|
HC VENOGRAM JUGULAR OR SINUS
|
Facility
|
OP
|
$10,156.00
|
|
|
Service Code
|
CPT 75860
|
| Hospital Charge Code |
909081580
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,688.24 |
| Max. Negotiated Rate |
$8,632.60 |
| Rate for Payer: Adventist Health Commercial |
$2,031.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,661.32
|
| 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 |
$3,560.85
|
| Rate for Payer: Blue Shield of California Commercial |
$6,215.47
|
| Rate for Payer: Blue Shield of California EPN |
$4,103.02
|
| Rate for Payer: Cash Price |
$4,570.20
|
| Rate for Payer: Cash Price |
$4,570.20
|
| Rate for Payer: Cigna of CA HMO |
$6,499.84
|
| Rate for Payer: Cigna of CA PPO |
$7,515.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,398.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3,999.21
|
| Rate for Payer: Galaxy Health WC |
$8,632.60
|
| Rate for Payer: Global Benefits Group Commercial |
$6,093.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,774.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,437.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,039.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,358.94
|
| Rate for Payer: Multiplan Commercial |
$8,124.80
|
| Rate for Payer: Networks By Design Commercial |
$6,601.40
|
| Rate for Payer: Prime Health Services Commercial |
$8,632.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,093.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,093.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,688.24
|
| Rate for Payer: United Healthcare All Other HMO |
$1,688.24
|
| Rate for Payer: United Healthcare HMO Rider |
$1,688.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,688.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,999.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC VENOGRAM JUGULAR OR SINUS
|
Facility
|
IP
|
$13,740.00
|
|
|
Service Code
|
CPT 75860
|
| Hospital Charge Code |
906820187
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,748.00 |
| Max. Negotiated Rate |
$11,679.00 |
| Rate for Payer: Adventist Health Commercial |
$2,748.00
|
| Rate for Payer: Cash Price |
$6,183.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,496.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,496.00
|
| Rate for Payer: Galaxy Health WC |
$11,679.00
|
| Rate for Payer: Global Benefits Group Commercial |
$8,244.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,164.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,234.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,505.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,297.60
|
| Rate for Payer: Multiplan Commercial |
$10,992.00
|
| Rate for Payer: Networks By Design Commercial |
$8,931.00
|
| Rate for Payer: Prime Health Services Commercial |
$11,679.00
|
|
|
HC VENOGRAM JUGULAR OR SINUS
|
Facility
|
IP
|
$10,156.00
|
|
|
Service Code
|
CPT 75860
|
| Hospital Charge Code |
909081580
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,031.20 |
| Max. Negotiated Rate |
$8,632.60 |
| Rate for Payer: Adventist Health Commercial |
$2,031.20
|
| Rate for Payer: Cash Price |
$4,570.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,062.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,062.40
|
| Rate for Payer: Galaxy Health WC |
$8,632.60
|
| Rate for Payer: Global Benefits Group Commercial |
$6,093.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,774.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,869.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,286.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,437.44
|
| Rate for Payer: Multiplan Commercial |
$8,124.80
|
| Rate for Payer: Networks By Design Commercial |
$6,601.40
|
| Rate for Payer: Prime Health Services Commercial |
$8,632.60
|
|
|
HC VENOGRAM ORBITAL
|
Facility
|
OP
|
$10,156.00
|
|
|
Service Code
|
CPT 75880
|
| Hospital Charge Code |
909081659
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$266.25 |
| Max. Negotiated Rate |
$8,632.60 |
| Rate for Payer: Adventist Health Commercial |
$2,031.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,661.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$864.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$785.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$266.25
|
| Rate for Payer: Blue Shield of California Commercial |
$6,215.47
|
| Rate for Payer: Blue Shield of California EPN |
$4,103.02
|
| Rate for Payer: Cash Price |
$4,570.20
|
| Rate for Payer: Cash Price |
$4,570.20
|
| Rate for Payer: Cigna of CA HMO |
$6,499.84
|
| Rate for Payer: Cigna of CA PPO |
$7,515.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$864.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$785.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,060.51
|
| Rate for Payer: EPIC Health Plan Senior |
$785.56
|
| Rate for Payer: Galaxy Health WC |
$8,632.60
|
| Rate for Payer: Global Benefits Group Commercial |
$6,093.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,288.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$785.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,774.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$785.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,437.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$989.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,052.65
|
| Rate for Payer: Multiplan Commercial |
$8,124.80
|
| Rate for Payer: Networks By Design Commercial |
$6,601.40
|
| Rate for Payer: Prime Health Services Commercial |
$8,632.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,093.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,093.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,688.24
|
| Rate for Payer: United Healthcare All Other HMO |
$1,688.24
|
| Rate for Payer: United Healthcare HMO Rider |
$1,688.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,688.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$785.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$864.12
|
| Rate for Payer: Vantage Medical Group Senior |
$785.56
|
|
|
HC VENOGRAM ORBITAL
|
Facility
|
IP
|
$10,156.00
|
|
|
Service Code
|
CPT 75880
|
| Hospital Charge Code |
909081659
