|
HC ANESTHESIA LEVEL III ADD'L 15MIN
|
Facility
|
IP
|
$485.00
|
|
| Hospital Charge Code |
904900405
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$116.40 |
| Max. Negotiated Rate |
$412.25 |
| Rate for Payer: Cash Price |
$218.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$194.00
|
| Rate for Payer: Galaxy Health WC |
$412.25
|
| Rate for Payer: Global Benefits Group Commercial |
$291.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$323.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$184.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.40
|
| Rate for Payer: Multiplan Commercial |
$388.00
|
| Rate for Payer: Networks By Design Commercial |
$315.25
|
| Rate for Payer: Prime Health Services Commercial |
$412.25
|
|
|
HC ANESTHESIA LEVEL IV 1ST 15MIN
|
Facility
|
IP
|
$3,811.00
|
|
| Hospital Charge Code |
904900406
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$914.64 |
| Max. Negotiated Rate |
$3,239.35 |
| Rate for Payer: Cash Price |
$1,714.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,524.40
|
| Rate for Payer: Galaxy Health WC |
$3,239.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,286.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,541.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,451.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$914.64
|
| Rate for Payer: Multiplan Commercial |
$3,048.80
|
| Rate for Payer: Networks By Design Commercial |
$2,477.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,239.35
|
|
|
HC ANESTHESIA LEVEL IV 1ST 15MIN
|
Facility
|
OP
|
$3,811.00
|
|
| Hospital Charge Code |
904900406
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$914.64 |
| Max. Negotiated Rate |
$3,239.35 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,499.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,239.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,096.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,096.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,270.59
|
| Rate for Payer: Blue Distinction Transplant |
$2,286.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,808.71
|
| Rate for Payer: Blue Shield of California EPN |
$2,225.62
|
| Rate for Payer: Cash Price |
$1,714.95
|
| Rate for Payer: Cigna of CA HMO |
$2,439.04
|
| Rate for Payer: Cigna of CA PPO |
$2,820.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,239.35
|
| Rate for Payer: Dignity Health Media |
$3,239.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,239.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,524.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,524.40
|
| Rate for Payer: Galaxy Health WC |
$3,239.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,286.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,858.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,541.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,451.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$914.64
|
| Rate for Payer: Multiplan Commercial |
$3,048.80
|
| Rate for Payer: Networks By Design Commercial |
$2,477.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,239.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,286.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,286.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,905.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,905.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,905.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,905.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,239.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,239.35
|
| Rate for Payer: Vantage Medical Group Senior |
$3,239.35
|
|
|
HC ANESTHESIA LEVEL IV ADD'L 15MIN
|
Facility
|
IP
|
$670.00
|
|
| Hospital Charge Code |
904900407
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$160.80 |
| Max. Negotiated Rate |
$569.50 |
| Rate for Payer: Cash Price |
$301.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$268.00
|
| Rate for Payer: Galaxy Health WC |
$569.50
|
| Rate for Payer: Global Benefits Group Commercial |
$402.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$446.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$255.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$160.80
|
| Rate for Payer: Multiplan Commercial |
$536.00
|
| Rate for Payer: Networks By Design Commercial |
$435.50
|
| Rate for Payer: Prime Health Services Commercial |
$569.50
|
|
|
HC ANESTHESIA LEVEL IV ADD'L 15MIN
|
Facility
|
OP
|
$670.00
|
|
| Hospital Charge Code |
904900407
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$160.80 |
| Max. Negotiated Rate |
$569.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$439.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$569.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$368.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$368.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$399.19
|
| Rate for Payer: Blue Distinction Transplant |
$402.00
|
| Rate for Payer: Blue Shield of California Commercial |
$493.79
|
| Rate for Payer: Blue Shield of California EPN |
$391.28
|
| Rate for Payer: Cash Price |
$301.50
|
| Rate for Payer: Cigna of CA HMO |
$428.80
|
| Rate for Payer: Cigna of CA PPO |
$495.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$569.50
|
| Rate for Payer: Dignity Health Media |
$569.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$569.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$268.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$268.00
|
| Rate for Payer: Galaxy Health WC |
$569.50
|
| Rate for Payer: Global Benefits Group Commercial |
$402.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$502.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$446.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$255.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$160.80
