|
HC THRCSCPY DGNSTC W BX OF PLEURA
|
Facility
|
IP
|
$20,482.00
|
|
|
Service Code
|
CPT 32609
|
| Hospital Charge Code |
900831705
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,096.40 |
| Max. Negotiated Rate |
$18,433.80 |
| Rate for Payer: Adventist Health Commercial |
$4,096.40
|
| Rate for Payer: Cash Price |
$9,216.90
|
| Rate for Payer: Central Health Plan Commercial |
$16,385.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14,337.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,192.80
|
| Rate for Payer: EPIC Health Plan Senior |
$8,192.80
|
| Rate for Payer: Galaxy Health WC |
$17,409.70
|
| Rate for Payer: Global Benefits Group Commercial |
$12,289.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$18,433.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13,006.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12,084.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,096.40
|
| Rate for Payer: Multiplan Commercial |
$15,361.50
|
| Rate for Payer: Networks By Design Commercial |
$13,313.30
|
| Rate for Payer: Prime Health Services Commercial |
$17,409.70
|
|
|
HC THRCSCPY SX W PRTL PLMNRY DCRTCTN
|
Facility
|
IP
|
$27,088.00
|
|
|
Service Code
|
CPT 32651
|
| Hospital Charge Code |
909010014
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,417.60 |
| Max. Negotiated Rate |
$24,379.20 |
| Rate for Payer: Adventist Health Commercial |
$5,417.60
|
| Rate for Payer: Cash Price |
$12,189.60
|
| Rate for Payer: Central Health Plan Commercial |
$21,670.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$18,961.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,835.20
|
| Rate for Payer: EPIC Health Plan Senior |
$10,835.20
|
| Rate for Payer: Galaxy Health WC |
$23,024.80
|
| Rate for Payer: Global Benefits Group Commercial |
$16,252.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$24,379.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17,200.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15,981.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,417.60
|
| Rate for Payer: Multiplan Commercial |
$20,316.00
|
| Rate for Payer: Networks By Design Commercial |
$17,607.20
|
| Rate for Payer: Prime Health Services Commercial |
$23,024.80
|
|
|
HC THRCSCPY SX W PRTL PLMNRY DCRTCTN
|
Facility
|
OP
|
$27,088.00
|
|
|
Service Code
|
CPT 32651
|
| Hospital Charge Code |
909010014
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$887.54 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$5,417.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23,024.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14,898.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20,316.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,924.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$12,189.60
|
| Rate for Payer: Cash Price |
$12,189.60
|
| Rate for Payer: Cash Price |
$12,189.60
|
| Rate for Payer: Central Health Plan Commercial |
$21,670.40
|
| Rate for Payer: Cigna of CA HMO |
$17,336.32
|
| Rate for Payer: Cigna of CA PPO |
$20,045.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23,024.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$23,024.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23,024.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$18,961.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,835.20
|
| Rate for Payer: EPIC Health Plan Senior |
$10,835.20
|
| Rate for Payer: Galaxy Health WC |
$23,024.80
|
| Rate for Payer: Global Benefits Group Commercial |
$16,252.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$24,379.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$887.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17,200.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$980.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15,981.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,417.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18,961.60
|
| Rate for Payer: Multiplan Commercial |
$20,316.00
|
| Rate for Payer: Networks By Design Commercial |
$17,607.20
|
| Rate for Payer: Prime Health Services Commercial |
$23,024.80
|
| Rate for Payer: Riverside University Health System MISP |
$10,835.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16,252.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,544.00
|
| 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: Vantage Medical Group Commercial/Exchange |
$23,024.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23,024.80
|
| Rate for Payer: Vantage Medical Group Senior |
$23,024.80
|
|
|
HC THRCSCPY SX W RMVL IP FB OR FIBRIN DEP
|
Facility
|
OP
|
$27,088.00
|
|
|
Service Code
|
CPT 32653
|
| Hospital Charge Code |
909010015
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$833.10 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$5,417.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23,024.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14,898.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20,316.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,074.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$12,189.60
|
| Rate for Payer: Cash Price |
$12,189.60
|
| Rate for Payer: Cash Price |
$12,189.60
|
| Rate for Payer: Central Health Plan Commercial |
$21,670.40
|
| Rate for Payer: Cigna of CA HMO |
$17,336.32
|
| Rate for Payer: Cigna of CA PPO |
$20,045.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23,024.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$23,024.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23,024.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$18,961.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,835.20
|