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,031.20 |
| Max. Negotiated Rate |
$8,632.60 |
| Rate for Payer: Adventist Health Commercial |
$2,031.20
|
| Rate for Payer: Cash Price |
$4,570.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,062.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,062.40
|
| Rate for Payer: Galaxy Health WC |
$8,632.60
|
| Rate for Payer: Global Benefits Group Commercial |
$6,093.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,774.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,869.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,286.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,437.44
|
| Rate for Payer: Multiplan Commercial |
$8,124.80
|
| Rate for Payer: Networks By Design Commercial |
$6,601.40
|
| Rate for Payer: Prime Health Services Commercial |
$8,632.60
|
|
|
HC VENOGRAM RENAL BILAT
|
Facility
|
OP
|
$9,857.00
|
|
|
Service Code
|
CPT 75833
|
| Hospital Charge Code |
909081636
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,971.40 |
| Max. Negotiated Rate |
$8,378.45 |
| Rate for Payer: Galaxy Health WC |
$8,378.45
|
| Rate for Payer: Adventist Health Commercial |
$1,971.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,465.21
|
| 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 |
$3,560.85
|
| Rate for Payer: Blue Shield of California Commercial |
$6,032.48
|
| Rate for Payer: Blue Shield of California EPN |
$3,982.23
|
| Rate for Payer: Cash Price |
$4,435.65
|
| Rate for Payer: Cash Price |
$4,435.65
|
| Rate for Payer: Cigna of CA HMO |
$6,308.48
|
| Rate for Payer: Cigna of CA PPO |
$7,294.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,398.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3,999.21
|
| Rate for Payer: Global Benefits Group Commercial |
$5,914.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,574.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,365.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,039.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,358.94
|
| Rate for Payer: Multiplan Commercial |
$7,885.60
|
| Rate for Payer: Networks By Design Commercial |
$6,407.05
|
| Rate for Payer: Prime Health Services Commercial |
$8,378.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,914.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,914.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,341.78
|
| Rate for Payer: United Healthcare All Other HMO |
$5,341.78
|
| Rate for Payer: United Healthcare HMO Rider |
$5,341.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,341.78
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,999.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC VENOGRAM RENAL BILAT
|
Facility
|
IP
|
$9,857.00
|
|
|
Service Code
|
CPT 75833
|
| Hospital Charge Code |
909081636
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,971.40 |
| Max. Negotiated Rate |
$8,378.45 |
| Rate for Payer: Adventist Health Commercial |
$1,971.40
|
| Rate for Payer: Cash Price |
$4,435.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,942.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,942.80
|
| Rate for Payer: Galaxy Health WC |
$8,378.45
|
| Rate for Payer: Global Benefits Group Commercial |
$5,914.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,574.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,755.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,101.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,365.68
|
| Rate for Payer: Multiplan Commercial |
$7,885.60
|
| Rate for Payer: Networks By Design Commercial |
$6,407.05
|
| Rate for Payer: Prime Health Services Commercial |
$8,378.45
|
|
|
HC VENOGRAM RENAL UNILAT
|
Facility
|
OP
|
$6,571.00
|
|
|
Service Code
|
CPT 75831
|
| Hospital Charge Code |
909081578
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,314.20 |
| Max. Negotiated Rate |
$6,558.70 |
| Rate for Payer: Adventist Health Commercial |
$1,314.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4,309.92
|
| 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 |
$3,559.19
|
| Rate for Payer: Blue Shield of California Commercial |
$4,021.45
|
| Rate for Payer: Blue Shield of California EPN |
$2,654.68
|
| Rate for Payer: Cash Price |
$2,956.95
|
| Rate for Payer: Cash Price |
$2,956.95
|
| Rate for Payer: Cigna of CA HMO |
$4,205.44
|
| Rate for Payer: Cigna of CA PPO |
$4,862.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,398.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3,999.21
|
| Rate for Payer: Galaxy Health WC |
$5,585.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,942.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,382.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,577.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,039.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,358.94
|
| Rate for Payer: Multiplan Commercial |
$5,256.80
|
| Rate for Payer: Networks By Design Commercial |
$4,271.15
|
| Rate for Payer: Prime Health Services Commercial |
$5,585.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,942.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,942.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,341.78
|
| Rate for Payer: United Healthcare All Other HMO |
$5,341.78
|
| Rate for Payer: United Healthcare HMO Rider |
$5,341.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,341.78
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,999.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC VENOGRAM RENAL UNILAT
|
Facility
|
IP
|
$6,571.00
|
|
|
Service Code
|
CPT 75831
|
| Hospital Charge Code |
909081578
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,314.20 |
| Max. Negotiated Rate |
$5,585.35 |
| Rate for Payer: Adventist Health Commercial |
$1,314.20
|
| Rate for Payer: Cash Price |
$2,956.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,628.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,628.40
|
| Rate for Payer: Galaxy Health WC |
$5,585.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,942.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,382.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,503.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,067.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,577.04