|
| Rate for Payer: Multiplan Commercial |
$536.00
|
| Rate for Payer: Networks By Design Commercial |
$435.50
|
| Rate for Payer: Prime Health Services Commercial |
$569.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$402.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$402.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$335.00
|
| Rate for Payer: United Healthcare All Other HMO |
$335.00
|
| Rate for Payer: United Healthcare HMO Rider |
$335.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$335.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$569.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$569.50
|
| Rate for Payer: Vantage Medical Group Senior |
$569.50
|
|
|
HC ANESTHESIA LEVEL V 1ST 15MIN
|
Facility
|
IP
|
$4,752.00
|
|
| Hospital Charge Code |
904900408
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$1,140.48 |
| Max. Negotiated Rate |
$4,039.20 |
| Rate for Payer: Cash Price |
$2,138.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,900.80
|
| Rate for Payer: Galaxy Health WC |
$4,039.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,851.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,169.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,810.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,140.48
|
| Rate for Payer: Multiplan Commercial |
$3,801.60
|
| Rate for Payer: Networks By Design Commercial |
$3,088.80
|
| Rate for Payer: Prime Health Services Commercial |
$4,039.20
|
|
|
HC ANESTHESIA LEVEL V 1ST 15MIN
|
Facility
|
OP
|
$4,752.00
|
|
| Hospital Charge Code |
904900408
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$1,140.48 |
| Max. Negotiated Rate |
$4,039.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,116.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,039.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,613.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,613.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,831.24
|
| Rate for Payer: Blue Distinction Transplant |
$2,851.20
|
| Rate for Payer: Blue Shield of California Commercial |
$3,502.22
|
| Rate for Payer: Blue Shield of California EPN |
$2,775.17
|
| Rate for Payer: Cash Price |
$2,138.40
|
| Rate for Payer: Cigna of CA HMO |
$3,041.28
|
| Rate for Payer: Cigna of CA PPO |
$3,516.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,039.20
|
| Rate for Payer: Dignity Health Media |
$4,039.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,039.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,900.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,900.80
|
| Rate for Payer: Galaxy Health WC |
$4,039.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,851.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,564.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,169.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,810.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,140.48
|
| Rate for Payer: Multiplan Commercial |
$3,801.60
|
| Rate for Payer: Networks By Design Commercial |
$3,088.80
|
| Rate for Payer: Prime Health Services Commercial |
$4,039.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,851.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,851.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,376.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,376.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,376.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,376.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,039.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,039.20
|
| Rate for Payer: Vantage Medical Group Senior |
$4,039.20
|
|
|
HC ANESTHESIA LEVEL V ADD'L 15MIN
|
Facility
|
IP
|
$856.00
|
|
| Hospital Charge Code |
904900409
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$205.44 |
| Max. Negotiated Rate |
$727.60 |
| Rate for Payer: Cash Price |
$385.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$342.40
|
| Rate for Payer: Galaxy Health WC |
$727.60
|
| Rate for Payer: Global Benefits Group Commercial |
$513.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$570.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$326.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$205.44
|
| Rate for Payer: Multiplan Commercial |
$684.80
|
| Rate for Payer: Networks By Design Commercial |
$556.40
|
| Rate for Payer: Prime Health Services Commercial |
$727.60
|
|
|
HC ANESTHESIA LEVEL V ADD'L 15MIN
|
Facility
|
OP
|
$856.00
|
|
| Hospital Charge Code |
904900409
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$205.44 |
| Max. Negotiated Rate |
$727.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$561.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$727.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$470.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$470.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$510.00
|
| Rate for Payer: Blue Distinction Transplant |
$513.60
|
| Rate for Payer: Blue Shield of California Commercial |
$630.87
|
| Rate for Payer: Blue Shield of California EPN |
$499.90
|
| Rate for Payer: Cash Price |
$385.20
|
| Rate for Payer: Cigna of CA HMO |
$547.84
|
| Rate for Payer: Cigna of CA PPO |
$633.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$727.60
|
| Rate for Payer: Dignity Health Media |
$727.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$727.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$342.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$342.40
|
| Rate for Payer: Galaxy Health WC |
$727.60
|
| Rate for Payer: Global Benefits Group Commercial |
$513.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$642.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$570.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$326.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$205.44
|