| Rate for Payer: EPIC Health Plan Senior |
$10,835.20
|
| Rate for Payer: Galaxy Health WC |
$23,024.80
|
| Rate for Payer: Global Benefits Group Commercial |
$16,252.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$24,379.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$833.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17,200.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$920.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15,981.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,417.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18,961.60
|
| Rate for Payer: Multiplan Commercial |
$20,316.00
|
| Rate for Payer: Networks By Design Commercial |
$17,607.20
|
| Rate for Payer: Prime Health Services Commercial |
$23,024.80
|
| Rate for Payer: Riverside University Health System MISP |
$10,835.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16,252.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,544.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23,024.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23,024.80
|
| Rate for Payer: Vantage Medical Group Senior |
$23,024.80
|
|
|
HC THRCSCPY SX W RMVL IP FB OR FIBRIN DEP
|
Facility
|
IP
|
$27,088.00
|
|
|
Service Code
|
CPT 32653
|
| Hospital Charge Code |
909010015
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,417.60 |
| Max. Negotiated Rate |
$24,379.20 |
| Rate for Payer: Adventist Health Commercial |
$5,417.60
|
| Rate for Payer: Cash Price |
$12,189.60
|
| Rate for Payer: Central Health Plan Commercial |
$21,670.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$18,961.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,835.20
|
| Rate for Payer: EPIC Health Plan Senior |
$10,835.20
|
| Rate for Payer: Galaxy Health WC |
$23,024.80
|
| Rate for Payer: Global Benefits Group Commercial |
$16,252.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$24,379.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17,200.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15,981.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,417.60
|
| Rate for Payer: Multiplan Commercial |
$20,316.00
|
| Rate for Payer: Networks By Design Commercial |
$17,607.20
|
| Rate for Payer: Prime Health Services Commercial |
$23,024.80
|
|
|
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 |
$1,296.00 |
| Rate for Payer: Adventist Health Commercial |
$288.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,154.88
|
| Rate for Payer: Blue Shield of California EPN |
$725.76
|
| Rate for Payer: Cash Price |
$648.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,152.00
|
| Rate for Payer: Cigna of CA HMO |
$1,008.00
|
| Rate for Payer: Cigna of CA PPO |
$1,008.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Health Management Network EPO/PPO |
$1,296.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$914.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$849.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$288.00
|
| Rate for Payer: Multiplan Commercial |
$1,080.00
|
| 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 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 |
$1,296.00 |
| 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 Exchange |
$657.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$789.70
|
| Rate for Payer: Blue Shield of California Commercial |
$1,154.88
|
| Rate for Payer: Blue Shield of California EPN |
$725.76
|
| Rate for Payer: Cash Price |
$648.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,152.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Health Management Network EPO/PPO |
$1,296.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$914.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$522.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$849.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$288.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,008.00
|
| Rate for Payer: Multiplan Commercial |
$1,080.00
|
| Rate for Payer: Networks By Design Commercial |
$720.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,224.00
|
| Rate for Payer: Riverside University Health System MISP |
$576.00
|
| 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 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 |
$155.70 |
| Rate for Payer: Adventist Health Commercial |
$34.60
|
| Rate for Payer: Cash Price |
$77.85
|
| Rate for Payer: Central Health Plan Commercial |
$138.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$121.10
|
| 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: Health Management Network EPO/PPO |
$155.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$109.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$102.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.60
|
| Rate for Payer: Multiplan Commercial |
$129.75
|
| Rate for Payer: Networks By Design Commercial |
$112.45
|
| Rate for Payer: Prime Health Services Commercial |
$147.05
|
|
|
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 |
$155.70 |
| Rate for Payer: Adventist Health Commercial |
$34.60
|
| Rate for Payer: Adventist Health Commercial |
$6.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$5.77
|
| Rate for Payer: Adventist Health Medi-Cal |
$5.77
|
| Rate for Payer: Aetna of CA HMO/PPO |
$42.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$42.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.65
|
| 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 Medi-Cal |
$6.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$42.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$42.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$58.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$58.49
|
