|
HC THROMBOLYSIS, INTRACORONARY
|
Facility
IP
|
$1,580.00
|
|
|
Service Code
|
CPT 92975
|
| Hospital Charge Code |
906811110
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$285.98 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$316.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,085.46
|
| Rate for Payer: Cash Price |
$711.00
|
| Rate for Payer: Cash Price |
$711.00
|
| 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 |
$285.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$395.00
|
| Rate for Payer: Multiplan Commercial |
$1,185.00
|
|
|
HC THROMBOLYSIS, INTRACORONARY
|
Facility
IP
|
$1,512.00
|
|
|
Service Code
|
CPT 92975
|
| Hospital Charge Code |
906820029
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$273.67 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$302.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,038.74
|
| Rate for Payer: Cash Price |
$680.40
|
| Rate for Payer: Cash Price |
$680.40
|
| 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 |
$273.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$378.00
|
| Rate for Payer: Multiplan Commercial |
$1,134.00
|
|
|
HC THROMBOLYSIS VEIN
|
Facility
OP
|
$4,012.00
|
|
|
Service Code
|
CPT 37212
|
| Hospital Charge Code |
909020155
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$450.68 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$802.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,756.24
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,491.45
|
| Rate for Payer: Blue Shield of California EPN |
$2,355.04
|
| Rate for Payer: Cash Price |
$1,805.40
|
| Rate for Payer: Cash Price |
$1,805.40
|
| Rate for Payer: Cash Price |
$1,805.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,607.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: Dignity Health Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,982.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,483.43
|
| Rate for Payer: Heritage Provider Network Senior |
$2,483.43
|
| Rate for Payer: Humana Medicare |
$3,982.55
|
| Rate for Payer: IEHP Medi-Cal |
$450.68
|
| Rate for Payer: IEHP Medicare Advantage |
$3,982.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,566.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$726.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,699.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,003.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,018.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,018.01
|
| Rate for Payer: Multiplan Commercial |
$3,009.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,982.55
|
| Rate for Payer: TriValley Medical Group Senior |
$3,982.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC THROMBOLYSIS VEIN
|
Facility
IP
|
$4,012.00
|
|
|
Service Code
|
CPT 37212
|
| Hospital Charge Code |
909020155
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$726.17 |
| Max. Negotiated Rate |
$3,009.00 |
| Rate for Payer: Adventist Health Commercial |
$802.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,756.24
|
| Rate for Payer: Cash Price |
$1,805.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,716.12
|
| Rate for Payer: Heritage Provider Network Senior |
$2,716.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$726.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,003.00
|
| Rate for Payer: Multiplan Commercial |
$3,009.00
|
|
|
HC THROMBOLYSIS VEIN
|
Facility
OP
|
$4,109.00
|
|
|
Service Code
|
CPT 37212
|
| Hospital Charge Code |
906820225
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$450.68 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$821.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,822.88
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,551.69
|
| Rate for Payer: Blue Shield of California EPN |
$2,411.98
|
| Rate for Payer: Cash Price |
$1,849.05
|
| Rate for Payer: Cash Price |
$1,849.05
|
| Rate for Payer: Cash Price |
$1,849.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,670.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: Dignity Health Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,982.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,543.47
|
| Rate for Payer: Heritage Provider Network Senior |
$2,543.47
|
| Rate for Payer: Humana Medicare |
$3,982.55
|
| Rate for Payer: IEHP Medi-Cal |
$450.68
|
| Rate for Payer: IEHP Medicare Advantage |
$3,982.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,566.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$743.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,699.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,027.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,018.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,018.01
|
| Rate for Payer: Multiplan Commercial |
$3,081.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,982.55
|
| Rate for Payer: TriValley Medical Group Senior |
$3,982.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC THROMBOLYSIS VEIN
|
Facility
IP
|
$4,109.00
|
|
|
Service Code
|
CPT 37212
|
| Hospital Charge Code |
906820225
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$743.73 |
| Max. Negotiated Rate |
$3,081.75 |
| Rate for Payer: Adventist Health Commercial |
$821.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,822.88
|
| Rate for Payer: Cash Price |
$1,849.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,781.79
|
| Rate for Payer: Heritage Provider Network Senior |
