|
HC VENIPUNCTURE W/SPECIMEN
|
Facility
|
IP
|
$54.00
|
|
|
Service Code
|
CPT 36415
|
| Hospital Charge Code |
900910099
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.80 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Adventist Health Commercial |
$10.80
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.60
|
| Rate for Payer: EPIC Health Plan Senior |
$21.60
|
| Rate for Payer: Galaxy Health WC |
$45.90
|
| Rate for Payer: Global Benefits Group Commercial |
$32.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.96
|
| Rate for Payer: Multiplan Commercial |
$43.20
|
| Rate for Payer: Networks By Design Commercial |
$35.10
|
| Rate for Payer: Prime Health Services Commercial |
$45.90
|
|
|
HC VENOGRAM ADRENAL BILAT
|
Facility
|
IP
|
$9,857.00
|
|
|
Service Code
|
CPT 75842
|
| Hospital Charge Code |
909081638
|
|
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 |
$5,421.35
|
| 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 ADRENAL BILAT
|
Facility
|
OP
|
$9,857.00
|
|
|
Service Code
|
CPT 75842
|
| Hospital Charge Code |
909081638
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$243.68 |
| Max. Negotiated Rate |
$11,264.31 |
| 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 |
$10,302.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,555.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,868.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$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 |
$5,421.35
|
| Rate for Payer: Cash Price |
$5,421.35
|
| 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 |
$10,302.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,555.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,868.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,272.45
|
| Rate for Payer: EPIC Health Plan Senior |
$6,868.48
|
| Rate for Payer: Galaxy Health WC |
$8,378.45
|
| Rate for Payer: Global Benefits Group Commercial |
$5,914.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,264.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$243.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,868.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,574.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$275.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,868.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,365.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,654.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,203.76
|
| 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 |
$6,868.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,555.33
|
| Rate for Payer: Vantage Medical Group Senior |
$6,868.48
|
|
|
HC VENOGRAM ADRENAL UNILAT
|
Facility
|
OP
|
$6,571.00
|
|
|
Service Code
|
CPT 75840
|
| Hospital Charge Code |
909081579
|
|
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 |
$3,560.85
|
| 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 |
$3,614.05
|
| Rate for Payer: Cash Price |
$3,614.05
|
| 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 ADRENAL UNILAT
|
Facility
|
IP
|
$6,571.00
|
|
|
Service Code
|
CPT 75840
|
| Hospital Charge Code |
909081579
|
|
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 |
$3,614.05
|
| 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 EPIDURAL
|
Facility
|
IP
|
$10,156.00
|
|
|
Service Code
|
CPT 75872
|
| Hospital Charge Code |
909081642
|
|
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 |
$5,585.80
|
| 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 EPIDURAL
|
Facility
|
OP
|
$10,156.00
|
|
|
Service Code
|
CPT 75872
|
| Hospital Charge Code |
909081642
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$785.56 |
| 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 |
$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 |
$5,585.80
|
| Rate for Payer: Cash Price |
$5,585.80
|
| 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 EXRTM BILATERAL
|
Facility
|
OP
|
$5,077.00
|
|
|
Service Code
|
CPT 75822
|
| Hospital Charge Code |
906811381
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$157.62 |
| Max. Negotiated Rate |
$4,315.45 |
| Rate for Payer: Adventist Health Commercial |
$1,015.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,330.00
|
| 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 |
$416.20
|
| Rate for Payer: Blue Shield of California Commercial |
$3,107.12
|
| Rate for Payer: Blue Shield of California EPN |
$2,051.11
|
| Rate for Payer: Cash Price |
$2,792.35
|
| Rate for Payer: Cash Price |
$2,792.35
|
| Rate for Payer: Cigna of CA HMO |
$3,249.28
|
| Rate for Payer: Cigna of CA PPO |
$3,756.98
|
| 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 |
$4,315.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,046.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,237.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$157.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,973.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,386.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$178.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,973.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,218.48
|
| 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 |
$4,061.60
|
| Rate for Payer: Networks By Design Commercial |
$3,300.05
|