| Rate for Payer: Blue Shield of California Commercial |
$20.16
|
| Rate for Payer: Blue Shield of California Commercial |
$108.99
|
| Rate for Payer: Blue Shield of California EPN |
$12.70
|
| Rate for Payer: Blue Shield of California EPN |
$68.68
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cash Price |
$77.85
|
| Rate for Payer: Cash Price |
$77.85
|
| Rate for Payer: Central Health Plan Commercial |
$138.40
|
| Rate for Payer: Central Health Plan Commercial |
$25.60
|
| Rate for Payer: Cigna of CA HMO |
$20.48
|
| Rate for Payer: Cigna of CA HMO |
$110.72
|
| Rate for Payer: Cigna of CA PPO |
$23.68
|
| Rate for Payer: Cigna of CA PPO |
$128.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.77
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$121.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$22.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.52
|
| Rate for Payer: EPIC Health Plan Senior |
$6.35
|
| Rate for Payer: EPIC Health Plan Senior |
$6.35
|
| Rate for Payer: Galaxy Health WC |
$27.20
|
| Rate for Payer: Galaxy Health WC |
$147.05
|
| Rate for Payer: Global Benefits Group Commercial |
$19.20
|
| Rate for Payer: Global Benefits Group Commercial |
$103.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$28.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$155.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$9.46
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$9.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$109.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$20.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.73
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: Multiplan Commercial |
$129.75
|
| Rate for Payer: Networks By Design Commercial |
$112.45
|
| Rate for Payer: Networks By Design Commercial |
$20.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5.77
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5.77
|
| Rate for Payer: Prime Health Services Commercial |
$27.20
|
| Rate for Payer: Prime Health Services Commercial |
$147.05
|
| Rate for Payer: Prime Health Services Medicare |
$6.12
|
| Rate for Payer: Prime Health Services Medicare |
$6.12
|
| Rate for Payer: Riverside University Health System MISP |
$6.35
|
| Rate for Payer: Riverside University Health System MISP |
$6.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$103.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$19.20
|
| 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 Commercial |
$4.67
|
| Rate for Payer: United Healthcare All Other HMO |
$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 HMO Rider |
$4.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.67
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.77
|
| 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 Commercial/Exchange |
$8.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.35
|
| Rate for Payer: Vantage Medical Group Senior |
$5.77
|
| Rate for Payer: Vantage Medical Group Senior |
$5.77
|
|
|
HC THROMBOELASTOGRAPH
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
CPT 85396
|
| Hospital Charge Code |
900912024
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$162.19 |
| Rate for Payer: Adventist Health Commercial |
$14.00
|
| Rate for Payer: Adventist Health Commercial |
$106.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$106.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$106.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$59.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$453.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.50
|
| 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: Alpha Care Medical Group Medicare Advantage/Dual Product |
$52.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$116.66
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$116.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$162.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$162.19
|
| Rate for Payer: Blue Shield of California Commercial |
$335.79
|
| Rate for Payer: Blue Shield of California Commercial |
$44.10
|
| Rate for Payer: Blue Shield of California EPN |
$211.60
|
| Rate for Payer: Blue Shield of California EPN |
$27.79
|
| Rate for Payer: Cash Price |
$239.85
|
| Rate for Payer: Cash Price |
$239.85
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Central Health Plan Commercial |
$56.00
|
| Rate for Payer: Central Health Plan Commercial |
$426.40
|
| Rate for Payer: Cigna of CA HMO |
$341.12
|
| Rate for Payer: Cigna of CA HMO |
$44.80
|
| Rate for Payer: Cigna of CA PPO |
$394.42
|
| Rate for Payer: Cigna of CA PPO |
$51.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$453.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$59.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$59.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$453.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$453.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$59.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$373.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$49.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$213.20
|
| Rate for Payer: EPIC Health Plan Senior |
$28.00
|
| Rate for Payer: EPIC Health Plan Senior |
$213.20
|
| Rate for Payer: Galaxy Health WC |
$453.05
|
| Rate for Payer: Galaxy Health WC |
$59.50
|
| Rate for Payer: Global Benefits Group Commercial |
$42.00
|
| Rate for Payer: Global Benefits Group Commercial |