| Rate for Payer: Multiplan Commercial |
$684.80
|
| Rate for Payer: Networks By Design Commercial |
$556.40
|
| Rate for Payer: Prime Health Services Commercial |
$727.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$513.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$513.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$428.00
|
| Rate for Payer: United Healthcare All Other HMO |
$428.00
|
| Rate for Payer: United Healthcare HMO Rider |
$428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$428.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$727.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$727.60
|
| Rate for Payer: Vantage Medical Group Senior |
$727.60
|
|
|
HC ANESTHESIA LEVEL VI 1ST 15MIN
|
Facility
|
IP
|
$5,705.00
|
|
| Hospital Charge Code |
904900410
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$1,369.20 |
| Max. Negotiated Rate |
$4,849.25 |
| Rate for Payer: Cash Price |
$2,567.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,282.00
|
| Rate for Payer: Galaxy Health WC |
$4,849.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,423.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,805.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,173.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,369.20
|
| Rate for Payer: Multiplan Commercial |
$4,564.00
|
| Rate for Payer: Networks By Design Commercial |
$3,708.25
|
| Rate for Payer: Prime Health Services Commercial |
$4,849.25
|
|
|
HC ANESTHESIA LEVEL VI 1ST 15MIN
|
Facility
|
OP
|
$5,705.00
|
|
| Hospital Charge Code |
904900410
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$1,369.20 |
| Max. Negotiated Rate |
$4,849.25 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,741.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,849.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,137.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,137.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,399.04
|
| Rate for Payer: Blue Distinction Transplant |
$3,423.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,204.58
|
| Rate for Payer: Blue Shield of California EPN |
$3,331.72
|
| Rate for Payer: Cash Price |
$2,567.25
|
| Rate for Payer: Cigna of CA HMO |
$3,651.20
|
| Rate for Payer: Cigna of CA PPO |
$4,221.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,849.25
|
| Rate for Payer: Dignity Health Media |
$4,849.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,849.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,282.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,282.00
|
| Rate for Payer: Galaxy Health WC |
$4,849.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,423.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,278.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,805.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,173.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,369.20
|
| Rate for Payer: Multiplan Commercial |
$4,564.00
|
| Rate for Payer: Networks By Design Commercial |
$3,708.25
|
| Rate for Payer: Prime Health Services Commercial |
$4,849.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,423.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,423.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,852.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,852.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,852.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,852.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,849.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,849.25
|
| Rate for Payer: Vantage Medical Group Senior |
$4,849.25
|
|
|
HC ANESTHESIA LEVEL VI ADD'L 15MIN
|
Facility
|
IP
|
$1,056.00
|
|
| Hospital Charge Code |
904900411
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$253.44 |
| Max. Negotiated Rate |
$897.60 |
| Rate for Payer: Cash Price |
$475.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$422.40
|
| Rate for Payer: Galaxy Health WC |
$897.60
|
| Rate for Payer: Global Benefits Group Commercial |
$633.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$704.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$402.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$253.44
|
| Rate for Payer: Multiplan Commercial |
$844.80
|
| Rate for Payer: Networks By Design Commercial |
$686.40
|
| Rate for Payer: Prime Health Services Commercial |
$897.60
|
|
|
HC ANESTHESIA LEVEL VI ADD'L 15MIN
|
Facility
|
OP
|
$1,056.00
|
|
| Hospital Charge Code |
904900411
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$253.44 |
| Max. Negotiated Rate |
$897.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$692.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$897.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$580.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$580.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$629.16
|
| Rate for Payer: Blue Distinction Transplant |
$633.60
|
| Rate for Payer: Blue Shield of California Commercial |
$778.27
|
| Rate for Payer: Blue Shield of California EPN |
$616.70
|
| Rate for Payer: Cash Price |
$475.20
|
| Rate for Payer: Cigna of CA HMO |
$675.84
|
| Rate for Payer: Cigna of CA PPO |
$781.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$897.60
|
| Rate for Payer: Dignity Health Media |
$897.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$897.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$422.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$422.40
|
| Rate for Payer: Galaxy Health WC |
$897.60
|
| Rate for Payer: Global Benefits Group Commercial |
$633.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$792.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$704.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$402.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$253.44
|
