|
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 |
$591.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$717.09
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$671.55
|
| Rate for Payer: Cash Price |
$671.55
|
| Rate for Payer: Cash Price |
$671.55
|
| 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: 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: Inland Empire Health Plan (IEHP) medi-cal |
$579.28
|
| Rate for Payer: InnovAge PACE Commercial |
$610.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$814.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$639.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$755.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$244.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$854.70
|
| Rate for Payer: Molina Healthcare of CA 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 |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,037.85
|
| 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 |
$671.55
|
| Rate for Payer: Central Health Plan Commercial |
$976.80
|
| 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 Permanente of CA Commercial/Self Funded |
$814.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$465.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$755.80
|
| 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
|
OP
|
$5,434.00
|
|
|
Service Code
|
CPT 37212
|
| Hospital Charge Code |
909020155
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$496.91 |
| Max. Negotiated Rate |
$7,764.00 |
| Rate for Payer: Adventist Health Commercial |
$1,086.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$3,999.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,764.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,298.44
|
| Rate for Payer: Blue Shield of California EPN |
$2,157.30
|
| Rate for Payer: Cash Price |
$2,988.70
|
| Rate for Payer: Cash Price |
$2,988.70
|
| Rate for Payer: Cash Price |
$2,988.70
|
| 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 |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,398.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3,999.21
|
| Rate for Payer: Galaxy Health WC |
$4,618.90
|
| 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 |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$496.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: InnovAge PACE Commercial |
$5,998.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,624.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$548.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,086.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,358.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,358.94
|
| 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 |
$3,999.21
|
| Rate for Payer: Prime Health Services Commercial |
$4,618.90
|
| Rate for Payer: Prime Health Services Medicare |
$4,239.16
|
| Rate for Payer: Riverside University Health System MISP |
$4,399.13
|
| 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 |
$3,999.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC THROMBOLYSIS VEIN
|
Facility
|
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 |
$2,988.70
|
| Rate for Payer: Central Health Plan Commercial |
$4,347.20
|
| 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 Permanente of CA Commercial/Self Funded |
$3,624.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,070.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,363.65
|
| 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
|
$4,725.00
|
|
|
Service Code
|
CPT 37212
|
| Hospital Charge Code |
906820225
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$496.91 |
| Max. Negotiated Rate |
$7,764.00 |
| Rate for Payer: Adventist Health Commercial |
$945.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$3,999.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,764.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,868.07
|
| Rate for Payer: Blue Shield of California EPN |
$1,875.83
|
| Rate for Payer: Cash Price |
$2,598.75
|
| Rate for Payer: Cash Price |
$2,598.75
|
| Rate for Payer: Cash Price |
$2,598.75
|
| Rate for Payer: Central Health Plan Commercial |
$3,780.00
|
| Rate for Payer: Cigna of CA HMO |
$3,024.00
|
| Rate for Payer: Cigna of CA PPO |
$3,496.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,398.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3,999.21
|
| Rate for Payer: Galaxy Health WC |
$4,016.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,835.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,252.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$496.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: InnovAge PACE Commercial |
$5,998.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,151.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$548.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$945.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,358.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,358.94
|
| Rate for Payer: Multiplan Commercial |
$3,543.75
|
| Rate for Payer: Networks By Design Commercial |
$3,071.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Prime Health Services Commercial |
$4,016.25
|
| Rate for Payer: Prime Health Services Medicare |
$4,239.16
|
| Rate for Payer: Riverside University Health System MISP |
