|
HC THROMBOLYSIS ART
|
Facility
|
OP
|
$5,306.00
|
|
|
Service Code
|
CPT 37211
|
| Hospital Charge Code |
909020164
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$960.39 |
| Max. Negotiated Rate |
$10,735.29 |
| Rate for Payer: Adventist Health Commercial |
$1,061.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,279.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,735.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,872.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,156.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| 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 |
$2,387.70
|
| Rate for Payer: Cash Price |
$2,387.70
|
| Rate for Payer: Cash Price |
$2,387.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,448.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,735.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,872.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,156.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,156.86
|
| 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) Medicare Advantage |
$7,156.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,530.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$960.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,230.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,326.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9,590.19
|
| Rate for Payer: Multiplan Commercial |
$3,979.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$7,156.86
|
| Rate for Payer: TriValley Medical Group Senior |
$7,156.86
|
| 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 |
$10,735.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,872.55
|
| Rate for Payer: Vantage Medical Group Senior |
$7,156.86
|
|
|
HC THROMBOLYSIS COMPLETE
|
Facility
|
OP
|
$12,096.00
|
|
|
Service Code
|
CPT 37214
|
| Hospital Charge Code |
909020157
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,189.38 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$2,419.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,475.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,061.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| 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 |
$5,443.20
|
| Rate for Payer: Cash Price |
$5,443.20
|
| Rate for Payer: Cash Price |
$5,443.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,862.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,467.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,061.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,061.05
|
| 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) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$5,769.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,189.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,670.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,024.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,441.81
|
| Rate for Payer: Multiplan Commercial |
$9,072.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,061.05
|
| Rate for Payer: TriValley Medical Group Senior |
$4,061.05
|
| 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 |
$6,091.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Vantage Medical Group Senior |
$4,061.05
|
|
|
HC THROMBOLYSIS 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: Aetna of CA Non-Gatekeeper |
$7,789.82
|
| Rate for Payer: Cash Price |
$5,443.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,188.99
|
| Rate for Payer: Heritage Provider Network Senior |
$8,188.99
|
| Rate for Payer: Kaiser Foundation Hospitals 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, 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: Aetna of CA Non-Gatekeeper |
$786.32
|
| Rate for Payer: Cash Price |
$549.45
|
| Rate for Payer: Cash Price |
$549.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$221.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$305.25
|
| Rate for Payer: Multiplan Commercial |
$915.75
|
|
|
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 Non-Gatekeeper |
$754.58
|
| 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 |
$3,672.00
|
| 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 |
$549.45
|
| Rate for Payer: Cash Price |
$549.45
|
| 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 Medicare Advantage |
$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: Kaiser Foundation Hospitals Commercial |
$582.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$221.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$305.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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 VEIN
|
Facility
|
IP
|
$5,306.00
|
|
|
Service Code
|
CPT 37212
|
| Hospital Charge Code |
909020155
|
|
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: Aetna of CA Non-Gatekeeper |
$3,417.06
|
| Rate for Payer: Cash Price |
$2,387.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,592.16
|
| Rate for Payer: Heritage Provider Network Senior |
$3,592.16
|
| Rate for Payer: Kaiser Foundation Hospitals 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 VEIN
|
Facility
|
OP
|
$5,306.00
|
|
|
Service Code
|
CPT 37212
|
| Hospital Charge Code |
909020155
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$960.39 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,061.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,279.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,061.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| 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 |
$2,387.70
|
| Rate for Payer: Cash Price |
$2,387.70
|
| Rate for Payer: Cash Price |
$2,387.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,448.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,467.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,061.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,061.05
|