$2,781.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$743.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,027.25
|
| Rate for Payer: Multiplan Commercial |
$3,081.75
|
|
|
HC THROMBO SUBSEQUENT DAY
|
Facility
OP
|
$8,872.00
|
|
|
Service Code
|
CPT 37213
|
| Hospital Charge Code |
909020156
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$314.20 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,774.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,095.06
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,509.51
|
| Rate for Payer: Blue Shield of California EPN |
$5,207.86
|
| Rate for Payer: Cash Price |
$3,992.40
|
| Rate for Payer: Cash Price |
$3,992.40
|
| Rate for Payer: Cash Price |
$3,992.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,766.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: Dignity Health Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,982.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,491.77
|
| Rate for Payer: Heritage Provider Network Senior |
$5,491.77
|
| Rate for Payer: Humana Medicare |
$3,982.55
|
| Rate for Payer: IEHP Medi-Cal |
$314.20
|
| Rate for Payer: IEHP Medicare Advantage |
$3,982.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,566.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,605.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,699.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,218.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,018.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,018.01
|
| Rate for Payer: Multiplan Commercial |
$6,654.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,982.55
|
| Rate for Payer: TriValley Medical Group Senior |
$3,982.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC THROMBO SUBSEQUENT DAY
|
Facility
OP
|
$8,724.00
|
|
|
Service Code
|
CPT 37213
|
| Hospital Charge Code |
906820226
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$314.20 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,744.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,993.39
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,417.60
|
| Rate for Payer: Blue Shield of California EPN |
$5,120.99
|
| Rate for Payer: Cash Price |
$3,925.80
|
| Rate for Payer: Cash Price |
$3,925.80
|
| Rate for Payer: Cash Price |
$3,925.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,670.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: Dignity Health Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,982.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,400.16
|
| Rate for Payer: Heritage Provider Network Senior |
$5,400.16
|
| Rate for Payer: Humana Medicare |
$3,982.55
|
| Rate for Payer: IEHP Medi-Cal |
$314.20
|
| Rate for Payer: IEHP Medicare Advantage |
$3,982.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,566.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,579.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,699.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,181.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,018.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,018.01
|
| Rate for Payer: Multiplan Commercial |
$6,543.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,982.55
|
| Rate for Payer: TriValley Medical Group Senior |
$3,982.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC THROMBO SUBSEQUENT DAY
|
Facility
IP
|
$8,872.00
|
|
|
Service Code
|
CPT 37213
|
| Hospital Charge Code |
909020156
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,605.83 |
| Max. Negotiated Rate |
$6,654.00 |
| Rate for Payer: Adventist Health Commercial |
$1,774.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,095.06
|
| Rate for Payer: Cash Price |
$3,992.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,006.34
|
| Rate for Payer: Heritage Provider Network Senior |
$6,006.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,605.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,218.00
|
| Rate for Payer: Multiplan Commercial |
$6,654.00
|
|
|
HC THROMBO SUBSEQUENT DAY
|
Facility
IP
|
$8,724.00
|
|
|
Service Code
|
CPT 37213
|
| Hospital Charge Code |
906820226
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,579.04 |
| Max. Negotiated Rate |
$6,543.00 |
| Rate for Payer: Adventist Health Commercial |
$1,744.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,993.39
|
| Rate for Payer: Cash Price |
$3,925.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,906.15
|
| Rate for Payer: Heritage Provider Network Senior |
$5,906.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,579.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,181.00
|
| Rate for Payer: Multiplan Commercial |
$6,543.00
|
|
|
HC THROM DIALYSIS CRCT W STNT PLC
|
Facility
IP
|
$38,887.00
|
|
|
Service Code
|
CPT 36906
|
| Hospital Charge Code |
909036906
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,038.55 |
| Max. Negotiated Rate |
$29,165.25 |
| Rate for Payer: Adventist Health Commercial |
$7,777.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26,715.37
|
| Rate for Payer: Cash Price |
$17,499.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$26,326.50
|
| Rate for Payer: Heritage Provider Network Senior |
$26,326.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,038.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,721.75
|
| Rate for Payer: Multiplan Commercial |
$29,165.25
|
|
|
HC THROM DIALYSIS CRCT W STNT PLC
|
Facility
OP