$4,399.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,835.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,835.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,362.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,362.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,362.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,362.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,999.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC THROMBOLYSIS VEIN
|
Facility
|
IP
|
$4,725.00
|
|
|
Service Code
|
CPT 37212
|
| Hospital Charge Code |
906820225
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$945.00 |
| Max. Negotiated Rate |
$4,252.50 |
| Rate for Payer: Adventist Health Commercial |
$945.00
|
| Rate for Payer: Cash Price |
$2,598.75
|
| Rate for Payer: Central Health Plan Commercial |
$3,780.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,890.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,890.00
|
| Rate for Payer: Galaxy Health WC |
$4,016.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,835.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,252.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,151.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,800.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,924.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$945.00
|
| Rate for Payer: Multiplan Commercial |
$3,543.75
|
| Rate for Payer: Networks By Design Commercial |
$3,071.25
|
| Rate for Payer: Prime Health Services Commercial |
$4,016.25
|
|
|
HC THROMBO SUBSEQUENT DAY
|
Facility
|
OP
|
$10,033.00
|
|
|
Service Code
|
CPT 37213
|
| Hospital Charge Code |
906820226
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$346.43 |
| Max. Negotiated Rate |
$9,029.70 |
| Rate for Payer: Adventist Health Commercial |
$2,006.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$3,999.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,764.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,090.03
|
| Rate for Payer: Blue Shield of California EPN |
$3,983.10
|
| Rate for Payer: Cash Price |
$5,518.15
|
| Rate for Payer: Cash Price |
$5,518.15
|
| Rate for Payer: Cash Price |
$5,518.15
|
| Rate for Payer: Central Health Plan Commercial |
$8,026.40
|
| Rate for Payer: Cigna of CA HMO |
$6,421.12
|
| Rate for Payer: Cigna of CA PPO |
$7,424.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,398.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3,999.21
|
| Rate for Payer: Galaxy Health WC |
$8,528.05
|
| Rate for Payer: Global Benefits Group Commercial |
$6,019.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,029.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$346.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: InnovAge PACE Commercial |
$5,998.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,692.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$382.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,006.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,358.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,358.94
|
| Rate for Payer: Multiplan Commercial |
$7,524.75
|
| Rate for Payer: Networks By Design Commercial |
$6,521.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Prime Health Services Commercial |
$8,528.05
|
| Rate for Payer: Prime Health Services Medicare |
$4,239.16
|
| Rate for Payer: Riverside University Health System MISP |
$4,399.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,019.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,019.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,016.50
|
| Rate for Payer: United Healthcare All Other HMO |
$5,016.50
|
| Rate for Payer: United Healthcare HMO Rider |
$5,016.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,016.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,999.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC 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 |
$6,345.90
|
| Rate for Payer: Central Health Plan Commercial |
$9,230.40
|
| 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 Permanente of CA Commercial/Self Funded |
$7,695.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,395.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,142.02
|
| 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 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 |
$3,999.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,764.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,003.57
|
| Rate for Payer: Blue Shield of California EPN |
$4,580.59
|
| Rate for Payer: Cash Price |
$6,345.90
|
| Rate for Payer: Cash Price |
$6,345.90
|
| Rate for Payer: Cash Price |
$6,345.90
|
| 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 |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,398.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3,999.21
|
| Rate for Payer: Galaxy Health WC |
$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 |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$346.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: InnovAge PACE Commercial |
$5,998.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,695.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$382.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,307.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,358.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,358.94