| 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) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,530.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$960.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,670.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,326.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,441.81
|
| Rate for Payer: Multiplan Commercial |
$3,979.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,061.05
|
| Rate for Payer: TriValley Medical Group Senior |
$4,061.05
|
| 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 |
$6,091.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Vantage Medical Group Senior |
$4,061.05
|
|
|
HC THROMBO SUBSEQUENT DAY
|
Facility
|
IP
|
$11,538.00
|
|
|
Service Code
|
CPT 37213
|
| Hospital Charge Code |
909020156
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,088.38 |
| Max. Negotiated Rate |
$8,653.50 |
| Rate for Payer: Adventist Health Commercial |
$2,307.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,430.47
|
| Rate for Payer: Cash Price |
$5,192.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,811.23
|
| Rate for Payer: Heritage Provider Network Senior |
$7,811.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,088.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,884.50
|
| Rate for Payer: Multiplan Commercial |
$8,653.50
|
|
|
HC THROMBO SUBSEQUENT DAY
|
Facility
|
OP
|
$11,538.00
|
|
|
Service Code
|
CPT 37213
|
| Hospital Charge Code |
909020156
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,088.38 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$2,307.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,130.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,061.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,038.18
|
| Rate for Payer: Blue Shield of California EPN |
$5,630.54
|
| Rate for Payer: Cash Price |
$5,192.10
|
| Rate for Payer: Cash Price |
$5,192.10
|
| Rate for Payer: Cash Price |
$5,192.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,499.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,467.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,061.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,061.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,142.02
|
| Rate for Payer: Heritage Provider Network Senior |
$7,142.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$5,503.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,088.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,670.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,884.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,441.81
|
| Rate for Payer: Multiplan Commercial |
$8,653.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,061.05
|
| Rate for Payer: TriValley Medical Group Senior |
$4,061.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5,769.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,769.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Vantage Medical Group Senior |
$4,061.05
|
|
|
HC THROM DIALYSIS CRCT W STNT PLC
|
Facility
|
IP
|
$33,190.00
|
|
|
Service Code
|
CPT 36906
|
| Hospital Charge Code |
909036906
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,007.39 |
| Max. Negotiated Rate |
$24,892.50 |
| Rate for Payer: Adventist Health Commercial |
$6,638.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21,374.36
|
| Rate for Payer: Cash Price |
$14,935.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$22,469.63
|
| Rate for Payer: Heritage Provider Network Senior |
$22,469.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6,007.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,297.50
|
| Rate for Payer: Multiplan Commercial |
$24,892.50
|
|
|
HC THROM DIALYSIS CRCT W STNT PLC
|
Facility
|
OP
|
$33,190.00
|
|
|
Service Code
|
CPT 36906
|
| Hospital Charge Code |
909036906
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,007.39 |
| Max. Negotiated Rate |
$44,797.35 |
| Rate for Payer: Adventist Health Commercial |
$6,638.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$20,511.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,935.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23,577.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,245.00
|
| Rate for Payer: Blue Shield of California Commercial |
$14,574.13
|
| Rate for Payer: Blue Shield of California EPN |
$11,673.59
|
| Rate for Payer: Cash Price |
$14,935.50
|
| Rate for Payer: Cash Price |
$14,935.50
|
| Rate for Payer: Cash Price |
$14,935.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$21,573.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,935.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23,577.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$23,577.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$20,544.61
|
| Rate for Payer: Heritage Provider Network Senior |
$29,000.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23,577.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$44,797.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6,007.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27,114.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,297.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$31,593.92
|
| Rate for Payer: Multiplan Commercial |
$24,892.50
|
| Rate for Payer: Multiplan WC |
$36,352.92
|
| Rate for Payer: TriValley Medical Group Commercial |
$25,935.31
|
| Rate for Payer: TriValley Medical Group Senior |
$25,935.31
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18,953.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,939.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,935.31
|
| Rate for Payer: Vantage Medical Group Senior |
$23,577.55
|
|
|
HC THROM DIALYSIS CRCT W TRAN BLN
|
Facility
|
OP
|
$21,897.00
|
|
|
Service Code
|
CPT 36905
|
| Hospital Charge Code |
909036905
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,963.36 |
| Max. Negotiated Rate |
$28,210.74 |
| Rate for Payer: Adventist Health Commercial |