$319.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$479.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$63.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$30.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$30.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$338.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$44.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$33.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$33.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$314.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$41.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$106.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$49.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$373.10
|
| Rate for Payer: Multiplan Commercial |
$52.50
|
| Rate for Payer: Multiplan Commercial |
$399.75
|
| Rate for Payer: Networks By Design Commercial |
$45.50
|
| Rate for Payer: Networks By Design Commercial |
$346.45
|
| Rate for Payer: Prime Health Services Commercial |
$453.05
|
| Rate for Payer: Prime Health Services Commercial |
$59.50
|
| Rate for Payer: Riverside University Health System MISP |
$28.00
|
| Rate for Payer: Riverside University Health System MISP |
$213.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$319.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.00
|
| 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 Commercial |
$15.98
|
| Rate for Payer: United Healthcare All Other HMO |
$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 HMO Rider |
$15.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$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 Commercial/Exchange |
$59.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$59.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$453.05
|
| Rate for Payer: Vantage Medical Group Senior |
$453.05
|
| Rate for Payer: Vantage Medical Group Senior |
$59.50
|
|
|
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 |
$479.70 |
| Rate for Payer: Adventist Health Commercial |
$106.60
|
| Rate for Payer: Cash Price |
$239.85
|
| Rate for Payer: Central Health Plan Commercial |
$426.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$373.10
|
| 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: Health Management Network EPO/PPO |
$479.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$338.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$314.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$106.60
|
| Rate for Payer: Multiplan Commercial |
$399.75
|
| Rate for Payer: Networks By Design Commercial |
$346.45
|
| Rate for Payer: Prime Health Services Commercial |
$453.05
|
|
|
HC THROMBOLYSIS ART
|
Facility
|
IP
|
$6,522.00
|
|
|
Service Code
|
CPT 37211
|
| Hospital Charge Code |
909020164
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,304.40 |
| Max. Negotiated Rate |
$5,869.80 |
| Rate for Payer: Adventist Health Commercial |
$1,304.40
|
| Rate for Payer: Cash Price |
$2,934.90
|
| Rate for Payer: Central Health Plan Commercial |
$5,217.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,565.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,608.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,608.80
|
| Rate for Payer: Galaxy Health WC |
$5,543.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,913.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,869.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,141.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,847.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,304.40
|
| Rate for Payer: Multiplan Commercial |
$4,891.50
|
| Rate for Payer: Networks By Design Commercial |
$4,239.30
|
| Rate for Payer: Prime Health Services Commercial |
$5,543.70
|
|
|
HC THROMBOLYSIS ART
|
Facility
|
OP
|
$6,522.00
|
|
|
Service Code
|
CPT 37211
|
| Hospital Charge Code |
909020164
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$564.80 |
| Max. Negotiated Rate |
$11,808.82 |
| Rate for Payer: Adventist Health Commercial |
$1,304.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$7,156.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,229.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,735.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,872.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,156.86
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,108.86
|
| Rate for Payer: Blue Shield of California EPN |
$2,589.23
|
| Rate for Payer: Cash Price |
$2,934.90
|
| Rate for Payer: Cash Price |
$2,934.90
|
| Rate for Payer: Cash Price |
$2,934.90
|
| Rate for Payer: Central Health Plan Commercial |
$5,217.60
|
| Rate for Payer: Cigna of CA HMO |
$4,174.08
|
| Rate for Payer: Cigna of CA PPO |
$4,826.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,735.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,872.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,156.86
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,565.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,808.82
|
| Rate for Payer: EPIC Health Plan Senior |
$7,872.55
|
| Rate for Payer: Galaxy Health WC |
$5,543.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,913.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,869.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,737.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$564.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,156.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,141.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$623.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,019.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,304.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9,590.19
|
| Rate for Payer: Multiplan Commercial |
$4,891.50
|
| Rate for Payer: Networks By Design Commercial |
$4,239.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7,156.86
|
| Rate for Payer: Prime Health Services Commercial |
