|
HC VENIPUNCTURE GT 3 YRS OLD
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
CPT 36410
|
| Hospital Charge Code |
910100005
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.14 |
| Max. Negotiated Rate |
$127.50 |
| Rate for Payer: Adventist Health Commercial |
$30.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$61.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$127.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$82.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$112.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$96.25
|
| Rate for Payer: Blue Shield of California Commercial |
$104.55
|
| Rate for Payer: Blue Shield of California Commercial |
$69.15
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna of CA HMO |
$96.00
|
| Rate for Payer: Cigna of CA PPO |
$111.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$127.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$127.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$127.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$105.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.00
|
| Rate for Payer: EPIC Health Plan Senior |
$60.00
|
| Rate for Payer: Galaxy Health WC |
$127.50
|
| Rate for Payer: Global Benefits Group Commercial |
$90.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$95.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$88.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$105.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$105.00
|
| Rate for Payer: Multiplan Commercial |
$120.00
|
| Rate for Payer: Networks By Design Commercial |
$97.50
|
| Rate for Payer: Prime Health Services Commercial |
$127.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$90.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$90.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$75.00
|
| Rate for Payer: United Healthcare All Other HMO |
$75.00
|
| Rate for Payer: United Healthcare HMO Rider |
$75.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$75.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$127.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$127.50
|
| Rate for Payer: Vantage Medical Group Senior |
$127.50
|
|
|
HC VENIPUNCTURE GT 3 YRS OLD
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
CPT 36410
|
| Hospital Charge Code |
910100005
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$20.52 |
| Max. Negotiated Rate |
$2,601.00 |
| Rate for Payer: Adventist Health Commercial |
$61.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$61.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$127.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$82.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$112.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,601.00
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna of CA HMO |
$96.00
|
| Rate for Payer: Cigna of CA PPO |
$111.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$127.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$127.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$127.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$105.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.00
|
| Rate for Payer: EPIC Health Plan Senior |
$60.00
|
| Rate for Payer: Galaxy Health WC |
$127.50
|
| Rate for Payer: Global Benefits Group Commercial |
$90.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$95.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$88.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$105.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$105.00
|
| Rate for Payer: Multiplan Commercial |
$120.00
|
| Rate for Payer: Networks By Design Commercial |
$97.50
|
| Rate for Payer: Prime Health Services Commercial |
$127.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$90.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$90.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$127.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$127.50
|
| Rate for Payer: Vantage Medical Group Senior |
$127.50
|
|
|
HC VENIPUNCTURE GT 3 YRS OLD
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
CPT 36410
|
| Hospital Charge Code |
910100005
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$127.50 |
| Rate for Payer: Adventist Health Commercial |
$30.00
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$105.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.00
|
| Rate for Payer: EPIC Health Plan Senior |
$60.00
|
| Rate for Payer: Galaxy Health WC |
$127.50
|
| Rate for Payer: Global Benefits Group Commercial |
$90.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$95.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$88.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.00
|
| Rate for Payer: Multiplan Commercial |
$120.00
|
| Rate for Payer: Networks By Design Commercial |
$97.50
|
| Rate for Payer: Prime Health Services Commercial |
$127.50
|
|
|
HC VENIPUNCTURE W SPECIMEN
|
Facility
|
IP
|
$54.00
|
|
|
Service Code
|
CPT 36415
|
| Hospital Charge Code |
900510279
|
|
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 |
$24.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$37.80
|
| 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 Foundation Hospitals Commercial/Self Funded |
$34.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31.86
|
| 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 VENIPUNCTURE W SPECIMEN
|
Facility
|
OP
|
$47.00
|
|
|
Service Code
|
CPT 36415
|
| Hospital Charge Code |
900510279
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.43 |
| Max. Negotiated Rate |
$39.95 |
| Rate for Payer: Adventist Health Commercial |
$9.40
|
| Rate for Payer: Adventist Health Commercial |
$10.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.10
|
| Rate for Payer: Blue Shield of California Commercial |
$37.64
|
| Rate for Payer: Blue Shield of California Commercial |
$21.67
|
| Rate for Payer: Blue Shield of California Commercial |
$32.76
|
| Rate for Payer: Blue Shield of California Commercial |
$24.89
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cash Price |
$21.15
|
| Rate for Payer: Cash Price |
$21.15
|
| Rate for Payer: Cigna of CA HMO |
$30.08
|
| Rate for Payer: Cigna of CA HMO |
$34.56
|
| Rate for Payer: Cigna of CA PPO |
$39.96
|
| Rate for Payer: Cigna of CA PPO |
$34.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$37.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$32.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.41
|
| Rate for Payer: EPIC Health Plan Senior |
$10.27
|
| Rate for Payer: EPIC Health Plan Senior |
$10.27
|
| Rate for Payer: Galaxy Health WC |
$39.95
|
| Rate for Payer: Galaxy Health WC |
$45.90
|
| Rate for Payer: Global Benefits Group Commercial |
$28.20
|
| Rate for Payer: Global Benefits Group Commercial |
$32.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$15.32
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$15.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$34.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$29.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.52