|
| Rate for Payer: Multiplan Commercial |
$5,256.80
|
| Rate for Payer: Networks By Design Commercial |
$4,271.15
|
| Rate for Payer: Prime Health Services Commercial |
$5,585.35
|
|
|
HC VENOGRAM SUPERIOR VENACAVA
|
Facility
|
OP
|
$5,519.00
|
|
|
Service Code
|
CPT 75827
|
| Hospital Charge Code |
909081634
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$183.54 |
| Max. Negotiated Rate |
$4,691.15 |
| Rate for Payer: Adventist Health Commercial |
$1,103.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,619.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,171.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,973.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,541.30
|
| Rate for Payer: Blue Shield of California Commercial |
$3,377.63
|
| Rate for Payer: Blue Shield of California EPN |
$2,229.68
|
| Rate for Payer: Cash Price |
$2,483.55
|
| Rate for Payer: Cash Price |
$2,483.55
|
| Rate for Payer: Cigna of CA HMO |
$3,532.16
|
| Rate for Payer: Cigna of CA PPO |
$4,084.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,171.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,973.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,664.63
|
| Rate for Payer: EPIC Health Plan Senior |
$1,973.80
|
| Rate for Payer: Galaxy Health WC |
$4,691.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,311.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,237.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$183.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,973.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,681.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$207.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,973.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,324.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,486.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,644.89
|
| Rate for Payer: Multiplan Commercial |
$4,415.20
|
| Rate for Payer: Networks By Design Commercial |
$3,587.35
|
| Rate for Payer: Prime Health Services Commercial |
$4,691.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,311.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,311.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,688.24
|
| Rate for Payer: United Healthcare All Other HMO |
$1,688.24
|
| Rate for Payer: United Healthcare HMO Rider |
$1,688.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,688.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,973.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,171.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,973.80
|
|
|
HC VENOGRAM SUPERIOR VENACAVA
|
Facility
|
IP
|
$7,467.00
|
|
|
Service Code
|
CPT 75827
|
| Hospital Charge Code |
906820196
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,493.40 |
| Max. Negotiated Rate |
$6,346.95 |
| Rate for Payer: Adventist Health Commercial |
$1,493.40
|
| Rate for Payer: Cash Price |
$3,360.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,986.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,986.80
|
| Rate for Payer: Galaxy Health WC |
$6,346.95
|
| Rate for Payer: Global Benefits Group Commercial |
$4,480.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,980.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,844.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,622.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,792.08
|
| Rate for Payer: Multiplan Commercial |
$5,973.60
|
| Rate for Payer: Networks By Design Commercial |
$4,853.55
|
| Rate for Payer: Prime Health Services Commercial |
$6,346.95
|
|
|
HC VENOGRAM SUPERIOR VENACAVA
|
Facility
|
IP
|
$5,519.00
|
|
|
Service Code
|
CPT 75827
|
| Hospital Charge Code |
909081634
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,103.80 |
| Max. Negotiated Rate |
$4,691.15 |
| Rate for Payer: Adventist Health Commercial |
$1,103.80
|
| Rate for Payer: Cash Price |
$2,483.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,207.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,207.60
|
| Rate for Payer: Galaxy Health WC |
$4,691.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,311.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,681.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,102.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,416.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,324.56
|
| Rate for Payer: Multiplan Commercial |
$4,415.20
|
| Rate for Payer: Networks By Design Commercial |
$3,587.35
|
| Rate for Payer: Prime Health Services Commercial |
$4,691.15
|
|
|
HC VENOGRAM SUPERIOR VENACAVA
|
Facility
|
OP
|
$7,467.00
|
|
|
Service Code
|
CPT 75827
|
| Hospital Charge Code |
906820196
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$183.54 |
| Max. Negotiated Rate |
$6,346.95 |
| Rate for Payer: Adventist Health Commercial |
$1,493.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4,897.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,171.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,973.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,541.30
|
| Rate for Payer: Blue Shield of California Commercial |
$4,569.80
|
| Rate for Payer: Blue Shield of California EPN |
$3,016.67
|
| Rate for Payer: Cash Price |
$3,360.15
|
| Rate for Payer: Cash Price |
$3,360.15
|
| Rate for Payer: Cigna of CA HMO |
$4,778.88
|
| Rate for Payer: Cigna of CA PPO |
$5,525.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,171.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,973.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,664.63
|
| Rate for Payer: EPIC Health Plan Senior |
$1,973.80
|
| Rate for Payer: Galaxy Health WC |
$6,346.95
|
| Rate for Payer: Global Benefits Group Commercial |
$4,480.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,237.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$183.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,973.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,980.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$207.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,973.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,792.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,486.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,644.89