| Rate for Payer: Prime Health Services Commercial |
$4,315.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,046.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,046.20
|
| 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 EXRTM BILATERAL
|
Facility
|
IP
|
$6,869.00
|
|
|
Service Code
|
CPT 75822
|
| Hospital Charge Code |
906820127
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,373.80 |
| Max. Negotiated Rate |
$5,838.65 |
| Rate for Payer: Adventist Health Commercial |
$1,373.80
|
| Rate for Payer: Cash Price |
$3,777.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,747.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,747.60
|
| Rate for Payer: Galaxy Health WC |
$5,838.65
|
| Rate for Payer: Global Benefits Group Commercial |
$4,121.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,581.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,617.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,251.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,648.56
|
| Rate for Payer: Multiplan Commercial |
$5,495.20
|
| Rate for Payer: Networks By Design Commercial |
$4,464.85
|
| Rate for Payer: Prime Health Services Commercial |
$5,838.65
|
|
|
HC VENOGRAM EXRTM BILATERAL
|
Facility
|
IP
|
$5,077.00
|
|
|
Service Code
|
CPT 75822
|
| Hospital Charge Code |
906811381
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,015.40 |
| Max. Negotiated Rate |
$4,315.45 |
| Rate for Payer: Adventist Health Commercial |
$1,015.40
|
| Rate for Payer: Cash Price |
$2,792.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,030.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,030.80
|
| Rate for Payer: Galaxy Health WC |
$4,315.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,046.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,386.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,934.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,142.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,218.48
|
| Rate for Payer: Multiplan Commercial |
$4,061.60
|
| Rate for Payer: Networks By Design Commercial |
$3,300.05
|
| Rate for Payer: Prime Health Services Commercial |
$4,315.45
|
|
|
HC VENOGRAM EXRTM BILATERAL
|
Facility
|
OP
|
$6,869.00
|
|
|
Service Code
|
CPT 75822
|
| Hospital Charge Code |
906820127
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$157.62 |
| Max. Negotiated Rate |
$5,838.65 |
| Rate for Payer: Adventist Health Commercial |
$1,373.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4,505.38
|
| 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 |
$416.20
|
| Rate for Payer: Blue Shield of California Commercial |
$4,203.83
|
| Rate for Payer: Blue Shield of California EPN |
$2,775.08
|
| Rate for Payer: Cash Price |
$3,777.95
|
| Rate for Payer: Cash Price |
$3,777.95
|
| Rate for Payer: Cigna of CA HMO |
$4,396.16
|
| Rate for Payer: Cigna of CA PPO |
$5,083.06
|
| 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 |
$5,838.65
|
| Rate for Payer: Global Benefits Group Commercial |
$4,121.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,237.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$157.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,973.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,581.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$178.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,973.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,648.56
|
| 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 |
$5,495.20
|
| Rate for Payer: Networks By Design Commercial |
$4,464.85
|
| Rate for Payer: Prime Health Services Commercial |
$5,838.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,121.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,121.40
|
| 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 EXTRM UNILATERAL
|
Facility
|
OP
|
$4,579.00
|
|
|
Service Code
|
CPT 75820
|
| Hospital Charge Code |
906820126
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$102.68 |
| Max. Negotiated Rate |
$3,892.15 |
| Rate for Payer: Vantage Medical Group Senior |
$1,973.80
|
| Rate for Payer: Adventist Health Commercial |
$915.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,003.37
|
| 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 |
$266.25
|
| Rate for Payer: Blue Shield of California Commercial |
$2,802.35
|
| Rate for Payer: Blue Shield of California EPN |
$1,849.92
|
| Rate for Payer: Cash Price |
$2,518.45
|
| Rate for Payer: Cash Price |
$2,518.45
|
| Rate for Payer: Cigna of CA HMO |
$2,930.56
|
| Rate for Payer: Cigna of CA PPO |
$3,388.46
|
| 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 |
$3,892.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,747.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,237.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$102.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,973.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,054.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$116.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,973.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,098.96
|
| 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 |
$3,663.20
|
| Rate for Payer: Networks By Design Commercial |
$2,976.35
|
| Rate for Payer: Prime Health Services Commercial |