$5,543.70
|
| Rate for Payer: Prime Health Services Medicare |
$7,586.27
|
| Rate for Payer: Riverside University Health System MISP |
$7,872.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,913.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,913.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,261.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,261.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,261.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,156.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,735.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,872.55
|
| Rate for Payer: Vantage Medical Group Senior |
$7,156.86
|
|
|
HC THROMBOLYSIS COMPLETE
|
Facility
|
IP
|
$13,638.00
|
|
|
Service Code
|
CPT 37214
|
| Hospital Charge Code |
909020157
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,727.60 |
| Max. Negotiated Rate |
$12,274.20 |
| Rate for Payer: Adventist Health Commercial |
$2,727.60
|
| Rate for Payer: Cash Price |
$6,137.10
|
| Rate for Payer: Central Health Plan Commercial |
$10,910.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,546.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,455.20
|
| Rate for Payer: EPIC Health Plan Senior |
$5,455.20
|
| Rate for Payer: Galaxy Health WC |
$11,592.30
|
| Rate for Payer: Global Benefits Group Commercial |
$8,182.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,274.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,660.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,046.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,727.60
|
| Rate for Payer: Multiplan Commercial |
$10,228.50
|
| Rate for Payer: Networks By Design Commercial |
$8,864.70
|
| Rate for Payer: Prime Health Services Commercial |
$11,592.30
|
|
|
HC THROMBOLYSIS COMPLETE
|
Facility
|
OP
|
$13,638.00
|
|
|
Service Code
|
CPT 37214
|
| Hospital Charge Code |
909020157
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$205.56 |
| Max. Negotiated Rate |
$12,274.20 |
| Rate for Payer: Adventist Health Commercial |
$2,727.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,061.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$813.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,061.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,591.94
|
| Rate for Payer: Blue Shield of California EPN |
$5,414.29
|
| Rate for Payer: Cash Price |
$6,137.10
|
| Rate for Payer: Cash Price |
$6,137.10
|
| Rate for Payer: Cash Price |
$6,137.10
|
| Rate for Payer: Central Health Plan Commercial |
$10,910.40
|
| Rate for Payer: Cigna of CA HMO |
$8,728.32
|
| Rate for Payer: Cigna of CA PPO |
$10,092.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,467.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,061.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,546.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,700.73
|
| Rate for Payer: EPIC Health Plan Senior |
$4,467.15
|
| Rate for Payer: Galaxy Health WC |
$11,592.30
|
| Rate for Payer: Global Benefits Group Commercial |
$8,182.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,274.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,660.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$205.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,660.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$227.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,685.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,727.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,441.81
|
| Rate for Payer: Multiplan Commercial |
$10,228.50
|
| Rate for Payer: Networks By Design Commercial |
$8,864.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Prime Health Services Commercial |
$11,592.30
|
| Rate for Payer: Prime Health Services Medicare |
$4,304.71
|
| Rate for Payer: Riverside University Health System MISP |
$4,467.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,182.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8,182.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,819.00
|
| Rate for Payer: United Healthcare All Other HMO |
$6,819.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6,819.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,819.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,061.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Vantage Medical Group Senior |
$4,061.05
|
|
|
HC THROMBOLYSIS, INTRACORONARY
|
Facility
|
OP
|
$1,221.00
|
|
|
Service Code
|
CPT 92975
|
| Hospital Charge Code |
906811110
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$244.20 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$244.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,037.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$671.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$915.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$549.45
|
| Rate for Payer: Cash Price |
$549.45
|
| Rate for Payer: Central Health Plan Commercial |
$976.80
|
| Rate for Payer: Cigna of CA HMO |
$793.65
|
| Rate for Payer: Cigna of CA PPO |
$903.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,037.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,037.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,037.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$854.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$488.40
|
| Rate for Payer: EPIC Health Plan Senior |
$488.40
|
| Rate for Payer: Galaxy Health WC |
$1,037.85
|
| Rate for Payer: Global Benefits Group Commercial |
$732.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,098.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$775.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$443.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$720.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$244.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$854.70