|
| 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 |
$3,999.21
|
| Rate for Payer: Prime Health Services Commercial |
$9,807.30
|
| Rate for Payer: Prime Health Services Medicare |
$4,239.16
|
| Rate for Payer: Riverside University Health System MISP |
$4,399.13
|
| 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 |
$3,999.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC THROMBO SUBSEQUENT DAY
|
Facility
|
IP
|
$10,033.00
|
|
|
Service Code
|
CPT 37213
|
| Hospital Charge Code |
906820226
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,006.60 |
| Max. Negotiated Rate |
$9,029.70 |
| Rate for Payer: Adventist Health Commercial |
$2,006.60
|
| Rate for Payer: Cash Price |
$5,518.15
|
| Rate for Payer: Central Health Plan Commercial |
$8,026.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,013.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,013.20
|
| Rate for Payer: Galaxy Health WC |
$8,528.05
|
| Rate for Payer: Global Benefits Group Commercial |
$6,019.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,029.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,692.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,822.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,210.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,006.60
|
| Rate for Payer: Multiplan Commercial |
$7,524.75
|
| Rate for Payer: Networks By Design Commercial |
$6,521.45
|
| Rate for Payer: Prime Health Services Commercial |
$8,528.05
|
|
|
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 |
$8,315.83 |
| Max. Negotiated Rate |
$71,375.00 |
| Rate for Payer: Adventist Health Commercial |
$8,437.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$22,815.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,620.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22,815.81
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,461.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,320.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$36,352.92
|
| Rate for Payer: Blue Shield of California Commercial |
$12,745.22
|
| Rate for Payer: Blue Shield of California EPN |
$8,315.83
|
| Rate for Payer: Cash Price |
$23,202.30
|
| Rate for Payer: Cash Price |
$23,202.30
|
| Rate for Payer: Cash Price |
$23,202.30
|
| 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 |
$34,223.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,097.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22,815.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$30,801.34
|
| Rate for Payer: EPIC Health Plan Senior |
$22,815.81
|
| Rate for Payer: Galaxy Health WC |
$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 |
$37,417.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$10,766.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,815.81
|
| Rate for Payer: InnovAge PACE Commercial |
$34,223.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28,138.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,893.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,815.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,437.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30,573.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30,573.19
|
| 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 |
$22,815.81
|
| 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 |
$24,184.76
|
| Rate for Payer: Prime Health Services WC |
$35,981.98
|
| Rate for Payer: Riverside University Health System MISP |
$25,097.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25,311.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$60,866.00
|
| Rate for Payer: United Healthcare All Other HMO |
$71,375.00
|
| Rate for Payer: United Healthcare HMO Rider |
$57,385.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$52,575.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$22,815.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Vantage Medical Group Senior |
$22,815.81
|
|
|
HC THROM DIALYSIS CRCT W 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 |
$23,202.30
|
| Rate for Payer: Central Health Plan Commercial |
$33,748.80
|
| 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 Permanente of CA Commercial/Self Funded |
$28,138.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16,072.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26,113.13
|
| 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
|
$28,722.00
|
|
|
Service Code
|
CPT 36905
|
| Hospital Charge Code |
906820282
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,564.22 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$5,744.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$14,409.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,620.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,409.33
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,461.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,320.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$22,958.69
|
| Rate for Payer: Blue Shield of California Commercial |
$12,745.22
|
| Rate for Payer: Blue Shield of California EPN |
$8,315.83
|
| Rate for Payer: Cash Price |
$15,797.10
|
| Rate for Payer: Cash Price |
$15,797.10
|
| Rate for Payer: Cash Price |