|
| Rate for Payer: Multiplan Commercial |
$37.60
|
| Rate for Payer: Multiplan Commercial |
$43.20
|
| Rate for Payer: Networks By Design Commercial |
$35.10
|
| Rate for Payer: Networks By Design Commercial |
$30.55
|
| Rate for Payer: Prime Health Services Commercial |
$39.95
|
| Rate for Payer: Prime Health Services Commercial |
$45.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.43
|
| Rate for Payer: United Healthcare All Other HMO |
$2.43
|
| Rate for Payer: United Healthcare All Other HMO |
$2.43
|
| Rate for Payer: United Healthcare HMO Rider |
$2.43
|
| Rate for Payer: United Healthcare HMO Rider |
$2.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.43
|
| Rate for Payer: Upland Medical Group Pediatric |
$9.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$9.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.27
|
| Rate for Payer: Vantage Medical Group Senior |
$9.34
|
| Rate for Payer: Vantage Medical Group Senior |
$9.34
|
|
|
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 |
$24.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$37.80
|
| 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 Foundation Hospitals Commercial/Self Funded |
$34.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31.86
|
| 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 VENIPUNCTURE W/SPECIMEN
|
Facility
|
OP
|
$47.00
|
|
|
Service Code
|
CPT 36415
|
| Hospital Charge Code |
900910099
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.43 |
| Max. Negotiated Rate |
$39.95 |
| Rate for Payer: Aetna of CA HMO/PPO |
$18.35
|
| Rate for Payer: Vantage Medical Group Senior |
$9.34
|
| Rate for Payer: Vantage Medical Group Senior |
$9.34
|
| Rate for Payer: Adventist Health Commercial |
$9.40
|
| Rate for Payer: Adventist Health Commercial |
$10.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.10
|
| Rate for Payer: Blue Shield of California Commercial |
$37.64
|
| Rate for Payer: Blue Shield of California Commercial |
$21.67
|
| Rate for Payer: Blue Shield of California Commercial |
$32.76
|
| Rate for Payer: Blue Shield of California Commercial |
$24.89
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cash Price |
$21.15
|
| Rate for Payer: Cash Price |
$21.15
|
| Rate for Payer: Cigna of CA HMO |
$30.08
|
| Rate for Payer: Cigna of CA HMO |
$34.56
|
| Rate for Payer: Cigna of CA PPO |
$39.96
|
| Rate for Payer: Cigna of CA PPO |
$34.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$37.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$32.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.41
|
| Rate for Payer: EPIC Health Plan Senior |
$10.27
|
| Rate for Payer: EPIC Health Plan Senior |
$10.27
|
| Rate for Payer: Galaxy Health WC |
$39.95
|
| Rate for Payer: Galaxy Health WC |
$45.90
|
| Rate for Payer: Global Benefits Group Commercial |
$28.20
|
| Rate for Payer: Global Benefits Group Commercial |
$32.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$15.32
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$15.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$34.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$29.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.52
|
| Rate for Payer: Multiplan Commercial |
$37.60
|
| Rate for Payer: Multiplan Commercial |
$43.20
|
| Rate for Payer: Networks By Design Commercial |
$35.10
|
| Rate for Payer: Networks By Design Commercial |
$30.55
|
| Rate for Payer: Prime Health Services Commercial |
$39.95
|
| Rate for Payer: Prime Health Services Commercial |
$45.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.43
|
| Rate for Payer: United Healthcare All Other HMO |
$2.43
|
| Rate for Payer: United Healthcare All Other HMO |
$2.43
|
| Rate for Payer: United Healthcare HMO Rider |
$2.43
|
| Rate for Payer: United Healthcare HMO Rider |
$2.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.43
|
| Rate for Payer: Upland Medical Group Pediatric |
$9.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$9.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.27
|
|
|
HC VENOGRAM ADRENAL BILAT
|
Facility
|
OP
|
$9,857.00
|
|
|
Service Code
|
CPT 75842
|
| Hospital Charge Code |
909081638
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,216.43 |
| Max. Negotiated Rate |
$8,378.45 |
| Rate for Payer: Adventist Health Commercial |
$1,971.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,216.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,378.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,421.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,392.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,721.07
|
| Rate for Payer: Blue Shield of California Commercial |
$6,288.77
|
| Rate for Payer: Blue Shield of California Commercial |
$4,149.80
|
| 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 |
$8,378.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,378.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,378.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,899.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$6,259.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,578.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,815.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,365.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,899.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,899.90
|
| 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: Vantage Medical Group Commercial/Exchange |
$8,378.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,378.45
|
| Rate for Payer: Vantage Medical Group Senior |
$8,378.45
|
|
|
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 |
$4,435.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,899.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$6,259.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,815.63
|
| 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 UNILAT
|
Facility
|
OP
|
$6,571.00
|
|
|
Service Code
|
CPT 75840
|
| Hospital Charge Code |
909081579
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,084.13 |
| Max. Negotiated Rate |
$6,700.73 |
| Rate for Payer: Adventist Health Commercial |
$1,314.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,084.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,061.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,721.07
|
| Rate for Payer: Blue Shield of California Commercial |
$2,766.39
|
| Rate for Payer: Blue Shield of California Commercial |
$4,192.30
|
| 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 |
$6,091.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,467.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,061.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,599.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,700.73
|
| Rate for Payer: EPIC Health Plan Senior |
$4,467.15
|
| 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/Senior |
