|
HC ANGIO CORONARY
|
Facility
|
IP
|
$3,029.00
|
|
|
Service Code
|
CPT 93563
|
| Hospital Charge Code |
906820069
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$605.80 |
| Max. Negotiated Rate |
$2,574.65 |
| Rate for Payer: Adventist Health Commercial |
$605.80
|
| Rate for Payer: Cash Price |
$1,363.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,211.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,211.60
|
| Rate for Payer: Galaxy Health WC |
$2,574.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,817.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,020.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,154.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,874.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$726.96
|
| Rate for Payer: Multiplan Commercial |
$2,423.20
|
| Rate for Payer: Networks By Design Commercial |
$1,968.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,574.65
|
|
|
HC ANGIO CORONARY
|
Facility
|
OP
|
$3,029.00
|
|
|
Service Code
|
CPT 93563
|
| Hospital Charge Code |
906820069
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$78.79 |
| Max. Negotiated Rate |
$6,906.11 |
| Rate for Payer: Adventist Health Commercial |
$605.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,574.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,665.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,271.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$1,363.05
|
| Rate for Payer: Cash Price |
$1,363.05
|
| Rate for Payer: Cash Price |
$1,363.05
|
| Rate for Payer: Cigna of CA HMO |
$1,968.85
|
| Rate for Payer: Cigna of CA PPO |
$2,241.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,574.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,574.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,574.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,211.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,211.60
|
| Rate for Payer: Galaxy Health WC |
$2,574.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,817.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$78.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,020.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,874.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$726.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,120.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,120.30
|
| Rate for Payer: Multiplan Commercial |
$2,423.20
|
| Rate for Payer: Networks By Design Commercial |
$1,968.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,574.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,817.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,817.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,574.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,574.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,574.65
|
|
|
HC ANGIO CORONARY
|
Facility
|
OP
|
$3,116.00
|
|
|
Service Code
|
CPT 93563
|
| Hospital Charge Code |
906811412
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$78.79 |
| Max. Negotiated Rate |
$6,906.11 |
| Rate for Payer: Adventist Health Commercial |
$623.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,648.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,713.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,337.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$1,402.20
|
| Rate for Payer: Cash Price |
$1,402.20
|
| Rate for Payer: Cash Price |
$1,402.20
|
| Rate for Payer: Cigna of CA HMO |
$2,025.40
|
| Rate for Payer: Cigna of CA PPO |
$2,305.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,648.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,648.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,648.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,246.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,246.40
|
| Rate for Payer: Galaxy Health WC |
$2,648.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,869.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$78.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,078.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,928.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$747.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,181.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,181.20
|
| Rate for Payer: Multiplan Commercial |
$2,492.80
|
| Rate for Payer: Networks By Design Commercial |
$2,025.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,648.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,869.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,869.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,648.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,648.60
|
| Rate for Payer: Vantage Medical Group Senior |
$2,648.60
|
|
|
HC ANGIOGRAPH ADRENAL BILAT
|
Facility
|
OP
|
$10,556.00
|
|
|
Service Code
|
CPT 75733
|
| Hospital Charge Code |
909081624
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$260.05 |
| Max. Negotiated Rate |
$8,972.60 |
| Rate for Payer: Adventist Health Commercial |
$2,111.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,923.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,560.78
|
| Rate for Payer: Blue Shield of California Commercial |
