|
HC THORACIC FACET JONT INJ,EA ADL
|
Facility
|
OP
|
$1,634.00
|
|
|
Service Code
|
CPT 64491
|
| Hospital Charge Code |
909000231
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$326.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,122.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,388.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$898.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,225.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$898.70
|
| Rate for Payer: Cash Price |
$898.70
|
| Rate for Payer: Cash Price |
$898.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,062.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,388.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,388.90
|
| Rate for Payer: Dignity Health Senior |
$1,388.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$980.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,011.45
|
| Rate for Payer: Heritage Provider Network Senior |
$1,011.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$129.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$779.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$295.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$408.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,143.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,143.80
|
| Rate for Payer: Multiplan Commercial |
$1,225.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,388.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,388.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1,388.90
|
|
|
HC THORACIC SPINE 2VIEWS
|
Facility
|
OP
|
$584.00
|
|
|
Service Code
|
CPT 72070
|
| Hospital Charge Code |
909001311
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$45.42 |
| Max. Negotiated Rate |
$438.00 |
| Rate for Payer: Adventist Health Commercial |
$116.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$312.15
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$401.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$169.82
|
| Rate for Payer: Blue Shield of California Commercial |
$137.09
|
| Rate for Payer: Blue Shield of California EPN |
$110.24
|
| Rate for Payer: Cash Price |
$321.20
|
| Rate for Payer: Cash Price |
$321.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$379.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Senior |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$379.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$135.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$361.50
|
| Rate for Payer: Heritage Provider Network Senior |
$361.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$45.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$278.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$105.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$155.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$146.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$170.25
|
| Rate for Payer: Multiplan Commercial |
$438.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$135.12
|
| Rate for Payer: TriValley Medical Group Senior |
$135.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$71.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$71.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC THORACIC SPINE 2VIEWS
|
Facility
|
IP
|
$584.00
|
|
|
Service Code
|
CPT 72070
|
| Hospital Charge Code |
909001311
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$105.70 |
| Max. Negotiated Rate |
$438.00 |
| Rate for Payer: Adventist Health Commercial |
$116.80
|
| Rate for Payer: Cash Price |
$321.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$395.37
|
| Rate for Payer: Heritage Provider Network Senior |
$395.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$105.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$146.00
|
| Rate for Payer: Multiplan Commercial |
$438.00
|
|
|
HC THORACIC SPINE 3VIEWS
|
Facility
|
OP
|
$737.00
|
|
|
Service Code
|
CPT 72072
|
| Hospital Charge Code |
909001310
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$49.94 |
| Max. Negotiated Rate |
$552.75 |
| Rate for Payer: Adventist Health Commercial |
$147.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$393.93
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$506.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$192.99
|
| Rate for Payer: Blue Shield of California Commercial |
$156.72
|
| Rate for Payer: Blue Shield of California EPN |
$126.03
|
| Rate for Payer: Cash Price |
$405.35
|
| Rate for Payer: Cash Price |
$405.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$479.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Senior |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$479.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$135.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$456.20
|
| Rate for Payer: Heritage Provider Network Senior |
$456.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$49.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$351.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$155.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$184.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$170.25
|
| Rate for Payer: Multiplan Commercial |
$552.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$135.12
|
| Rate for Payer: TriValley Medical Group Senior |
$135.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$71.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$71.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC THORACIC SPINE 3VIEWS
|
Facility
|
IP
|
$737.00
|
|
|
Service Code
|
CPT 72072
|
| Hospital Charge Code |
909001310
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$133.40 |
| Max. Negotiated Rate |
$552.75 |
| Rate for Payer: Adventist Health Commercial |
$147.40
|
| Rate for Payer: Cash Price |
$405.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$498.95
|
| Rate for Payer: Heritage Provider Network Senior |
$498.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$184.25
|
| Rate for Payer: Multiplan Commercial |
$552.75
|
|
|
HC THORACIC SPINE 4 VIEWS
|
Facility
|
IP
|
$789.00
|
|
|
Service Code
|
CPT 72074
|
| Hospital Charge Code |
909001313
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$142.81 |
| Max. Negotiated Rate |
$591.75 |
| Rate for Payer: Adventist Health Commercial |
$157.80
|
| Rate for Payer: Cash Price |
$433.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$534.15
|
| Rate for Payer: Heritage Provider Network Senior |
$534.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$142.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$197.25
|
| Rate for Payer: Multiplan Commercial |
$591.75
|
|
|
HC THORACIC SPINE 4 VIEWS
|
Facility
|
OP
|
$789.00
|
|
|
Service Code
|
CPT 72074
|
| Hospital Charge Code |
909001313
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$56.88 |
| Max. Negotiated Rate |
$591.75 |
| Rate for Payer: Adventist Health Commercial |
$157.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$421.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$542.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$238.35
|
