|
HC ANGIOGRAPH EXTREMITY UNILAT
|
Facility
|
OP
|
$11,282.00
|
|
|
Service Code
|
CPT 75710
|
| Hospital Charge Code |
909081572
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$258.67 |
| Max. Negotiated Rate |
$9,589.70 |
| 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 |
$6,769.20
|
| Rate for Payer: Blue Shield of California Commercial |
$6,667.66
|
| Rate for Payer: Blue Shield of California EPN |
$5,291.26
|
| Rate for Payer: Cash Price |
$5,076.90
|
| Rate for Payer: Cash Price |
$5,076.90
|
| Rate for Payer: Cigna of CA HMO |
$7,220.48
|
| Rate for Payer: Cigna of CA PPO |
$8,348.68
|
| 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 |
$9,589.70
|
| Rate for Payer: Global Benefits Group Commercial |
$6,769.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8,461.50
|
| 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 |
$7,525.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$258.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,982.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,707.68
|
| 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 |
$9,025.60
|
| Rate for Payer: Networks By Design Commercial |
$7,333.30
|
| Rate for Payer: Prime Health Services Commercial |
$9,589.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,769.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,769.20
|
| 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 |
$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 EXTREMITY UNILAT
|
Facility
|
IP
|
$11,282.00
|
|
|
Service Code
|
CPT 75710
|
| Hospital Charge Code |
909081572
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$2,707.68 |
| Max. Negotiated Rate |
$9,589.70 |
| Rate for Payer: Cash Price |
$5,076.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,512.80
|
| Rate for Payer: Galaxy Health WC |
$9,589.70
|
| Rate for Payer: Global Benefits Group Commercial |
$6,769.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,525.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,298.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,707.68
|
| Rate for Payer: Multiplan Commercial |
$9,025.60
|
| Rate for Payer: Networks By Design Commercial |
$7,333.30
|
| Rate for Payer: Prime Health Services Commercial |
$9,589.70
|
|
|
HC ANGIOGRAPH INTERNAL MAMMARY
|
Facility
|
OP
|
$11,948.00
|
|
|
Service Code
|
CPT 75756
|
| Hospital Charge Code |
909081576
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$276.24 |
| Max. Negotiated Rate |
$10,155.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,133.07
|
| 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 |
$7,168.80
|
| Rate for Payer: Blue Shield of California Commercial |
$7,061.27
|
| Rate for Payer: Blue Shield of California EPN |
$5,603.61
|
| Rate for Payer: Cash Price |
$5,376.60
|
| Rate for Payer: Cash Price |
$5,376.60
|
| Rate for Payer: Cigna of CA HMO |
$7,646.72
|
| Rate for Payer: Cigna of CA PPO |
$8,841.52
|
| 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 |
$10,155.80
|
| Rate for Payer: Global Benefits Group Commercial |
$7,168.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8,961.00
|
| 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 |
$7,969.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$276.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,982.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,867.52
|
| 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 |
$9,558.40
|
| Rate for Payer: Networks By Design Commercial |
$7,766.20
|
| Rate for Payer: Prime Health Services Commercial |
$10,155.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,168.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,168.80
|
| 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: 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 INTERNAL MAMMARY
|
Facility
|
IP
|
$11,948.00
|
|
|
Service Code
|
CPT 75756
|
| Hospital Charge Code |
909081576
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$2,867.52 |
| Max. Negotiated Rate |
$10,155.80 |
| Rate for Payer: Cash Price |
$5,376.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,779.20
|
| Rate for Payer: Galaxy Health WC |
$10,155.80
|
| Rate for Payer: Global Benefits Group Commercial |
$7,168.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,969.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,552.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,867.52
|
| Rate for Payer: Multiplan Commercial |
$9,558.40
|
| Rate for Payer: Networks By Design Commercial |
$7,766.20
|
| Rate for Payer: Prime Health Services Commercial |
$10,155.80
|
|
|
HC ANGIOGRAPH PULMONARY BILAT
|
Facility
|
IP
|
$11,597.00
|
|
|
Service Code
|
CPT 75743
|
| Hospital Charge Code |
909081627
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$2,783.28 |
| Max. Negotiated Rate |
$9,857.45 |
| Rate for Payer: Cash Price |
$5,218.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,638.80
|
| Rate for Payer: Galaxy Health WC |
$9,857.45
|
| Rate for Payer: Global Benefits Group Commercial |
$6,958.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,735.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,418.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,783.28
|
| Rate for Payer: Multiplan Commercial |
$9,277.60
|
| Rate for Payer: Networks By Design Commercial |
$7,538.05
|