|
| Rate for Payer: Multiplan Commercial |
$915.75
|
| Rate for Payer: Networks By Design Commercial |
$793.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,037.85
|
| Rate for Payer: Riverside University Health System MISP |
$488.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$732.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$732.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$610.50
|
| 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 |
$1,037.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,037.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,037.85
|
|
|
HC THROMBOLYSIS, INTRACORONARY
|
Facility
|
IP
|
$1,221.00
|
|
|
Service Code
|
CPT 92975
|
| Hospital Charge Code |
906811110
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$244.20 |
| Max. Negotiated Rate |
$1,098.90 |
| Rate for Payer: Adventist Health Commercial |
$244.20
|
| Rate for Payer: Cash Price |
$549.45
|
| Rate for Payer: Central Health Plan Commercial |
$976.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$854.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$488.40
|
| Rate for Payer: EPIC Health Plan Senior |
$488.40
|
| Rate for Payer: Galaxy Health WC |
$1,037.85
|
| Rate for Payer: Global Benefits Group Commercial |
$732.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,098.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$775.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$720.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$244.20
|
| Rate for Payer: Multiplan Commercial |
$915.75
|
| Rate for Payer: Networks By Design Commercial |
$793.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,037.85
|
|
|
HC THROMBOLYSIS VEIN
|
Facility
|
IP
|
$5,434.00
|
|
|
Service Code
|
CPT 37212
|
| Hospital Charge Code |
909020155
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,086.80 |
| Max. Negotiated Rate |
$4,890.60 |
| Rate for Payer: Adventist Health Commercial |
$1,086.80
|
| Rate for Payer: Cash Price |
$2,445.30
|
| Rate for Payer: Central Health Plan Commercial |
$4,347.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,803.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,173.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,173.60
|
| Rate for Payer: Galaxy Health WC |
$4,618.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,260.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,890.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,450.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,206.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,086.80
|
| Rate for Payer: Multiplan Commercial |
$4,075.50
|
| Rate for Payer: Networks By Design Commercial |
$3,532.10
|
| Rate for Payer: Prime Health Services Commercial |
$4,618.90
|
|
|
HC THROMBOLYSIS VEIN
|
Facility
|
OP
|
$5,434.00
|
|
|
Service Code
|
CPT 37212
|
| Hospital Charge Code |
909020155
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$496.91 |
| Max. Negotiated Rate |
$6,700.73 |
| Rate for Payer: Adventist Health Commercial |
$1,086.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,061.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,967.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,061.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,423.42
|
| Rate for Payer: Blue Shield of California EPN |
$2,157.30
|
| Rate for Payer: Cash Price |
$2,445.30
|
| Rate for Payer: Cash Price |
$2,445.30
|
| Rate for Payer: Cash Price |
$2,445.30
|
| Rate for Payer: Central Health Plan Commercial |
$4,347.20
|
| Rate for Payer: Cigna of CA HMO |
$3,477.76
|
| Rate for Payer: Cigna of CA PPO |
$4,021.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,467.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,061.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,803.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,700.73
|
| Rate for Payer: EPIC Health Plan Senior |
$4,467.15
|
| Rate for Payer: Galaxy Health WC |
$4,618.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,260.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,890.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,660.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$496.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,450.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$548.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,685.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,086.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,441.81
|
| Rate for Payer: Multiplan Commercial |
$4,075.50
|
| Rate for Payer: Networks By Design Commercial |
$3,532.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Prime Health Services Commercial |
$4,618.90
|
| Rate for Payer: Prime Health Services Medicare |
$4,304.71
|
| Rate for Payer: Riverside University Health System MISP |
$4,467.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,260.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,260.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,717.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,717.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,717.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,717.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,061.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Vantage Medical Group Senior |
$4,061.05
|
|
|
HC THROMBO SUBSEQUENT DAY
|
Facility
|
OP
|
$11,538.00
|
|
|
Service Code
|
CPT 37213
|
| Hospital Charge Code |
909020156
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$346.43 |