|
$38,887.00
|
|
|
Service Code
|
CPT 36906
|
| Hospital Charge Code |
909036906
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,420.00 |
| Max. Negotiated Rate |
$41,627.02 |
| Rate for Payer: Adventist Health Commercial |
$7,777.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,420.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26,715.37
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$32,863.44
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$24,099.86
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$21,908.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Blue Shield of California Commercial |
$14,131.19
|
| Rate for Payer: Blue Shield of California EPN |
$12,145.11
|
| Rate for Payer: Cash Price |
$17,499.15
|
| Rate for Payer: Cash Price |
$17,499.15
|
| Rate for Payer: Cash Price |
$17,499.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$25,276.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$24,099.86
|
| Rate for Payer: Dignity Health Senior |
$21,908.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$21,908.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$24,071.05
|
| Rate for Payer: Heritage Provider Network Senior |
$26,948.02
|
| Rate for Payer: Humana Medicare |
$21,908.96
|
| Rate for Payer: IEHP Medi-Cal |
$9,765.37
|
| Rate for Payer: IEHP Medicare Advantage |
$21,908.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$41,627.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,038.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25,852.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,721.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27,605.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27,605.29
|
| Rate for Payer: Multiplan Commercial |
$29,165.25
|
| Rate for Payer: Multiplan WC |
$29,952.68
|
| Rate for Payer: TriValley Medical Group Commercial |
$24,099.86
|
| Rate for Payer: TriValley Medical Group Senior |
$24,099.86
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18,042.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,173.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24,099.86
|
| Rate for Payer: Vantage Medical Group Senior |
$21,908.96
|
|
|
HC THROM DIALYSIS CRCT W TRAN BLN
|
Facility
OP
|
$30,234.00
|
|
|
Service Code
|
CPT 36905
|
| Hospital Charge Code |
906820282
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,232.66 |
| Max. Negotiated Rate |
$26,115.92 |
| Rate for Payer: Adventist Health Commercial |
$6,046.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$20,770.76
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$20,617.83
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$15,119.74
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13,745.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| Rate for Payer: Blue Shield of California Commercial |
$14,131.19
|
| Rate for Payer: Blue Shield of California EPN |
$12,145.11
|
| Rate for Payer: Cash Price |
$13,605.30
|
| Rate for Payer: Cash Price |
$13,605.30
|
| Rate for Payer: Cash Price |
$13,605.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$19,652.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,119.74
|
| Rate for Payer: Dignity Health Senior |
$13,745.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$13,745.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$18,714.85
|
| Rate for Payer: Heritage Provider Network Senior |
$16,906.62
|
| Rate for Payer: Humana Medicare |
$13,745.22
|
| Rate for Payer: IEHP Medi-Cal |
$3,232.66
|
| Rate for Payer: IEHP Medicare Advantage |
$13,745.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$26,115.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,472.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,219.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,558.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,318.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17,318.98
|
| Rate for Payer: Multiplan Commercial |
$22,675.50
|
| Rate for Payer: Multiplan WC |
$18,791.68
|
| Rate for Payer: TriValley Medical Group Commercial |
$15,119.74
|
| Rate for Payer: TriValley Medical Group Senior |
$15,119.74
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,002.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14,303.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,119.74
|
| Rate for Payer: Vantage Medical Group Senior |
$13,745.22
|
|
|
HC THROM DIALYSIS CRCT W TRAN BLN
|
Facility
IP
|
$30,234.00
|
|
|
Service Code
|
CPT 36905
|
| Hospital Charge Code |
906820282
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,472.35 |
| Max. Negotiated Rate |
$22,675.50 |
| Rate for Payer: Adventist Health Commercial |
$6,046.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$20,770.76
|
| Rate for Payer: Cash Price |
$13,605.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$20,468.42
|
| Rate for Payer: Heritage Provider Network Senior |
$20,468.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,472.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,558.50
|
| Rate for Payer: Multiplan Commercial |
$22,675.50
|
|
|
HC THROM DIALYSIS CRCT W TRAN BLN
|
Facility
IP
|
$25,656.00
|
|
|
Service Code
|
CPT 36905
|
| Hospital Charge Code |
909036905
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,643.74 |
| Max. Negotiated Rate |
$19,242.00 |
| Rate for Payer: Adventist Health Commercial |
$5,131.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17,625.67
|