| Rate for Payer: Prime Health Services Commercial |
$9,857.45
|
|
|
HC ANGIOGRAPH PULMONARY BILAT
|
Facility
|
OP
|
$11,597.00
|
|
|
Service Code
|
CPT 75743
|
| Hospital Charge Code |
909081627
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$255.63 |
| Max. Negotiated Rate |
$9,857.45 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,033.51
|
| 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 |
$6,958.20
|
| Rate for Payer: Blue Shield of California Commercial |
$6,853.83
|
| Rate for Payer: Blue Shield of California EPN |
$5,438.99
|
| Rate for Payer: Cash Price |
$5,218.65
|
| Rate for Payer: Cash Price |
$5,218.65
|
| Rate for Payer: Cigna of CA HMO |
$7,422.08
|
| Rate for Payer: Cigna of CA PPO |
$8,581.78
|
| 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 |
$9,857.45
|
| Rate for Payer: Global Benefits Group Commercial |
$6,958.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8,697.75
|
| 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 |
$7,735.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$255.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,982.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,783.28
|
| 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 |
$9,277.60
|
| Rate for Payer: Networks By Design Commercial |
$7,538.05
|
| Rate for Payer: Prime Health Services Commercial |
$9,857.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,958.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,958.20
|
| 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 |
$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 PULMONARY UNILAT
|
Facility
|
IP
|
$7,731.00
|
|
|
Service Code
|
CPT 75741
|
| Hospital Charge Code |
909081575
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$1,855.44 |
| Max. Negotiated Rate |
$6,571.35 |
| Rate for Payer: Cash Price |
$3,478.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,092.40
|
| Rate for Payer: Galaxy Health WC |
$6,571.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4,638.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,156.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,945.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,855.44
|
| Rate for Payer: Multiplan Commercial |
$6,184.80
|
| Rate for Payer: Networks By Design Commercial |
$5,025.15
|
| Rate for Payer: Prime Health Services Commercial |
$6,571.35
|
|
|
HC ANGIOGRAPH PULMONARY UNILAT
|
Facility
|
OP
|
$7,731.00
|
|
|
Service Code
|
CPT 75741
|
| Hospital Charge Code |
909081575
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$226.16 |
| Max. Negotiated Rate |
$6,571.35 |
| Rate for Payer: Aetna of CA HMO/PPO |
$979.43
|
| 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 |
$3,271.07
|
| Rate for Payer: Blue Distinction Transplant |
$4,638.60
|
| Rate for Payer: Blue Shield of California Commercial |
$4,569.02
|
| Rate for Payer: Blue Shield of California EPN |
$3,625.84
|
| Rate for Payer: Cash Price |
$3,478.95
|
| Rate for Payer: Cash Price |
$3,478.95
|
| Rate for Payer: Cigna of CA HMO |
$4,947.84
|
| Rate for Payer: Cigna of CA PPO |
$5,720.94
|
| 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 |
$6,571.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4,638.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,798.25
|
| 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 |
$5,156.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$226.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,982.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,855.44
|
| 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 |
$6,184.80
|
| Rate for Payer: Networks By Design Commercial |
$5,025.15
|
| Rate for Payer: Prime Health Services Commercial |
$6,571.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,638.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,638.60
|
| 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
|
|
|
HC ANGIOGRAPH PULMONARY VENOUS INJ
|
Facility
|
IP
|
$11,948.00
|
|
|
Service Code
|
CPT 75746
|
| Hospital Charge Code |
909081628
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$2,867.52 |
| Max. Negotiated Rate |
$10,155.80 |
| Rate for Payer: Cash Price |
$5,376.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,779.20
|
| Rate for Payer: Galaxy Health WC |
$10,155.80
|
| Rate for Payer: Global Benefits Group Commercial |
$7,168.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,969.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,552.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,867.52
|
| Rate for Payer: Multiplan Commercial |
$9,558.40
|
| Rate for Payer: Networks By Design Commercial |
$7,766.20
|
| Rate for Payer: Prime Health Services Commercial |
$10,155.80
|
|
|
HC ANGIOGRAPH PULMONARY VENOUS INJ
|
Facility
|
OP
|
$11,948.00
|
|
|
Service Code
|
CPT 75746
|
| Hospital Charge Code |
909081628
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$233.26 |
| Max. Negotiated Rate |
$10,155.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,065.98
|
| 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 |
$3,289.19
|
| Rate for Payer: Blue Distinction Transplant |
$7,168.80
|
| Rate for Payer: Blue Shield of California Commercial |
$7,061.27
|
| Rate for Payer: Blue Shield of California EPN |
$5,603.61
|
| Rate for Payer: Cash Price |
$5,376.60
|
| Rate for Payer: Cash Price |