| Rate for Payer: Blue Shield of California Commercial |
$192.48
|
| Rate for Payer: Blue Shield of California EPN |
$154.79
|
| Rate for Payer: Cash Price |
$433.95
|
| Rate for Payer: Cash Price |
$433.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$512.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Senior |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$512.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$135.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$488.39
|
| Rate for Payer: Heritage Provider Network Senior |
$488.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$56.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$376.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$142.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$155.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$197.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$170.25
|
| Rate for Payer: Multiplan Commercial |
$591.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$135.12
|
| Rate for Payer: TriValley Medical Group Senior |
$135.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$71.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$71.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC THORACOTOMY CARDIAC
|
Facility
|
IP
|
$6,936.00
|
|
|
Service Code
|
CPT 32160
|
| Hospital Charge Code |
900501127
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,255.42 |
| Max. Negotiated Rate |
$5,202.00 |
| Rate for Payer: Adventist Health Commercial |
$1,387.20
|
| Rate for Payer: Cash Price |
$3,814.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,695.67
|
| Rate for Payer: Heritage Provider Network Senior |
$4,695.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,255.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,734.00
|
| Rate for Payer: Multiplan Commercial |
$5,202.00
|
|
|
HC THORACOTOMY CARDIAC
|
Facility
|
OP
|
$6,936.00
|
|
|
Service Code
|
CPT 32160
|
| Hospital Charge Code |
900501127
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$180.94 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$1,387.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,765.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,895.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,814.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,202.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,785.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$3,814.80
|
| Rate for Payer: Cash Price |
$3,814.80
|
| Rate for Payer: Cash Price |
$3,814.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,508.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,895.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,895.60
|
| Rate for Payer: Dignity Health Senior |
$5,895.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,293.38
|
| Rate for Payer: Heritage Provider Network Senior |
$4,293.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$180.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,308.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,255.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,734.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,855.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,855.20
|
| Rate for Payer: Multiplan Commercial |
$5,202.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,895.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,895.60
|
| Rate for Payer: Vantage Medical Group Senior |
$5,895.60
|
|
|
HC THROMBECTOMY CATH, 6&7F HYDROL
|
Facility
|
IP
|
$1,440.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909081406
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$288.00 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$288.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$691.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$578.88
|
| Rate for Payer: Blue Shield of California EPN |
$578.88
|
| Rate for Payer: Cash Price |
$792.00
|
| Rate for Payer: Cash Price |
$792.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$662.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$777.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$666.72
|
| Rate for Payer: Heritage Provider Network Senior |
$666.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$720.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$720.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$720.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$360.00
|
| Rate for Payer: Multiplan Commercial |
$1,080.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$520.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$476.78
|
|
|
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 |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$288.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$691.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$989.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,224.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$792.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,080.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$578.88
|
| Rate for Payer: Blue Shield of California EPN |
$578.88
|
| Rate for Payer: Cash Price |
$792.00
|
| Rate for Payer: Cash Price |
$792.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$662.40
|
| 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 Senior |
$1,224.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$921.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$666.72
|
| Rate for Payer: Heritage Provider Network Senior |
$666.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$720.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$720.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$720.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$360.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,008.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,008.00
|
| Rate for Payer: Multiplan Commercial |
$1,080.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$520.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$476.78
|
| 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 |
$31.31 |
| Max. Negotiated Rate |
$129.75 |
| Rate for Payer: Adventist Health Commercial |
$34.60
|
| Rate for Payer: Cash Price |
$95.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$117.12
|
| Rate for Payer: Heritage Provider Network Senior |
$117.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.25
|
| Rate for Payer: Multiplan Commercial |
$129.75
|
|
|
HC THROMBIN TIME
|
Facility
|
OP
|
$173.00
|
|
|
Service Code
|
CPT 85670
|
| Hospital Charge Code |
900910021
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.77 |
| Max. Negotiated Rate |
$129.75 |
| Rate for Payer: Adventist Health Commercial |
$34.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$92.47
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$118.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$52.80
|
| Rate for Payer: Blue Shield of California Commercial |
$46.48
|
| Rate for Payer: Blue Shield of California EPN |
$37.28
|
| Rate for Payer: Cash Price |
$95.15
|
| Rate for Payer: Cash Price |