|
| Rate for Payer: Multiplan Commercial |
$5,973.60
|
| Rate for Payer: Networks By Design Commercial |
$4,853.55
|
| Rate for Payer: Prime Health Services Commercial |
$6,346.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,480.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,480.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,688.24
|
| Rate for Payer: United Healthcare All Other HMO |
$1,688.24
|
| Rate for Payer: United Healthcare HMO Rider |
$1,688.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,688.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,973.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,171.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,973.80
|
|
|
HC VENOGRAM SUP SAG SINUS
|
Facility
|
OP
|
$3,611.00
|
|
|
Service Code
|
CPT 75870
|
| Hospital Charge Code |
909081641
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$224.55 |
| Max. Negotiated Rate |
$6,558.70 |
| Rate for Payer: Adventist Health Commercial |
$722.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,368.45
|
| 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 |
$3,560.85
|
| Rate for Payer: Blue Shield of California Commercial |
$2,209.93
|
| Rate for Payer: Blue Shield of California EPN |
$1,458.84
|
| Rate for Payer: Cash Price |
$1,624.95
|
| Rate for Payer: Cash Price |
$1,624.95
|
| Rate for Payer: Cigna of CA HMO |
$2,311.04
|
| Rate for Payer: Cigna of CA PPO |
$2,672.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,398.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3,999.21
|
| Rate for Payer: Galaxy Health WC |
$3,069.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,166.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$224.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,408.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$253.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$866.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,039.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,358.94
|
| Rate for Payer: Multiplan Commercial |
$2,888.80
|
| Rate for Payer: Networks By Design Commercial |
$2,347.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,069.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,166.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,166.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,688.24
|
| Rate for Payer: United Healthcare All Other HMO |
$1,688.24
|
| Rate for Payer: United Healthcare HMO Rider |
$1,688.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,688.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,999.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC VENOGRAM SUP SAG SINUS
|
Facility
|
IP
|
$3,611.00
|
|
|
Service Code
|
CPT 75870
|
| Hospital Charge Code |
909081641
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$722.20 |
| Max. Negotiated Rate |
$3,069.35 |
| Rate for Payer: Adventist Health Commercial |
$722.20
|
| Rate for Payer: Cash Price |
$1,624.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,444.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,444.40
|
| Rate for Payer: Galaxy Health WC |
$3,069.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,166.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,408.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,375.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,235.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$866.64
|
| Rate for Payer: Multiplan Commercial |
$2,888.80
|
| Rate for Payer: Networks By Design Commercial |
$2,347.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,069.35
|
|
|
HC VENOGRAPHY AZYGOS HEMIAZYGOS VENOUS
|
Facility
|
IP
|
$2,989.00
|
|
|
Service Code
|
CPT 93585
|
| Hospital Charge Code |
906811585
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$597.80 |
| Max. Negotiated Rate |
$2,540.65 |
| Rate for Payer: Adventist Health Commercial |
$597.80
|
| Rate for Payer: Cash Price |
$1,345.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,195.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,195.60
|
| Rate for Payer: Galaxy Health WC |
$2,540.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,793.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,993.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,138.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,850.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$717.36
|
| Rate for Payer: Multiplan Commercial |
$2,391.20
|
| Rate for Payer: Networks By Design Commercial |
$1,942.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,540.65
|
|
|
HC VENOGRAPHY AZYGOS HEMIAZYGOS VENOUS
|
Facility
|
OP
|
$2,989.00
|
|
|
Service Code
|
CPT 93585
|
| Hospital Charge Code |
906811585
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$570.02 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$597.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,540.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,643.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,241.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,835.54
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$570.02
|
| Rate for Payer: Cash Price |
$1,345.05
|
| Rate for Payer: Cash Price |
$1,345.05
|
| Rate for Payer: Cigna of CA HMO |
$1,942.85
|
| Rate for Payer: Cigna of CA PPO |
$2,211.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,540.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,540.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,540.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,195.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,195.60
|
| Rate for Payer: Galaxy Health WC |
$2,540.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,793.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,993.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,850.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$717.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,092.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,092.30
|
| Rate for Payer: Multiplan Commercial |
$2,391.20
|
| Rate for Payer: Networks By Design Commercial |