$6,460.27
|
| Rate for Payer: Blue Shield of California EPN |
$4,264.62
|
| Rate for Payer: Cash Price |
$4,750.20
|
| Rate for Payer: Cash Price |
$4,750.20
|
| Rate for Payer: Cigna of CA HMO |
$6,755.84
|
| Rate for Payer: Cigna of CA PPO |
$7,811.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,398.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3,999.21
|
| Rate for Payer: Galaxy Health WC |
$8,972.60
|
| Rate for Payer: Global Benefits Group Commercial |
$6,333.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$260.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,040.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$294.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,533.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,039.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,358.94
|
| Rate for Payer: Multiplan Commercial |
$8,444.80
|
| Rate for Payer: Networks By Design Commercial |
$6,861.40
|
| Rate for Payer: Prime Health Services Commercial |
$8,972.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,333.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,333.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,341.78
|
| Rate for Payer: United Healthcare All Other HMO |
$5,341.78
|
| Rate for Payer: United Healthcare HMO Rider |
$5,341.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,341.78
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,999.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC ANGIOGRAPH ADRENAL BILAT
|
Facility
|
IP
|
$10,556.00
|
|
|
Service Code
|
CPT 75733
|
| Hospital Charge Code |
909081624
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$2,111.20 |
| Max. Negotiated Rate |
$8,972.60 |
| Rate for Payer: Adventist Health Commercial |
$2,111.20
|
| Rate for Payer: Cash Price |
$4,750.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,222.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,222.40
|
| Rate for Payer: Galaxy Health WC |
$8,972.60
|
| Rate for Payer: Global Benefits Group Commercial |
$6,333.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,040.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,021.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,534.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,533.44
|
| Rate for Payer: Multiplan Commercial |
$8,444.80
|
| Rate for Payer: Networks By Design Commercial |
$6,861.40
|
| Rate for Payer: Prime Health Services Commercial |
$8,972.60
|
|
|
HC ANGIOGRAPH ADRENAL UNILAT
|
Facility
|
OP
|
$6,915.00
|
|
|
Service Code
|
CPT 75731
|
| Hospital Charge Code |
909081574
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$234.31 |
| Max. Negotiated Rate |
$6,558.70 |
| Rate for Payer: Adventist Health Commercial |
$1,383.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4,535.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,541.30
|
| Rate for Payer: Blue Shield of California Commercial |
$4,231.98
|
| Rate for Payer: Blue Shield of California EPN |
$2,793.66
|
| Rate for Payer: Cash Price |
$3,111.75
|
| Rate for Payer: Cash Price |
$3,111.75
|
| Rate for Payer: Cigna of CA HMO |
$4,425.60
|
| Rate for Payer: Cigna of CA PPO |
$5,117.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,398.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3,999.21
|
| Rate for Payer: Galaxy Health WC |
$5,877.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4,149.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$234.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,612.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$264.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,659.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,039.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,358.94
|
| Rate for Payer: Multiplan Commercial |
$5,532.00
|
| Rate for Payer: Networks By Design Commercial |
$4,494.75
|
| Rate for Payer: Prime Health Services Commercial |
$5,877.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,149.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,149.00
|
| 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: Upland Medical Group Pediatric |
$3,999.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC ANGIOGRAPH ADRENAL UNILAT
|
Facility
|
IP
|
$6,915.00
|
|
|
Service Code
|
CPT 75731
|
| Hospital Charge Code |
909081574
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$1,383.00 |
| Max. Negotiated Rate |
$5,877.75 |
| Rate for Payer: Adventist Health Commercial |
$1,383.00
|
| Rate for Payer: Cash Price |
$3,111.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,766.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,766.00
|
| Rate for Payer: Galaxy Health WC |
$5,877.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4,149.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,612.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,634.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,280.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,659.60
|
| Rate for Payer: Multiplan Commercial |
$5,532.00
|
| Rate for Payer: Networks By Design Commercial |
$4,494.75
|
| Rate for Payer: Prime Health Services Commercial |
$5,877.75
|
|
