Rate for Payer: Networks By Design Commercial |
$39.65
|
| Rate for Payer: Prime Health Services Commercial |
$51.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$36.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$36.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$51.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$51.85
|
| Rate for Payer: Vantage Medical Group Senior |
$51.85
|
|
|
HC THRPTC INTVN EA ADD 15MIN OT
|
Facility
|
OP
|
$61.00
|
|
|
Service Code
|
CPT 97130
|
| Hospital Charge Code |
905107133
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$14.64 |
| Max. Negotiated Rate |
$421.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$109.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$51.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$33.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$33.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: Blue Distinction Transplant |
$36.60
|
| Rate for Payer: Blue Shield of California Commercial |
$407.00
|
| Rate for Payer: Blue Shield of California EPN |
$293.00
|
| Rate for Payer: Cash Price |
$27.45
|
| Rate for Payer: Cash Price |
$27.45
|
| Rate for Payer: Cash Price |
$27.45
|
| Rate for Payer: Cash Price |
$27.45
|
| Rate for Payer: Cigna of CA HMO |
$39.04
|
| Rate for Payer: Cigna of CA PPO |
$45.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$51.85
|
| Rate for Payer: Dignity Health Media |
$51.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$51.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$24.40
|
| Rate for Payer: Galaxy Health WC |
$51.85
|
| Rate for Payer: Global Benefits Group Commercial |
$36.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$45.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.64
|
| Rate for Payer: Multiplan Commercial |
$48.80
|
| Rate for Payer: Networks By Design Commercial |
$39.65
|
| Rate for Payer: Prime Health Services Commercial |
$51.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$36.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$36.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$51.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$51.85
|
| Rate for Payer: Vantage Medical Group Senior |
$51.85
|
|
|
HC THRPTC INTVN EA ADD 15MIN OT
|
Facility
|
IP
|
$61.00
|
|
|
Service Code
|
CPT 97130
|
| Hospital Charge Code |
905107133
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$14.64 |
| Max. Negotiated Rate |
$51.85 |
| Rate for Payer: Cash Price |
$27.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.40
|
| Rate for Payer: Galaxy Health WC |
$51.85
|
| Rate for Payer: Global Benefits Group Commercial |
$36.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.64
|
| Rate for Payer: Multiplan Commercial |
$48.80
|
| Rate for Payer: Networks By Design Commercial |
$39.65
|
| Rate for Payer: Prime Health Services Commercial |
$51.85
|
|
|
HC THRPTC INTVN EA ADD 15MIN ST
|
Facility
|
OP
|
$61.00
|
|
|
Service Code
|
CPT 97130
|
| Hospital Charge Code |
905107134
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$14.64 |
| Max. Negotiated Rate |
$421.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$109.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$51.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$33.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$33.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: Blue Distinction Transplant |
$36.60
|
| Rate for Payer: Blue Shield of California Commercial |
$407.00
|
| Rate for Payer: Blue Shield of California EPN |
$293.00
|
| Rate for Payer: Cash Price |
$27.45
|
| Rate for Payer: Cash Price |
$27.45
|
| Rate for Payer: Cash Price |
$27.45
|
| Rate for Payer: Cash Price |
$27.45
|
| Rate for Payer: Cigna of CA HMO |
$39.04
|
| Rate for Payer: Cigna of CA PPO |
$45.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$51.85
|
| Rate for Payer: Dignity Health Media |
$51.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$51.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$24.40
|
| Rate for Payer: Galaxy Health WC |
$51.85
|
| Rate for Payer: Global Benefits Group Commercial |
$36.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$45.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.64
|
| Rate for Payer: Multiplan Commercial |
$48.80
|
| Rate for Payer: Networks By Design Commercial |
$39.65
|
| Rate for Payer: Prime Health Services Commercial |
$51.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$36.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$36.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$51.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$51.85
|
| Rate for Payer: Vantage Medical Group Senior |
$51.85
|
|
|
HC THRPTC INTVN EA ADD 15MIN ST
|
Facility
|
IP
|
$61.00
|
|
|
Service Code
|
CPT 97130
|
| Hospital Charge Code |
905107134
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$14.64 |
| Max. Negotiated Rate |
$51.85 |
| Rate for Payer: Cash Price |
$27.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.40
|
| Rate for Payer: Galaxy Health WC |
$51.85
|
| Rate for Payer: Global Benefits Group Commercial |
$36.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.64
|
| Rate for Payer: Multiplan Commercial |
$48.80
|
| Rate for Payer: Networks By Design Commercial |
$39.65
|
| Rate for Payer: Prime Health Services Commercial |
$51.85
|
|
|
HC THRPTC SPNL PNCTR CSF FLUOR/CT
|
Facility
|
OP
|
$2,331.00
|
|
|
Service Code
|
CPT 62329
|
| Hospital Charge Code |
909002329
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$558.96 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$864.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,398.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$1,048.95
|
| Rate for Payer: Cash Price |
$1,048.95
|
| Rate for Payer: Cigna of CA PPO |
$1,724.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Dignity Health Media |
$864.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$950.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,166.45
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$864.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$864.04
|
| Rate for Payer: Galaxy Health WC |
$1,981.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,398.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,748.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,417.03
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,417.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,399.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,399.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$864.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,554.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$558.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$864.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$559.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,088.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,157.81
|
| Rate for Payer: Multiplan Commercial |
$1,864.80
|
| Rate for Payer: Networks By Design Commercial |
$1,515.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,981.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,398.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: Vantage Medical Group Senior |
$864.04
|
|
|
HC THRPTC SPNL PNCTR CSF FLUOR/CT
|
Facility
|
IP
|
$2,331.00
|
|
|
Service Code
|
CPT 62329
|
| Hospital Charge Code |
909002329
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$559.44 |
| Max. Negotiated Rate |
$1,981.35 |
| Rate for Payer: Cash Price |
$1,048.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$932.40
|
| Rate for Payer: Galaxy Health WC |
$1,981.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,398.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,554.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$888.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$559.44
|
| Rate for Payer: Multiplan Commercial |
$1,864.80
|
| Rate for Payer: Networks By Design Commercial |
$1,515.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,981.35
|
|
|
HC THYROID BIOPSY PERCUTANEOUS
|
Facility
|
IP
|
$2,015.00
|
|
|
Service Code
|
CPT 60100
|
| Hospital Charge Code |
909000178
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$483.60 |
| Max. Negotiated Rate |
$1,712.75 |
| Rate for Payer: Cash Price |
$906.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$806.00
|
| Rate for Payer: Galaxy Health WC |
$1,712.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,209.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,344.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$767.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$483.60
|
| Rate for Payer: Multiplan Commercial |
$1,612.00
|
| Rate for Payer: Networks By Design Commercial |
$1,309.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,712.75
|
|