$15,797.10
|
| Rate for Payer: Central Health Plan Commercial |
$22,977.60
|
| Rate for Payer: Cigna of CA HMO |
$18,382.08
|
| Rate for Payer: Cigna of CA PPO |
$21,254.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,850.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,409.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,452.60
|
| Rate for Payer: EPIC Health Plan Senior |
$14,409.33
|
| Rate for Payer: Galaxy Health WC |
$24,413.70
|
| Rate for Payer: Global Benefits Group Commercial |
$17,233.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$25,849.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23,631.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,564.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,409.33
|
| Rate for Payer: InnovAge PACE Commercial |
$21,613.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19,157.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,937.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,409.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,744.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19,308.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,308.50
|
| Rate for Payer: Multiplan Commercial |
$21,541.50
|
| Rate for Payer: Multiplan WC |
$22,958.69
|
| Rate for Payer: Networks By Design Commercial |
$18,669.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14,409.33
|
| Rate for Payer: Preferred Health Network WC |
$23,427.23
|
| Rate for Payer: Prime Health Services Commercial |
$24,413.70
|
| Rate for Payer: Prime Health Services Medicare |
$15,273.89
|
| Rate for Payer: Prime Health Services WC |
$22,724.41
|
| Rate for Payer: Riverside University Health System MISP |
$15,850.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17,233.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$31,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$14,409.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Vantage Medical Group Senior |
$14,409.33
|
|
|
HC THROM DIALYSIS CRCT W TRAN BLN
|
Facility
|
IP
|
$28,722.00
|
|
|
Service Code
|
CPT 36905
|
| Hospital Charge Code |
906820282
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,744.40 |
| Max. Negotiated Rate |
$25,849.80 |
| Rate for Payer: Adventist Health Commercial |
$5,744.40
|
| Rate for Payer: Cash Price |
$15,797.10
|
| Rate for Payer: Central Health Plan Commercial |
$22,977.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,488.80
|
| Rate for Payer: EPIC Health Plan Senior |
$11,488.80
|
| Rate for Payer: Galaxy Health WC |
$24,413.70
|
| Rate for Payer: Global Benefits Group Commercial |
$17,233.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$25,849.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19,157.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,943.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17,778.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,744.40
|
| Rate for Payer: Multiplan Commercial |
$21,541.50
|
| Rate for Payer: Networks By Design Commercial |
$18,669.30
|
| Rate for Payer: Prime Health Services Commercial |
$24,413.70
|
|
|
HC THROM DIALYSIS CRCT W TRAN BLN
|
Facility
|
IP
|
$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 |
$13,427.70
|
| Rate for Payer: Central Health Plan Commercial |
$19,531.20
|
| 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 Permanente of CA Commercial/Self Funded |
$16,284.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,301.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,112.27
|
| 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
|
|
|
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 |
$14,409.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,620.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,409.33
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,461.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,320.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$22,958.69
|
| Rate for Payer: Blue Shield of California Commercial |
$12,745.22
|
| Rate for Payer: Blue Shield of California EPN |
$8,315.83
|
| Rate for Payer: Cash Price |
$13,427.70
|
| Rate for Payer: Cash Price |
$13,427.70
|
| Rate for Payer: Cash Price |
$13,427.70
|
| 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 |
$21,613.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,850.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,409.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,452.60
|
| Rate for Payer: EPIC Health Plan Senior |
$14,409.33
|
| Rate for Payer: Galaxy Health WC |
$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 |
$23,631.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,564.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,409.33
|
| Rate for Payer: InnovAge PACE Commercial |
$21,613.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,284.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,937.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,409.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,882.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19,308.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,308.50
|
| 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 |
$14,409.33
|
| 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 |
$15,273.89
|