|
HC ANGIOGRAPH EXT CAROTID UNILAT
|
Facility
|
IP
|
$17,988.00
|
|
|
Service Code
|
CPT 36227
|
| Hospital Charge Code |
909081608
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,597.60 |
| Max. Negotiated Rate |
$15,289.80 |
| Rate for Payer: Adventist Health Commercial |
$3,597.60
|
| Rate for Payer: Cash Price |
$8,094.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,195.20
|
| Rate for Payer: EPIC Health Plan Senior |
$7,195.20
|
| Rate for Payer: Galaxy Health WC |
$15,289.80
|
| Rate for Payer: Global Benefits Group Commercial |
$10,792.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,998.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,853.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,134.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,317.12
|
| Rate for Payer: Multiplan Commercial |
$14,390.40
|
| Rate for Payer: Networks By Design Commercial |
$11,692.20
|
| Rate for Payer: Prime Health Services Commercial |
$15,289.80
|
|
|
HC ANGIOGRAPH EXT CAROTID UNILAT
|
Facility
|
OP
|
$17,988.00
|
|
|
Service Code
|
CPT 36227
|
| Hospital Charge Code |
909081608
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$148.86 |
| Max. Negotiated Rate |
$15,289.80 |
| Rate for Payer: Adventist Health Commercial |
$3,597.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15,289.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,893.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,491.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$8,094.60
|
| Rate for Payer: Cash Price |
$8,094.60
|
| Rate for Payer: Cash Price |
$8,094.60
|
| Rate for Payer: Cigna of CA HMO |
$11,512.32
|
| Rate for Payer: Cigna of CA PPO |
$13,311.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15,289.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,289.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15,289.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,195.20
|
| Rate for Payer: EPIC Health Plan Senior |
$7,195.20
|
| Rate for Payer: Galaxy Health WC |
$15,289.80
|
| Rate for Payer: Global Benefits Group Commercial |
$10,792.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$148.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,998.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$168.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,134.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,317.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12,591.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12,591.60
|
| Rate for Payer: Multiplan Commercial |
$14,390.40
|
| Rate for Payer: Networks By Design Commercial |
$11,692.20
|
| Rate for Payer: Prime Health Services Commercial |
$15,289.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,792.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15,289.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,289.80
|
| Rate for Payer: Vantage Medical Group Senior |
$15,289.80
|
|
|
HC ANGIOGRAPH EXTREMITY BILAT
|
Facility
|
IP
|
$15,106.00
|
|
|
Service Code
|
CPT 75716
|
| Hospital Charge Code |
906820191
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$3,021.20 |
| Max. Negotiated Rate |
$12,840.10 |
| Rate for Payer: Adventist Health Commercial |
$3,021.20
|
| Rate for Payer: Cash Price |
$6,797.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,042.40
|
| Rate for Payer: EPIC Health Plan Senior |
$6,042.40
|
| Rate for Payer: Galaxy Health WC |
$12,840.10
|
| Rate for Payer: Global Benefits Group Commercial |
$9,063.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,075.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,755.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,350.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,625.44
|
| Rate for Payer: Multiplan Commercial |
$12,084.80
|
| Rate for Payer: Networks By Design Commercial |
$9,818.90
|
| Rate for Payer: Prime Health Services Commercial |
$12,840.10
|
|
|
HC ANGIOGRAPH EXTREMITY BILAT
|
Facility
|
OP
|
$15,106.00
|
|
|
Service Code
|
CPT 75716
|
| Hospital Charge Code |
906820191
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$246.94 |
| Max. Negotiated Rate |
$12,840.10 |
| Rate for Payer: Adventist Health Commercial |
$3,021.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,908.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,560.78
|
| Rate for Payer: Blue Shield of California Commercial |
$9,244.87
|
| Rate for Payer: Blue Shield of California EPN |
$6,102.82
|
| Rate for Payer: Cash Price |
$6,797.70
|
| Rate for Payer: Cash Price |
$6,797.70
|
| Rate for Payer: Cigna of CA HMO |
$9,667.84
|
| Rate for Payer: Cigna of CA PPO |
$11,178.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,398.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3,999.21
|
| Rate for Payer: Galaxy Health WC |
$12,840.10
|
| Rate for Payer: Global Benefits Group Commercial |
$9,063.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$246.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,075.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$279.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,625.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,039.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,358.94