$5,376.60
|
| Rate for Payer: Cigna of CA HMO |
$7,646.72
|
| Rate for Payer: Cigna of CA PPO |
$8,841.52
|
| 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 |
$10,155.80
|
| Rate for Payer: Global Benefits Group Commercial |
$7,168.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8,961.00
|
| 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 |
$7,969.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$233.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,982.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,867.52
|
| 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 |
$9,558.40
|
| Rate for Payer: Networks By Design Commercial |
$7,766.20
|
| Rate for Payer: Prime Health Services Commercial |
$10,155.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,168.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,168.80
|
| 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: 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 SPINAL
|
Facility
|
OP
|
$16,220.00
|
|
|
Service Code
|
CPT 75705
|
| Hospital Charge Code |
909081617
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$401.58 |
| Max. Negotiated Rate |
$13,787.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,126.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,552.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,866.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,289.13
|
| Rate for Payer: Blue Distinction Transplant |
$9,732.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,586.02
|
| Rate for Payer: Blue Shield of California EPN |
$7,607.18
|
| Rate for Payer: Cash Price |
$7,299.00
|
| Rate for Payer: Cash Price |
$7,299.00
|
| Rate for Payer: Cigna of CA HMO |
$10,380.80
|
| Rate for Payer: Cigna of CA PPO |
$12,002.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Dignity Health Media |
$6,866.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,552.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,269.19
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$6,866.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$6,866.07
|
| Rate for Payer: Galaxy Health WC |
$13,787.00
|
| Rate for Payer: Global Benefits Group Commercial |
$9,732.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$12,165.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,260.35
|
| Rate for Payer: Heritage Provider Network Transplant |
$11,260.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11,123.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$11,123.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,866.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,818.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$401.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,866.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,892.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,651.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,200.53
|
| Rate for Payer: Multiplan Commercial |
$12,976.00
|
| Rate for Payer: Networks By Design Commercial |
$10,543.00
|
| Rate for Payer: Prime Health Services Commercial |
$13,787.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,732.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,732.00
|
| 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 |
$10,299.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,552.68
|
| Rate for Payer: Vantage Medical Group Senior |
$6,866.07
|
|
|
HC ANGIOGRAPH SPINAL
|
Facility
|
IP
|
$16,220.00
|
|
|
Service Code
|
CPT 75705
|
| Hospital Charge Code |
909081617
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$3,892.80 |
| Max. Negotiated Rate |
$13,787.00 |
| Rate for Payer: Cash Price |
$7,299.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,488.00
|
| Rate for Payer: Galaxy Health WC |
$13,787.00
|
| Rate for Payer: Global Benefits Group Commercial |
$9,732.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,818.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,179.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,892.80
|
| Rate for Payer: Multiplan Commercial |
$12,976.00
|
| Rate for Payer: Networks By Design Commercial |
$10,543.00
|
| Rate for Payer: Prime Health Services Commercial |
$13,787.00
|
|
|
HC ANGIOGRAPH VISCERAL BASIC
|
Facility
|
OP
|
$14,102.00
|
|
|
Service Code
|
CPT 75726
|
| Hospital Charge Code |
909081622
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$247.49 |
| Max. Negotiated Rate |
$11,986.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,113.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,552.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,866.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,271.14
|
| Rate for Payer: Blue Distinction Transplant |
$8,461.20
|
| Rate for Payer: Blue Shield of California Commercial |
$8,334.28
|
| Rate for Payer: Blue Shield of California EPN |
$6,613.84
|
| Rate for Payer: Cash Price |
$6,345.90
|
| Rate for Payer: Cash Price |
$6,345.90
|
| Rate for Payer: Cigna of CA HMO |
$9,025.28
|
| Rate for Payer: Cigna of CA PPO |
$10,435.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Dignity Health Media |
$6,866.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,552.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,269.19
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$6,866.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$6,866.07