| Rate for Payer: Prime Health Services WC |
$22,724.41
|
| Rate for Payer: Riverside University Health System MISP |
$15,850.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14,648.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$31,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$14,409.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Vantage Medical Group Senior |
$14,409.33
|
|
|
HC THRPTC INTVN 1ST 15 MIN
|
Facility
|
IP
|
$48.00
|
|
|
Service Code
|
CPT 97129
|
| Hospital Charge Code |
905107129
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$9.60 |
| Max. Negotiated Rate |
$43.20 |
| Rate for Payer: Adventist Health Commercial |
$9.60
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Central Health Plan Commercial |
$38.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.20
|
| Rate for Payer: EPIC Health Plan Senior |
$19.20
|
| Rate for Payer: Galaxy Health WC |
$40.80
|
| Rate for Payer: Global Benefits Group Commercial |
$28.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$43.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.60
|
| Rate for Payer: Multiplan Commercial |
$36.00
|
| Rate for Payer: Networks By Design Commercial |
$31.20
|
| Rate for Payer: Prime Health Services Commercial |
$40.80
|
|
|
HC THRPTC INTVN 1ST 15 MIN
|
Facility
|
OP
|
$48.00
|
|
|
Service Code
|
CPT 97129
|
| Hospital Charge Code |
905107129
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$19.20 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$19.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$29.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$36.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Central Health Plan Commercial |
$38.40
|
| Rate for Payer: Cigna of CA HMO |
$30.72
|
| Rate for Payer: Cigna of CA PPO |
$35.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$40.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.20
|
| Rate for Payer: EPIC Health Plan Senior |
$19.20
|
| Rate for Payer: Galaxy Health WC |
$40.80
|
| Rate for Payer: Global Benefits Group Commercial |
$28.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$43.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$35.74
|
| Rate for Payer: InnovAge PACE Commercial |
$24.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33.60
|
| Rate for Payer: Multiplan Commercial |
$36.00
|
| Rate for Payer: Networks By Design Commercial |
$31.20
|
| Rate for Payer: Prime Health Services Commercial |
$40.80
|
| Rate for Payer: Riverside University Health System MISP |
$19.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.80
|
| Rate for Payer: Vantage Medical Group Senior |
$40.80
|
|
|
HC THRPTC INTVN 1ST 15 MIN OT
|
Facility
|
IP
|
$48.00
|
|
|
Service Code
|
CPT 97129
|
| Hospital Charge Code |
905107131
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$9.60 |
| Max. Negotiated Rate |
$43.20 |
| Rate for Payer: Adventist Health Commercial |
$9.60
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Central Health Plan Commercial |
$38.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.20
|
| Rate for Payer: EPIC Health Plan Senior |
$19.20
|
| Rate for Payer: Galaxy Health WC |
$40.80
|
| Rate for Payer: Global Benefits Group Commercial |
$28.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$43.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.60
|
| Rate for Payer: Multiplan Commercial |
$36.00
|
| Rate for Payer: Networks By Design Commercial |
$31.20
|
| Rate for Payer: Prime Health Services Commercial |
$40.80
|
|
|
HC THRPTC INTVN 1ST 15 MIN OT
|
Facility
|
OP
|
$48.00
|
|
|
Service Code
|
CPT 97129
|
| Hospital Charge Code |
905107131
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$19.20 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$19.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$29.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$36.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Central Health Plan Commercial |
$38.40
|
| Rate for Payer: Cigna of CA HMO |
$30.72
|
| Rate for Payer: Cigna of CA PPO |
$35.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$40.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.20
|
| Rate for Payer: EPIC Health Plan Senior |
$19.20
|
| Rate for Payer: Galaxy Health WC |
$40.80
|
| Rate for Payer: Global Benefits Group Commercial |
$28.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$43.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$35.74
|
| Rate for Payer: InnovAge PACE Commercial |
$24.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33.60
|
| Rate for Payer: Multiplan Commercial |
$36.00
|
| Rate for Payer: Networks By Design Commercial |
$31.20
|
| Rate for Payer: Prime Health Services Commercial |
$40.80
|
| Rate for Payer: Riverside University Health System MISP |
$19.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.80
|
| Rate for Payer: Vantage Medical Group Senior |
$40.80
|
|
|
HC THRPTC INTVN 1ST 15 MIN ST
|
Facility
|
OP
|
$48.00
|
|
|
Service Code
|
CPT 97129
|
| Hospital Charge Code |
905107132
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$19.20 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$19.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$29.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$36.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Central Health Plan Commercial |