|
| Rate for Payer: Multiplan Commercial |
$12,084.80
|
| Rate for Payer: Networks By Design Commercial |
$9,818.90
|
| Rate for Payer: Prime Health Services Commercial |
$12,840.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,063.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,063.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,341.78
|
| Rate for Payer: United Healthcare All Other HMO |
$5,341.78
|
| Rate for Payer: United Healthcare HMO Rider |
$5,341.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,341.78
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,999.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC ANGIOGRAPH EXTREMITY BILAT
|
Facility
|
IP
|
$11,166.00
|
|
|
Service Code
|
CPT 75716
|
| Hospital Charge Code |
909081619
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$2,233.20 |
| Max. Negotiated Rate |
$9,491.10 |
| Rate for Payer: Adventist Health Commercial |
$2,233.20
|
| Rate for Payer: Cash Price |
$5,024.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,466.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,466.40
|
| Rate for Payer: Galaxy Health WC |
$9,491.10
|
| Rate for Payer: Global Benefits Group Commercial |
$6,699.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,447.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,254.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,911.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,679.84
|
| Rate for Payer: Multiplan Commercial |
$8,932.80
|
| Rate for Payer: Networks By Design Commercial |
$7,257.90
|
| Rate for Payer: Prime Health Services Commercial |
$9,491.10
|
|
|
HC ANGIOGRAPH EXTREMITY BILAT
|
Facility
|
OP
|
$11,166.00
|
|
|
Service Code
|
CPT 75716
|
| Hospital Charge Code |
909081619
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$246.94 |
| Max. Negotiated Rate |
$9,491.10 |
| Rate for Payer: Adventist Health Commercial |
$2,233.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,323.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,560.78
|
| Rate for Payer: Blue Shield of California Commercial |
$6,833.59
|
| Rate for Payer: Blue Shield of California EPN |
$4,511.06
|
| Rate for Payer: Cash Price |
$5,024.70
|
| Rate for Payer: Cash Price |
$5,024.70
|
| Rate for Payer: Cigna of CA HMO |
$7,146.24
|
| Rate for Payer: Cigna of CA PPO |
$8,262.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,398.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3,999.21
|
| Rate for Payer: Galaxy Health WC |
$9,491.10
|
| Rate for Payer: Global Benefits Group Commercial |
$6,699.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$246.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,447.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$279.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,679.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,039.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,358.94
|
| Rate for Payer: Multiplan Commercial |
$8,932.80
|
| Rate for Payer: Networks By Design Commercial |
$7,257.90
|
| Rate for Payer: Prime Health Services Commercial |
$9,491.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,699.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,699.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,341.78
|
| Rate for Payer: United Healthcare All Other HMO |
$5,341.78
|
| Rate for Payer: United Healthcare HMO Rider |
$5,341.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,341.78
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,999.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC ANGIOGRAPH EXTREMITY UNILAT
|
Facility
|
OP
|
$9,590.00
|
|
|
Service Code
|
CPT 75710
|
| Hospital Charge Code |
909081572
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$228.72 |
| Max. Negotiated Rate |
$8,151.50 |
| Rate for Payer: Adventist Health Commercial |
$1,918.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,290.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,541.30
|
| Rate for Payer: Blue Shield of California Commercial |
$5,869.08
|
| Rate for Payer: Blue Shield of California EPN |
$3,874.36
|
| Rate for Payer: Cash Price |
$4,315.50
|
| Rate for Payer: Cash Price |
$4,315.50
|
| Rate for Payer: Cigna of CA HMO |
$6,137.60
|
| Rate for Payer: Cigna of CA PPO |
$7,096.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,398.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3,999.21
|
| Rate for Payer: Galaxy Health WC |
$8,151.50
|
| Rate for Payer: Global Benefits Group Commercial |
$5,754.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$228.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,396.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$258.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,301.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,039.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,358.94
|
| Rate for Payer: Multiplan Commercial |
$7,672.00
|
| Rate for Payer: Networks By Design Commercial |
$6,233.50
|
| Rate for Payer: Prime Health Services Commercial |
$8,151.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,754.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,754.00