|
| Rate for Payer: Galaxy Health WC |
$11,986.70
|
| Rate for Payer: Global Benefits Group Commercial |
$8,461.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$10,576.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,260.35
|
| Rate for Payer: Heritage Provider Network Transplant |
$11,260.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11,123.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$11,123.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,866.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,406.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$247.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,866.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,384.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,651.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,200.53
|
| Rate for Payer: Multiplan Commercial |
$11,281.60
|
| Rate for Payer: Networks By Design Commercial |
$9,166.30
|
| Rate for Payer: Prime Health Services Commercial |
$11,986.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,461.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8,461.20
|
| 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 |
$10,299.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,552.68
|
| Rate for Payer: Vantage Medical Group Senior |
$6,866.07
|
|
|
HC ANGIOGRAPH VISCERAL BASIC
|
Facility
|
IP
|
$14,102.00
|
|
|
Service Code
|
CPT 75726
|
| Hospital Charge Code |
909081622
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$3,384.48 |
| Max. Negotiated Rate |
$11,986.70 |
| Rate for Payer: Cash Price |
$6,345.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,640.80
|
| Rate for Payer: Galaxy Health WC |
$11,986.70
|
| Rate for Payer: Global Benefits Group Commercial |
$8,461.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,406.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,372.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,384.48
|
| Rate for Payer: Multiplan Commercial |
$11,281.60
|
| Rate for Payer: Networks By Design Commercial |
$9,166.30
|
| Rate for Payer: Prime Health Services Commercial |
$11,986.70
|
|
|
HC ANGIO LV/OR LA
|
Facility
|
OP
|
$2,194.00
|
|
|
Service Code
|
CPT 93565
|
| Hospital Charge Code |
906811414
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$68.46 |
| Max. Negotiated Rate |
$6,668.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,411.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,864.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,206.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,206.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,316.40
|
| 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 |
$987.30
|
| Rate for Payer: Cash Price |
$987.30
|
| Rate for Payer: Cash Price |
$987.30
|
| Rate for Payer: Cigna of CA PPO |
$1,623.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,864.90
|
| Rate for Payer: Dignity Health Media |
$1,864.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,864.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$877.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$877.60
|
| Rate for Payer: Galaxy Health WC |
$1,864.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,316.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,645.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,463.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$526.56
|
| Rate for Payer: Multiplan Commercial |
$1,755.20
|
| Rate for Payer: Networks By Design Commercial |
$1,426.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,864.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,316.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,316.40
|
| 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 |
$1,864.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,864.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1,864.90
|
|
|
HC ANGIO LV/OR LA
|
Facility
|
IP
|
$2,194.00
|
|
|
Service Code
|
CPT 93565
|
| Hospital Charge Code |
906811414
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$526.56 |
| Max. Negotiated Rate |
$1,864.90 |
| Rate for Payer: Cash Price |
$987.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$877.60
|
| Rate for Payer: Galaxy Health WC |
$1,864.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,316.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,463.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$835.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$526.56
|
| Rate for Payer: Multiplan Commercial |
$1,755.20
|
| Rate for Payer: Networks By Design Commercial |
$1,426.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,864.90
|
|
|
HC ANGIOPLASTY INTRACRANIAL
|
Facility
|
OP
|
$6,497.00
|
|
|
Service Code
|
CPT 61630
|
| Hospital Charge Code |
909081013
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,559.28 |
| Max. Negotiated Rate |
$8,049.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,556.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,522.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,573.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,573.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,049.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,898.20
|
| 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 |
$2,923.65
|