| Rate for Payer: Multiplan Commercial |
$844.80
|
| Rate for Payer: Networks By Design Commercial |
$686.40
|
| Rate for Payer: Prime Health Services Commercial |
$897.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$633.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$633.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$528.00
|
| Rate for Payer: United Healthcare All Other HMO |
$528.00
|
| Rate for Payer: United Healthcare HMO Rider |
$528.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$528.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$897.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$897.60
|
| Rate for Payer: Vantage Medical Group Senior |
$897.60
|
|
|
HC ANGIO ADD'L VESSEL
|
Facility
|
OP
|
$4,464.00
|
|
|
Service Code
|
CPT 75774
|
| Hospital Charge Code |
909081284
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$143.49 |
| Max. Negotiated Rate |
$3,794.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$899.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,794.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,455.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,455.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,271.01
|
| Rate for Payer: Blue Distinction Transplant |
$2,678.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,638.22
|
| Rate for Payer: Blue Shield of California EPN |
$2,093.62
|
| Rate for Payer: Cash Price |
$2,008.80
|
| Rate for Payer: Cash Price |
$2,008.80
|
| Rate for Payer: Cigna of CA HMO |
$2,856.96
|
| Rate for Payer: Cigna of CA PPO |
$3,303.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,794.40
|
| Rate for Payer: Dignity Health Media |
$3,794.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,794.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,785.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,785.60
|
| Rate for Payer: Galaxy Health WC |
$3,794.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2,678.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,348.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,977.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$143.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,071.36
|
| Rate for Payer: Multiplan Commercial |
$3,571.20
|
| Rate for Payer: Networks By Design Commercial |
$2,901.60
|
| Rate for Payer: Prime Health Services Commercial |
$3,794.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,678.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,678.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,232.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,232.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,232.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,232.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,794.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,794.40
|
| Rate for Payer: Vantage Medical Group Senior |
$3,794.40
|
|
|
HC ANGIO ADD'L VESSEL
|
Facility
|
IP
|
$4,464.00
|
|
|
Service Code
|
CPT 75774
|
| Hospital Charge Code |
909081284
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$1,071.36 |
| Max. Negotiated Rate |
$3,794.40 |
| Rate for Payer: Cash Price |
$2,008.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,785.60
|
| Rate for Payer: Galaxy Health WC |
$3,794.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2,678.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,977.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,700.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,071.36
|
| Rate for Payer: Multiplan Commercial |
$3,571.20
|
| Rate for Payer: Networks By Design Commercial |
$2,901.60
|
| Rate for Payer: Prime Health Services Commercial |
$3,794.40
|
|
|
HC ANGIO CORONARY
|
Facility
|
IP
|
$3,188.00
|
|
|
Service Code
|
CPT 93563
|
| Hospital Charge Code |
906811412
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$765.12 |
| Max. Negotiated Rate |
$2,709.80 |
| Rate for Payer: Cash Price |
$1,434.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,275.20
|
| Rate for Payer: Galaxy Health WC |
$2,709.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,912.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,126.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,214.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$765.12
|
| Rate for Payer: Multiplan Commercial |
$2,550.40
|
| Rate for Payer: Networks By Design Commercial |
$2,072.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,709.80
|
|
|
HC ANGIO CORONARY
|
Facility
|
OP
|
$3,188.00
|
|
|
Service Code
|
CPT 93563
|
| Hospital Charge Code |
906811412
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$89.11 |
| Max. Negotiated Rate |
$6,668.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,051.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,709.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,753.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,753.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,912.80
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$1,434.60
|
| Rate for Payer: Cash Price |
$1,434.60
|
| Rate for Payer: Cash Price |
$1,434.60
|
| Rate for Payer: Cigna of CA PPO |
$2,359.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,709.80
|
| Rate for Payer: Dignity Health Media |
$2,709.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,709.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,275.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,275.20
|
| Rate for Payer: Galaxy Health WC |
$2,709.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,912.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,391.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,126.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$765.12
|
| Rate for Payer: Multiplan Commercial |
$2,550.40
|
| Rate for Payer: Networks By Design Commercial |