$6,660.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,172.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,685.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,577.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,116.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,441.81
|
| 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 |
$4,061.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Vantage Medical Group Senior |
$4,061.05
|
|
|
HC 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 |
$2,956.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,599.70
|
| 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 Foundation Hospitals Commercial/Self Funded |
$4,172.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,876.89
|
| 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 |
$4,570.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,109.20
|
| 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 Foundation Hospitals Commercial/Self Funded |
$6,449.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,992.04
|
| 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 |
$806.82 |
| Max. Negotiated Rate |
$8,632.60 |
| Rate for Payer: Adventist Health Commercial |
$2,031.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,610.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,210.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$887.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$806.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,721.07
|
| Rate for Payer: Blue Shield of California Commercial |
$4,275.68
|
| Rate for Payer: Blue Shield of California Commercial |
$6,479.53
|
| 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 |
$1,210.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$887.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$806.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,109.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,331.25
|
| Rate for Payer: EPIC Health Plan Senior |
$887.50
|
| 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/Senior |
$1,323.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$806.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,449.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,129.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,437.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,016.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,081.14
|
| 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 |
$806.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,210.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$887.50
|
| Rate for Payer: Vantage Medical Group Senior |
$806.82
|
|
|
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 |
$2,284.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,553.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$3,223.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,995.43
|
| 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
|
$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 |
$731.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,036.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,227.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,024.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$434.93
|
| Rate for Payer: Blue Shield of California Commercial |
$2,137.42
|
| Rate for Payer: Blue Shield of California Commercial |
$3,239.13
|
| Rate for Payer: Cash Price |
$2,284.65
|
| Rate for Payer: Cash Price |
$2,284.65
|
| 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 |
$3,036.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,227.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,024.63
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,553.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,340.64
|
| Rate for Payer: EPIC Health Plan Senior |
$2,227.09
|
| 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/Senior |
$3,320.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$157.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,024.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,223.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$178.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,834.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,218.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,551.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,713.00
|
| 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 |
$2,024.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,036.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,227.09
|
| Rate for Payer: Vantage Medical Group Senior |
$2,024.63
|
|
|
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 |
$3,340.64 |
| Rate for Payer: Adventist Health Commercial |
$677.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$653.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,036.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,227.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,024.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$278.23
|
| Rate for Payer: Blue Shield of California Commercial |
$1,425.09
|
| Rate for Payer: Blue Shield of California Commercial |
$2,159.63
|
| Rate for Payer: Cash Price |
$1,523.25
|
| Rate for Payer: Cash Price |
$1,523.25
|
| 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 |
$3,036.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,227.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,024.63
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,369.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,340.64
|
| Rate for Payer: EPIC Health Plan Senior |
$2,227.09
|
| 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/Senior |
$3,320.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$102.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,024.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,149.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$116.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,834.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$812.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,551.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,713.00
|
| 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 |
$2,024.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,036.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,227.09
|
| Rate for Payer: Vantage Medical Group Senior |
$2,024.63
|
|
|
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 |
$1,523.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,369.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$2,149.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,997.15
|
| 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 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 |
$5,004.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,785.40
|
| 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 Foundation Hospitals Commercial/Self Funded |
$7,062.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,561.98
|
| 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
|
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 |