|
| 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: Upland Medical Group Pediatric |
$3,999.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC ANGIOGRAPH EXTREMITY UNILAT
|
Facility
|
OP
|
$12,974.00
|
|
|
Service Code
|
CPT 75710
|
| Hospital Charge Code |
906820184
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$228.72 |
| Max. Negotiated Rate |
$11,027.90 |
| Rate for Payer: Adventist Health Commercial |
$2,594.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,509.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,541.30
|
| Rate for Payer: Blue Shield of California Commercial |
$7,940.09
|
| Rate for Payer: Blue Shield of California EPN |
$5,241.50
|
| Rate for Payer: Cash Price |
$5,838.30
|
| Rate for Payer: Cash Price |
$5,838.30
|
| Rate for Payer: Cigna of CA HMO |
$8,303.36
|
| Rate for Payer: Cigna of CA PPO |
$9,600.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,398.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3,999.21
|
| Rate for Payer: Galaxy Health WC |
$11,027.90
|
| Rate for Payer: Global Benefits Group Commercial |
$7,784.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$228.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,653.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$258.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,113.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,039.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,358.94
|
| Rate for Payer: Multiplan Commercial |
$10,379.20
|
| Rate for Payer: Networks By Design Commercial |
$8,433.10
|
| Rate for Payer: Prime Health Services Commercial |
$11,027.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,784.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,784.40
|
| 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: Upland Medical Group Pediatric |
$3,999.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC ANGIOGRAPH EXTREMITY UNILAT
|
Facility
|
IP
|
$12,974.00
|
|
|
Service Code
|
CPT 75710
|
| Hospital Charge Code |
906820184
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$2,594.80 |
| Max. Negotiated Rate |
$11,027.90 |
| Rate for Payer: Adventist Health Commercial |
$2,594.80
|
| Rate for Payer: Cash Price |
$5,838.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,189.60
|
| Rate for Payer: EPIC Health Plan Senior |
$5,189.60
|
| Rate for Payer: Galaxy Health WC |
$11,027.90
|
| Rate for Payer: Global Benefits Group Commercial |
$7,784.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,653.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,943.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,030.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,113.76
|
| Rate for Payer: Multiplan Commercial |
$10,379.20
|
| Rate for Payer: Networks By Design Commercial |
$8,433.10
|
| Rate for Payer: Prime Health Services Commercial |
$11,027.90
|
|
|
HC ANGIOGRAPH EXTREMITY UNILAT
|
Facility
|
IP
|
$9,590.00
|
|
|
Service Code
|
CPT 75710
|
| Hospital Charge Code |
909081572
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$1,918.00 |
| Max. Negotiated Rate |
$8,151.50 |
| Rate for Payer: Adventist Health Commercial |
$1,918.00
|
| Rate for Payer: Cash Price |
$4,315.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,836.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,836.00
|
| Rate for Payer: Galaxy Health WC |
$8,151.50
|
| Rate for Payer: Global Benefits Group Commercial |
$5,754.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,396.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,653.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,936.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,301.60
|
| Rate for Payer: Multiplan Commercial |
$7,672.00
|
| Rate for Payer: Networks By Design Commercial |
$6,233.50
|
| Rate for Payer: Prime Health Services Commercial |
$8,151.50
|
|
|
HC ANGIOGRAPH INTERNAL MAMMARY
|
Facility
|
OP
|
$13,740.00
|
|
|
Service Code
|
CPT 75756
|
| Hospital Charge Code |
906820186
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$244.26 |
| Max. Negotiated Rate |
$11,679.00 |
| Rate for Payer: Adventist Health Commercial |
$2,748.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,012.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,541.30
|
| Rate for Payer: Blue Shield of California Commercial |
$8,408.88
|
| Rate for Payer: Blue Shield of California EPN |
$5,550.96
|
| Rate for Payer: Cash Price |
$6,183.00
|
| Rate for Payer: Cash Price |
$6,183.00
|
| Rate for Payer: Cigna of CA HMO |
$8,793.60
|
| Rate for Payer: Cigna of CA PPO |
$10,167.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,398.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3,999.21
|
| Rate for Payer: Galaxy Health WC |
$11,679.00
|
| Rate for Payer: Global Benefits Group Commercial |
$8,244.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$244.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,164.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$276.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,297.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,039.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,358.94
|