| Rate for Payer: Cash Price |
$2,923.65
|
| Rate for Payer: Cash Price |
$2,923.65
|
| Rate for Payer: Cigna of CA PPO |
$4,807.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,522.45
|
| Rate for Payer: Dignity Health Media |
$5,522.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,522.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,598.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,598.80
|
| Rate for Payer: Galaxy Health WC |
$5,522.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,898.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,872.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,333.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,559.28
|
| Rate for Payer: Multiplan Commercial |
$5,197.60
|
| Rate for Payer: Networks By Design Commercial |
$4,223.05
|
| Rate for Payer: Prime Health Services Commercial |
$5,522.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,898.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,522.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,522.45
|
| Rate for Payer: Vantage Medical Group Senior |
$5,522.45
|
|
|
HC ANGIOPLASTY INTRACRANIAL
|
Facility
|
IP
|
$6,497.00
|
|
|
Service Code
|
CPT 61630
|
| Hospital Charge Code |
909081013
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,559.28 |
| Max. Negotiated Rate |
$5,522.45 |
| Rate for Payer: Cash Price |
$2,923.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,598.80
|
| Rate for Payer: Galaxy Health WC |
$5,522.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,898.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,333.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,475.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,559.28
|
| Rate for Payer: Multiplan Commercial |
$5,197.60
|
| Rate for Payer: Networks By Design Commercial |
$4,223.05
|
| Rate for Payer: Prime Health Services Commercial |
$5,522.45
|
|
|
HC ANGIO RV/OR RA
|
Facility
|
IP
|
$1,956.00
|
|
|
Service Code
|
CPT 93566
|
| Hospital Charge Code |
906811415
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$469.44 |
| Max. Negotiated Rate |
$1,662.60 |
| Rate for Payer: Cash Price |
$880.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$782.40
|
| Rate for Payer: Galaxy Health WC |
$1,662.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,173.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,304.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$745.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$469.44
|
| Rate for Payer: Multiplan Commercial |
$1,564.80
|
| Rate for Payer: Networks By Design Commercial |
$1,271.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,662.60
|
|
|
HC ANGIO RV/OR RA
|
Facility
|
OP
|
$1,956.00
|
|
|
Service Code
|
CPT 93566
|
| Hospital Charge Code |
906811415
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$293.91 |
| Max. Negotiated Rate |
$6,668.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,258.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,662.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,075.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,075.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,173.60
|
| 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 |
$880.20
|
| Rate for Payer: Cash Price |
$880.20
|
| Rate for Payer: Cash Price |
$880.20
|
| Rate for Payer: Cigna of CA PPO |
$1,447.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,662.60
|
| Rate for Payer: Dignity Health Media |
$1,662.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,662.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$782.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$782.40
|
| Rate for Payer: Galaxy Health WC |
$1,662.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,173.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,467.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,304.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$293.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$469.44
|
| Rate for Payer: Multiplan Commercial |
$1,564.80
|
| Rate for Payer: Networks By Design Commercial |
$1,271.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,662.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,173.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,173.60
|
| 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 |
$1,662.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,662.60
|
| Rate for Payer: Vantage Medical Group Senior |
$1,662.60
|
|
|
HC ANKLE ARTHROGRAPHY INJECTION
|
Facility
|
OP
|
$455.00
|
|
|
Service Code
|
CPT 27648
|
| Hospital Charge Code |
909000118
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$109.20 |
| Max. Negotiated Rate |
$6,668.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$386.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$250.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$250.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$273.00
|
| 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 |
$204.75
|
| Rate for Payer: Cash Price |
$204.75
|
| Rate for Payer: Cash Price |
$204.75
|
| Rate for Payer: Cigna of CA PPO |
$336.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$386.75
|
| Rate for Payer: Dignity Health Media |
$386.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$386.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$182.00