$3,892.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,747.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,747.40
|
| 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
|
|
|
HC VENOGRAM EXTRM UNILATERAL
|
Facility
|
IP
|
$4,579.00
|
|
|
Service Code
|
CPT 75820
|
| Hospital Charge Code |
906820126
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$915.80 |
| Max. Negotiated Rate |
$3,892.15 |
| Rate for Payer: Adventist Health Commercial |
$915.80
|
| Rate for Payer: Cash Price |
$2,518.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,831.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,831.60
|
| Rate for Payer: Galaxy Health WC |
$3,892.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,747.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,054.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,744.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,834.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,098.96
|
| Rate for Payer: Multiplan Commercial |
$3,663.20
|
| Rate for Payer: Networks By Design Commercial |
$2,976.35
|
| Rate for Payer: Prime Health Services Commercial |
$3,892.15
|
|
|
HC VENOGRAM EXTRM UNILATERAL
|
Facility
|
IP
|
$3,385.00
|
|
|
Service Code
|
CPT 75820
|
| Hospital Charge Code |
906811380
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$677.00 |
| Max. Negotiated Rate |
$2,877.25 |
| Rate for Payer: Adventist Health Commercial |
$677.00
|
| Rate for Payer: Cash Price |
$1,861.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,354.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,354.00
|
| Rate for Payer: Galaxy Health WC |
$2,877.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,031.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,257.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,289.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,095.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$812.40
|
| Rate for Payer: Multiplan Commercial |
$2,708.00
|
| Rate for Payer: Networks By Design Commercial |
$2,200.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,877.25
|
|
|
HC VENOGRAM EXTRM UNILATERAL
|
Facility
|
OP
|
$3,385.00
|
|
|
Service Code
|
CPT 75820
|
| Hospital Charge Code |
906811380
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$102.68 |
| Max. Negotiated Rate |
$3,237.03 |
| Rate for Payer: Adventist Health Commercial |
$677.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,220.22
|
| 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 |
$266.25
|
| Rate for Payer: Blue Shield of California Commercial |
$2,071.62
|
| Rate for Payer: Blue Shield of California EPN |
$1,367.54
|
| Rate for Payer: Cash Price |
$1,861.75
|
| Rate for Payer: Cash Price |
$1,861.75
|
| Rate for Payer: Cigna of CA HMO |
$2,166.40
|
| Rate for Payer: Cigna of CA PPO |
$2,504.90
|
| 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 |
$2,877.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,031.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,237.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$102.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,973.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,257.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$116.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,973.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$812.40
|
| 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 |
$2,708.00
|
| Rate for Payer: Networks By Design Commercial |
$2,200.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,877.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,031.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,031.00
|
| 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 INFERIOR VENACAVA
|
Facility
|
IP
|
$11,122.00
|
|
|
Service Code
|
CPT 75825
|
| Hospital Charge Code |
909081633
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,224.40 |
| Max. Negotiated Rate |
$9,453.70 |
| Rate for Payer: Adventist Health Commercial |
$2,224.40
|
| Rate for Payer: Cash Price |
$6,117.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,448.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4,448.80
|
| Rate for Payer: Galaxy Health WC |
$9,453.70
|
| Rate for Payer: Global Benefits Group Commercial |
$6,673.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,418.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,237.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,884.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,669.28
|
| Rate for Payer: Multiplan Commercial |
$8,897.60
|
| Rate for Payer: Networks By Design Commercial |
$7,229.30
|
| Rate for Payer: Prime Health Services Commercial |
$9,453.70
|
|
|
HC VENOGRAM INFERIOR VENACAVA
|
Facility
|
IP
|
$15,048.00
|
|
|
Service Code
|
CPT 75825
|
| Hospital Charge Code |
906820195
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$3,009.60 |
| Max. Negotiated Rate |
$12,790.80 |
| Rate for Payer: Adventist Health Commercial |
$3,009.60
|
| Rate for Payer: Cash Price |
$8,276.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,019.20
|
| Rate for Payer: EPIC Health Plan Senior |
$6,019.20
|
| Rate for Payer: Galaxy Health WC |
$12,790.80
|
| Rate for Payer: Global Benefits Group Commercial |