$2,072.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,709.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,912.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,912.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,709.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,709.80
|
| Rate for Payer: Vantage Medical Group Senior |
$2,709.80
|
|
|
HC ANGIOGRAPH ADRENAL BILAT
|
Facility
|
IP
|
$12,419.00
|
|
|
Service Code
|
CPT 75733
|
| Hospital Charge Code |
909081624
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$2,980.56 |
| Max. Negotiated Rate |
$10,556.15 |
| Rate for Payer: Cash Price |
$5,588.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,967.60
|
| Rate for Payer: Galaxy Health WC |
$10,556.15
|
| Rate for Payer: Global Benefits Group Commercial |
$7,451.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,283.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,731.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,980.56
|
| Rate for Payer: Multiplan Commercial |
$9,935.20
|
| Rate for Payer: Networks By Design Commercial |
$8,072.35
|
| Rate for Payer: Prime Health Services Commercial |
$10,556.15
|
|
|
HC ANGIOGRAPH ADRENAL BILAT
|
Facility
|
OP
|
$12,419.00
|
|
|
Service Code
|
CPT 75733
|
| Hospital Charge Code |
909081624
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$294.10 |
| Max. Negotiated Rate |
$10,556.15 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,295.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,289.13
|
| Rate for Payer: Blue Distinction Transplant |
$7,451.40
|
| Rate for Payer: Blue Shield of California Commercial |
$7,339.63
|
| Rate for Payer: Blue Shield of California EPN |
$5,824.51
|
| Rate for Payer: Cash Price |
$5,588.55
|
| Rate for Payer: Cash Price |
$5,588.55
|
| Rate for Payer: Cigna of CA HMO |
$7,948.16
|
| Rate for Payer: Cigna of CA PPO |
$9,190.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Media |
$3,982.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,376.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,982.55
|
| Rate for Payer: Galaxy Health WC |
$10,556.15
|
| Rate for Payer: Global Benefits Group Commercial |
$7,451.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9,314.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,531.38
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,531.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6,451.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$6,451.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,982.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,283.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$294.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,982.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,980.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,018.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,336.62
|
| Rate for Payer: Multiplan Commercial |
$9,935.20
|
| Rate for Payer: Networks By Design Commercial |
$8,072.35
|
| Rate for Payer: Prime Health Services Commercial |
$10,556.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,451.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,451.40
|
| 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 |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC ANGIOGRAPH ADRENAL UNILAT
|
Facility
|
IP
|
$8,135.00
|
|
|
Service Code
|
CPT 75731
|
| Hospital Charge Code |
909081574
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$1,952.40 |
| Max. Negotiated Rate |
$6,914.75 |
| Rate for Payer: Cash Price |
$3,660.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,254.00
|
| Rate for Payer: Galaxy Health WC |
$6,914.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4,881.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,426.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,099.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,952.40
|
| Rate for Payer: Multiplan Commercial |
$6,508.00
|
| Rate for Payer: Networks By Design Commercial |
$5,287.75
|
| Rate for Payer: Prime Health Services Commercial |
$6,914.75
|
|
|
HC ANGIOGRAPH ADRENAL UNILAT
|
Facility
|
OP
|
$8,135.00
|
|
|
Service Code
|
CPT 75731
|
| Hospital Charge Code |
909081574
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$264.99 |
| Max. Negotiated Rate |
$6,914.75 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,130.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,271.14
|
| Rate for Payer: Blue Distinction Transplant |
$4,881.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,807.78
|
| Rate for Payer: Blue Shield of California EPN |
$3,815.32
|
| Rate for Payer: Cash Price |
$3,660.75
|
| Rate for Payer: Cash Price |
$3,660.75
|
| Rate for Payer: Cigna of CA HMO |
$5,206.40
|
| Rate for Payer: Cigna of CA PPO |
$6,019.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Media |
$3,982.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,376.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,982.55
|
| Rate for Payer: Galaxy Health WC |
$6,914.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4,881.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6,101.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,531.38
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,531.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6,451.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$6,451.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,982.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,426.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$264.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,982.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,952.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,018.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,336.62
|
| Rate for Payer: Multiplan Commercial |
$6,508.00