| Max. Negotiated Rate |
$10,384.20 |
| Rate for Payer: Adventist Health Commercial |
$2,307.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,061.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,372.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,061.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,268.94
|
| Rate for Payer: Blue Shield of California EPN |
$4,580.59
|
| Rate for Payer: Cash Price |
$5,192.10
|
| Rate for Payer: Cash Price |
$5,192.10
|
| Rate for Payer: Cash Price |
$5,192.10
|
| Rate for Payer: Central Health Plan Commercial |
$9,230.40
|
| Rate for Payer: Cigna of CA HMO |
$7,384.32
|
| Rate for Payer: Cigna of CA PPO |
$8,538.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,467.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,061.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,076.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,700.73
|
| Rate for Payer: EPIC Health Plan Senior |
$4,467.15
|
| Rate for Payer: Galaxy Health WC |
$9,807.30
|
| Rate for Payer: Global Benefits Group Commercial |
$6,922.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,384.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,660.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$346.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,326.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$382.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,685.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,307.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,441.81
|
| Rate for Payer: Multiplan Commercial |
$8,653.50
|
| Rate for Payer: Networks By Design Commercial |
$7,499.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Prime Health Services Commercial |
$9,807.30
|
| Rate for Payer: Prime Health Services Medicare |
$4,304.71
|
| Rate for Payer: Riverside University Health System MISP |
$4,467.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,922.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,922.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,769.00
|
| Rate for Payer: United Healthcare All Other HMO |
$5,769.00
|
| Rate for Payer: United Healthcare HMO Rider |
$5,769.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,769.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,061.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Vantage Medical Group Senior |
$4,061.05
|
|
|
HC THROMBO SUBSEQUENT DAY
|
Facility
|
IP
|
$11,538.00
|
|
|
Service Code
|
CPT 37213
|
| Hospital Charge Code |
909020156
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,307.60 |
| Max. Negotiated Rate |
$10,384.20 |
| Rate for Payer: Adventist Health Commercial |
$2,307.60
|
| Rate for Payer: Cash Price |
$5,192.10
|
| Rate for Payer: Central Health Plan Commercial |
$9,230.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,076.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,615.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,615.20
|
| Rate for Payer: Galaxy Health WC |
$9,807.30
|
| Rate for Payer: Global Benefits Group Commercial |
$6,922.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,384.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,326.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,807.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,307.60
|
| Rate for Payer: Multiplan Commercial |
$8,653.50
|
| Rate for Payer: Networks By Design Commercial |
$7,499.70
|
| Rate for Payer: Prime Health Services Commercial |
$9,807.30
|
|
|
HC THROM DIALYSIS CRCT W STNT PLC
|
Facility
|
OP
|
$42,186.00
|
|
|
Service Code
|
CPT 36906
|
| Hospital Charge Code |
909036906
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,806.00 |
| Max. Negotiated Rate |
$71,375.00 |
| Rate for Payer: Adventist Health Commercial |
$8,437.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$23,577.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,935.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23,577.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,074.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$36,352.92
|
| Rate for Payer: Blue Shield of California Commercial |
$13,231.02
|
| Rate for Payer: Blue Shield of California EPN |
$8,315.83
|
| Rate for Payer: Cash Price |
$18,983.70
|
| Rate for Payer: Cash Price |
$18,983.70
|
| Rate for Payer: Cash Price |
$18,983.70
|
| Rate for Payer: Central Health Plan Commercial |
$33,748.80
|
| Rate for Payer: Cigna of CA HMO |
$26,999.04
|
| Rate for Payer: Cigna of CA PPO |
$31,217.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,935.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23,577.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$29,530.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$38,902.96
|
| Rate for Payer: EPIC Health Plan Senior |
$25,935.31
|
| Rate for Payer: Galaxy Health WC |
$35,858.10
|
| Rate for Payer: Global Benefits Group Commercial |
$25,311.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$37,967.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$38,667.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$10,766.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23,577.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$26,788.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11,893.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33,008.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,437.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$31,593.92
|
| Rate for Payer: Multiplan Commercial |
$31,639.50
|
| Rate for Payer: Multiplan WC |
$36,352.92
|
| Rate for Payer: Networks By Design Commercial |
$27,420.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$23,577.55