$95.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$112.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.35
|
| Rate for Payer: Dignity Health Senior |
$5.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$107.09
|
| Rate for Payer: Heritage Provider Network Senior |
$107.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$82.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.27
|
| Rate for Payer: Multiplan Commercial |
$129.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.77
|
| Rate for Payer: TriValley Medical Group Senior |
$5.77
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.23
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.35
|
| Rate for Payer: Vantage Medical Group Senior |
$5.77
|
|
|
HC THROMBOELASTOGRAPH
|
Facility
|
OP
|
$533.00
|
|
|
Service Code
|
CPT 85396
|
| Hospital Charge Code |
900912024
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$21.31 |
| Max. Negotiated Rate |
$453.05 |
| Rate for Payer: Adventist Health Commercial |
$106.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$284.89
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$366.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$453.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$293.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$399.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$146.40
|
| Rate for Payer: Blue Shield of California Commercial |
$38.11
|
| Rate for Payer: Blue Shield of California EPN |
$30.65
|
| Rate for Payer: Cash Price |
$293.15
|
| Rate for Payer: Cash Price |
$293.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$346.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$453.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$453.05
|
| Rate for Payer: Dignity Health Senior |
$453.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$346.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$329.93
|
| Rate for Payer: Heritage Provider Network Senior |
$329.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$28.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$254.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$96.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$133.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$373.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$373.10
|
| Rate for Payer: Multiplan Commercial |
$399.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$21.31
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$21.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$453.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$453.05
|
| Rate for Payer: Vantage Medical Group Senior |
$453.05
|
|
|
HC THROMBOELASTOGRAPH
|
Facility
|
IP
|
$533.00
|
|
|
Service Code
|
CPT 85396
|
| Hospital Charge Code |
900912024
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$96.47 |
| Max. Negotiated Rate |
$399.75 |
| Rate for Payer: Adventist Health Commercial |
$106.60
|
| Rate for Payer: Cash Price |
$293.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$360.84
|
| Rate for Payer: Heritage Provider Network Senior |
$360.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$96.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$133.25
|
| Rate for Payer: Multiplan Commercial |
$399.75
|
|
|
HC THROMBOLYSIS ART
|
Facility
|
OP
|
$5,306.00
|
|
|
Service Code
|
CPT 37211
|
| Hospital Charge Code |
909020164
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$10,302.72 |
| Rate for Payer: Adventist Health Commercial |
$1,061.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,645.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,555.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,868.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,236.66
|
| Rate for Payer: Blue Shield of California EPN |
$2,589.33
|
| Rate for Payer: Cash Price |
$2,918.30
|
| Rate for Payer: Cash Price |
$2,918.30
|
| Rate for Payer: Cash Price |
$2,918.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,448.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,555.33
|
| Rate for Payer: Dignity Health Senior |
$6,868.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$6,868.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,284.41
|
| Rate for Payer: Heritage Provider Network Senior |
$3,284.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$531.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,868.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,530.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$960.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,898.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,326.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,654.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,654.28
|
| Rate for Payer: Multiplan Commercial |
$3,979.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$6,868.48
|
| Rate for Payer: TriValley Medical Group Senior |
$6,868.48
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,653.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,653.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,555.33
|
| Rate for Payer: Vantage Medical Group Senior |
$6,868.48
|
|
|
HC THROMBOLYSIS ART
|
Facility
|
IP
|
$5,306.00
|
|
|
Service Code
|
CPT 37211
|
| Hospital Charge Code |
909020164
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$960.39 |
| Max. Negotiated Rate |
$3,979.50 |
| Rate for Payer: Adventist Health Commercial |
$1,061.20
|
| Rate for Payer: Cash Price |
$2,918.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,592.16
|
| Rate for Payer: Heritage Provider Network Senior |
$3,592.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$960.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,326.50
|
| Rate for Payer: Multiplan Commercial |
$3,979.50
|
|
|
HC THROMBOLYSIS ART
|
Facility
|
OP
|
$5,671.00
|
|
|
Service Code
|
CPT 37211
|
| Hospital Charge Code |
906820230
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$10,302.72 |
| Rate for Payer: Adventist Health Commercial |
$1,134.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,895.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,555.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,868.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,459.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,767.45
|
| Rate for Payer: Cash Price |
$3,119.05
|
| Rate for Payer: Cash Price |
$3,119.05
|
| Rate for Payer: Cash Price |
$3,119.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,686.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,555.33
|
| Rate for Payer: Dignity Health Senior |
$6,868.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$6,868.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,510.35
|
| Rate for Payer: Heritage Provider Network Senior |
$3,510.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$531.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,868.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,705.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,026.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,898.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,417.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,654.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,654.28