$1,942.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,540.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,793.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,793.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,494.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,494.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,494.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,494.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,540.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,540.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,540.65
|
|
|
HC VENOGRAPHY CONG HEART DEFECT
|
Facility
|
IP
|
$2,989.00
|
|
|
Service Code
|
CPT 93584
|
| Hospital Charge Code |
906811584
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$597.80 |
| Max. Negotiated Rate |
$2,540.65 |
| Rate for Payer: Adventist Health Commercial |
$597.80
|
| Rate for Payer: Cash Price |
$1,345.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,195.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,195.60
|
| Rate for Payer: Galaxy Health WC |
$2,540.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,793.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,993.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,138.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,850.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$717.36
|
| Rate for Payer: Multiplan Commercial |
$2,391.20
|
| Rate for Payer: Networks By Design Commercial |
$1,942.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,540.65
|
|
|
HC VENOGRAPHY CONG HEART DEFECT
|
Facility
|
OP
|
$2,989.00
|
|
|
Service Code
|
CPT 93584
|
| Hospital Charge Code |
906811584
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$570.02 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$597.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,540.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,643.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,241.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,835.54
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$570.02
|
| Rate for Payer: Cash Price |
$1,345.05
|
| Rate for Payer: Cash Price |
$1,345.05
|
| Rate for Payer: Cigna of CA HMO |
$1,942.85
|
| Rate for Payer: Cigna of CA PPO |
$2,211.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,540.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,540.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,540.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,195.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,195.60
|
| Rate for Payer: Galaxy Health WC |
$2,540.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,793.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,993.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,850.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$717.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,092.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,092.30
|
| Rate for Payer: Multiplan Commercial |
$2,391.20
|
| Rate for Payer: Networks By Design Commercial |
$1,942.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,540.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,793.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,793.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,494.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,494.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,494.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,494.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,540.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,540.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,540.65
|
|
|
HC VENOGRAPHY CORONARY SINUS
|
Facility
|
OP
|
$2,989.00
|
|
|
Service Code
|
CPT 93586
|
| Hospital Charge Code |
906811586
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$570.02 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$597.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,540.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,643.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,241.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,835.54
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$570.02
|
| Rate for Payer: Cash Price |
$1,345.05
|
| Rate for Payer: Cash Price |
$1,345.05
|
| Rate for Payer: Cigna of CA HMO |
$1,942.85
|
| Rate for Payer: Cigna of CA PPO |
$2,211.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,540.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,540.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,540.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,195.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,195.60
|
| Rate for Payer: Galaxy Health WC |
$2,540.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,793.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,993.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,850.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$717.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,092.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,092.30
|
| Rate for Payer: Multiplan Commercial |
$2,391.20
|
| Rate for Payer: Networks By Design Commercial |
$1,942.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,540.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,793.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,793.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,494.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,494.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,494.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,494.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,540.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,540.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,540.65
|
|
|
HC VENOGRAPHY CORONARY SINUS
|
Facility
|
IP
|
$2,989.00
|
|
|
Service Code
|
CPT 93586
|
| Hospital Charge Code |
906811586
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$597.80 |
| Max. Negotiated Rate |
$2,540.65 |
| Rate for Payer: Adventist Health Commercial |
$597.80
|
| Rate for Payer: Cash Price |
$1,345.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,195.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,195.60
|
| Rate for Payer: Galaxy Health WC |