| Rate for Payer: Multiplan Commercial |
$10,992.00
|
| Rate for Payer: Networks By Design Commercial |
$8,931.00
|
| Rate for Payer: Prime Health Services Commercial |
$11,679.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,244.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8,244.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,688.24
|
| Rate for Payer: United Healthcare All Other HMO |
$1,688.24
|
| Rate for Payer: United Healthcare HMO Rider |
$1,688.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,688.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,999.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC ANGIOGRAPH INTERNAL MAMMARY
|
Facility
|
IP
|
$10,156.00
|
|
|
Service Code
|
CPT 75756
|
| Hospital Charge Code |
909081576
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$2,031.20 |
| Max. Negotiated Rate |
$8,632.60 |
| Rate for Payer: Adventist Health Commercial |
$2,031.20
|
| Rate for Payer: Cash Price |
$4,570.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,062.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,062.40
|
| Rate for Payer: Galaxy Health WC |
$8,632.60
|
| Rate for Payer: Global Benefits Group Commercial |
$6,093.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,774.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,869.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,286.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,437.44
|
| Rate for Payer: Multiplan Commercial |
$8,124.80
|
| Rate for Payer: Networks By Design Commercial |
$6,601.40
|
| Rate for Payer: Prime Health Services Commercial |
$8,632.60
|
|
|
HC ANGIOGRAPH INTERNAL MAMMARY
|
Facility
|
IP
|
$13,740.00
|
|
|
Service Code
|
CPT 75756
|
| Hospital Charge Code |
906820186
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$2,748.00 |
| Max. Negotiated Rate |
$11,679.00 |
| Rate for Payer: Adventist Health Commercial |
$2,748.00
|
| Rate for Payer: Cash Price |
$6,183.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,496.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,496.00
|
| Rate for Payer: Galaxy Health WC |
$11,679.00
|
| Rate for Payer: Global Benefits Group Commercial |
$8,244.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,164.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,234.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,505.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,297.60
|
| Rate for Payer: Multiplan Commercial |
$10,992.00
|
| Rate for Payer: Networks By Design Commercial |
$8,931.00
|
| Rate for Payer: Prime Health Services Commercial |
$11,679.00
|
|
|
HC ANGIOGRAPH INTERNAL MAMMARY
|
Facility
|
OP
|
$10,156.00
|
|
|
Service Code
|
CPT 75756
|
| Hospital Charge Code |
909081576
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$244.26 |
| Max. Negotiated Rate |
$8,632.60 |
| Rate for Payer: Adventist Health Commercial |
$2,031.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,661.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,541.30
|
| Rate for Payer: Blue Shield of California Commercial |
$6,215.47
|
| Rate for Payer: Blue Shield of California EPN |
$4,103.02
|
| Rate for Payer: Cash Price |
$4,570.20
|
| Rate for Payer: Cash Price |
$4,570.20
|
| Rate for Payer: Cigna of CA HMO |
$6,499.84
|
| Rate for Payer: Cigna of CA PPO |
$7,515.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,398.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3,999.21
|
| Rate for Payer: Galaxy Health WC |
$8,632.60
|
| Rate for Payer: Global Benefits Group Commercial |
$6,093.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$244.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,774.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$276.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,437.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,039.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,358.94
|
| Rate for Payer: Multiplan Commercial |
$8,124.80
|
| Rate for Payer: Networks By Design Commercial |
$6,601.40
|
| Rate for Payer: Prime Health Services Commercial |
$8,632.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,093.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,093.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,688.24
|
| Rate for Payer: United Healthcare All Other HMO |
$1,688.24
|
| Rate for Payer: United Healthcare HMO Rider |
$1,688.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,688.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,999.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC ANGIOGRAPH PULMONARY BILAT
|
Facility
|
IP
|
$13,337.00
|
|
|
Service Code
|
CPT 75743
|
| Hospital Charge Code |
906820194
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$2,667.40 |
| Max. Negotiated Rate |
$11,336.45 |
| Rate for Payer: Adventist Health Commercial |
$2,667.40
|
| Rate for Payer: Cash Price |
$6,001.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,334.80
|
| Rate for Payer: EPIC Health Plan Senior |
$5,334.80
|
| Rate for Payer: Galaxy Health WC |
$11,336.45
|
| Rate for Payer: Global Benefits Group Commercial |