|
| Rate for Payer: Multiplan Commercial |
$4,253.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$6,868.48
|
| Rate for Payer: TriValley Medical Group Senior |
$6,868.48
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,835.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,835.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,555.33
|
| Rate for Payer: Vantage Medical Group Senior |
$6,868.48
|
|
|
HC THROMBOLYSIS ART
|
Facility
|
IP
|
$5,671.00
|
|
|
Service Code
|
CPT 37211
|
| Hospital Charge Code |
906820230
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,026.45 |
| Max. Negotiated Rate |
$4,253.25 |
| Rate for Payer: Adventist Health Commercial |
$1,134.20
|
| Rate for Payer: Cash Price |
$3,119.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,839.27
|
| Rate for Payer: Heritage Provider Network Senior |
$3,839.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,026.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,417.75
|
| Rate for Payer: Multiplan Commercial |
$4,253.25
|
|
|
HC THROMBOLYSIS COMPLETE
|
Facility
|
OP
|
$11,859.00
|
|
|
Service Code
|
CPT 37214
|
| Hospital Charge Code |
906820227
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$2,371.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,147.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,233.99
|
| Rate for Payer: Blue Shield of California EPN |
$5,787.19
|
| Rate for Payer: Cash Price |
$6,522.45
|
| Rate for Payer: Cash Price |
$6,522.45
|
| Rate for Payer: Cash Price |
$6,522.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,708.35
|
| 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 Senior |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,999.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,340.72
|
| Rate for Payer: Heritage Provider Network Senior |
$7,340.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$193.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5,656.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,146.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,599.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,964.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,039.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,039.00
|
| Rate for Payer: Multiplan Commercial |
$8,894.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,999.21
|
| Rate for Payer: TriValley Medical Group Senior |
$3,999.21
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5,929.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,929.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC THROMBOLYSIS COMPLETE
|
Facility
|
IP
|
$12,096.00
|
|
|
Service Code
|
CPT 37214
|
| Hospital Charge Code |
909020157
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,189.38 |
| Max. Negotiated Rate |
$9,072.00 |
| Rate for Payer: Adventist Health Commercial |
$2,419.20
|
| Rate for Payer: Cash Price |
$6,652.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,188.99
|
| Rate for Payer: Heritage Provider Network Senior |
$8,188.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,189.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,024.00
|
| Rate for Payer: Multiplan Commercial |
$9,072.00
|
|
|
HC THROMBOLYSIS COMPLETE
|
Facility
|
OP
|
$12,096.00
|
|
|
Service Code
|
CPT 37214
|
| Hospital Charge Code |
909020157
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$2,419.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,309.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,378.56
|
| Rate for Payer: Blue Shield of California EPN |
$5,902.85
|
| Rate for Payer: Cash Price |
$6,652.80
|
| Rate for Payer: Cash Price |
$6,652.80
|
| Rate for Payer: Cash Price |
$6,652.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,862.40
|
| 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 Senior |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,999.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,487.42
|
| Rate for Payer: Heritage Provider Network Senior |
$7,487.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$193.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5,769.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,189.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,599.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,024.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,039.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,039.00
|
| Rate for Payer: Multiplan Commercial |
$9,072.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,999.21
|
| Rate for Payer: TriValley Medical Group Senior |
$3,999.21
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,048.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,048.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC THROMBOLYSIS COMPLETE
|
Facility
|
IP
|
$11,859.00
|
|
|
Service Code
|
CPT 37214
|
| Hospital Charge Code |
906820227
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,146.48 |
| Max. Negotiated Rate |
$8,894.25 |
| Rate for Payer: Adventist Health Commercial |
$2,371.80
|
| Rate for Payer: Cash Price |
$6,522.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,028.54
|
| Rate for Payer: Heritage Provider Network Senior |
$8,028.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,146.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,964.75
|
| Rate for Payer: Multiplan Commercial |
$8,894.25
|
|
|
HC THROMBOLYSIS, INTRACORONARY
|
Facility
|
OP
|
$1,221.00
|
|
|
Service Code
|
CPT 92975
|
| Hospital Charge Code |
906811110
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$221.00 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$244.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$652.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$838.83
|
| 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 HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$671.55
|
| Rate for Payer: Cash Price |
$671.55
|
| Rate for Payer: Cash Price |
$671.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| 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 Senior |
$1,037.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,556.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$755.80
|
| Rate for Payer: Heritage Provider Network Senior |
$755.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$545.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$582.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$221.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$305.25
|
| 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: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| 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 |
$221.00 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$244.20
|
| Rate for Payer: Cash Price |
$671.55
|
| Rate for Payer: Cash Price |
$671.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$221.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$305.25
|
| Rate for Payer: Multiplan Commercial |
$915.75
|
|