$2,540.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,793.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,993.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,138.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,850.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$717.36
|
| Rate for Payer: Multiplan Commercial |
$2,391.20
|
| Rate for Payer: Networks By Design Commercial |
$1,942.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,540.65
|
|
|
HC VENOUS 1ST ORDER CATH PLCMT
|
Facility
|
IP
|
$862.00
|
|
|
Service Code
|
CPT 36011
|
| Hospital Charge Code |
906820169
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$172.40 |
| Max. Negotiated Rate |
$732.70 |
| Rate for Payer: Adventist Health Commercial |
$172.40
|
| Rate for Payer: Cash Price |
$387.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$344.80
|
| Rate for Payer: EPIC Health Plan Senior |
$344.80
|
| Rate for Payer: Galaxy Health WC |
$732.70
|
| Rate for Payer: Global Benefits Group Commercial |
$517.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$574.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$328.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$533.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$206.88
|
| Rate for Payer: Multiplan Commercial |
$689.60
|
| Rate for Payer: Networks By Design Commercial |
$560.30
|
| Rate for Payer: Prime Health Services Commercial |
$732.70
|
|
|
HC VENOUS 1ST ORDER CATH PLCMT
|
Facility
|
IP
|
$887.00
|
|
|
Service Code
|
CPT 36011
|
| Hospital Charge Code |
909081309
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$177.40 |
| Max. Negotiated Rate |
$753.95 |
| Rate for Payer: Adventist Health Commercial |
$177.40
|
| Rate for Payer: Cash Price |
$399.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$354.80
|
| Rate for Payer: EPIC Health Plan Senior |
$354.80
|
| Rate for Payer: Galaxy Health WC |
$753.95
|
| Rate for Payer: Global Benefits Group Commercial |
$532.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$591.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$337.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$549.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$212.88
|
| Rate for Payer: Multiplan Commercial |
$709.60
|
| Rate for Payer: Networks By Design Commercial |
$576.55
|
| Rate for Payer: Prime Health Services Commercial |
$753.95
|
|
|
HC VENOUS 1ST ORDER CATH PLCMT
|
Facility
|
OP
|
$887.00
|
|
|
Service Code
|
CPT 36011
|
| Hospital Charge Code |
909081309
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$135.73 |
| Max. Negotiated Rate |
$6,906.11 |
| Rate for Payer: Adventist Health Commercial |
$177.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$753.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$487.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$665.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$399.15
|
| Rate for Payer: Cash Price |
$399.15
|
| Rate for Payer: Cash Price |
$399.15
|
| Rate for Payer: Cigna of CA HMO |
$567.68
|
| Rate for Payer: Cigna of CA PPO |
$656.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$753.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$753.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$753.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$354.80
|
| Rate for Payer: EPIC Health Plan Senior |
$354.80
|
| Rate for Payer: Galaxy Health WC |
$753.95
|
| Rate for Payer: Global Benefits Group Commercial |
$532.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$135.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$591.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$153.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$549.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$212.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$620.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$620.90
|
| Rate for Payer: Multiplan Commercial |
$709.60
|
| Rate for Payer: Networks By Design Commercial |
$576.55
|
| Rate for Payer: Prime Health Services Commercial |
$753.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$532.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$753.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$753.95
|
| Rate for Payer: Vantage Medical Group Senior |
$753.95
|
|
|
HC VENOUS 1ST ORDER CATH PLCMT
|
Facility
|
OP
|
$862.00
|
|
|
Service Code
|
CPT 36011
|
| Hospital Charge Code |
906820169
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$135.73 |
| Max. Negotiated Rate |
$6,906.11 |
| Rate for Payer: Adventist Health Commercial |
$172.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$732.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$474.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$646.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$387.90
|
| Rate for Payer: Cash Price |
$387.90
|
| Rate for Payer: Cash Price |
$387.90
|
| Rate for Payer: Cigna of CA HMO |
$551.68
|
| Rate for Payer: Cigna of CA PPO |
$637.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$732.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$732.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$732.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$344.80
|
| Rate for Payer: EPIC Health Plan Senior |
$344.80
|
| Rate for Payer: Galaxy Health WC |
$732.70
|
| Rate for Payer: Global Benefits Group Commercial |
$517.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$135.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$574.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$153.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$533.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$206.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$603.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$603.40
|
| Rate for Payer: Multiplan Commercial |
$689.60
|
| Rate for Payer: Networks By Design Commercial |
$560.30
|
| Rate for Payer: Prime Health Services Commercial |
$732.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$517.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$732.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$732.70
|
| Rate for Payer: Vantage Medical Group Senior |
$732.70
|
|