| Rate for Payer: Cash Price |
$11,545.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$17,369.11
|
| Rate for Payer: Heritage Provider Network Senior |
$17,369.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,643.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,414.00
|
| Rate for Payer: Multiplan Commercial |
$19,242.00
|
|
|
HC THROM DIALYSIS CRCT W TRAN BLN
|
Facility
OP
|
$25,656.00
|
|
|
Service Code
|
CPT 36905
|
| Hospital Charge Code |
909036905
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,232.66 |
| Max. Negotiated Rate |
$26,115.92 |
| Rate for Payer: Adventist Health Commercial |
$5,131.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17,625.67
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$20,617.83
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$15,119.74
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13,745.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| Rate for Payer: Blue Shield of California Commercial |
$14,131.19
|
| Rate for Payer: Blue Shield of California EPN |
$12,145.11
|
| Rate for Payer: Cash Price |
$11,545.20
|
| Rate for Payer: Cash Price |
$11,545.20
|
| Rate for Payer: Cash Price |
$11,545.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16,676.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,119.74
|
| Rate for Payer: Dignity Health Senior |
$13,745.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$13,745.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$15,881.06
|
| Rate for Payer: Heritage Provider Network Senior |
$16,906.62
|
| Rate for Payer: Humana Medicare |
$13,745.22
|
| Rate for Payer: IEHP Medi-Cal |
$3,232.66
|
| Rate for Payer: IEHP Medicare Advantage |
$13,745.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$26,115.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,643.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,219.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,414.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,318.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17,318.98
|
| Rate for Payer: Multiplan Commercial |
$19,242.00
|
| Rate for Payer: Multiplan WC |
$18,791.68
|
| Rate for Payer: TriValley Medical Group Commercial |
$15,119.74
|
| Rate for Payer: TriValley Medical Group Senior |
$15,119.74
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,002.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14,303.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,119.74
|
| Rate for Payer: Vantage Medical Group Senior |
$13,745.22
|
|
|
HC THRPTC INTVN 1ST 15 MIN
|
Facility
IP
|
$57.00
|
|
|
Service Code
|
CPT 97129
|
| Hospital Charge Code |
905107129
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$10.32 |
| Max. Negotiated Rate |
$42.75 |
| Rate for Payer: Adventist Health Commercial |
$11.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$39.16
|
| Rate for Payer: Cash Price |
$25.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$38.59
|
| Rate for Payer: Heritage Provider Network Senior |
$38.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.25
|
| Rate for Payer: Multiplan Commercial |
$42.75
|
|
|
HC THRPTC INTVN 1ST 15 MIN
|
Facility
OP
|
$57.00
|
|
|
Service Code
|
CPT 97129
|
| Hospital Charge Code |
905107129
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$10.32 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$11.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$39.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$39.16
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$48.45
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$31.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$42.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$25.65
|
| Rate for Payer: Cash Price |
$25.65
|
| Rate for Payer: Cash Price |
$25.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$37.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$48.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$48.45
|
| Rate for Payer: Dignity Health Senior |
$48.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$37.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$35.28
|
| Rate for Payer: Heritage Provider Network Senior |
$35.28
|
| Rate for Payer: IEHP Medi-Cal |
$32.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$27.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.25
|
| Rate for Payer: Multiplan Commercial |
$42.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$48.45
|
| Rate for Payer: Vantage Medical Group Senior |
$48.45
|
|
|
HC THRPTC INTVN 1ST 15 MIN OT
|
Facility
IP
|
$57.00
|
|
|
Service Code
|
CPT 97129
|
| Hospital Charge Code |
905107131
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$10.32 |
| Max. Negotiated Rate |
$42.75 |
| Rate for Payer: Adventist Health Commercial |
$11.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$39.16
|
| Rate for Payer: Cash Price |
$25.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$38.59
|
| Rate for Payer: Heritage Provider Network Senior |
$38.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.25
|
| Rate for Payer: Multiplan Commercial |
$42.75
|
|
|
HC THRPTC INTVN 1ST 15 MIN OT
|
Facility
OP
|
$57.00
|
|
|
Service Code
|
CPT 97129
|
| Hospital Charge Code |
905107131
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$10.32 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$11.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$39.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$39.16