$8,002.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,895.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,081.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,255.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,200.88
|
| Rate for Payer: Multiplan Commercial |
$10,669.60
|
| Rate for Payer: Networks By Design Commercial |
$8,669.05
|
| Rate for Payer: Prime Health Services Commercial |
$11,336.45
|
|
|
HC ANGIOGRAPH PULMONARY BILAT
|
Facility
|
OP
|
$9,857.00
|
|
|
Service Code
|
CPT 75743
|
| Hospital Charge Code |
909081627
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$226.03 |
| Max. Negotiated Rate |
$8,378.45 |
| Rate for Payer: Adventist Health Commercial |
$1,971.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,465.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,560.78
|
| Rate for Payer: Blue Shield of California Commercial |
$6,032.48
|
| Rate for Payer: Blue Shield of California EPN |
$3,982.23
|
| Rate for Payer: Cash Price |
$4,435.65
|
| Rate for Payer: Cash Price |
$4,435.65
|
| Rate for Payer: Cigna of CA HMO |
$6,308.48
|
| Rate for Payer: Cigna of CA PPO |
$7,294.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,398.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3,999.21
|
| Rate for Payer: Galaxy Health WC |
$8,378.45
|
| Rate for Payer: Global Benefits Group Commercial |
$5,914.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$226.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,574.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$255.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,365.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,039.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,358.94
|
| Rate for Payer: Multiplan Commercial |
$7,885.60
|
| Rate for Payer: Networks By Design Commercial |
$6,407.05
|
| Rate for Payer: Prime Health Services Commercial |
$8,378.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,914.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,914.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,341.78
|
| Rate for Payer: United Healthcare All Other HMO |
$5,341.78
|
| Rate for Payer: United Healthcare HMO Rider |
$5,341.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,341.78
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,999.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC ANGIOGRAPH PULMONARY BILAT
|
Facility
|
OP
|
$13,337.00
|
|
|
Service Code
|
CPT 75743
|
| Hospital Charge Code |
906820194
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$226.03 |
| Max. Negotiated Rate |
$11,336.45 |
| Rate for Payer: Adventist Health Commercial |
$2,667.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,747.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,560.78
|
| Rate for Payer: Blue Shield of California Commercial |
$8,162.24
|
| Rate for Payer: Blue Shield of California EPN |
$5,388.15
|
| Rate for Payer: Cash Price |
$6,001.65
|
| Rate for Payer: Cash Price |
$6,001.65
|
| Rate for Payer: Cigna of CA HMO |
$8,535.68
|
| Rate for Payer: Cigna of CA PPO |
$9,869.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,398.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3,999.21
|
| Rate for Payer: Galaxy Health WC |
$11,336.45
|
| Rate for Payer: Global Benefits Group Commercial |
$8,002.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$226.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,895.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$255.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,200.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,039.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,358.94
|
| Rate for Payer: Multiplan Commercial |
$10,669.60
|
| Rate for Payer: Networks By Design Commercial |
$8,669.05
|
| Rate for Payer: Prime Health Services Commercial |
$11,336.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,002.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8,002.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,341.78
|
| Rate for Payer: United Healthcare All Other HMO |
$5,341.78
|
| Rate for Payer: United Healthcare HMO Rider |
$5,341.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,341.78
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,999.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC ANGIOGRAPH PULMONARY BILAT
|
Facility
|
IP
|
$9,857.00
|
|
|
Service Code
|
CPT 75743
|
| Hospital Charge Code |
909081627
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$1,971.40 |
| Max. Negotiated Rate |
$8,378.45 |
| Rate for Payer: Adventist Health Commercial |
$1,971.40
|
| Rate for Payer: Cash Price |
$4,435.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,942.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,942.80
|
| Rate for Payer: Galaxy Health WC |
$8,378.45
|
| Rate for Payer: Global Benefits Group Commercial |
$5,914.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,574.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,755.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,101.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,365.68
|
| Rate for Payer: Multiplan Commercial |
$7,885.60
|
| Rate for Payer: Networks By Design Commercial |
$6,407.05
|
| Rate for Payer: Prime Health Services Commercial |
$8,378.45
|
|