|
| Rate for Payer: Galaxy Health WC |
$386.75
|
| Rate for Payer: Global Benefits Group Commercial |
$273.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$341.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$303.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$304.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$109.20
|
| Rate for Payer: Multiplan Commercial |
$364.00
|
| Rate for Payer: Networks By Design Commercial |
$295.75
|
| Rate for Payer: Prime Health Services Commercial |
$386.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$273.00
|
| 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 |
$386.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$386.75
|
| Rate for Payer: Vantage Medical Group Senior |
$386.75
|
|
|
HC ANKLE ARTHROGRAPHY INJECTION
|
Facility
|
IP
|
$455.00
|
|
|
Service Code
|
CPT 27648
|
| Hospital Charge Code |
909000118
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$109.20 |
| Max. Negotiated Rate |
$386.75 |
| Rate for Payer: Blue Shield of California Commercial |
$323.96
|
| Rate for Payer: Blue Shield of California EPN |
$232.96
|
| Rate for Payer: Cash Price |
$204.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.00
|
| Rate for Payer: Galaxy Health WC |
$386.75
|
| Rate for Payer: Global Benefits Group Commercial |
$273.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$303.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$173.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$109.20
|
| Rate for Payer: Multiplan Commercial |
$364.00
|
| Rate for Payer: Networks By Design Commercial |
$295.75
|
| Rate for Payer: Prime Health Services Commercial |
$386.75
|
|
|
HC ANKLE COMPLETE
|
Facility
|
IP
|
$930.00
|
|
|
Service Code
|
CPT 73610
|
| Hospital Charge Code |
909001648
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$223.20 |
| Max. Negotiated Rate |
$790.50 |
| Rate for Payer: Cash Price |
$418.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$372.00
|
| Rate for Payer: Galaxy Health WC |
$790.50
|
| Rate for Payer: Global Benefits Group Commercial |
$558.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$620.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$354.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$223.20
|
| Rate for Payer: Multiplan Commercial |
$744.00
|
| Rate for Payer: Networks By Design Commercial |
$604.50
|
| Rate for Payer: Prime Health Services Commercial |
$790.50
|
|
|
HC ANKLE COMPLETE
|
Facility
|
OP
|
$930.00
|
|
|
Service Code
|
CPT 73610
|
| Hospital Charge Code |
909001648
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$47.77 |
| Max. Negotiated Rate |
$790.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$152.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$113.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$138.45
|
| Rate for Payer: Blue Distinction Transplant |
$558.00
|
| Rate for Payer: Blue Shield of California Commercial |
$549.63
|
| Rate for Payer: Blue Shield of California EPN |
$436.17
|
| Rate for Payer: Cash Price |
$418.50
|
| Rate for Payer: Cash Price |
$418.50
|
| Rate for Payer: Cigna of CA HMO |
$595.20
|
| Rate for Payer: Cigna of CA PPO |
$688.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.31
|
| Rate for Payer: Dignity Health Media |
$113.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.28
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$113.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$113.54
|
| Rate for Payer: Galaxy Health WC |
$790.50
|
| Rate for Payer: Global Benefits Group Commercial |
$558.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$697.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$186.21
|
| Rate for Payer: Heritage Provider Network Transplant |
$186.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$183.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$183.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$113.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$620.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$223.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$143.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$152.14
|
| Rate for Payer: Multiplan Commercial |
$744.00
|
| Rate for Payer: Networks By Design Commercial |
$604.50
|
| Rate for Payer: Prime Health Services Commercial |
$790.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$558.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$558.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Vantage Medical Group Senior |
$113.54
|
|
|
HC ANKLE LIMITED
|
Facility
|
IP
|
$794.00
|
|
|
Service Code
|
CPT 73600
|
| Hospital Charge Code |
909001642
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$190.56 |
| Max. Negotiated Rate |
$674.90 |
| Rate for Payer: Cash Price |
$357.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$317.60
|
| Rate for Payer: Galaxy Health WC |
$674.90
|
| Rate for Payer: Global Benefits Group Commercial |
$476.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$529.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$302.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.56
|
| Rate for Payer: Multiplan Commercial |
$635.20
|
| Rate for Payer: Networks By Design Commercial |
$516.10
|
| Rate for Payer: Prime Health Services Commercial |
$674.90
|
|