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$48.45
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$31.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$42.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$25.65
|
| Rate for Payer: Cash Price |
$25.65
|
| Rate for Payer: Cash Price |
$25.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$37.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$48.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$48.45
|
| Rate for Payer: Dignity Health Senior |
$48.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$37.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$35.28
|
| Rate for Payer: Heritage Provider Network Senior |
$35.28
|
| Rate for Payer: IEHP Medi-Cal |
$32.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$27.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.25
|
| Rate for Payer: Multiplan Commercial |
$42.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$48.45
|
| Rate for Payer: Vantage Medical Group Senior |
$48.45
|
|
|
HC THRPTC INTVN 1ST 15 MIN ST
|
Facility
IP
|
$57.00
|
|
|
Service Code
|
CPT 97129
|
| Hospital Charge Code |
905107132
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$10.32 |
| Max. Negotiated Rate |
$42.75 |
| Rate for Payer: Adventist Health Commercial |
$11.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$39.16
|
| Rate for Payer: Cash Price |
$25.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$38.59
|
| Rate for Payer: Heritage Provider Network Senior |
$38.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.25
|
| Rate for Payer: Multiplan Commercial |
$42.75
|
|
|
HC THRPTC INTVN 1ST 15 MIN ST
|
Facility
OP
|
$57.00
|
|
|
Service Code
|
CPT 97129
|
| Hospital Charge Code |
905107132
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$10.32 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$11.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$39.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$39.16
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$48.45
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$31.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$42.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$25.65
|
| Rate for Payer: Cash Price |
$25.65
|
| Rate for Payer: Cash Price |
$25.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$37.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$48.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$48.45
|
| Rate for Payer: Dignity Health Senior |
$48.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$37.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$35.28
|
| Rate for Payer: Heritage Provider Network Senior |
$35.28
|
| Rate for Payer: IEHP Medi-Cal |
$32.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$27.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.25
|
| Rate for Payer: Multiplan Commercial |
$42.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$125.00
|
| Rate for Payer: TriValley Medical Group Senior |
$125.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$48.45
|
| Rate for Payer: Vantage Medical Group Senior |
$48.45
|
|
|
HC THRPTC INTVN EA ADD 15MIN
|
Facility
IP
|
$55.00
|
|
|
Service Code
|
CPT 97130
|
| Hospital Charge Code |
905107130
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$9.96 |
| Max. Negotiated Rate |
$41.25 |
| Rate for Payer: Adventist Health Commercial |
$11.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$37.78
|
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$37.24
|
| Rate for Payer: Heritage Provider Network Senior |
$37.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.75
|
| Rate for Payer: Multiplan Commercial |
$41.25
|
|
|
HC THRPTC INTVN EA ADD 15MIN
|
Facility
OP
|
$55.00
|
|
|
Service Code
|
CPT 97130
|
| Hospital Charge Code |
905107130
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$9.96 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$11.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$38.33
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$37.78
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$46.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$30.25
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$41.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$35.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$46.75
|
| Rate for Payer: Dignity Health Senior |
$46.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$34.04
|
| Rate for Payer: Heritage Provider Network Senior |
$34.04
|
| Rate for Payer: IEHP Medi-Cal |
$30.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$26.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.75
|
| Rate for Payer: Multiplan Commercial |
$41.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$46.75
|
| Rate for Payer: Vantage Medical Group Senior |
$46.75
|
|
|
HC THRPTC INTVN EA ADD 15MIN OT
|
Facility
IP
|
$55.00
|
|
|
Service Code
|
CPT 97130
|
| Hospital Charge Code |
905107133
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$9.96 |
| Max. Negotiated Rate |
$41.25 |
| Rate for Payer: Adventist Health Commercial |
$11.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$37.78
|
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$37.24
|
| Rate for Payer: Heritage Provider Network Senior |
$37.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.75
|
| Rate for Payer: Multiplan Commercial |
$41.25
|
|