$38.40
|
| Rate for Payer: Cigna of CA HMO |
$30.72
|
| Rate for Payer: Cigna of CA PPO |
$35.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$40.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.20
|
| Rate for Payer: EPIC Health Plan Senior |
$19.20
|
| Rate for Payer: Galaxy Health WC |
$40.80
|
| Rate for Payer: Global Benefits Group Commercial |
$28.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$43.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$35.74
|
| Rate for Payer: InnovAge PACE Commercial |
$24.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33.60
|
| Rate for Payer: Multiplan Commercial |
$36.00
|
| Rate for Payer: Networks By Design Commercial |
$31.20
|
| Rate for Payer: Prime Health Services Commercial |
$40.80
|
| Rate for Payer: Riverside University Health System MISP |
$19.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.80
|
| Rate for Payer: Vantage Medical Group Senior |
$40.80
|
|
|
HC THRPTC INTVN 1ST 15 MIN ST
|
Facility
|
IP
|
$48.00
|
|
|
Service Code
|
CPT 97129
|
| Hospital Charge Code |
905107132
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$9.60 |
| Max. Negotiated Rate |
$43.20 |
| Rate for Payer: Adventist Health Commercial |
$9.60
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Central Health Plan Commercial |
$38.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.20
|
| Rate for Payer: EPIC Health Plan Senior |
$19.20
|
| Rate for Payer: Galaxy Health WC |
$40.80
|
| Rate for Payer: Global Benefits Group Commercial |
$28.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$43.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.60
|
| Rate for Payer: Multiplan Commercial |
$36.00
|
| Rate for Payer: Networks By Design Commercial |
$31.20
|
| Rate for Payer: Prime Health Services Commercial |
$40.80
|
|
|
HC THRPTC INTVN EA ADD 15MIN
|
Facility
|
IP
|
$47.00
|
|
|
Service Code
|
CPT 97130
|
| Hospital Charge Code |
905107130
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$9.40 |
| Max. Negotiated Rate |
$42.30 |
| Rate for Payer: Adventist Health Commercial |
$9.40
|
| Rate for Payer: Cash Price |
$25.85
|
| Rate for Payer: Central Health Plan Commercial |
$37.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.80
|
| Rate for Payer: EPIC Health Plan Senior |
$18.80
|
| Rate for Payer: Galaxy Health WC |
$39.95
|
| Rate for Payer: Global Benefits Group Commercial |
$28.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$42.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.40
|
| Rate for Payer: Multiplan Commercial |
$35.25
|
| Rate for Payer: Networks By Design Commercial |
$30.55
|
| Rate for Payer: Prime Health Services Commercial |
$39.95
|
|
|
HC THRPTC INTVN EA ADD 15MIN
|
Facility
|
OP
|
$47.00
|
|
|
Service Code
|
CPT 97130
|
| Hospital Charge Code |
905107130
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$18.80 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$19.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$28.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$39.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$25.85
|
| Rate for Payer: Cash Price |
$25.85
|
| Rate for Payer: Cash Price |
$25.85
|
| Rate for Payer: Cash Price |
$25.85
|
| Rate for Payer: Central Health Plan Commercial |
$37.60
|
| Rate for Payer: Cigna of CA HMO |
$30.08
|
| Rate for Payer: Cigna of CA PPO |
$34.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$39.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$39.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$39.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.80
|
| Rate for Payer: EPIC Health Plan Senior |
$18.80
|
| Rate for Payer: Galaxy Health WC |
$39.95
|
| Rate for Payer: Global Benefits Group Commercial |
$28.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$42.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$34.12
|
| Rate for Payer: InnovAge PACE Commercial |
$23.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32.90
|
| Rate for Payer: Multiplan Commercial |
$35.25
|
| Rate for Payer: Networks By Design Commercial |
$30.55
|
| Rate for Payer: Prime Health Services Commercial |
$39.95
|
| Rate for Payer: Riverside University Health System MISP |
$18.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$39.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$39.95
|
| Rate for Payer: Vantage Medical Group Senior |
$39.95
|
|
|
HC THRPTC INTVN EA ADD 15MIN OT
|
Facility
|
IP
|
$47.00
|
|
|
Service Code
|
CPT 97130
|
| Hospital Charge Code |
905107133
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$9.40 |
| Max. Negotiated Rate |
$42.30 |
| Rate for Payer: Adventist Health Commercial |
$9.40
|
| Rate for Payer: Cash Price |
$25.85
|
| Rate for Payer: Central Health Plan Commercial |
$37.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.80
|
| Rate for Payer: EPIC Health Plan Senior |
$18.80
|
| Rate for Payer: Galaxy Health WC |
$39.95
|
| Rate for Payer: Global Benefits Group Commercial |
$28.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$42.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.40
|
| Rate for Payer: Multiplan Commercial |
$35.25
|
| Rate for Payer: Networks By Design Commercial |
$30.55
|
| Rate for Payer: Prime Health Services Commercial |
$39.95
|
|