|
| Rate for Payer: Preferred Health Network WC |
$37,094.82
|
| Rate for Payer: Prime Health Services Commercial |
$35,858.10
|
| Rate for Payer: Prime Health Services Medicare |
$24,992.20
|
| Rate for Payer: Prime Health Services WC |
$35,981.98
|
| Rate for Payer: Riverside University Health System MISP |
$25,935.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25,311.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$21,093.00
|
| 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 |
$23,577.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,935.31
|
| Rate for Payer: Vantage Medical Group Senior |
$23,577.55
|
|
|
HC THROM DIALYSIS CRCT W STNT PLC
|
Facility
|
IP
|
$42,186.00
|
|
|
Service Code
|
CPT 36906
|
| Hospital Charge Code |
909036906
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$8,437.20 |
| Max. Negotiated Rate |
$37,967.40 |
| Rate for Payer: Adventist Health Commercial |
$8,437.20
|
| Rate for Payer: Cash Price |
$18,983.70
|
| Rate for Payer: Central Health Plan Commercial |
$33,748.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$29,530.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$16,874.40
|
| Rate for Payer: EPIC Health Plan Senior |
$16,874.40
|
| Rate for Payer: Galaxy Health WC |
$35,858.10
|
| Rate for Payer: Global Benefits Group Commercial |
$25,311.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$37,967.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$26,788.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24,889.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,437.20
|
| Rate for Payer: Multiplan Commercial |
$31,639.50
|
| Rate for Payer: Networks By Design Commercial |
$27,420.90
|
| Rate for Payer: Prime Health Services Commercial |
$35,858.10
|
|
|
HC THROM DIALYSIS CRCT W TRAN BLN
|
Facility
|
OP
|
$24,414.00
|
|
|
Service Code
|
CPT 36905
|
| Hospital Charge Code |
909036905
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,564.22 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$4,882.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$14,847.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16,332.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,847.76
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,924.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$22,958.69
|
| Rate for Payer: Blue Shield of California Commercial |
$13,231.02
|
| Rate for Payer: Blue Shield of California EPN |
$8,315.83
|
| Rate for Payer: Cash Price |
$10,986.30
|
| Rate for Payer: Cash Price |
$10,986.30
|
| Rate for Payer: Cash Price |
$10,986.30
|
| Rate for Payer: Central Health Plan Commercial |
$19,531.20
|
| Rate for Payer: Cigna of CA HMO |
$15,624.96
|
| Rate for Payer: Cigna of CA PPO |
$18,066.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$16,332.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,847.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17,089.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$24,498.80
|
| Rate for Payer: EPIC Health Plan Senior |
$16,332.54
|
| Rate for Payer: Galaxy Health WC |
$20,751.90
|
| Rate for Payer: Global Benefits Group Commercial |
$14,648.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$21,972.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$24,350.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,564.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,847.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15,502.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,937.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20,786.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,882.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19,896.00
|
| Rate for Payer: Multiplan Commercial |
$18,310.50
|
| Rate for Payer: Multiplan WC |
$22,958.69
|
| Rate for Payer: Networks By Design Commercial |
$15,869.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14,847.76
|
| Rate for Payer: Preferred Health Network WC |
$23,427.23
|
| Rate for Payer: Prime Health Services Commercial |
$20,751.90
|
| Rate for Payer: Prime Health Services Medicare |
$15,738.63
|
| Rate for Payer: Prime Health Services WC |
$22,724.41
|
| Rate for Payer: Riverside University Health System MISP |
$16,332.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14,648.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,207.00
|
| 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 |
$14,847.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16,332.54
|
| Rate for Payer: Vantage Medical Group Senior |
$14,847.76
|
|
|
HC THROM DIALYSIS CRCT W TRAN BLN
|
Facility
|
IP
|
$24,414.00
|
|
|
Service Code
|
CPT 36905
|
| Hospital Charge Code |
909036905
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,882.80 |
| Max. Negotiated Rate |
$21,972.60 |
| Rate for Payer: Adventist Health Commercial |
$4,882.80
|
| Rate for Payer: Cash Price |
$10,986.30
|
| Rate for Payer: Central Health Plan Commercial |
$19,531.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17,089.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,765.60
|
| Rate for Payer: EPIC Health Plan Senior |
$9,765.60
|
| Rate for Payer: Galaxy Health WC |
$20,751.90
|
| Rate for Payer: Global Benefits Group Commercial |
$14,648.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$21,972.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15,502.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14,404.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,882.80
|
| Rate for Payer: Multiplan Commercial |
$18,310.50
|
| Rate for Payer: Networks By Design Commercial |
$15,869.10
|
| Rate for Payer: Prime Health Services Commercial |
$20,751.90
|
|