$4,379.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13,532.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16,332.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,847.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,435.00
|
| Rate for Payer: Blue Shield of California Commercial |
$14,574.13
|
| Rate for Payer: Blue Shield of California EPN |
$11,673.59
|
| Rate for Payer: Cash Price |
$9,853.65
|
| Rate for Payer: Cash Price |
$9,853.65
|
| Rate for Payer: Cash Price |
$9,853.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14,233.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$16,332.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,847.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$14,847.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$13,554.24
|
| Rate for Payer: Heritage Provider Network Senior |
$18,262.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,847.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$28,210.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,963.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17,074.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,474.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19,896.00
|
| Rate for Payer: Multiplan Commercial |
$16,422.75
|
| Rate for Payer: Multiplan WC |
$22,958.69
|
| Rate for Payer: TriValley Medical Group Commercial |
$16,332.54
|
| Rate for Payer: TriValley Medical Group Senior |
$16,332.54
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,861.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,025.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16,332.54
|
| Rate for Payer: Vantage Medical Group Senior |
$14,847.76
|
|
|
HC THROM DIALYSIS CRCT W TRAN BLN
|
Facility
|
IP
|
$21,897.00
|
|
|
Service Code
|
CPT 36905
|
| Hospital Charge Code |
909036905
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,963.36 |
| Max. Negotiated Rate |
$16,422.75 |
| Rate for Payer: Adventist Health Commercial |
$4,379.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14,101.67
|
| Rate for Payer: Cash Price |
$9,853.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$14,824.27
|
| Rate for Payer: Heritage Provider Network Senior |
$14,824.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,963.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,474.25
|
| Rate for Payer: Multiplan Commercial |
$16,422.75
|
|
|
HC THRPTC INTVN 1ST 15 MIN
|
Facility
|
OP
|
$46.00
|
|
|
Service Code
|
CPT 97129
|
| Hospital Charge Code |
905107129
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$8.33 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$18.86
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$28.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$39.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$34.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$29.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$39.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$39.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$39.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$28.47
|
| Rate for Payer: Heritage Provider Network Senior |
$28.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$21.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$32.20
|
| Rate for Payer: Multiplan Commercial |
$34.50
|
| 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 |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$39.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$39.10
|
| Rate for Payer: Vantage Medical Group Senior |
$39.10
|
|
|
HC THRPTC INTVN 1ST 15 MIN
|
Facility
|
IP
|
$46.00
|
|
|
Service Code
|
CPT 97129
|
| Hospital Charge Code |
905107129
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$8.33 |
| Max. Negotiated Rate |
$34.50 |
| Rate for Payer: Adventist Health Commercial |
$9.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$29.62
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$31.14
|
| Rate for Payer: Heritage Provider Network Senior |
$31.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.50
|
| Rate for Payer: Multiplan Commercial |
$34.50
|
|
|
HC THRPTC INTVN 1ST 15 MIN OT
|
Facility
|
IP
|
$46.00
|
|
|
Service Code
|
CPT 97129
|
| Hospital Charge Code |
905107131
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$8.33 |
| Max. Negotiated Rate |
$34.50 |
| Rate for Payer: Adventist Health Commercial |
$9.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$29.62
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$31.14
|
| Rate for Payer: Heritage Provider Network Senior |
$31.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.50
|
| Rate for Payer: Multiplan Commercial |
$34.50
|
|
|
HC THRPTC INTVN 1ST 15 MIN OT
|
Facility
|
OP
|
$46.00
|
|
|
Service Code
|
CPT 97129
|
| Hospital Charge Code |
905107131
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$8.33 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$18.86
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$28.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$39.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$34.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$29.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$39.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$39.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$39.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$28.47
|
| Rate for Payer: Heritage Provider Network Senior |
$28.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$21.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$32.20
|
| Rate for Payer: Multiplan Commercial |
$34.50
|
| 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 |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$39.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$39.10
|
| Rate for Payer: Vantage Medical Group Senior |
$39.10
|
|
|
HC THRPTC INTVN 1ST 15 MIN ST
|
Facility
|
OP
|
$46.00
|
|
|
Service Code
|
CPT 97129
|
| Hospital Charge Code |
905107132
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$8.33 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$18.86