|
| Rate for Payer: Networks By Design Commercial |
$5,287.75
|
| Rate for Payer: Prime Health Services Commercial |
$6,914.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,881.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,881.00
|
| 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 |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC ANGIOGRAPH EXT CAROTID UNILAT
|
Facility
|
IP
|
$21,162.00
|
|
|
Service Code
|
CPT 36227
|
| Hospital Charge Code |
909081608
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,078.88 |
| Max. Negotiated Rate |
$17,987.70 |
| Rate for Payer: Cash Price |
$9,522.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,464.80
|
| Rate for Payer: Galaxy Health WC |
$17,987.70
|
| Rate for Payer: Global Benefits Group Commercial |
$12,697.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,115.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,062.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,078.88
|
| Rate for Payer: Multiplan Commercial |
$16,929.60
|
| Rate for Payer: Networks By Design Commercial |
$13,755.30
|
| Rate for Payer: Prime Health Services Commercial |
$17,987.70
|
|
|
HC ANGIOGRAPH EXT CAROTID UNILAT
|
Facility
|
OP
|
$21,162.00
|
|
|
Service Code
|
CPT 36227
|
| Hospital Charge Code |
909081608
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$168.36 |
| Max. Negotiated Rate |
$17,987.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17,987.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11,639.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11,639.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: Blue Distinction Transplant |
$12,697.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$9,522.90
|
| Rate for Payer: Cash Price |
$9,522.90
|
| Rate for Payer: Cigna of CA PPO |
$15,659.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17,987.70
|
| Rate for Payer: Dignity Health Media |
$17,987.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$17,987.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,464.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$8,464.80
|
| Rate for Payer: Galaxy Health WC |
$17,987.70
|
| Rate for Payer: Global Benefits Group Commercial |
$12,697.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$15,871.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,115.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$168.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,078.88
|
| Rate for Payer: Multiplan Commercial |
$16,929.60
|
| Rate for Payer: Networks By Design Commercial |
$13,755.30
|
| Rate for Payer: Prime Health Services Commercial |
$17,987.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12,697.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17,987.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17,987.70
|
| Rate for Payer: Vantage Medical Group Senior |
$17,987.70
|
|
|
HC ANGIOGRAPH EXTREMITY BILAT
|
Facility
|
IP
|
$13,136.00
|
|
|
Service Code
|
CPT 75716
|
| Hospital Charge Code |
909081619
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$3,152.64 |
| Max. Negotiated Rate |
$11,165.60 |
| Rate for Payer: Cash Price |
$5,911.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,254.40
|
| Rate for Payer: Galaxy Health WC |
$11,165.60
|
| Rate for Payer: Global Benefits Group Commercial |
$7,881.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,761.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,004.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,152.64
|
| Rate for Payer: Multiplan Commercial |
$10,508.80
|
| Rate for Payer: Networks By Design Commercial |
$8,538.40
|
| Rate for Payer: Prime Health Services Commercial |
$11,165.60
|
|
|
HC ANGIOGRAPH EXTREMITY BILAT
|
Facility
|
OP
|
$13,136.00
|
|
|
Service Code
|
CPT 75716
|
| Hospital Charge Code |
909081619
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$279.28 |
| Max. Negotiated Rate |
$11,165.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,299.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,289.13
|
| Rate for Payer: Blue Distinction Transplant |
$7,881.60
|
| Rate for Payer: Blue Shield of California Commercial |
$7,763.38
|
| Rate for Payer: Blue Shield of California EPN |
$6,160.78
|
| Rate for Payer: Cash Price |
$5,911.20
|
| Rate for Payer: Cash Price |
$5,911.20
|
| Rate for Payer: Cigna of CA HMO |
$8,407.04
|
| Rate for Payer: Cigna of CA PPO |
$9,720.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Media |
$3,982.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,376.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,982.55
|
| Rate for Payer: Galaxy Health WC |
$11,165.60
|
| Rate for Payer: Global Benefits Group Commercial |
$7,881.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9,852.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,531.38
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,531.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6,451.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$6,451.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,982.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,761.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$279.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,982.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,152.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,018.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,336.62
|
| Rate for Payer: Multiplan Commercial |
$10,508.80
|
| Rate for Payer: Networks By Design Commercial |
$8,538.40
|
| Rate for Payer: Prime Health Services Commercial |
$11,165.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,881.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,881.60
|
| 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: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