$1,081.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,061.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,700.64
|
| Rate for Payer: Blue Shield of California Commercial |
$4,682.36
|
| Rate for Payer: Blue Shield of California Commercial |
$7,095.84
|
| Rate for Payer: Cash Price |
$5,004.90
|
| Rate for Payer: Cash Price |
$5,004.90
|
| 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 |
$6,091.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,467.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,061.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,785.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,700.73
|
| Rate for Payer: EPIC Health Plan Senior |
$4,467.15
|
| 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/Senior |
$6,660.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$173.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,062.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$196.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,685.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,669.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,116.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,441.81
|
| 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 |
$4,061.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Vantage Medical Group Senior |
$4,061.05
|
|
|
HC 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,109.20
|
| 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 Foundation Hospitals Commercial/Self Funded |
$6,449.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,992.04
|
| 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
|
$10,156.00
|
|
|
Service Code
|
CPT 75860
|
| Hospital Charge Code |
909081580
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,118.40 |
| Max. Negotiated Rate |
$8,632.60 |
| Rate for Payer: Adventist Health Commercial |
$2,031.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,118.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,061.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,721.07
|
| Rate for Payer: Blue Shield of California Commercial |
$4,275.68
|
| Rate for Payer: Blue Shield of California Commercial |
$6,479.53
|
| 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 |
$6,091.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,467.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,061.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,109.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,700.73
|
| Rate for Payer: EPIC Health Plan Senior |
$4,467.15
|
| 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/Senior |
$6,660.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,449.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,685.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,437.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,116.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,441.81
|
| 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 |
$4,061.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Vantage Medical Group Senior |
$4,061.05
|
|
|
HC VENOGRAM ORBITAL
|
Facility
|
OP
|
$10,156.00
|
|
|
Service Code
|
CPT 75880
|
| Hospital Charge Code |
909081659
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$278.23 |
| Max. Negotiated Rate |
$8,632.60 |
| Rate for Payer: Adventist Health Commercial |
$2,031.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$981.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,210.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$887.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$806.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$278.23
|
| Rate for Payer: Blue Shield of California Commercial |
$4,275.68
|
| Rate for Payer: Blue Shield of California Commercial |
$6,479.53
|
| 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 |
$1,210.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$887.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$806.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,109.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,331.25
|
| Rate for Payer: EPIC Health Plan Senior |
$887.50
|
| 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/Senior |
$1,323.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$806.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,449.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,129.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,437.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,016.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,081.14
|
| 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 |
$806.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,210.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$887.50
|
| Rate for Payer: Vantage Medical Group Senior |
$806.82
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,109.20
|
| 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 Foundation Hospitals Commercial/Self Funded |
$6,449.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,992.04
|
| 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 |
$1,223.73 |
| Max. Negotiated Rate |
$8,378.45 |
| Rate for Payer: Adventist Health Commercial |
$1,971.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,223.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,061.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,721.07
|
| Rate for Payer: Blue Shield of California Commercial |
$4,149.80
|
| Rate for Payer: Blue Shield of California Commercial |
$6,288.77
|
| 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 |
$6,091.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,467.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,061.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,899.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,700.73
|
| Rate for Payer: EPIC Health Plan Senior |
$4,467.15
|
| 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/Senior |
$6,660.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,259.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,685.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,365.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,116.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,441.81
|
| 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 |
$4,061.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Vantage Medical Group Senior |
$4,061.05
|
|
|
HC 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: Galaxy Health WC |
$8,378.45
|
| Rate for Payer: Adventist Health Commercial |
$1,971.40
|
| Rate for Payer: Cash Price |
$4,435.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,899.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,942.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,942.80
|
| Rate for Payer: Global Benefits Group Commercial |
$5,914.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,259.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,815.63
|
| 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
|
|