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$28.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$39.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$34.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$29.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$39.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$39.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$39.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$28.47
|
| Rate for Payer: Heritage Provider Network Senior |
$28.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$21.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$32.20
|
| Rate for Payer: Multiplan Commercial |
$34.50
|
| 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 |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$39.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$39.10
|
| Rate for Payer: Vantage Medical Group Senior |
$39.10
|
|
|
HC THRPTC INTVN 1ST 15 MIN ST
|
Facility
|
IP
|
$46.00
|
|
|
Service Code
|
CPT 97129
|
| Hospital Charge Code |
905107132
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$8.33 |
| Max. Negotiated Rate |
$34.50 |
| Rate for Payer: Adventist Health Commercial |
$9.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$29.62
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$31.14
|
| Rate for Payer: Heritage Provider Network Senior |
$31.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.50
|
| Rate for Payer: Multiplan Commercial |
$34.50
|
|
|
HC THRPTC INTVN EA ADD 15MIN
|
Facility
|
OP
|
$44.00
|
|
|
Service Code
|
CPT 97130
|
| Hospital Charge Code |
905107130
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$7.96 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$18.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$27.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$33.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$28.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$37.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.24
|
| Rate for Payer: Heritage Provider Network Senior |
$27.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$20.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$30.80
|
| Rate for Payer: Multiplan Commercial |
$33.00
|
| 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 |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$37.40
|
| Rate for Payer: Vantage Medical Group Senior |
$37.40
|
|
|
HC THRPTC INTVN EA ADD 15MIN
|
Facility
|
IP
|
$44.00
|
|
|
Service Code
|
CPT 97130
|
| Hospital Charge Code |
905107130
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$7.96 |
| Max. Negotiated Rate |
$33.00 |
| Rate for Payer: Adventist Health Commercial |
$8.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$28.34
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$29.79
|
| Rate for Payer: Heritage Provider Network Senior |
$29.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.00
|
| Rate for Payer: Multiplan Commercial |
$33.00
|
|
|
HC THRPTC INTVN EA ADD 15MIN OT
|
Facility
|
OP
|
$44.00
|
|
|
Service Code
|
CPT 97130
|
| Hospital Charge Code |
905107133
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$7.96 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$18.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$27.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$33.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$28.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$37.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.24
|
| Rate for Payer: Heritage Provider Network Senior |
$27.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$20.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$30.80
|
| Rate for Payer: Multiplan Commercial |
$33.00
|
| 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 |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$37.40
|
| Rate for Payer: Vantage Medical Group Senior |
$37.40
|
|
|
HC THRPTC INTVN EA ADD 15MIN OT
|
Facility
|
IP
|
$44.00
|
|
|
Service Code
|
CPT 97130
|
| Hospital Charge Code |
905107133
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$7.96 |
| Max. Negotiated Rate |
$33.00 |
| Rate for Payer: Adventist Health Commercial |
$8.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$28.34
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$29.79
|
| Rate for Payer: Heritage Provider Network Senior |
$29.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.00
|
| Rate for Payer: Multiplan Commercial |
$33.00
|
|
|
HC THRPTC INTVN EA ADD 15MIN ST
|
Facility
|
IP
|
$44.00
|
|
|
Service Code
|
CPT 97130
|
| Hospital Charge Code |
905107134
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$7.96 |
| Max. Negotiated Rate |
$33.00 |
| Rate for Payer: Adventist Health Commercial |
$8.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$28.34
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$29.79
|
| Rate for Payer: Heritage Provider Network Senior |
$29.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.00
|
| Rate for Payer: Multiplan Commercial |
$33.00
|
|
|
HC THRPTC INTVN EA ADD 15MIN ST
|
Facility
|
OP
|
$44.00
|
|
|
Service Code
|
CPT 97130
|
| Hospital Charge Code |
905107134
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$7.96 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$18.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$27.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$33.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$28.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$37.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.24
|
| Rate for Payer: Heritage Provider Network Senior |
$27.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$20.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$30.80
|
| Rate for Payer: Multiplan Commercial |
$33.00
|
| 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 |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$37.40
|
| Rate for Payer: Vantage Medical Group Senior |
$37.40
|
|