$9,028.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,037.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,733.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,314.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,611.52
|
| Rate for Payer: Multiplan Commercial |
$12,038.40
|
| Rate for Payer: Networks By Design Commercial |
$9,781.20
|
| Rate for Payer: Prime Health Services Commercial |
$12,790.80
|
|
|
HC VENOGRAM INFERIOR VENACAVA
|
Facility
|
OP
|
$11,122.00
|
|
|
Service Code
|
CPT 75825
|
| Hospital Charge Code |
909081633
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$173.91 |
| Max. Negotiated Rate |
$9,453.70 |
| Rate for Payer: Adventist Health Commercial |
$2,224.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,294.92
|
| 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 |
$3,541.30
|
| Rate for Payer: Blue Shield of California Commercial |
$6,806.66
|
| Rate for Payer: Blue Shield of California EPN |
$4,493.29
|
| Rate for Payer: Cash Price |
$6,117.10
|
| Rate for Payer: Cash Price |
$6,117.10
|
| Rate for Payer: Cigna of CA HMO |
$7,118.08
|
| Rate for Payer: Cigna of CA PPO |
$8,230.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,398.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3,999.21
|
| Rate for Payer: Galaxy Health WC |
$9,453.70
|
| Rate for Payer: Global Benefits Group Commercial |
$6,673.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$173.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,418.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$196.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,669.28
|
| 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 |
$8,897.60
|
| Rate for Payer: Networks By Design Commercial |
$7,229.30
|
| Rate for Payer: Prime Health Services Commercial |
$9,453.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,673.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,673.20
|
| 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 INFERIOR VENACAVA
|
Facility
|
OP
|
$15,048.00
|
|
|
Service Code
|
CPT 75825
|
| Hospital Charge Code |
906820195
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$173.91 |
| Max. Negotiated Rate |
$12,790.80 |
| Rate for Payer: Adventist Health Commercial |
$3,009.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,869.98
|
| 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 |
$3,541.30
|
| Rate for Payer: Blue Shield of California Commercial |
$9,209.38
|
| Rate for Payer: Blue Shield of California EPN |
$6,079.39
|
| Rate for Payer: Cash Price |
$8,276.40
|
| Rate for Payer: Cash Price |
$8,276.40
|
| Rate for Payer: Cigna of CA HMO |
$9,630.72
|
| Rate for Payer: Cigna of CA PPO |
$11,135.52
|
| 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 |
$12,790.80
|
| Rate for Payer: Global Benefits Group Commercial |
$9,028.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$173.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,037.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$196.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,611.52
|
| 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 |
$12,038.40
|
| Rate for Payer: Networks By Design Commercial |
$9,781.20
|
| Rate for Payer: Prime Health Services Commercial |
$12,790.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,028.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,028.80
|
| 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 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 |
$5,585.80
|
| 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 JUGULAR OR SINUS
|
Facility
|
OP
|
$13,740.00
|
|
|
Service Code
|
CPT 75860
|
| Hospital Charge Code |
906820187
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,688.24 |
| Max. Negotiated Rate |
$11,679.00 |
| Rate for Payer: Adventist Health Commercial |
$2,748.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,012.07
|
| 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 |
$8,408.88
|
| Rate for Payer: Blue Shield of California EPN |
$5,550.96
|
| Rate for Payer: Cash Price |
$7,557.00
|
| Rate for Payer: Cash Price |
$7,557.00
|
| Rate for Payer: Cigna of CA HMO |
$8,793.60
|
| Rate for Payer: Cigna of CA PPO |
$10,167.60
|
| 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 |
$11,679.00
|
| Rate for Payer: Global Benefits Group Commercial |
$8,244.00
|
| 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 |
$9,164.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,297.60
|
| 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 |
$10,992.00
|
| Rate for Payer: Networks By Design Commercial |
$8,931.00
|
| Rate for Payer: Prime Health Services Commercial |
$11,679.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,244.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8,244.00
|
| 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
|
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 |
$5,585.80
|
| Rate for Payer: Cash Price |
$5,585.80
|
| 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 |
$7,557.00
|
| 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 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 |
$5,585.80
|
| Rate for Payer: Cash Price |
$5,585.80
|
| 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 |
$5,585.80
|
| 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
|
|
